Racial disparities in trend, clinical characteristics and outcomes in Takotsubo syndrome.

INTRODUCTION: Takotsubo syndrome (TTS) is an acute transient nonischemic cardiomyopathy often characterized by its hallmark feature of left ventricular apical ballooning. The correlation between racial backgrounds and the prognosis of individuals with TTS remains poorly defined. Our study aimed to explore the influence of race on the trends, clinical presentations, and outcomes in patients diagnosed with TTS. METHODS: We queried the National Inpatient Sample (NIS) database from 2016 to 2020 and identified hospitalizations with TTS. We compared the clinical features and outcomes across three different races - non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic population. The primary outcome was in-hospital mortality. RESULTS: 76,505 weighted hospitalizations for TTS were identified, of which 65,495 (85.6%) were non-Hispanic White, 5,830 (7.6%) were non-Hispanic Black, and 5,180 (6.8%) were Hispanics. After propensity-score matching, NHB patients had higher odds of acute kidney injury (OR: 1.49, 95% CI: 1.21-1.84, p < 0.001) and mechanical ventilation (OR: 1.33, 95% CI: 1.04-1.68, p = 0.02). Hispanic patients had a higher incidence of acute kidney injury requiring dialysis when compared to NHW patients (OR: 2.53, 95% CI: 1.11-5.77, p = 0.027). There was no significant difference in terms of in-hospital mortality between NHB and Hispanic patients when compared to NHW patients. Notably, Hispanic populations experienced a higher mortality rate during the COVID-19 period. CONCLUSION: Our study suggested significant differences in the outcomes of TTS across different racial groups. Hispanic populations experienced a higher mortality rate with TTS during the COVID-19 era. Further research should emphasize discovering the factors contributing to the observed disparities.

Scrotal Extramammary Paget's Disease in an Elderly Caucasian Male.

Extramammary Paget's disease (EMPD) is a rare dermatologic malignancy affecting regions with a dense population of apocrine glands within the intraepithelial tissue, including the vulva, perineum, axilla, scrotum, and penile regions. Clinical presentation varies from being asymptomatic to burning, painful, and pruritic lesions. As a result, it could be misdiagnosed for other dermatologic diseases. Our case report discloses a patient with an erythematous pruritic lesion that was initially treated with topical antifungal therapy. After failed treatment, a biopsy revealed EMPD of the scrotum. With no standard guidelines in the treatment of EMPD, there are different treatment modalities for the disease. Mohs micrographic surgery currently is the preferred treatment modality presenting with the lowest rates of recurrence. With early diagnosis and treatment, the five-year survival rate for patients with primary EMPD is 87%. Therefore, there should be a high level of clinical suspicion for EMPD in patients presenting with pruritic lesions in areas with apocrine glands that have failed initial medical treatment.