Seasonal variations and social disparities in asthma hospitalizations and outcomes.

OBJECTIVE: Exposure to asthma exacerbating triggers may be dependent on the season and an individual's social factors and subsequent means to avoid triggers. We assessed for seasonal variations and differential outcomes based on race and income in admissions for asthma in a United States nationwide assessment. METHODS: This retrospective study assessed adult hospitalizations for asthma 2016-2019 using the National Inpatient Sample. Hospitalizations were categorized by season: winter (December-February), spring (March-May), summer (June-August), fall (September-November). Multivariable linear and logistic regression were used to assess associations between season, race, income quartile (determined by the median income within a patient's ZIP code), and outcomes. RESULTS: The study included 423,140 admissions with a mean age of 51 years, and 73% of the cohort being female and 56% non-white. Admissions peaked during winter (124, 145) and were lowest in summer (80,525). Intubation rates were increased in summer compared to winter (2.73 vs 1.93%, aOR = 1.19, 95% CI: 1.04-1.37) as were rates of noninvasive positive pressure ventilation (NIPPV) (7.92 vs 7.06%, aOR = 1.08, 95% CI: 1.00-1.17). Compared to white patients, intubation (2.53 vs 1.87%, absolute difference 0.66%, aOR = 1.14, 95% CI: 1.02-1.29) and NIPPV (9.95 vs 5.45%, absolute difference 4.5%, aOR = 1.69, 95% CI: 1.57-1.82) were increased in Black patients. No significant associations between income and clinical outcomes were found. CONCLUSIONS: Asthma admission peak during winter, while summer admissions and non-white race are associated with higher rates of NIPPV and intubation. Public health initiatives and strategically timed outpatient visits could combat seasonal variation and social disparities in asthma outcomes.

Bloodless medicine: current strategies and emerging treatment paradigms.

BACKGROUND: Advances in our understanding of the risks associated with allogeneic blood transfusions (ABTs) and the growing number of patients who wish to avoid ABTs have led to the emergence of new treatment paradigms for "bloodless" medicine and surgery. STUDY DESIGN AND METHODS: Here, we review prior studies and summarize current strategies for bloodless care used at our institution. We advocate three basic principles: 1) diagnosing and aggressively treating anemia, 2) minimizing blood loss from laboratory testing and invasive procedures, and 3) identifying and managing bleeding diatheses. Anemia is treated with erythropoiesis-stimulating agents as well as iron, folate, and B12 when indicated. Low-volume phlebotomy tubes are used for laboratory testing. Autologous blood salvage is used for childbirth and surgical patients who have the potential for substantial bleeding. RESULTS: Although there have been few retrospective studies and no prospective studies to guide management, prior studies suggest that outcomes for surgical patients managed without ABTs are comparable to those of historic controls. CONCLUSIONS: Given the emerging evidence that patients who avoid ABTs do as well if not better than patients who accept ABTs, further efforts are needed to determine whether all patients could benefit from bloodless strategies. Bloodless approaches in selected patients could reduce risks, improve outcomes, and decrease costs for all patients.

Relationships between sex and in-hospital outcomes of patients with acute cardiogenic shock receiving mechanical circulatory support.

BACKGROUND: Cardiovascular disease is the leading cause of mortality in women. Despite this there is a paucity of data on the impact of sex on utilization and outcomes of temporary mechanical circulatory support (tMCS) in patients hospitalized with Acute Myocardial Infarction (AMI) Cardiogenic Shock (CS). METHODS: We examined the 2016-2019 National Inpatient Sample database to identify cases of AMI-CS. Men were used as our control group, while women comprised our cohort. The primary outcome was in-hospital mortality. Secondary outcomes included the use of tMCS including; left ventricular assist device (LVAD) use, Impella use, and Intra-Aortic Balloon Pump (IABP) use, length of stay (LOS) and total hospitalization cost (THC). Multivariate linear and logistic regression models were used to adjust for confounders. RESULTS: Among patients hospitalized for AMI (N = 2,622,939), 37.7 % were Female. A Female sex was associated with a higher inpatient mortality (adjusted OR [aOR] 1.06, p < 0.001), a lower likelihood of LVAD use (2.3 % vs. 2.9 % and p < 0.001), IABP use (3.0 % vs. 4.4 % and p < 0.001), Impella use (1.0 % vs. 1.5 % and p < 0.001), a longer mean LOS (4.4 vs 4.3 days and p < 0.001) and lower THC ($88,097 vs. $104,101, p < 0.001) compared to male patients for AMI-CS. CONCLUSION: Female patients admitted for AMI-CS were less likely to receive tMCS despite a higher mortality rate and a slightly longer LOS compared to male patients. Further studies are necessary to confirm these findings and elucidate clearer causality for such disparities.

