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BACKGROUND: Opioid Use Disorder (OUD) is a major public health concern, with mortality rates in individuals who use opioid medications being up to 30 times greater than those of individuals who do not use such medications. Social risk factors influence one's ability to make healthy choices and pose challenges for individuals recovering from OUD. OBJECTIVE: This study aimed to explore the relationship between OUD and social risk factors for patients who have been prescribed opioid medications. METHODS: Data for this retrospective cohort study were obtained from a health care system's comprehensive data warehouses consisting of electronic health records (EHR) with Social Determinants of Health (SDoH) screening information, and medical and prescription claims data. The study compared patients 18 years of age or older with an opioid prescription who were considered users of opioids to patients who had a documented diagnosis of OUD in the EHR. All patients were screened for SDoH. The analyses were performed using Statistical Analysis System (SAS) (SAS Institute Inc, Cary, NC). RESULTS: The study included patients with an outpatient visit at one of the health care system's primary care or oncology facilities between January 1, 2017 and December 31, 2018. There were 5003 patients with an opioid prescription who were considered users of opioids, and 209 patients with an opioid prescription as well as a diagnosis of OUD. Compared to the opioid use group, patients with OUD were more likely to have a lower educational attainment, encounter financial hardship, or be food insecure. Being female, older than 40, and having a higher Charlson Comorbidity Index score were factors associated with lower rates of opioid misuse. CONCLUSION: Identifying social risk factors and providing appropriate services to individuals with OUD is essential in mitigating challenges to recovery and promoting overall health for these individuals.
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Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Humanos , Feminino , Adolescente , Adulto , Masculino , Analgésicos Opioides/efeitos adversos , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Prescrições de Medicamentos , Fatores de RiscoRESUMO
BACKGROUND: An evidence-based practice (EBP) approach to implementing change is relevant and pertinent to the strategy to improve outcomes for hospitalized patients with central venous catheters (CVC). As health systems endeavor to achieve the ambitious goals of improving the patient experience of care, improving the health of populations, and reducing the cost of health care, it is imperative to understand the impact of a central line-associated bloodstream infection (CLABSI) on outcomes. AIMS: The purpose of the study was to contribute to the evidence of the association of CLABSI with the outcomes of hospital length of stay (LOS), readmission rates, and mortality rates for hospitalized patients. METHODS: A retrospective study was conducted, including all hospitalized patients with a CVC within four hospitals in an integrated health system in northwest Ohio and southeast Michigan. The sample population was stratified into two groups, CLABSI and no CLABSI, and the outcomes of interest for each group were compared. RESULTS: The findings substantiate the association between CLABSI and the hospital mortality rate, LOS, and readmission. Patients with a CVC who develop a CLABSI were 36.6% more likely to die in the hospital and 37.0% more likely to be readmitted compared with patients with a CVC who did not develop a CLABSI. In addition, hospital LOS increased an average of 2 days compared with patients without CLABSI. This study evokes implications for EBP change to reduce the rate of CLABSI and for quality improvement during in-hospital care. LINKING EVIDENCE TO ACTION: There is an association between CLABSI and hospital mortality rate, LOS, and 30-day readmission outcomes, presenting a profound sense of urgency for EBP change. There were potential variances in processes or practice relative to insertion, maintenance, and removal in the hospitals studied, representing an opportunity to examine the best practices in the hospitals that are performing well. Implementation of EBP requires selecting effective and innovative strategies, with a focus on stakeholder involvement and needs.
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Infecções Relacionadas a Cateter , Readmissão do Paciente , Infecções Relacionadas a Cateter/epidemiologia , Hospitais , Humanos , Tempo de Internação , Estudos RetrospectivosRESUMO
BACKGROUND: Autologous stem cell transplantation (ASCT) reverses kidney failure in one-third of multiple myeloma (MM) patients, which may lead to blood pressure (BP) improvement. We evaluate the long term impact of ASCT on BP and renal function in MM patients. METHODS: We studied 192 MM patients that underwent ASCT. We compared BP readings and glomerular filtration rate (GFR) at 4 weeks before ASCT, on day of ASCT and post-ASCT at 30, 100 and 180 days. RESULTS: Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) on day of ASCT and at both 30 and 100 days post-ASCT was significantly lower as compared to pre-ASCT SBP and DBP. There was a significantly higher mean GFR at day of ASCT and 30 days post-ASCT and significantly lower mean GFR at 180 days post-ASCT as compared to pre-ASCT. White patients had similar patterns to the total group for SBP, DBP, and GFR except for SBP which was still significantly lower and GFR which was not significantly different at 180 days. African-American patients showed no significant reductions in the mean values of SBP and DBP and no significant increases for GFR in follow-up after day of ASCT. Furthermore, the mean value of GFR was significantly lower at 180 days post-ASCT. CONCLUSIONS: ASCT in MM patients had a positive impact on SBP and DBP and GFR but the impact was minimal for African-American patients. We recommend that clinicians consider closer follow-up of BP and kidney function and more intense therapy in African-Americans with MM.
