CHARACTERISTICS AND OUTCOMES OF HOSPITALISED PATIENTS WITH HEART FAILURE AND SARCOIDOSIS: A PROPENISTY-MATCHED ANALYSIS OF THE NATIONWIDE READMISSIONS DATABASE 2010-2019.

BACKGROUND: Sarcoidosis is associated with a poor prognosis. There is a lack of data examining the outcomes and readmission rates of sarcoidosis patients with heart failure (SwHF) and without heart failure (SwoHF). We aimed to compare the impact of non-ischemic heart failure on outcomes and readmissions in these two groups. METHODS: The US Nationwide Readmission Database was queried from 2010-2019 for SwHF and SwoHF patients identified using the International Classification of Diseases, Ninth and Tenth Editions. Those with ischemic heart disease were excluded, and both cohorts were propensity matched for age, gender, and Charlson Comorbidity Index (CCI). Clinical characteristics, length of stay, adjusted healthcare-associated costs, 90-day readmission and mortality were analyzed. RESULTS: We identified 97,961 hospitalized patients (median age 63 years, 37.9% male) with a diagnosis of sarcoidosis (35.9% SwHF vs. 64.1% SwoHF). On index admission, heart failure patients had higher prevalences of atrioventricular block (3.3% vs. 1.4%, p<0.0001), ventricular tachycardia (6.5% vs. 1.3%, p<0.0001), ventricular fibrillation (0.4% vs. 0.1%, p<0.0001) and atrial fibrillation (22.1% vs. 7.5%, p<0.0001). SwHF patients were more likely to be readmitted (hazard ratio 1.28, p<0.0001), had higher length of hospital stay (5 vs. 4 days, p<0.0001), adjusted healthcare-associated costs ($9,667.0 vs. $9,087.1, p<0.0001) and mortality rates on readmission (5.1% vs. 3.8%, p<0.0001). Predictors of mortality included heart failure, increasing age, male sex, higher CCI and liver disease. CONCLUSION: SwHF is associated with higher rates of arrhythmia at index admission, as well as greater hospital cost, readmission and mortality rates compared to those without heart failure.

Sex differences in heart transplantation - analysis of the national inpatient sample 2012-2019.

INTRODUCTION: Advanced heart failure therapies and heart transplantation (HT) have been underutilized in women. Therefore, we aimed to explore the clinical characteristics and outcomes of HT by sex. METHODS: We conducted a retrospective analysis of adult discharges from the National Inpatient Sample (NIS) between 2012 and 2019. International Classification of Disease (ICD) procedure codes were used to identify those who underwent HT. RESULTS: A total of 20,180 HT hospitalizations were identified from 2012-2019. Among them, 28 % were female. Women undergoing HT were younger (mean age 51 vs. 54.5 years, p<0.001). HT hospitalizations among men were more likely to have atrial fibrillation, diabetes, hypertension, renal failure, dyslipidemia, smoking, and ischemic heart disease. HT hospitalizations among women were more likely to have hypothyroidism and valvular heart disease. HT hospitalizations in women were associated with no significant difference in risk of in-hospital mortality (adjusted odds ratio [OR] 0.82; 95 % confidence interval [CI] 0.58-1.16, p=0.271), no significant difference in length of stay or inflation-adjusted cost. Men were more likely to develop acute kidney injury during HT hospitalization (69.2 % vs. 59.7 %, adjusted OR 0.71, 95 % CI 0.61-0.83, p<0.001). CONCLUSIONS: HT utilization is lower in women. However, most major in-hospital outcomes for HT are similar between the sexes. Further studies are need to explore the causes of lower rates of HT in women.

Sudden Cardiac Death in Young Individuals: A Current Review of Evaluation, Screening and Prevention.

