An ADP-ribosyltransferase toxin kills bacterial cells by modifying structured non-coding RNAs.

ADP-ribosyltransferases (ARTs) were among the first identified bacterial virulence factors. Canonical ART toxins are delivered into host cells where they modify essential proteins, thereby inactivating cellular processes and promoting pathogenesis. Our understanding of ARTs has since expanded beyond protein-targeting toxins to include antibiotic inactivation and DNA damage repair. Here, we report the discovery of RhsP2 as an ART toxin delivered between competing bacteria by a type VI secretion system of Pseudomonas aeruginosa. A structure of RhsP2 reveals that it resembles protein-targeting ARTs such as diphtheria toxin. Remarkably, however, RhsP2 ADP-ribosylates 2'-hydroxyl groups of double-stranded RNA, and thus, its activity is highly promiscuous with identified cellular targets including the tRNA pool and the RNA-processing ribozyme, ribonuclease P. Consequently, cell death arises from the inhibition of translation and disruption of tRNA processing. Overall, our data demonstrate a previously undescribed mechanism of bacterial antagonism and uncover an unprecedented activity catalyzed by ART enzymes.

Smoking impacts outcomes in transcervical Zenker's diverticulectomy.

PURPOSE: There is sparse literature discussing the impact of smoking on postoperative outcomes following surgical treatment of Zenker's diverticulum. In this study, we seek to characterize differences in the management and outcomes of open Zenker's diverticulectomy based on patient smoking status. METHODS AND MATERIALS: This paper is a retrospective cohort review. The 2005-2018 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for patients undergoing open Zenker's diverticulectomy. Chi-square and multivariable logistic regression were performed to determine statistical associations between postoperative outcomes and smoking status. RESULTS: Of the 715 identified patients, 70 (9.8 %) were smokers and 645 (91.2 %) were non-smokers. Smokers were younger than non-smokers (mean 63.9 vs. 71.7 years, p < 0.001) and more likely to have a prolonged operative time (20.0 % vs. 11.6 %, p = 0.044). On multivariable regression analysis controlling for demographics and comorbidities, smokers had greater odds than non-smokers for developing overall postoperative complications (OR: 2.776, p = 0.013), surgical infections (OR: 3.194, p = 0.039), medical complications (OR: 3.563, p = 0.011), and medical infections (OR: 1.247, p = 0.016). Smokers also had greater odds for requiring ventilation/intubation (OR: 8.508, p = 0.025) and having a prolonged postoperative stay (OR: 2.425, p = 0.030). CONCLUSION: In a cohort of patients undergoing transcervical Zenker's diverticulectomy, smokers are at increased risk for overall complications, medical complications, medical infections, surgical infections, prolonged postoperative stay, and ventilation/intubation.

National Trends and Predictors of Opioid Administration in Patients Presenting With Abdominal Pain to the Emergency Department (2010-2018).

Given the current opioid crisis, in this study, we assess the national trend and factors associated with opioid administration for patients presenting to the emergency department with abdominal pain. This is a retrospective cross-sectional study conducted using the National Hospital Ambulatory Medical Care Survey from 2010 to 2018. Weighted multiple logistic regression was applied to assess the independent factors associated with opioid administration in the emergency department. Trends of opioid administration were evaluated using the linear trend analysis. There were an estimated total of 100,925,982 emergency department visits for abdominal pain. Overall, opioid was administered in 16.8% of visits. Age less than 25 years was associated with lower odds of receiving opioids. Patients living in the Northeast had the lower odds of receiving opioids (odds ratio [OR] = 0.82, p = .006) than patients living in the Midwest. Patients in the West had the highest odds of receiving opioids (OR = 1.16, p = .01). Non-Hispanic White patients had higher odds of opioid administration (OR = 1.29, p < .001). Trend analysis demonstrated a statistically significant reduction in opioid administration. From 2010 to 2018, opioid administration has approximately decreased in half. Living in the West and the non-Hispanic White racial group were the significant factors associated with a higher risk of opioid administration.

Assessing Patient Satisfaction Following Blepharoplasty Using Social Media Reviews.