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Transplante de Células-Tronco Hematopoéticas/métodos , Hipertensão/terapia , Mieloma Múltiplo/terapia , Insuficiência Renal/terapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Insuficiência Renal/etiologia , Estudos Retrospectivos , Transplante Autólogo , Resultado do TratamentoRESUMO
BACKGROUND: Heart failure (HF) represents a substantial burden, impacting both health and financial domains. Despite the presence of evidence-based interventions for prevention and management, suboptimal care has been recognized as a critical contributor to adverse HF-related outcomes. We aim to analyze the impact of palliative care telehealth intervention compared to usual care in quality of life (QoL) and resource utilization of chronic HF patients. METHODS: We conducted a systematic search across various databases, including MEDLINE (via PubMed), Google Scholar, the Cochrane Library, and ScienceDirect to identify randomized controlled trials (RCTs) examining the impact of palliative care telehealth interventions on the QoL and health outcomes of HF patients from inception until May 2024. Statistical analysis was performed using RevMan 5.4, pooling odds ratios (OR), and weighted mean differences (WMD) via a random effects model for primary and secondary outcomes. The study protocol has been registered in PROSPERO (CRD42024542371). RESULTS: In our study, 16 RCTs involving 2,324 HF patients, averaging 69.2 years old, were included. Upon analyzing the primary outcome, QoL, assessed through the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Functional Assessment of Chronic Illness Therapy-Palliative Care (FACIT-Pal) Scale, we found a statistically significant improvement in QoL among patients who received palliative care or palliative care telehealth interventions compared to those who received usual care. The WMD for KCCQ was 3.56 (95% CI: 0.43 to 6.69, p = 0.03; I2 = 46%) and for FACIT-Pal was 2.54 (95% CI: 1.00 to 4.08, p = 0.001; I2 = 14%). Furthermore, HF patients receiving palliative care experienced a notable decrease in hospitalizations (OR: 0.60; 95% CI: 0.41 to 0.86; p = 0.006; I2 = 52%). However, we did not observe a significant change in all-cause mortality, with an OR of 1.22 (95% CI: 0.77 to 1.94, p = 0.39; I2 = 37%). CONCLUSION: The implementation of palliative care telehealth interventions demonstrates a notable impact, positively influencing the QoL and decreasing hospitalization rates among patients with chronic HF.
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Insuficiência Cardíaca , Cuidados Paliativos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Telemedicina , Humanos , Insuficiência Cardíaca/terapia , Cuidados Paliativos/métodos , Doença Crônica , Prestação Integrada de Cuidados de Saúde/organização & administraçãoRESUMO
Intermittent fasting (IF), characterized by alternating periods of fasting and unrestricted eating, typically within an 8-hour window or less each day, has gained significant attention as a possible dietary approach. While it is recognized for its metabolic advantages, like weight loss and enhanced glucose and insulin sensitivity, its effect on cardiovascular health remains a topic of mixed opinions. Recent findings suggest a potential downside, with reports indicating a concerning association: a 91 % higher risk of cardiovascular disease (CVD) mortality compared to eating spread across a 12- to 16-hour period. Despite this alarming statistic, the evidence cannot establish a causal link. The impact of IF on CVD is still insufficiently understood, with benefits sometimes exaggerated and risks downplayed in popular discourse. This scoping review aims to consolidate the current evidence, addressing unresolved questions about the benefits and risks of IF, particularly its association with CVD risks and mortality. The goal is to provide a balanced perspective on the potential health implications of IF, emphasizing the need for further research to clarify its long-term effects on cardiovascular health.