Sudden cardiac death (SCD) can affect all age groups, including young persons. While less common in the age < 35 population, the occurrence of SCD in the young raises concern, with multiple possible etiologies and often unanswered questions. While coronary artery disease is the leading cause in those > 35 years of age, the younger population faces a different subset of pathologies associated with SCD, including arrhythmias and cardiomyopathies. The tragic nature of SCD in the young entails that we explore and implement available screening methods for this population, and perform the necessary investigations such as electrocardiography (ECG) and echocardiography. In this review, we not only explore the vast etiology associated with SCD in those age < 35, but emphasize evaluation methods, who is at risk, and delve into screening of SCD in potential victims and their family members, in an attempt to prevent this traumatic event. Future research must work towards establishing preventative measures in order to reduce SCD, particularly unexplained SCD in the young.

Effect Of Eight Hours Per Day Of Intermittent Self Prone Positioning For Seven Days On The Severity Of Covid-19 Pneumonia/ Acute Respiratory Distress Syndrome.

BACKGROUND: Prone positioning improves ventilation-perfusion mismatch, distribution of gravitational gradient in pleural pressure, and oxygen saturation significantly in patients with Covid pneumonia. We aimed to find out the efficacy of eight hours per day of intermittent selfprone positioning for seven days in patients affected with COVID-19 pneumonia/ ARDS. METHODS: This Randomized Clinical Trial was conducted in the Covid isolation wards of Ayub Teaching Hospital, Abbottabad. Patients suffering from COVID-19 pneumonia/ ARDS were enrolled with permuted block randomization into a control and an experimental group each consisting of 36 patients. Parameters of Pneumonia Severity Index (PSI) score along with other sociodemographic data was noted on a preformed structured questionnaire. Death was confirmed by requesting the death certificate of patients on the 90th day of enrolment. Data Analysis was done with SPSS Version 25. Tests of significance were applied to calculate the difference in the patients of the two groups with respect to respiratory physiology and survival. RESULTS: The mean age of the patients was 63.79±15.26 years. A total of 25 (32.9%) male and 47 (61.8%) female patients were enrolled. Statistically significant improvement was found in the respiratory physiology of the patients at 7th and 14th DOA between the groups. Pearson Chi-Square test of significance showed a difference in mortality between the two groups at 14th DOA (pvalue=0.011) but not at 90th DOA (p-value=0.478). Log Rank (Mantel-Cox) test of significance, applied on the Kaplan Meier curve and showed no statistically significant difference among the groups based on the survival of the patients. (p-value=0.349). CONCLUSIONS: Early transient improvement in respiratory physiology and mortality does occur with 8 hours of self-prone positioning for seven days but there is no effect on the 90-day survival of the patients. Thus, the impact of the manoeuvre on improving survival needs to be explored with studies having an application of the manoeuvre for a longer duration and period.

Oestrogen And Progesterone Receptors' Expression Pattern In Fibro-Adenoma Of The Female Breast.

BACKGROUND: Fibro-adenoma is the most common benign condition of the female breast comprising about 68% of all breast lumps. Fibroadenoma is an independent risk factor for the development of breast cancer. Complex fibroadenoma has a 2-3-fold increased risk ratio and simple fibroadenoma has 1.49 times increased risk ratio of developing cancer than the normal population over a period of 20 years. This study aimed to qualitatively check the frequency of oestrogen receptor-positive and progesterone receptor-positive cases of fibroadenoma in our region. METHODS: This cross-sectional study was conducted in the pathology department of Ayub Medical College, Abbottabad from June 2020 to December 2021. Biopsy confirmed cases of fibroadenoma were examined using immune-histochemical stains to score qualitatively the expression pattern of ER and PR. Data was analyzed and assessed using SPSS version 25. A p-value of ≤0.05 was considered statistically significant. RESULTS: The mean age of patients who presented with fibro-adenoma was 24.5±9.29 years with a median age of 21.5 years. In most cases, oestrogen receptor expression was mild 23 (54.76%) whereas progesterone receptor expression was severe 19 (45.23%). On chi-square test, the pattern of progesterone receptor expression for the category of hormone intake showed significant differences. Whereas, the pattern of oestrogen receptor expression for the categories of marital status, history of hormone intake, history of menstrual cycle and type of fibroadenoma showed no statistically significant difference. CONCLUSIONS: Further study into the pathogenesis of fibroadenoma is required to understand the role of ER and PR and explore the therapeutic potential of such drugs that affects these receptors. Cabling.