BACKGROUND: Because patient satisfaction is a significant qualitative consideration in measuring aesthetic surgery outcome, it is important to characterize the individual factors that shape the patient perspective about blepharoplasty. OBJECTIVES: This study analyzed reviews by blepharoplasty patients on the aesthetic surgery social media platform RealSelf.com to determine which aspects of the surgical process have the most significant impact on patient satisfaction. METHODS: Blepharoplasty reviews were gathered from RealSelf.com with an automated web crawler. These reviews were characterized as positive or negative, then given a specific category that more specifically defined the theme of the review. Additional variables, including the specialty of the reviewed physician and any patient self-reported ratings, were documented. RESULTS: A total of 1991 reviews pertaining to blepharoplasty were collected. Among reviews with self-reported "worth it" ratings, 93.5% were positive. Following categorization of all reviews, 1865 (93.7%) were positive and 126 (6.3%) were negative. Of the positive reviews, the most common overall themes were bedside manner (n = 899, 48.2%), aesthetic result (n = 859, 46.1%), and overall comfort (n = 58, 3.1%). Among negative reviews, most pertained to aesthetic result (n = 100, 79.4%), and bedside manner (n = 14, 11.1%). The most frequently encountered physician specialties performing blepharoplasty were plastic surgery (n = 1101, 55.3%), ophthalmology (n = 634, 31.8%), and otolaryngology (n = 69, 3.5%). CONCLUSIONS: The majority of reviews were positive. The most prominent factor driving positive reviews was bedside manner, followed by aesthetic results. Negative reviews were most frequently attributed to suboptimal aesthetic results. Most blepharoplasties in our study cohort were performed by plastic and oculoplastic surgeons.

A comprehensive study on applications of nanomaterials in petroleum upstream and downstream industry.

Nanotechnology has emerged as a revolutionary technology that has been applied in the oil and gas industry for over a decade, spanning the upstream, midstream, and downstream sectors. Nanotechnology has made significant contributions to the exploration of crude oil and natural gas, both in underground and deep-water environments. It has also played a crucial role in improving the drilling process, enabling the extraction of oil and gas resources from beneath the Earth's surface. Nanoparticles, with their unique physical and chemical properties, such as high specific surface area, high pore volume, and small size, have demonstrated considerable potential in the oil industry. Extensive research has been conducted to explore various types of nanoparticles for advanced applications, including oil exploration, drilling, production, and enhanced oil recovery (EOR). Moreover, nanomaterials have found applications in downstream and intermediate sectors, such as crude oil refining, natural gas processing, and transportation and storage of petroleum products. Ongoing advancements in nanomaterial synthesis methods, the exploration of new nanomaterial uses, and understanding the remarkable properties of nanomaterials will continue to make them increasingly valuable in the oil and gas sector. The oil and gas industry recognises the potential of nanotechnology and nanoparticles and is investing significantly in research and development in this area. This comprehensive review aims to summarise successful applications of nanotechnology while addressing associated challenges. It serves as a valuable resource for future research and application endeavours in the field, highlighting the potential of nanotechnology in the oil and gas industry.

Exploring the Potential of Antibody-Drug Conjugates in Targeting Non-small Cell Lung Cancer Biomarkers.

Antibody-drug conjugates (ADCs), combining the cytotoxicity of the drug payload with the specificity of monoclonal antibodies, are one of the rapidly evolving classes of anti-cancer agents. These agents have been successfully incorporated into the treatment paradigm of many malignancies, including non-small cell lung cancer (NSCLC). The NSCLC is the most prevalent subtype of lung cancer, having a considerable burden on the cancer-related mortality and morbidity rates globally. Several ADC molecules are currently approved by the Food and Drug Administration (FDA) to be used in patients with NSCLC. However, the successful management of NSCLC patients using these agents was met with several challenges, including the development of resistance and toxicities. These shortcomings resulted in the exploration of novel therapeutic targets that can be targeted by the ADCs. This review aims to explore the recently identified ADC targets along with their oncologic mechanisms. The ADC molecules targeting these biomarkers are further discussed along with the evidence from clinical trials.

An analysis of lactate dehydrogenase (LDH) levels in advanced stage IV melanoma of the skin: prognostic capabilities and demographic variability.

