Cardiac Catheterization and Outcomes for Elderly Patients Hospitalized With Heart Failure

Background

Heart failure affects over 6 million people in the United States (US) with limited evidence to support the use of cardiac catheterization. The benefit of its use remains mostly as expert opinion. This study intends to assess the benefits and risks of cardiac catheterization in elderly patients admitted for heart failure.

Methods

This was a retrospective study using data from the National Inpatient Sample, including admissions 65 years and older hospitalized for heart failure, between 2008 and 2016. The outcomes analyzed were in-hospital mortality, total hospital costs, and length of stay.

Results

After controlling for covariates, cardiac catheterization was found to have a protective association with mortality (OR 0.87, 95% CI 0.833-0.912, P < .0001), an increased hospital length of stay by 2.88 days (95% CI: 2.84-2.92 days, P < .0001) and approximately $16 255 increase in cost.

Conclusions

Cardiac catheterization was associated with decreased in-hospital mortality, longer length of stay and higher total costs in admissions with heart failure aged 65 years or older.

Bright UV-C Phosphors with Excellent Thermal Stability-Y1-xScxPO4 Solid Solutions

The structural and luminescence properties of undoped Y_1-xSc_xPO₄ solid solutions have been studied. An intense thermally stable emission with fast decay (τ_1/e ~ 10^-7 s) and a band position varying from 5.21 to 5.94 eV depending on the Sc/Y ratio is detected and ascribed to the 2p O-3d Sc self-trapped excitons. The quantum yield of the UV-C emission, also depending on the Sc/Y ratio, reaches 34% for the solid solution with x = 0.5 at 300 K. It is shown by a combined analysis of theoretical and experimental data that the formation of Sc clusters occurs in the solid solutions studied. The clusters facilitate the creation of energy wells at the conduction band bottom, which enables deep localization of electronic excitations and the creation of luminescence centers characterized by high quantum yield and thermal stability of the UV-C emission.

Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States

BACKGROUND

Lower gastrointestinal bleeds (LGIB) is a very common inpatient condition in the United States. Gastrointestinal bleeds have a variety of presentations, from minor bleeding to severe hemorrhage and shock. Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB, there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings.

AIM

To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals.

METHODS

This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality. It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016. This study does not differentiate between acute and chronic LGIB and both are included in this study. The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds; the secondary outcome measures were in-hospital mortality, length of stay, and costs involved in those receiving colonoscopy for LGIB. Statistical analyses were all performed using STATA software. Logistic regression was used to analyze the utilization of colonoscopy and mortality, and a generalized linear model was used to analyze the length of stay and cost.

RESULTS

Our study found that 37.9% of LGIB patients at rural hospitals compared to approximately 45.1% at urban hospitals received colonoscopy, (OR = 0.730, 95%CI: 0.705-0.7, P > 0.0001). After controlling for covariates, colonoscopies were found to have a protective association with lower in-hospital mortality (OR = 0.498, 95%CI: 0.446-0.557, P < 0.0001), but a longer length of stay by 0.72 d (95%CI: 0.677-0.759 d, P < 0.0001) and approximately $2199 in increased costs.

CONCLUSION

Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals, patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality. In both settings, benefit came at a cost of extended stay, and higher total costs.

Salt Consumption and Myocardial Infarction: Is Limited Salt Intake Beneficial?

Introduction: Sodium is an essential mineral that plays a crucial role in the maintenance of normal cellular homeostasis, regulation of fluid and electrolytes, and blood pressure (BP). Due to the presence of sodium in a variety of regularly consumed food products, the deficiency of sodium is extremely unlikely. On the other hand, excess intake of dietary sodium is observed in many populations as it is generally used in most food products. Existing guidelines recommend lowering salt consumption for better cardiovascular health; these dietary sodium intake recommendations are not reassuring as the evolving studies show evidence that there is a higher risk of cardiovascular disease (CVD) with low sodium consumption. The aim of this study was to identify the association between salt consumption and myocardial infarction (MI).

Methods: The National Health and Nutrition Examination Survey (NHANES) data between 2017- 2018 was analyzed to examine the association between sodium intake (use in daily meal preparation) and reported history of MI. Logistic regression was used to assess for significant differences between the groups and calculated odds ratios while adjusting for confounders.

