Peripheral Vascular Disorders Research Articles

Outcomes of patients with cardiac amyloidosis undergoing percutaneous left atrial appendage occlusion.

There is limited data on the safety and efficacy of left atrial appendage occlusion (LAAO) devices in patients with cardiac amyloidosis. We examined the outcomes of patients with cardiac amyloidosis undergoing LAAO device implantation in a nationally representative cohort of patients. The National Readmissions Database (NRD) was analyzed from 2016 to 2019 to identify patients ≥ 18 years old with atrial fibrillation (AF) undergoing LAAO. Patients were divided into those with cardiac amyloidosis and those without cardiac amyloidosis. A multivariable logistic regression model was utilized to assess the independent association of cardiac amyloidosis with in-hospital, 30-day/90-day/180-day outcomes after adjusting for confounders. Our cohort included 54,900 LAAO implantation procedures, of which 220 (0.4%) had cardiac amyloidosis. Patients with cardiac amyloidosis had a lower proportion of women and a lower prevalence of comorbidities including anemia, obesity, diabetes, and peripheral vascular disorders but a higher prevalence of stroke, as compared to those without cardiac amyloidosis. On multivariable analysis, cardiac amyloidosis was associated with significantly higher odds of peri-procedural major adverse events (adjusted odds ratio [aOR]: 2.69; 95% confidence interval [CI]: 1.41-5.14; p<0.01) and neurological complications (aOR: 5.48; 95% CI: 2.47-12.8; p<0.01). There was no difference in the odds of other peri-procedural complications, in-hospital mortality, hospital resource utilization, and 30/90/180-day all-cause/bleeding/stroke-related readmissions between both groups. Patients with cardiac amyloidosis undergoing LAAO device implantation have an increased risk of peri-procedural complications without any difference in bleeding/stroke-related readmissions. These hypothesis-generating findings need validation in future prospective studies.

Role of Herbal Active Compound in Cardiac Failure Treatment

The prevalence of cardiovascular diseases (CVDs) is constantly rising, making them a major health burden. In terms of global mortality and morbidity, they are still at the top. An alternate method of treating many illnesses, including CVDs, is the use of medicinal herbs. There is a current, unprecedented push to include herbal remedies into contemporary healthcare systems. The widespread conviction in their safety and the fact that they offer more effective treatment at a lower cost than conventional modern medicines are two of the main factors propelling this movement. However, there has not been enough testing of the purported safety of herbal remedies. As a result, people need to know that medical herbs can be toxic, have possibly fatal side effects, and can interact negatively with other drugs. Experimental evidence suggests that medicinal herbs may be useful in the treatment of cardiovascular diseases (CVDs) due to their ability to inhibit multiple risk factors for these conditions. So, in order to successfully use herbs in CVD therapy, there have been numerous initiatives to transition medicinal herb research from the lab to the clinic. Presented below are cardiovascular diseases (CVDs) and the variables that put people at risk for developing them. Next, we provide a synopsis of herbal medicine's role in the treatment of disease, with a focus on cardiovascular diseases. In addition, information is compiled and examined about the ethnopharmacological therapeutic possibilities and medicinal qualities against cardiovascular diseases of four commonly used plants: ginseng, gingko biloba, ganoderma lucidum, and gymnostemma pentaphyllum. The use of these four plants in the treatment of cardiovascular diseases (CVDs) including myocardial infarction, hypertension, peripheral vascular disorders, coronary heart disease, cardiomyopathies, and dyslipidemias has been well examined. We are also making an effort to describe the current in vitro and in vivo investigations that have attempted to examine the cellular and molecular underpinnings of the four plants' cardio-protective effects. Lastly, we highlighted the effectiveness, safety, and toxicity of these four medicinal herbs by reviewing and reporting the results of current clinical trials.&#x0D; GRAPHICAL ABSTRACT&#x0D; &#x0D;