Despite its limitations, in part due to decreased specificity in advanced disease, serum lactate dehydrogenase (LDH) is one of few serum factors used in cancer staging. This study quantifies the predictive capabilities of LDH in stage IV melanoma of the skin and explores the validity of suggested demographic discrepancies which may exist in its use. The 1975-2017 Surveillance Epidemiology and End Results (SEER) database was queried for stage IV cutaneous melanoma cases. Demographic characteristics were compared between LDH groups using chi-square and t tests. Subsequent Cox multivariable regression was performed to assess survival differences. 334 cases of stage IV cutaneous melanoma (average age: 63.0 years) with measured serum LDH levels were identified. Of these patients, 150 (44.9%) had normal LDH, 112 (33.5%) had LDH < 1.5 × upper limit of normal (ULN), 57 (17.1%) had LDH 1.5-10 × ULN, and 15 (4.5%) had LDH > 10 × ULN. Lower incomes were associated with higher LDH; individuals with incomes < $50,000 had the greatest proportion of LDH 10 × ULN (19.2%; p = 0.0031). LDH > 10 × ULN also had the lowest proportion of White patients (p = 0.04). On Cox multivariable survival analysis, increasing LDH levels showed increased risk of death (LDH < 1.5 × ULN: HR = 2.05, p = 0.01; LDH 1.5-10 × ULN: HR = 1.46, p < 0.001; LDH > 10 × ULN: HR = 5.91, p < 0.001). This study reaffirms the utility of LDH as a significant predictor of mortality with incremental severity, suggesting possible use for mortality projections. We note that Black patients and those with lower incomes may be more likely to have an elevated LDH. Older age groups and presence of ulceration among patients with stage IV melanoma were also associated with a greater risk of mortality.

Prognostic significance of head and neck spindle cell carcinoma.

BACKGROUND: Our study investigates the prognostic significance of spindle cell histology on overall survival (OS) of conventional head and neck squamous cell carcinoma (HNSCC). METHODS: The 2004 to 2017 National Cancer Database was queried for patients with head and neck spindle cell carcinoma (HNSpCC) (n = 1572) or HNSCC (n = 242 697) of the oral cavity, major salivary glands, sinonasal tract, oropharynx, hypopharynx, and larynx treated with curative intent. RESULTS: Patients with HNSpCC presented more frequently with higher-grade tumors and cN0 disease than those with HNSCC (p < 0.001). In the oral cavity, the HR for death for SpCC compared with SCC was 1.33 (p < 0.001). In the oropharynx, the HR for death for SpCC compared with SCC was 1.47 (p = 0.028). CONCLUSIONS: After adjusting for patient, tumor, and treatment characteristics, SpCC histology had an independent adverse prognostic effect on OS in the oral cavity and oropharynx. SpCC histology does not necessarily portend poorer survival in all HNSCC.

A review of bilateral sudden sensorineural hearing loss in pediatric patients.

OBJECTIVE: Bilateral, sudden sensorineural hearing loss (SSNHL) in the pediatric population is a rare phenomenon potentially detrimental to language acquisition and social development. This study comprehensively reviews and analyzes existing literature to determine any correlation or commonality in etiologies, presentations, and management of this condition. METHODS: PubMed, Cochrane, Scopus, and Web of Science databases were systematically searched for articles related to pediatric SSNHL from 1970 to 2021. Case series, case reports, and cohort studies were included. Data on patient demographics, etiology, diagnostic testing, management, and hearing recovery were collected. RESULTS: Excluding duplicates, 553 unique titles were identified by established search criteria, of which 342 titles were relevant to pediatric sudden hearing loss. Forty-six papers reported cases of bilateral SSNHL, totaling 145 individual cases. Not included in the analysis were 45 cases documented as non-organic hearing loss. The average age of the total 145 included patients was 8.5 years and 51 were male. Reported etiologies included cytomegalovirus (n = 3), meningitis (n = 13), mumps (n = 5), ototoxin exposure (n = 13), and enlarged vestibular aqueduct (n = 9). Tinnitus (n = 30) was the most reported concurrent symptom, followed by vertigo (n = 21). Systemic steroid therapy was the most common treatment and, when follow up was reported, most patients (51.2%) had complete or partial recovery of hearing. CONCLUSIONS: This is a comprehensive review of pediatric bilateral SSNHL. Though often idiopathic, etiologies also include infectious, structural, and autoimmune. Treatment largely consists of systemic steroid therapy, with variables rates of recovery. Further studies on intratympanic administration of steroids may guide future treatment.

MELD-Na Score as a Predictor of Postoperative Complications in Ventral Skull Base Surgery.