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BACKGROUND: The benefits of achieving optimal cardiovascular health (CVH) through Life's Simple 7 (LS7) are well-documented across diverse populations. In this study, we assess the updated metrics, Life's Essential 8 (LE8), and their association with long-term cardiovascular disease (CVD) outcomes and mortality. METHODS: We conducted a comprehensive systematic review, searching PubMed, Google Scholar, Cochrane Library, and ScienceDirect from January 2022 until June 2024, focusing on studies that specifically assessed the impact of LE8 on CVH. The statistical analysis used RevMan 5.4 and applied a random effects model to synthesize hazard ratios (HRs) for primary and secondary outcomes. This study is registered in PROSPERO (CRD42024558493). RESULTS: Our final analysis comprised 34 observational studies, encompassing 1,786,664 participants aged 18-80, with an average follow-up of approximately 11.6 years. Pooled analysis revealed a statistically significant decrease in the risk of CVD among individuals with higher LE8 scores compared to those with lower scores, with an HR of 0.47 (95% CI: 0.39 to 0.56, p < 0.00001). Higher LE8 scores were also associated with significant reductions in both all-cause mortality (HR: 0.54, 95% CI: 0.43 to 0.69, p < 0.00001) and CVD-related mortality (HR: 0.37, 95% CI: 0.26 to 0.52, p < 0.00001. Moreover, individuals with high LE8 scores have a 56% lower risk of coronary heart disease and a 48% lower risk of stroke. CONCLUSION: LE8 has a strong inverse association with CVD risk and mortality, with higher LE8 scores corresponding to significantly lower risk levels.
The American Heart Association's newly introduced cardiovascular health metric, Life's Essential 8 (LE8), offers a more robust assessment of cardiovascular disease (CVD) and mortality risk compared to the older Life's Simple 7 score. Key Findings Higher Life's Essential 8 (LE8) scores show a significant reduction in overall cardiovascular disease (CVD) events, including coronary heart disease and stroke.Increased LE8 scores are consistently associated with lower rates of both all-cause mortality and cardiovascular disease-specific mortality.
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Background: Palliative care addresses a range of needs, from symptom management to providing support to patients with hepatocellular cancer (HCC) and their families throughout the illness. However, research on palliative care in HCC remains limited, particularly during the COVID-19 pandemic. This study investigates the healthcare utilization associated with palliative care referral among patients with HCC. Methods: This is a retrospective cross-sectional analysis conducted using the National Inpatient Sample (NIS) database from 2019 to 2021 among patients with HCC age ≥18 years. Results: Among the 35,220 hospitalizations with HCC as the principal diagnosis, 18.7% received inpatient palliative care referrals. Factors associated with increased palliative care referrals included age ≥65 years, Midwest region, Charlson Comorbidity Index (CCI) score ≥3, and end-of-life care, as reflected by discharge resulting in death. No racial or insurance disparities were observed. Palliative care consultations were associated with lower total hospital costs ($20,573 vs $26,035, <0.0001). A higher prevalence of "do-not-resuscitate" status was also found among patients with palliative care referrals. Conclusion: The study provides an understanding of palliative care utilization across pre-pandemic and pandemic periods. Factors such as advanced age, hospital region, and underlying comorbidities influenced the likelihood of referral, with no discernible racial or insurance disparities identified. Palliative care involvement has also been shown to provide cost-effective supportive care with lower hospital costs. These findings provide invaluable guidance for optimizing the integration of palliative care alongside HCC management.
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Introduction: This study examines whether being a client in the Northwest Ohio Pathways HUB program reduces stress and improves mental wellbeing for perinatal mothers. The HUB works to improve health by connecting mothers to community health workers (CHWs) who assess mothers' risk factors and connect them to evidence-based care pathways to reduce known risks associated with adverse birth outcomes. Methods: A one-time survey of 119 mothers in the program and monthly semi-structured interviews with 41 mothers, totaling 220 interviews. Results: Almost all mothers reported significantly reduced stress after joining the program. The majority also reported an improved sense of safety, security, and hope. Interviews show additional moderate reductions in stress over time while being a program client. Interviews also indicate that mothers' relationship with their CHW is key to these improvements: CHW provide social-emotional support, access to tangible goods, and help navigating social service bureaucracies. Discussion: The results support the broader literature on the health benefits of community health workers and address identified gaps within the literature, which has infrequently studied CHWs in the perinatal context. Conclusion: CHWs may be one way to address racial inequity in birth outcomes linked to infant mortality, given research on the links between inequitable exposure to stressors, the impacts of racism-induced stress, and preterm and low birth weight babies. Further, the findings indicate the need to better support CHWs, and the programs that utilize them, with increased funding, insurance reimbursement, and certification.
