Evaluation of Inpatient Sodium-Glucose Co-Transporter-2 Inhibitor Use in Patients Hospitalized for Acute Heart Failure

Hospitalization for acute heart failure (HF) represents an important opportunity for initiation and up-titration of guideline-directed medical therapy. This study aimed to determine whether sodium-glucose co-transporter-2 inhibitor (SGLT2I) use is safe in patients hospitalized for acute HF and whether its use is associated with improved clinical outcomes. We conducted a single-center, retrospective cohort study of adults hospitalized for acute HF with any ejection fraction and separated them into 2 matched groups based on inpatient SGLT2I use. The matching yielded 110 patients in the SGLT2I group and 110 patients in the control group. A total of 101 patients (91.8%) in the SGLT2I group were treated with dapagliflozin, whereas 9 (8.2%) were treated with empagliflozin. The mean age was 71 years, 37.7% were women, 70.9% were White, 22.7% were Black, and 64.1% were Hispanic or Latino. The length of stay was 10 days in the SGLT2I group and 11 days in the control group (p = 0.43). A total of 2 patients (1.8%) in the SGLT2I group and 13 patients (11.8%) in the control group died within 30 days of discharge (hazard ratio 0.15, 95% confidence interval [CI] 0.03 to 0.66, p = 0.012). A total of 17 patients (15.5%) in the SGLT2I group and 11 patients (10.0%) in the control group had an all-cause readmission within 30 days (hazard ratio 1.58, 95% CI 0.74 to 3.37, p = 0.239). In addition, 11 patients (10.0%) in the SGLT2I group and 3 patients (2.7%) in the control group had an HF readmission within 30 days (hazard ratio 3.75, 95% CI 1.05 to 13.44, p = 0.042). Acute kidney injury (54.5% vs 18.2%, p <0.001) and hypotension (12.7% vs 2.7%, p = 0.005) occurred significantly more frequently in the control group. In conclusion, SGLT2I use in patients hospitalized for acute HF was associated with decreased 30-day all-cause mortality and lower rates of acute kidney injury and hypotension; however, the rate of 30-day HF readmission increased.

Role for advanced heart failure therapies in the management of influenza B-associated fulminant myocarditis with recovery

A woman presented to the emergency department for syncope after developing influenza-like symptoms. She tested positive for influenza B. The patient rapidly decompensated into cardiogenic shock over 2 days, requiring aggressive pharmacological therapy and temporary mechanical circulatory support. She made a full recovery. This case highlights the importance of early intervention, urgent transplant evaluation and guideline directed medical therapy in the treatment of fulminant myocarditis secondary to influenza B infection.

[Diffuse stromal corneal opacity and alterations of the hands]

Bilateral stromal corneal opacity is a differential diagnostic challenge for ophthalmologists. In this article 2 female patients aged 30 and 36 years old, respectively, with different degrees of expression of stromal diffuse corneal opacity will be presented. Patient 1 was of short stature (114 cm) and patient 2 was 172 cm in size. Both patients exhibited altered joint structures of the hands and feet and diffuse stromal corneal opacity. Furthermore, patient 1 had both mitral and aortal insufficiencies and patient 2 an aorta insufficiency. The stromal diffuse corneal opacity was indicative of Schleie syndrome. For patients with reduced vision a lamellary keratoplasty is to be recommended.

Microbial metabolism of quinoline and related compounds. IV. Degradation of isoquinoline by Alcaligenes faecalis Pa and Pseudomonas diminuta 7

From sewage and soil isoquinoline-degrading organisms were enriched. Two strains could be isolated which were able to utilize isoquinoline as sole carbon source. The bacteria were tentatively identified as Alcaligenes faecalis and Pseudomonas diminuta with respect to their morphological and physiological characters. When growing on isoquinoline both strains excrete a metabolite into the medium which was identified as 1-oxo-1,2-dihydroisoquinoline. Alcaligenes faecalis was cultivated in continuous culture on 1-oxo-1,2-dihydroisoquinoline to improve growth on isoquinoline and degradative activity.

Intrasubject variability of pulmonary function testing in healthy children

The intrasubject variability of repeat pulmonary function testing was examined in 20 healthy children aged 10 to 16 years. The children were tested a maximum of 11 times over a period of two months. The tests examined were spirometry, maximum expiratory flow-volume curves, body plethysmograph determination of lung volumes, and single breath nitrogen washout. The time of day or the length of the re-test interval, up to a period of two months, did not significantly affect the variability. Standard deviation was used when comparing the variability of measurements with the same units and coefficient of variation was used when comparing measurements of different units. The vital capacity measured by spirometry was the least variable measurement. Functional residual capacity, residual volume and total lung capacity were equally reproducible but as a group were more variable than vital capacity. There was no significant difference between the variability of the following measurements: forced expired flow from 25 to 75% of the vital capacity, flows at 70%, 50% and 40% total lung capacity, and flows at 50% vital capacity. Flows at 25% vital capacity were significantly less variable than other measurements of flow. The variability of forced expired volume in one second was examined and the use of this measurement in determining significant bronchial hyper-reactivity was assessed.

Croup, recurrent group, allergy, and airways hyper-reactivity

One hundred and ten children were studied 9 years after each had been in hospital for croup. They were evaluated with a questionnaire, physical examination, allergy skin testing, pulmonary function tests, and a histamine inhalation challenge. Fifty-seven of them had recurrent episodes of croup, and 33 were defined as allergic. The association between allergy and recurrent croup was highly significant. Airways hyper-reactivity was found in 23 of them, and was associated with allergy and recurrent croup. The group of children with a history of recurrent croup could be distinguished from the group with one or two episodes by male predominance, onset of the disease at a younger age, familial predisposition, a significantly greater association with allergy and airways hyper-reactivity, slightly lower expiratory flow rates in pulmonary function tests, and a tendency towards the subsequent development of asthma.