Results: A total of 4626 participants were included in the study, with a mean age of 66 ± 11 years in those with a history of MI (n = 212). Amongst these participants, those with salt consumption "Occasionally used" or "Very often used" were less likely to have suffered from MI than those who "Never used" salt in meal preparation. Multivariable logistic regression was performed to control for confounders. “Occasionally used” compared to “Never used” odds ratio was 0.5227 (95% confidence interval (CI); 0.3053-0.9009 p = 0.0184) and “Very often used” compared to “Never used” odds ratio was 0.5033 (95% CI; 0.2892-0.8799 p = 0.0152).

Conclusion: After adjusting for confounders, the participants that used salt more liberally during meal preparation were less likely to have MI than those who minimally or never used salt in meal preparation.

Differences in nicotine dependence, smoke exposure and consumer characteristics between smokers of machine-injected roll-your-own cigarettes and factory-made cigarettes

BACKGROUND

Consumption of machine-injected roll-your-own (RYO) filtered cigarettes made from pipe tobacco increased almost 7-fold from 2008 to 2011 in the United States.

METHODS

We used data from the Pennsylvania Adult Smoking Study to compare the differences in sociodemographic, smoking topography, nicotine dependence, and cotinine levels between 280 smokers using factory made (FM) cigarettes and 68 smokers using RYO cigarettes.

RESULTS

RYO smokers were older (41 vs. 37, P = 0.053), had significantly lower levels of income (P < 0.001) and education (P = 0.007), and were less likely to be fully employed (P = 0.009). RYO smokers consumed more cigarettes per day [CPD] (21 vs. 15, P < 0.001), and had a higher mean score on the Fagerström Test for Cigarette/Nicotine Dependence (5.2 vs. 4.1, P < 0.001). The main reasons for choosing RYO cigarettes were the lower cost (68%) and believed they are less harmful (12%). The average cost per pack of FM cigarettes was $5.74 vs. $1.13 for RYO. In multiple regression analyses, RYO smokers had significantly lower cotinine levels across all levels of CPD. Among smokers of king-size cigarettes, mean interpuff interval (P < 0.05) and total smoke duration (P < 0.01) per cigarette was significantly greater in RYO smokers. In laboratory measurements, RYO cigarettes contained more tobacco by weight than FM cigarettes, but weight varied by both tobacco and cigarette tube brands.

CONCLUSIONS

Machine-injected RYO cigarettes made from pipe tobacco are cheaper than FM cigarettes but may have higher abuse liability. Smokers who might otherwise reduce their cigarette consumption or quit altogether may continue to smoke RYO cigarettes due to their affordability.

Septic Arthritis in the Temporomandibular Joint

Septic arthritis of the temporomandibular joint (TMJ) is a rare event that has only been reported a few dozen times worldwide. This case is remarkable for septic arthritis of the TMJ joint in an otherwise healthy male.

A widened pulse pressure: a potential valuable prognostic indicator of mortality in patients with sepsis

Background

Sepsis is one of the leading causes of death in the United States and the most common cause of death among critically ill patients in non-coronary intensive care units. Previous studies have showed pulse pressure (PP) to be a predictor of fluid responsiveness in patients with sepsis. Additionally, previous studies have correlated PP to cardiovascular risk factors and increase in mortality in end-stage renal disease patients.

Objectives

To determine the correlation between PP and mortality in patients with sepsis.

Methods

A retrospective review was conducted on 5,003 patients admitted with the diagnosis of sepsis using ICD-9 codes during the time period from January 2010 to December 2014 at two community-based hospitals in central Pennsylvania.

Results

Our study findings showed significant decrease in the mortality when the PP was greater than 70 mmHg of patients with sepsis (p-value: 0.0003, odds ratio: 0.67, 95% confidence limit: 0.54–0.83).

Conclusion

Based on our findings, we suggest that PP could be a valuable clinical tool in the early assessment of patients admitted with sepsis and could be used as a prognostic factor to assess and implement management therapy for the patients with sepsis.