Objective The Model for End-stage Liver Disease-Sodium (MELD-Na) score was designed for prognosis of chronic liver disease and has been predictive of outcomes in a variety of procedures. Few studies have investigated its utility in otolaryngology. This study uses the MELD-Na score to investigate the association between liver health and ventral skull base surgical complications. Methods The National Surgical Quality Improvement Program database was used to identify patients who underwent ventral skull base procedures between 2005 and 2015. Univariate and multivariate analyses were performed to investigate the association between elevated MELD-Na score and postoperative complications. Results We identified 1,077 patients undergoing ventral skull base surgery with laboratory values required to calculate the MELD-Na score. The mean age was 54.2 years. The mean MELD-Na score was 7.70 (standard deviation = 2.04). Univariate analysis showed that elevated MELD-Na score was significantly associated with increased age (58.6 vs 53.8 years) and male gender (70.8 vs 46.1%). Elevated MELD-Na score was associated with increased rates of postoperative acute renal failure, transfusion, septic shock, surgical complications, and extended length of hospital stay. On multivariate analysis, associations between elevated MELD-Na and increased risk of perioperative transfusions (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.20-2.93; p = 0.007) and surgical complications (OR, 1.58; 95% CI, 1.25-2.35; p = 0.009) remained significant. Conclusions This analysis points to an association between liver health and postoperative complications in ventral skull base surgery. Future research investigating this association is warranted.

In silico docking and ADME study of deketene curcumin derivatives (DKC) as an aromatase inhibitor or antagonist to the estrogen-alpha positive receptor (Erα+): potent application of breast cancer.

Regardless of many extensive studies, hormonal-based breast cancer is the most common cause of cancer-related mortality of females worldwide. Indeed, estrogen receptor-positive (ER +) is the communal subtype in breast cancer. To treat this, three types of medications are typically used: selective estrogen receptor modulators (SERMs), selective estrogen receptor down modulators (SERDMs), and aromatase inhibitors (AIs), all of which directly interact with the activation of the estrogen signaling pathway and its formation. Despite their effectiveness, the development of new treatments is required since clinical efficacy is restricted owing to resistance. As a result, in silico studies for drug discovery are booming over the decades because of their affordability and less time-consuming features. Here, 25 deketene curcumin derivatives have been selected for docking studies through MVD software over the positive type of breast cancer through both the treatment hosts Erα + receptor and aromatase. DKC compounds are used because they have several pharmacological uses, including anti-cancer, anti-diabetic, anti-viral, anti-fungal, and anti-bacterial properties. Moreover, an ADME study was carried out for DKC derivatives that reveal the optimum drug-likeness profile. From 25 derivatives, the results showed a better MolDock score, hydrogen bonding, and steric interaction between compounds DKC-10, DKC-20, and DKC-21 with Erα + and aromatase. Although the study was done on both the treatable path hosts, better results were obtained with Erα + as an antagonist. Therefore, it is proposed that three selected DKC derivatives would be better therapeutic agents against breast cancer. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11224-021-01871-2.

Impact of Social Determinants of Health on Stereotactic Radiotherapy for Vestibular Schwannoma.

OBJECTIVES/HYPOTHESIS: Linear accelerator (LINAC) and Gamma Knife (GK) are common stereotactic radiation therapies for treating vestibular schwannoma (VS). There is currently limited literature examining specific demographic and socioeconomic factors, which influence the type of stereotactic radiation therapy a patient with VS receives. STUDY DESIGN: Retrospective database review. METHODS: The National Cancer Database was queried for cases of VS between 2004 and 2016. Patient demographic characteristics were compared using chi-squared and t-tests between GK and LINAC treated groups. Multivariate regression analysis was performed to assess predictors of stereotactic radiation therapy received. RESULTS: Of the 6,208 included patients, 5,306 (85.5%) received GK and 902 (14.5%) received LINAC. The mean age of GK patients was significantly lower than that of LINAC patients (58.0 vs. 59.7, P < .001). Individuals treated with GK had greater proportions of private insurance (P < .001) and incomes greater than $63,332 (P = .003). A greater proportion of GK patients were treated in academic centers (P < .001), in high-volume facilities (P < .001), in metropolitan areas (P < .001), and in the Northeastern United States (P < .001). On multivariate logistic regression analysis, region, metropolitan area, facility type, tumor size, and distance traveled by patients independently predict receipt of GK versus LINAC. CONCLUSION: Differences in patient demographics and other social determinants of health influence choice of GK versus LINAC therapy for VS patients. Future studies focused on addressing barriers to care, which may influence postprocedural quality of life and clinical outcomes associated with these two treatments are necessary to better understand the impact of these social differences. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:2232-2240, 2022.