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Pregnant women and individuals with sickle cell trait (SCT) and underlying comorbidities are both independently more vulnerable to severe illness from coronavirus disease 2019 (COVID-19) compared to nonpregnant women and those without SCT. However, our understanding of the specific factors influencing susceptibility to COVID-19 infection among pregnant women with SCT is currently constrained by limited available data. This study aims to determine the risk and protective factors that influence the likelihood of COVID-19 infection in this population. A retrospective analysis was done among 151 women with SCT in the reproductive age group. Multivariable analysis was performed to determine the various factors affecting COVID-19 infection among pregnant women with SCT. The study found that COVID-19-vaccinated pregnant women with SCT had a 90% lower risk of contracting COVID-19 and were 9 times more likely to have a COVID-19 infection if they had a history of pulmonary conditions such as asthma or chronic obstructive pulmonary disease. The present study further emphasizes the importance of the COVID-19 vaccine in preventing infection and safeguarding the health of pregnant women with SCT, particularly those with underlying comorbidities.
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Even though patient portals are recognized as a promising mechanism to support greater patient engagement, questions remain about access and utilization. This study aims to identify factors related to portal adoption in 2019 and 2020 (before and during the COVID-19). Cross-sectional data from the Health Information National Trends Survey (HINTS) cycles- 2019 HINTS 5 cycle 3 (N = 5,438) and 2020 HINTS 5 cycle 4 (N = 3,865) were analyzed using STATA-SE version 17 to factors predicting portal adoption. Next, HINTS 5 cycles 3 and 4 were pooled to identify changes in portal feature use and ease of usage among portal users, and barrier to portal use among non-users. Respondents who were college graduates, high income, and married were more likely to adopt patient portals during 2019 and 2020. Aged 75+ and Hispanic respondents reported less frequency of portal access in 2020 versus 2019. Men were more likely to adopt patient portals in 2019 versus women in 2020. Portal users were more likely to use the portal-system features in 2019 versus 2020. Portal non-users reported having multiple-health records as less of a barrier in 2020 compared to 2019. Patient engagement needs heightened attention during the COVID-19 pandemic.
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COVID-19 , Portais do Paciente , Masculino , Humanos , Feminino , COVID-19/epidemiologia , Estudos Transversais , Pandemias , Participação do PacienteRESUMO
Guidelines recommend managing patients aged ≥75 with non-ST-segment elevation myocardial infarction (NSTEMI) similar to younger patients. We analyze disparities in NSTEMI management and compare those ≥80 years to those <80 years. This is a matched case-control study using the 2016 National Inpatient Sample data of adults with NSTEMI receiving percutaneous coronary intervention with drug-eluting stent (PCI-DES) - one artery or no intervention. We included the statistically significant variables in univariate analysis in exploratory multivariate logistic regression models. Total sample included 156,328 patients, out of which 43,265 were ≥ 80 years, and 113,048 were < 80 years. Patients ≥80 years were more likely to not have an intervention (73.3%) when compared to those <80 (44.1%), P < 0.0005. Regardless of age, PCI-DES-one artery improved survival compared to no intervention (Age < 80: OR 0.230, 95% CI 0.189-0.279, and ≥ 80: OR 0.265, 95% CI 0.195-0.361, P < 0.0005). Women (OR 0.785, 95% CI 0.766-0.804, P < 0.0005) and non-white race (OR 0.832, 95% CI 0.809-0.855, P < 0.0005) were less likely to receive an intervention. Non-Medicare/Medicaid insurance was associated with 40% lower likelihood of dying in <80 age group (OR 0.596, 95% CI 0.491-0.724, P < 0.0005), and 16% higher chance of intervention overall (OR 1.160, 95% CI 1.125-1.197, P < 0.0005). Patients aged ≥80 with NSTEMI were 29% less likely to receive an intervention compared to patients aged <80, even though patients >80 derived similar mortality benefits from the intervention. There were gender, payor, and race-based disparities in NSTEMI management in 2016.