Obesity hypoventilation syndrome is associated with worse in-hospital outcomes in patients with acute myocardial infarction: A nationwide study.

BACKGROUND: Obesity hypoventilation syndrome (OHS) is a condition characterized by obesity, daytime hypercapnia, and sleep-disordered breathing. The impact of OHS on outcomes in patients with acute myocardial infarction (AMI) remains poorly understood. METHODS: We conducted a retrospective analysis using data from the National Inpatient Sample (2016-2020) to evaluate the outcomes of patients with OHS admitted for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). RESULTS: Among STEMI and NSTEMI patients, 0.15 % and 0.37 % had OHS, respectively. After adjusting for confounders, OHS was associated with higher odds of in-hospital mortality, cardiac arrest, acute kidney injury, renal replacement therapy, and respiratory failure requiring intubation in NSTEMI patients. In STEMI patients, OHS was associated with higher odds of cardiac arrest, acute kidney injury, and respiratory failure. CONCLUSION: OHS is associated with worse clinical outcomes in patients admitted with AMI, particularly in those with NSTEMI.

Acquired Hemophilia A Post-COVID-19 Vaccination: A Case Report and Review.

Acquired hemophilia A (AHA) is an inhibitory coagulopathy that represents a rare variant of hemorrhagic syndromes. We present a case of idiopathic AHA in a 75-year-old male patient with a cutaneous hematoma that could be attributed to a recent COVID-19 vaccination. The aim of this report is to raise awareness of a possible association between AHA and COVID-19 vaccination and to review similar reported cases and management plans to prevent the development of possible morbidity and debilitating complications. This case illustrates an exceptionally rare side effect of the COVID-19 vaccination. The advantages of obtaining the COVID-19 vaccine outweigh the risks.

Pulmonary metastasis of head and neck cancer: surgical removal outcomes from a tertiary care center.

PURPOSE: There has been no clear data on the effectiveness of pulmonary metastasectomy on several original cancers, including head and neck. We aim to collect data about the metastasectomies performed in our center for eligible patients and elaborate more on predictors and prognosis. METHODS: A retrospective analysis of 56 patients who underwent metastasectomy from head and neck cancers at our facility between January 2000 and January 2016 (16 years). Statistical analysis was performed based on gender, disease-free interval (DFI), location of the original tumor, and histological subtypes to assess their effect and relevance to the prognosis and disease recurrence. RESULTS: Twenty-nine males and 27 females had lung metastasis from head and neck. The primary lesions of the lung metastasis were more often found in the thyroid (34%), followed by nasopharynx (32%). As for histology, the most common one was papillary cancer (34%), followed by squamous cell carcinomas (29%). The DFI was more than 2 years in 32 patients (57%). The survival rates were 79.5% at 3 years and 71.7% at 5 years. In the univariate analysis, histology was the only independent prognostic factor (p = 0.05). On the other hand, age (p = 0.6), DFI (p = 0.24), and site of the primary tumor (p = .06) showed no effect on the prognosis of head and neck cancers metastasizing to the lungs. CONCLUSION: Pulmonary metastasectomy for lesions originating from head and neck provides good long-term survival. Histological subtype was the only statistically significant prognostic factor.