Sex Disparities in Pediatric Acute Rhinosinusitis: A National Perspective.

OBJECTIVE: This study aims to provide an age-stratified analysis of associations with patient sex in pediatric inpatients with acute rhinosinusitis (ARS). STUDY DESIGN: Retrospective cohort study. SETTING: National administrative database. METHODS: The 2016 Kids' Inpatient Database was queried for pediatric inpatients (<21 years old) with ARS (ICD-10 J01). Orbital and intracranial sequelae were selected via ICD-10 codes. Statistical associations by sex were determined via univariate and multivariable analyses. Weighted measures are reported to provide national estimates. RESULTS: Of the 5882 patients identified with ARS, 2404 (40.9%) were female and 3478 (59.1%) were male. Male patients were younger than female patients (mean, 9.3 vs 9.9 years; P < .001). Multivariable analysis indicated that males and females had similar total charges ($71,094 vs $66,892, P = .464) and length of stay (5.8 vs 6.1 days, P = .263). However, male patients underwent more procedures (1.8 vs 1.5, P < .001). Mortality was similar between male and female patients (odds ratio [OR], 0.91; P = .664). Male patients also had increased odds for having orbital (OR, 1.58; P < .001) and intracranial (OR, 1.99; P < .001) complications. Differences in sex-dependent sequela risk were starkest in patients aged 14 to 20 years, with male patients being more likely to have orbital (OR, 2.91; P < .001) and intracranial (OR, 3.86; P < .001) complications. CONCLUSION: In a cohort of pediatric inpatients with ARS, males have increased odds for orbital and intracranial sequelae and undergo more procedures than females. However, males and females have similar charges and length of stay. Our study highlights age-stratified differences in ARS across patient sex.

In silico approach: docking study of oxindole derivatives against the main protease of COVID-19 and its comparison with existing therapeutic agents.

OBJECTIVES: Presently, the pandemic of COVID-19 has worsened the situation worldwide and received global attention. The United States of America have the highest numbers of a patient infected by this disease followed by Brazil, Russia, India and many other countries. Moreover, lots of research is going on to find out effective vaccines or medicine, but still, no potent vaccine or drug is discovered to cure COVID-19. As a consequence, many types of research have designated that computer-based studies, such as protein-ligand interactions, structural dynamics, and chembio modeling are the finest choice due to its low cost and time-saving features. Here, oxindole derivatives have been chosen for docking because of their immense pharmacological applications like antiviral, antidiabetic, anti-inflammatory, and so on. Molecular docking of 30 oxindole derivatives done on the crystallized structure of the protein (COVID-19 Mpro). METHODS: The process of docking, interaction, and binding the structure of ligand with protein has executed using Molegro Virtual Docker v.7.0.0 (MVD) and visualized the usage by Molegro Molecular Viewer v.7.0.0 (MMV). RESULTS: Among the 30 derivatives, the outcomes depicted better steric interaction and hydrogen bonding amongst OD-22 ligand, OD-16 ligand, OD-4 ligand, and OD-9 ligand (oxindole derivatives) with COVID-19. In addition to this, the comparative study of these four compounds with existing drugs that are under clinical trials shows comparatively good results in terms of its MolDock scores, H-bonding and steric interactions. CONCLUSIONS: Hence, It is proposed that these four oxindole derivatives have good potential as a new drug against coronavirus as possible therapeutic agents.

A comprehensive study on amalgamation of sustainable solar powered distillation for arsenic and fluoride removal from groundwater.