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Stents Farmacológicos , Infarto do Miocárdio sem Supradesnível do Segmento ST , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Adulto , Humanos , Feminino , Estados Unidos/epidemiologia , Idoso de 80 Anos ou mais , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Estudos de Casos e Controles , Fatores de Risco , Resultado do TratamentoRESUMO
Acute myocardial infarction (MI) may concomitantly occur with acute ischemic stroke. The incidence and outcomes of acute non-ST-elevation MI (NSTEMI) in acute ischemic stroke are not well studied. We examined hospitalized patients with acute ischemic stroke and a concomitant NSTEMI diagnosis who were included in the National Inpatient Sample 2016 to 2019. Acute ischemic stroke and NSTEMI were defined by using the International Classification of Diseases, Tenth Revision codes. Patients with ST-elevation MI were excluded. The outcomes were expressed as percentages. A multivariable logistic regression analysis was used to examine the association of concomitant acute ischemic stroke and NSTEMI with the primary outcome of mortality and the secondary outcomes. A subgroup analysis of patients with NSTEMI with acute ischemic stroke that underwent percutaneous coronary intervention (PCI) (angiography and angioplasty) was also performed. Of the total hospitalized patients with acute ischemic stroke (n = 1,726,265), 1.60% (n = 27,630) patients (mean age 73.5 years, 52.2% women, 67% White race) had NSTEMI diagnosed during the hospitalization. Of these, 14.1% (n = 3,890) died in the NSTEMI group and 3.4% (n = 57,670) died in the non-NSTEMI group. The most common outcomes in the NSTEMI group were Acute kidney injury 31.8%, Intracranial hemorrhage 6.6%, and sepsis 6.13%. NSTEMI in acute ischemic stroke was associated with mortality (odds ratio [OR] 3.60, 95% confidence interval [CI] 3.29 to 3.93, p ≤0.001), ICH (OR 1.46, 95% CI 1.30 to 1.63, p <0.001), and having any of the secondary outcomes (OR 2.73, 95% CI 2.57 to 2.90, p <0.001). PCI was performed in 9.14% of patients with acute ischemic stroke with NSTEMI. PCI was associated with having any of the secondary outcomes (OR 0.83, 95% CI 0.7 to 1.02, p = 0.8), mortality (OR 0.35, 95% CI 0.23 to 0.54, p <0.001), and ICH (OR 0.42, 95% CI 0.25 to 0.7, p = 0.01). In conclusion, NSTEMI in acute ischemic stroke is associated with increased mortality and other adverse events. PCI in the subgroup of patients with NSTEMI was not associated with increased mortality or intracranial bleeding.
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Infarto Miocárdico de Parede Anterior , AVC Isquêmico , Infarto do Miocárdio sem Supradesnível do Segmento ST , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Feminino , Idoso , Masculino , Pacientes Internados , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Prevalência , AVC Isquêmico/epidemiologia , Hemorragias IntracranianasRESUMO
PURPOSE OF STUDY: Accountable Care Organizations (ACOs) aiming to reduce healthcare expenditure adopt strategies targeting costly postacute service utilization, asking "why not home?" as a part of the hospital discharge planning paradigm. This study examined the impact of an interventional approach to implement evidence-based interventions to improve transitions of care to the least restrictive next site of care on the rate of skilled nursing facility (SNF) admissions per 1,000, SNF length of stay (LOS), and total SNF cost. PRIMARY PRACTICE SETTING: The impact of the interventional approach for an ACO-attributed Medicare population, analyzing Medicare Shared Savings Plan Part A and Part B beneficiary claims data, was examined. METHODOLOGY AND SAMPLE: A pre-/postintervention analysis was conducted, for dates of service 12 months pre- and postintervention for patients admitted to any hospital within the integrated health care system. The outcome variables were defined as SNF admission rate, SNF LOS, cost of care (total SNF cost, SNF cost per admission), and hospital LOS prior to SNF discharge. RESULTS: There was early evidence of the effectiveness of the multifaceted interventions that involved the delivery of interprofessional team member education focused on the tenets of value-based care and discharging patients to the least restrictive setting, as appropriate. In the normalized data review, it was noted that the rate of SNF discharges per 1,000 patients changed from 73 per 1,000 patients in the preintervention period to 70 per 1,000 patients in the postintervention period. The total SNF cost in the postintervention period only increased by 3%, with a difference of $616,014, despite the 10% increase in the total ACO-attributed patient population during the same period. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The results of this study imply that a multifaceted intervention with aims to shift the transitional care planning paradigm toward discharging to the least restrictive next site of care is an effective strategy for ACOs with aspirations to improve the utilization and expenditure in the postacute setting. The analyses suggest that providing education to interprofessional team members that reinforces the tenets of value-based care and the importance of asking, "why not home?" for every hospitalized patient, and leveraging technology-based insights positively impact discharge rates to SNF and other ACO outcomes.
