Internal and emergency medicine
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This study aims to determine the frequency and impact of concomitant cerebral infarction and acute myocardial infarction (AMI) and association with in-hospital outcomes. We analyzed the nationally representative data from National Inpatient Sample between 2016 and 2019. We used multiple logistic regressions to determine the impact of sustaining a cerebral infarction or AMI on in-hospital mortality and linear regression to evaluate length of stay and hospitalization costs. ⋯ The median total healthcare cost for cerebral infarction, AMI and when both occurred was US$10,647, $15,735 and $23,290, respectively (p < 0.001). After adjustments for potential confounders, in-hospital mortality [adjusted odds ratio (aOR) 4.07, 95% CI 3.93-4.21], length of stay (aOR 3.95 95% CI 3.85-4.04), and hospitalization cost (regression coefficient 15,480 95% CI 15,135-15,825) were greater for patients with AMI and cerebral infarction compared to admission for cerebral infarction only. Cerebral infarction and AMI during the same hospitalization occurs in 5% of admissions with cerebral infarction and 3% of admission with AMI and is associated with significant increase in mortality, length of stay and cost compared to admissions with either condition alone.
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Review Meta Analysis
Bleeding and thrombotic events in atrial fibrillation patients with cancer: a systematic review and meta-analysis.
Atrial fibrillation (AF) and cancer are frequently coexisting in elderly patients. Pooled metanalytic data on the impact of cancer on clinical outcomes in AF patients are lacking. We performed a systematic review and meta-regression analysis of clinical studies retrieved from Medline (PubMed) and Cochrane (CENTRAL) databases according to PRISMA guidelines. Bleeding endpoints included any, major, gastrointestinal (GI) bleeding and intracranial haemorrhage (ICH). ⋯ Patients with AF and cancer were less likely to suffer from IS/SE (HR 0.91, 95% CI 0.89-0.94). Cancer complicates the clinical history of AF patients, mainly increasing the risk of bleeding. Further analyses according to the type and stage of cancer are necessary to better stratify bleeding risk in these patients.
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Obesity is a serious and global health problem. The multiple complications of obesity reduce quality of life and increase mortality. Bariatric surgery is one of the best treatment options for obesity management. ⋯ The most frequent surgical options are Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). There is controversy regarding changes in food preferences and selection after bariatric surgery. In this review, we aim to outline the changes in food intake and selection, clarify the behavior changes in food intake, and assess the potential mechanisms responsible for these changes in patients after bariatric surgery.
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In febrile patients with known systemic autoimmune disease, early discrimination between infection and disease flare often represents a clinical challenge. This study aimed at evaluating the efficacy of procalcitonin (PCT) and other common inflammatory biomarkers in discriminating disease flare from bacterial infections in the Emergency Department (ED). In a cross-sectional observational retrospective study, we identified consecutive febrile patients with a known diagnosis of systemic autoimmune disease, admitted to the ED, and subsequently hospitalized. ⋯ However, only at a very high threshold value of 2 ng/ml, the PCT had a satisfactory negative predictive value of 88.9%, although with a very low specificity of 13.6% and a positive predictive value of 35.8%. Our data suggest that in the ED setting, the early PCT determination has low accuracy in the differentiation of disease flare from infection in patients with known rheumatologic disease. However, the PCT could be useful in elderly and comorbid subjects, in supporting clinical assessment and in recognizing those febrile patients needing prompt antibiotic treatment.