Due to the growing population and rapid urbanization, fresh water is becoming increasingly scarce. Apart from drinking, clean water is essential in a variety of applications such as batteries, pharmaceuticals, vehicles, and many research and development labs. Due to the unfeasible deficiency of the groundwater reserves, we must understand the importance of judicious usage and proper supervision of the groundwater resources. For the removal of various harmful substances in the groundwater such as arsenic, fluorides, and chlorides, we take the help of groundwater distillation. With the increase in environmental pollutions caused due to the use of injudicious usage of natural resources, we should look for an alternative for groundwater distillation techniques using renewable energy such as solar power. Groundwater is widely acknowledged as a major supply of water for drinking, agriculture, and a variety of other uses. Researchers have also employed solar distillation to transform groundwater into drinkable water. Hence, the main aim of the review paper is that we use solar power for groundwater distillation as solar energy is both a pressing necessity and a vital supply for all living things. Solar energy utilization is essential due to increased global warming and pollution, and it is being replaced by the traditional use of fuels in the globe today. We majorly focus on the removal of harmful compounds such as arsenic and fluoride from the groundwater with the help of solar-powered distillation techniques. The role of renewable energy technology in the sustainability of future water systems with a growing demanding share of groundwater distillation is presented in this paper.

Improved Mounting of Strain Sensors by Reactive Bonding.

Aim of this work is to improve the bond between a strain sensor and a device on which the strain shall be determined. As strain sensor, a CMOS-integrated chip featuring piezoresistive sensor elements was used which is capable of wireless energy and data transmission. The sensor chip was mounted on a standardized tensile test specimen of stainless steel by a bonding process using reactive multilayer systems (RMS). RMS provide a well-defined amount of heat within a very short reaction time of a few milliseconds and are placed in-between two bonding partners. RMS were combined with layers of solder which melt during the bonding process. Epoxy adhesive films were used as a reference bonding process. Under mechanical tensile loading, the sensor bonded with RMS shows a linear strain sensitivity in the whole range of tested forces whereas the adhesive-bonded sensor has slightly nonlinear behavior for low forces. Compared to the adhesive-bonded chips, the sensitivity of the reactively bonded chips is increased by a factor of about 2.5. This indicates a stronger mechanical coupling by reactive bonding as compared to adhesive bonding.

Structure of the Extracellular Region of the Bacterial Type VIIb Secretion System Subunit EsaA.

Gram-positive bacteria use type VII secretion systems (T7SSs) to export effector proteins that manipulate the physiology of nearby prokaryotic and eukaryotic cells. Several mycobacterial T7SSs have established roles in virulence. By contrast, the genetically distinct T7SSb pathway found in Firmicutes bacteria more often functions to mediate bacterial competition. A lack of structural information on the T7SSb has limited the understanding of effector export by this protein secretion apparatus. Here, we present the 2.4 Å crystal structure of the extracellular region of the T7SSb subunit EsaA from Streptococcus gallolyticus. Our structure reveals that homodimeric EsaA is an elongated, arrow-shaped protein with a surface-accessible "tip", which in some species of bacteria serves as a receptor for lytic bacteriophages. Because it is the only T7SSb subunit large enough to traverse the peptidoglycan layer of Firmicutes, we propose that EsaA plays a critical role in transporting effectors across the entirety of the Gram-positive cell envelope.

Burden of atrial fibrillation in patients with rheumatic diseases.

BACKGROUND: Studies have suggested that atrial fibrillation (AF) in patients with rheumatic diseases (RD) may be due to inflammation. AIM: To determine the highest association of AF among hospitalized RD patients and to determine morbidity and mortality associated with AF in hospitalized patients with RD. METHODS: The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF. A subgroup analysis was performed comparing outcomes of AF among different RD. RESULTS: The prevalence of AF was 23.9% among all patients with RD (n = 3949203). Among the RD subgroup, the prevalence of AF was highest in polymyalgia rheumatica (33.2%), gout (30.2%), and pseudogout (27.1%). After adjusting for comorbidities, the odds of having AF were increased with gout (1.25), vasculitis (1.19), polymyalgia rheumatica (1.15), dermatopolymyositis (1.14), psoriatic arthropathy (1.12), lupus (1.09), rheumatoid arthritis (1.05) and pseudogout (1.04). In contrast, enteropathic arthropathy (0.44), scleroderma (0.96), ankylosing spondylitis (0.96), and Sjorgen's syndrome (0.94) had a decreased association of AF. The mortality, length of stay, and hospitalization costs were higher in patients with RD having AF vs without AF. Among the RD subgroup, the highest mortality was found with scleroderma (4.8%), followed by vasculitis (4%) and dermatopolymyositis (3.5%). CONCLUSION: A highest association of AF was found with gout followed by vasculitis, and polymyalgia rheumatica when compared to other RD. Mortality was two-fold higher in patients with RD with AF.