From Epidemic to Pandemic: Comparing Hospital Staff Emotional Experience Between MERS and COVID-19.

Objective: Both Middle East Respiratory Syndrome (MERS) and Coronavirus Disease 2019 (COVID-19) have an emotional toll on healthcare workers (HCWs), but the difference of the impact between the two diseases remains unknown.Design: A cross sectional descriptive survey.Setting: A tertiary care hospital.Participants: 125 HCWs who worked during the 2014 MERS as well as the 2020 COVID-19 outbreaks in high-risk areas of the hospital including critical care, emergency room and COVID-19 clinics.Methods: The comprehensive survey comprised 5 sections and 68 questions and was administered to HCWs before availability of the COVID-19 vaccine. The survey evaluated hospital staff emotions, perceived stressors, external factors that reduced stress, personal coping strategies, and motivators for future outbreaks. The participants rated each question for MERS and COVID-19 simultaneously on a scale from 0-3. The responses were reported as mean and standard deviation, while Wilcoxon signed-rank test was used to calculate the difference in responses.Results: There were 102 (82%) participants who returned the questionnaire. The ritual of obsessive hand washing, emotional and physical fatigue, ongoing changes in infection control guidelines, fear of community transmission, and limitations on socialization and travel were the major stressors that were significantly worse during COVID-19 compared to MERS (P<0.05) and led to HCWs adoption of additional 'personal' coping strategies during COVID-19. There was no difference between COVID-19 and MERS, however, among preferences for 'external' factors made available to HCWs that could reduce stress or in their preferences for motivators to work in future outbreaks (P>.05).Conclusion: Both the MERS and COVID-19 outbreaks were emotionally draining for HCWs. However, COVID-19 was a relatively more stressful experience than MERS for HCWs and led to greater personal, behavioral, and protective adaptations by the hospital staff.

Agreement Between Two Nutritional Assessment Scores as Markers of Malnutrition in Patients with End-stage Renal Disease.

Background Malnutrition is directly related to morbidity and mortality in end-stage renal disease. This should be picked up using simple techniques. Methods Adult patients on maintenance haemodialysis were included using a consecutive sampling technique. Compliance was assessed from attendance register (minimum 75% attendance for good compliance). Hypoalbuminemia signified malnutrition. Blood samples for measurement of haemoglobin, serum albumin, calcium and phosphate levels were drawn from the dialyser tubing at the start of the first of the two haemodialysis sessions for each patient. Height and weight were recorded at the end of the first haemodialysis session for each patient. Mini Nutritional Assessment Questionnaire and Council on Nutrition Appetite Questionnaire were administered in direct face-to-face interviews during two consecutive dialysis sessions. Results There were 116 patients aged 53.46± 14.39 years. Majority were males (83.6%) and on twice a week haemodialysis (69.0%). Malnutrition was present in 30 (25.9%) patients. Serum albumin had a significant relationship with both haemoglobin (R = 0.399; p < 0.001) and serum phosphate levels (R = 0.253; p = 0.006) but not body mass index (R = 0.028; p = 0.769). Mean Mini Nutritional Assessment and Council on Nutrition Appetite scores were 19.45± 5.10 and 26.76± 6.28, respectively. Based on Mini Nutritional Assessment scores, 31 (26.7%) patients were malnourished, 59 (50.9%) were at risk of malnutrition, and 26 (22.4%) had normal nutritional status. Council on Nutrition Appetite scores were low in 65 (56.0%) patients, indicating risk of weight loss in next six months. Serum albumin had significant correlation with Mini Nutritional Assessment scores (R = 0.381; p < 0.001) and Council on Nutrition Appetite scores (R = 0.290; p = 0.002). Slopes of linear regression for Mini Nutritional Assessment and Council on Nutrition Appetite scores were not statistically different (p = 0.202). Conclusions Mini Nutritional Assessment and Council on Nutrition Appetite scores had a similar correlation with serum albumin levels. Either of the two could be used for evaluation of malnutrition in end-stage renal disease.