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Organizações de Assistência Responsáveis , Gastos em Saúde , Idoso , Humanos , Medicare , Alta do Paciente , Instituições de Cuidados Especializados de Enfermagem , Estados UnidosRESUMO
Understanding the relationships between discharge disposition, readmissions, and cost of care is an important strategy for Accountable Care Organizations (ACOs) with aspirations to achieve shared savings. The purpose of this retrospective cohort study is to examine whether there is an association between the discharge dispositions of home with home health (HH) compared to skilled nursing facility (SNF) and the readmission rate and cost of care for Medicare ACO patients discharged from the hospital. The authors studied the variables associated with readmission rates and cost of care, including discharge disposition and risk score for 1151 patients attributed to an ACO. In multivariate logistic regression analysis, variables associated with increased risk for 30-day readmission were the Centers for Medicare & Medicaid Services Hierarchical Condition Category risk score and the discharge setting. Discharges to SNF were almost 5 times more likely to be readmitted to the hospital at 30 days compared to patients discharged to the HH setting. The cost of care is lower for the HH discharge disposition, with an $8678 per patient difference between the cost of care for patients discharged to HH and SNF levels of care. Findings from this study suggest that employing a transitional care planning approach that prioritizes discharging patients to the least restrictive next site of care, shifting patients from SNF disposition to HH as appropriate, is an effective strategy to improve readmission rates and cost of care.
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Medicare , Alta do Paciente , Idoso , Humanos , Readmissão do Paciente , Estudos Retrospectivos , Instituições de Cuidados Especializados de Enfermagem , Estados UnidosRESUMO
Background: The aims of the study were to identify predictors of heparin-induced thrombocytopenia (HIT) in hospitalized adults, and to find additional factors associated with higher odds of HIT in primary hypercoagulable states. Methods: A retrospective matched case-control study using discharge data from National Inpatient Sample database (2012 - 2014) was conducted. In primary outcome analysis, hospitalized patients with and without HIT were included as cases and controls, both matched for age and gender. In secondary outcome analysis, hospitalized patients with primary hypercoagulable states with and without HIT were included as cases and controls, both matched for age and gender. The statistical analyses were performed using Statistical Package for Social Sciences version 25. Results: There are several predictors of HIT in hospitalized patients, such as obesity, malignancy, diabetes, renal failure, major surgery, congestive heart failure, and autoimmune diseases. In patients with primary hypercoagulable states, the presence of renal failure (odds ratio (OR) 2.955, 95% confidence interval (CI) 1.994 - 4.380), major surgery (OR 1.735, 95% CI 1.275 - 2.361), congestive heart failure (OR 4.497, 95% CI 2.466 - 8.202), or autoimmune diseases (OR 1.712, 95% CI 1.120 - 2.618) further increases the odds of HIT. Conclusions: In hospitalized patients with primary hypercoagulable states, especially in association with renal failure, major surgery, congestive heart failure, or autoimmune diseases, unfractionated heparin should be used with caution.
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Patient-related risk factors for venous thromboembolism (VTE) are infrequently studied. We compared the role of patient-related risk factors for VTE in patients with solid organ cancers to their role in patients without cancer using National Inpatient Sample (NIS) data. Patients with cancer: risk of VTE hospitalization; Increased: chronic pulmonary disease (OR 1.172, 95% CI 1.102-1.247), obesity (OR 1.369, 95% CI 1.244-1.506). Decreased: liver disease (OR 0.654, 95% CI 0.562-0.762), chronic kidney disease (CKD) (OR 0.539, 95% CI 0.491-0.593), end-stage renal disease (ESRD) (OR 0.247, 95% CI 0.187-0.326). Patients without cancer: Risk of VTE hospitalization; Increased: age (OR 1.024, 95% CI 1.022-1.025), congestive heart failure (OR 1.221, 95% CI: 1.107-1.346), chronic pulmonary disease (OR 1.372, 95% CI 1.279-1.473), obesity (OR 2.627, 95% CI 2.431-2.838). Decreased: female gender (OR 0.772, 95% CI 0.730-0.816), diabetes (OR 0.756, 95% CI 0.701-0.815), ESRD (OR 0.315, 95% CI 0.252-0.395). In conclusion, chronic pulmonary disease and obesity increase VTE hospitalization risk in patients with and without cancer and the risk decreases in cancer patients with liver disease, CKD or ESRD.