Clinical outcomes of atrial fibrillation with hyperthyroidism.

BACKGROUND: Atrial fibrillation (Afib) is a common cardiac manifestation of hyperthyroidism. The data regarding outcomes of Afib with and without hyperthyroidism are lacking. HYPOTHESIS: We hypothesized that patients with Afib and hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism. METHODS: We queried the National Inpatient Sample database for years 2015-2017 using Validated ICD-10-CM codes for Afib and hyperthyroidism. Patients were separated into two groups, Afib with hyperthyroidism and without hyperthyroidism. RESULTS: The study was conducted with 68 095 278 patients. A total of 9 727 295 Afib patients were identified, 90 635 (0.9%) had hyperthyroidism. The prevalence of hyperthyroidism was higher in patients with Afib (0.9% vs 0.4%, P < .001), compared with patients without Afib. Using multivariate regression analysis adjusting for various confounding factors, the odds ratio of Afib with hyperthyroidism was 2.08 (CI 2.07-2.10; P < .0001). Afib patients with hyperthyroidism were younger (71 vs 75 years, P < .0001) and more likely to be female (64% vs 47%; P < .0001) as compared with Afib patients without hyperthyroidism. Afib patients with hyperthyroidism had lower prevalence of CAD (36% vs 44%, P < .0001), cardiomyopathy (24.1% vs 25.9%, P < .0001), valvular disease (6.9% vs 7.4%, P < .0001), hypertension (60.7% vs 64.4%, P < .0001), diabetes mellitus (29% vs 32%, P < .0001) and obstructive sleep apnea (10.5% vs 12.2%, P < .0001). Afib with hyperthyroidism had lower hospitalization cost ($14 968 ± 21 871 vs $15 955 ± 22 233, P < .0001), shorter mean length of stay (5.7 ± 6.6 vs 5.9 ± 6.6 days, P < .0001) and lower in-hospital mortality (3.3% vs 4.8%, P < .0001. The disposition to home was higher in Afib with hyperthyroidism patients (51% vs 42; P < .0001). CONCLUSION: Hyperthyroidism is associated with Afib in both univariate and multivariate analysis. Afib patients with hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism.

Arrhythmia in tumor lysis syndrome and associated in-hospital mortality: A nationwide inpatient analysis.

BACKGROUND: Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency associated with fatal complications including arrhythmia. The epidemiology and mortality outcomes of arrhythmia in TLS are scarcely studied in the literature. METHODS: We used the National Inpatient Sample (NIS) to study the prevalence and outcome of arrhythmia in patients hospitalized with TLS (ICD-9 code 277.88) from 2009 to 2014. Baseline characteristics, burden of arrhythmia, and pertinent outcomes were analyzed. Multivariable regression analysis was performed to identify the impact of underlying malignancy in predicting TLS-related mortality. RESULTS: A total of 9034 cases of arrhythmia among 37 861 TLS patients were identified. More than half of the arrhythmia cases (67%) were found among white old (>65) males admitted to large bed size and urban teaching hospitals. Arrhythmic cohort showed higher frequency of comorbidities such as fluid-electrolyte disturbances, hypertension, congestive heart failure, renal failure, dyslipidemia, diabetes, pulmonary circulatory disorders, chronic pulmonary disease, coagulopathy, and deficiency anemia. The most common malignancies were leukemia, lymphoma, metastatic tumor, and solid tumor without metastasis. We found significantly higher odds of in-hospital mortality among patients with TLS compared to general inpatient population on unadjusted (OR 9.69, 95% CI: 9.27-10.13, P < .001) and adjusted (OR 4.62, 95% CI: 4.39-4.85) multivariable analyses. Overall in-hospital mortality (32% vs 21.3%), median length of stay (11 days vs 9 days), and hospital charges were higher among arrhythmic than nonarrhythmic patients. CONCLUSION: With the availability of more advanced cancer therapy in the US, nearly one in four inpatient encounters of TLS had arrhythmia. Arrhythmia in TLS patients was associated with higher odds of mortality and increased resource utilization. Therefore, strategies to improve the supportive care of TLS patients plus timely diagnosis and treatment of arrhythmia are of utmost importance in reducing mortality and health-care cost.