A prediction model for Clostridium difficile recurrence

Background

Clostridium difficile infection (CDI) is a growing problem in the community and hospital setting. Its incidence has been on the rise over the past two decades, and it is quickly becoming a major concern for the health care system. High rate of recurrence is one of the major hurdles in the successful treatment of C. difficile infection. There have been few studies that have looked at patterns of recurrence. The studies currently available have shown a number of risk factors associated with C. difficile recurrence (CDR); however, there is little consensus on the impact of most of the identified risk factors.

Methods

Our study was a retrospective chart review of 198 patients diagnosed with CDI via Polymerase Chain Reaction (PCR) from January 2009 to Jun 2013. In our study, we decided to use a machine learning algorithm called the Random Forest (RF) to analyze all of the factors proposed to be associated with CDR. This model is capable of making predictions based on a large number of variables, and has outperformed numerous other models and statistical methods.

Results

We came up with a model that was able to accurately predict the CDR with a sensitivity of 83.3%, specificity of 63.1%, and area under curve of 82.6%. Like other similar studies that have used the RF model, we also had very impressive results.

Conclusions

We hope that in the future, machine learning algorithms, such as the RF, will see a wider application.

Formation of Helices in Graphene Nanoribbons under Torsion

We use objective boundary conditions and self-consistent charge density-functional-based tight-binding to simulate at the atomistic scale the formation of helices in narrow graphene nanoribbons with armchair edges terminated with fluorine and hydrogen. We interpret the microscopic data using an inextensible, unshearable elastic rod model, which considers both bending and torsional strains. When fitted to the atomistic data, the simple rod model uses closed-form solutions for a cubic equation to predict the strain energy and morphology at a given twist angle and the crossover point between pure torsion and a helix. Our modeling and simulation bring key insights into the origin of the helical graphene morphologies stored inside of carbon nanotubes. They can be useful for designing chiral nanoribbons with tailored properties.

Subchronic nose-only inhalation study of propylene glycol in Sprague-Dawley rats

Groups of nineteen Sprague-Dawley rats of each sex were exposed by a nose-only inhalation to 0.0, 0.16, 1.0 or 2.2 mg propylene glycol/litre air, for 6 hr/day, 5 days/wk for 90 days. There were no significant differences in respiratory rates, minute volumes or tidal volumes between any of the groups during aerosol exposure. The uniformity of respiratory parameters between dose groups implied that the delivered doses were proportional to the exposure concentrations. The mean terminal body weights were not significantly different from controls for any group of male animals. The mean body weights of the females exposed to 2.2 mg/litre were significantly less than those of female controls from day 50 onwards. This effect, in female rats, was consistent with a decrease in feed consumption for the high-exposure female rats beginning on study day 43. Statistically significant differences between the treated and control groups in certain haematological parameters, serum enzyme activities, other serum chemistry parameters and organ weights did not show clear dose relationships. There was a significant increase in the number of goblet cells or an increase in the mucin content of the existing goblet cells in the nasal passages of the medium- and high-exposure animals. Exposure to the above concentrations of propylene glycol caused nasal haemorrhage and ocular discharge in a high proportion of animals, possibly as a result of dehydration of the nares and eyes.

[Toxic action and deratization effect of acute rodenticide]

Tested was the toxic action and the deratization effect of the new acutely acting rodenticide EL614 recently introduced into deratization practice. The experiments were carried out with laboratory rats and pigs as well as with the rats found in a swine breeding complex. Studied were the morphologic and histopathologic changes in the internal organs of rats that had swallowed baits carrying the preparation in various concentration. It was found that LD50 for rats up to the 24th hour after swallowing the poison was 4.13 mg/kg, and it was 1.78 mg/kg at the 48t hour, and 1.32 mg/kg at the 72nd hour. Intoxication and death set in as the result of impaired function of almost all organs, which was explained by the lipidotropic action of the preparation. Particularly severe were the lesions (hemodynamic and degenerative) in the brain. In field trials the baits contained EL614 in concentration of 0.005 per cent, showed a low deratization effect the first day after setting them. In this case the effect could be explained by the stress developing among the rodent population. The same baits in amounts surpassing 300-400 g caused intoxication and death in pigs of 20 kg live weight.