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Hospitalização , Neoplasias/complicações , Tromboembolia Venosa/etiologia , Doença Crônica , Feminino , Insuficiência Cardíaca , Humanos , Falência Renal Crônica , Hepatopatias , Pneumopatias , Masculino , Obesidade , Insuficiência Renal Crônica , Fatores de Risco , Fatores Sexuais , Tromboembolia Venosa/epidemiologiaRESUMO
A 62-year-old female with a history of hepatitis C presented with one week of worsening abdominal distension. On physical examination, she had icterus, abdominal distension, shifting dullness, and a positive fluid wave. Computed tomography (CT) of the abdomen and pelvis demonstrated a small left hepatic lobe lesion and moderate ascites. Chest CT demonstrated a large substernal mass (3.5 × 1.7 cm) in the anterior mediastinal fat in the region of prepericardial lymph nodes. Following resection of the substernal mass, histopathology revealed metastatic involvement by poorly differentiated hepatocellular carcinoma (HCC). The patient was in fulminant liver failure postoperatively and succumbed to her disease. Mediastinal lymph nodes metastases in HCC are rare and often portend a poor prognosis when present. We discuss a case of HCC presenting with a substernal mass, and provide a literature review of the management and prognosis of lymphatic spread of HCC.
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The Fusobacterium species is known for its association with septic thrombophlebitis of the internal jugular vein (Lemierre's syndrome). Lemierre's syndrome is associated with septic emboli to the liver and lungs, often causing multiple abscesses. We present a unique case of Fusobacterium septicemia in which the bacteria invaded the portal vein through the gastrointestinal mucosa due to diverticulitis and spread hematogenously to the liver and lungs, causing abscesses. It was treated successfully with 6 weeks of antibiotics. Physicians should be aware of this rare pathogen and suspect its presence in severe pharyngitis or culture-negative liver abscess.
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Hemicorporectomy, or translumbar amputation, is a radical surgery involving the dissection of the body at the waist and is usually reserved for complex medical conditions including locally invasive malignancy and terminal pelvic osteomyelitis. Only 71 cases have previously been reported. We present a rare case of hemicorporectomy in a 53-year-old patient with terminal pelvic osteomyelitis which occurred after he suffered a gunshot wound at T6 causing paraplegia at the age of 31. Unfortunately, this patient continued to suffer recurrent hospitalisations and sepsis events secondary to chronic, non-healing advanced pressure ulcers and complicated urinary tract infections despite repeated courses of broad-spectrum intravenous antibiotics and surgical debridements. In light of his diminished quality of life and poor prognosis, the patient's family chose to manage his condition conservatively with home hospice. This case illustrates the significant challenges in the medical and surgical management of hemicorporectomy patients.
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Amputação Cirúrgica/efeitos adversos , Osteomielite/cirurgia , Ossos Pélvicos/cirurgia , Pelve/cirurgia , Complicações Pós-Operatórias/etiologia , Úlcera por Pressão/etiologia , Amputação Cirúrgica/métodos , Evolução Fatal , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Paraplegia/complicações , Ferimentos por Arma de Fogo/complicaçõesRESUMO
The Drug Induced Liver Injury Network reports dietary supplements as one of the most important causes of drug induced hepatotoxicity, yet millions of people use these supplements without being aware of their potential life-threatening side effects. Garcinia cambogia (GC) extract is an herbal weight loss supplement, reported to cause fulminant hepatic failure. We present a case of a 57-year-old female with no previous history of liver disease, who presented with acute hepatitis due to GC extract taken for weight loss, which resolved after stopping it and got reaggravated on retaking it. Obtaining a history of herbal supplement use is critical in the evaluation of acute hepatitis.