In-hospital outcomes in COVID-19 patients with non-alcoholic fatty liver disease by severity of obesity: Insights from national inpatient sample 2020.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) increases the risk of cardiovascular diseases independently of other risk factors. However, data on its effect on cardiovascular outcomes in coronavirus disease 2019 (COVID-19) hospitalizations with varied obesity levels is scarce. Clinical management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity levels. AIM: To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of obesity. METHODS: COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease -10 CM codes in the 2020 National Inpatient Sample database. Overweight and Obesity Classes I, II, and III (body mass index 30-40) were compared. Major adverse cardiac and cerebrovascular events (MACCE) (all-cause mortality, acute myocardial infarction, cardiac arrest, and stroke) were compared between groups. Multivariable regression analyses adjusted for sociodemographic, hospitalization features, and comorbidities. RESULTS: Our analysis comprised 13260 hospitalizations, 7.3% of which were overweight, 24.3% Class I, 24.1% Class II, and 44.3% Class III. Class III obesity includes younger patients, blacks, females, diabetics, and hypertensive patients. On multivariable logistic analysis, Class III obese patients had higher risks of MACCE, inpatient mortality, and respiratory failure than Class I obese patients. Class II obesity showed increased risks of MACCE, inpatient mortality, and respiratory failure than Class I, but not significantly. All obesity classes had non-significant risks of MACCE, inpatient mortality, and respiratory failure compared to the overweight group. CONCLUSION: Class III obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class I. Using the overweight group as the reference, unfavorable outcomes were not significantly different. Morbid obesity had a greater risk of MACCE regardless of the referent group (overweight or Class I obese) compared to overweight NAFLD patients admitted with COVID-19.

Navigating Diagnostic Challenges in Acute Coronary Syndrome: A Case of Bezold-Jarisch Reflex and Wellens Pattern.

Acute coronary syndrome (ACS) presents significant diagnostic challenges, particularly in cases with atypical presentations and complex clinical scenarios. Here, we describe the case of a 59-year-old man who presented with presyncope, bradycardia, hypotension, and later syncope, attributed to the Bezold-Jarisch reflex. Electrocardiographic findings suggested both inferior and anterior wall infarction, with dynamic changes in T-wave morphology further complicating the diagnostic process. Despite a type A Wellens' pattern indicating critical stenosis in the proximal left anterior descending (LAD) artery, coronary angiography revealed a complete thrombotic lesion in the proximal right coronary artery (RCA), necessitating urgent intervention. Despite the Wellens pattern indicating LAD involvement, RCA revascularization took precedence due to immediate thrombotic risk. This case underscores the diagnostic challenges associated with conflicting clinical manifestations in ACS and highlights the importance of individualized management strategies integrating advanced diagnostic modalities to optimize outcomes. Understanding the interplay of complex clinical presentations and employing a nuanced approach to management are crucial in effectively navigating ACS scenarios.

Epidemiologic and Clinical Characteristics of Marantic Endocarditis: A Systematic Review and Meta-analysis of 416 Reports.

Nonbacterial thrombotic endocarditis (NBTE) is a distinctive condition marked by the presence of aseptic fibrin depositions on cardiac valves due to hypercoagulability and endocardial damage. There is a scarcity of large cohort studies clarifying factors associated with morbidity and mortality of this condition. A systematic literature review was performed utilizing the PubMed, Embase, Cochrane, and Web-of-Science databases to retrieve case reports and series documenting cases of NBTE from inception until September-2022. A descriptive analysis of basic characteristics was carried out, followed by multivariate regression analysis to identify risk factors associated with morbidity and mortality. A total of 416 case reports and series were identified, of which 450 patients were extracted. The female-to-male ratio was around 2:1 with an overall sample median age of 48 (interquartile range [IQR]:34-61). Stroke-like symptoms were the most common presentation and embolic phenomena occurred in 70% of cases, the majority of which were due to stroke. Cancer was associated with higher embolic complications (aOR:6.38, 95% CI = 3.75-10.83, p < 0.01) in comparison to other NBTE etiologies, while age, sex, and vegetation size were not (p > 0.05). All-cause in-hospital mortality was 36%, with cancer etiology being associated with higher mortality: 56% (aOR:3.64, 95% CI = 1.57-8.43, p < 0.01) in comparison to other NBTE etiologies:19%. A significant decrease in NBTE mortality was seen in recent years in comparison to admissions that occurred during the 20th century (aOR:0.07, 95% CI = 0.04-0.15, p < 0.01). While there has been an observed improvement in overall in-hospital mortality rates for patients admitted with NBTE in recent years, it is important to note that cases associated with a cancer etiology are still linked to high morbidity and mortality during hospitalization.

Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment.

The prevalence of atrial flutter (AFL) is increasing among the elderly population, and managing this condition presents specific challenges within this demographic. As patients age, they often exhibit reduced responsiveness to conservative treatment, necessitating a more invasive approach. We present a case of a 93-year-old female who presented to the hospital with acute decompensated heart failure (ADHF) and AFL. A year prior, she was diagnosed with arrhythmia-induced cardiomyopathy. Despite recovering her ejection fraction (EF) through guideline-directed medical therapy (GDMT), her EF deteriorated again. The patient declined invasive management for her arrhythmia on multiple occasions. Managing such patients is challenging since the approach with pharmacotherapy alone often fails to maintain sinus rhythm or adequately control the ventricular rate. Growing evidence shows that invasive management, especially ablation, may be a safe and effective procedure for this patient population. Furthermore, the studies suggest that ablation may yield particular benefits for patients with simultaneous heart failure and atrial fibrillation/AFL (AF/AFL). Unfortunately, limited data exist regarding the invasive management of AFL in the elderly. Therefore, this case report aims to provide a comprehensive review of the current evidence regarding the safety and efficacy of ablation as a therapeutic option for AFL in elderly patients, with a particular focus on how patients with concomitant heart failure may benefit from ablation.

A population-based cross-sectional study to determine the practices of breastfeeding among the lactating mothers of Patiala city.

INTRODUCTION: The present study was undertaken to study the breastfeeding practices and the influence of literacy and prevailing cultural factors on different aspects of breastfeeding. MATERIALS AND METHODS: A community-based cross-sectional study was conducted at Badungar, a semi-urban area in Patiala city including a total of 370 mothers. Mothers were interviewed using pre-formed, semi-structured Performa. The participant's demographic information, awareness and practices regarding breastfeeding were recorded by paying house to house visits. Data were analyzed using SPSS ver. 21. RESULTS: Only 27.30% of the mothers knew that breastfeeding should be initiated within 1 hour of birth. A total of 51.62% mothers considered prelacteal feed to be the right practice while 55.95% considered colostrum bad for the baby. Only 53.78% of the lactating mothers knew the correct meaning of exclusive breastfeeding. Only 24.86% mothers started breastfeeding within an hour after birth. Colostrum was not given by 57.29% of the lactating mothers while Prelacteal feeds were given by 50.81% mothers. Exclusive breastfeeding till 6 months was given by 45.67% mothers. A significant association was observed in high mother's education, high socio-economic status, nuclear status of family, history of antenatal care registration, and hospital delivery with exclusive breastfeeding (P < 0.01). CONCLUSION: Study concluded that breastfeeding practices were not optimum; hence promotion of knowledge regarding the right practices of breastfeeding and focus on the factors affecting them is highly warranted in this area.