Analysis of the incidence and risk factors of blood transfusion in total knee revision: a retrospective nationwide inpatient sample database study

ObjectiveThis study sought to determine the incidence and risk factors of blood transfusion among patients undergoing total knee revision (TKR) using a nationwide database.MethodsA retrospective data analysis was conducted based on the Nationwide Inpatient Sample (NIS), enrolling patients who underwent TKR from 2010 to 2019 with complete information. The patients were divided into two groups based on whether they received blood transfusion or not. The demographic characteristics (race, sex, and age), length of stay (LOS), total charge of hospitalization, hospital characteristics (admission type, insurance type, bed size, teaching status, location, and region of hospital), hospital mortality, comorbidities, and perioperative complications were analyzed. Finally, we conducted univariate and multivariate logistic regression to identify factors that were associated with TKR patients to require blood transfusion.ResultsThe NIS database included 115,072 patients who underwent TKR. Among them, 14,899 patients received blood transfusion, and the incidence of blood transfusion was 13.0%. There was a dramatic decrease in the incidence over the years from 2010 to 2019, dropping from 20.4 to 6.5%. TKR patients requiring transfusions had experienced longer LOS, incurred higher total medical expenses, utilized Medicare more frequently, and had increased in-hospital mortality rates (all P < 0.001). Independent predictors for blood transfusion included advanced age, female gender, iron-deficiency anemia, rheumatoid disease, chronic blood loss anemia, congestive heart failure, coagulopathy, uncomplicated diabetes, lymphoma, fluid and electrolyte disorders, metastatic carcinoma, other neurological diseases, paralysis, peripheral vascular disorders, pulmonary circulation disorders, renal failure, valvular disease, and weight loss. In addition, risk factors for transfusion in TKR surgery included sepsis, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, gastrointestinal bleeding, heart failure, renal insufficiency, pneumonia, wound infection, lower limb nerve injury, hemorrhage/seroma/hematoma, wound rupture/non healing, urinary tract infection, acute renal failure, and postoperative delirium.ConclusionsOur findings highlight the importance of recognizing the risk factors of blood transfusion in TKR to reduce the occurrence of adverse events.

Cross-sectional analysis of cardiovascular disease and risk factors in patients with spondyloarthritis: a real-life evidence from biostar nationwide registry

The association between spondyloarthritis and cardiovascular (CV) diseases is complex with variable outcomes. This study aimed to assess the prevalence rates of CV diseases and to analyze the impact of CV risk factors on CV disease in patients with spondyloarthritis. A multi-center cross-sectional study using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) database was performed on patients with spondyloarthritis. Socio-demographic, laboratory, and clinical data were collected. Patients with and without major adverse cardiovascular events (MACE) were grouped as Group 1 and Group 2. The primary outcome was the overall group’s prevalence rates of CV disease and CV risk factors. The secondary outcome was the difference in socio-demographic and clinical characteristics between the groups and predictive risk factors for CV disease. There were 1457 patients with a mean age of 45.7 ± 10.9 years. The prevalence rate for CV disease was 3% (n = 44). The distribution of these diseases was coronary artery disease (n = 42), congestive heart failure (n = 4), peripheral vascular disorders (n = 6), and cerebrovascular events (n = 4). Patients in Group 1 were significantly male (p = 0.014) and older than those in Group 2 (p < 0.001). There were significantly more patients with hypertension, diabetes mellitus, chronic renal failure, dyslipidemia, and malignancy in Group 1 than in Group 2 (p < 0.05). Smoking (36.7%), obesity (24.4%), and hypertension (13.8%) were the most prevalent traditional CV risk factors. Hypertension (HR = 3.147, 95% CI 1.461–6.778, p = 0.003), dyslipidemia (HR = 3.476, 95% CI 1.631–7.406, p = 0.001), and cancer history (HR = 5.852, 95% CI 1.189–28.810, p = 0.030) were the independent predictors for CV disease. A multi-center cross-sectional study using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) database was performed on patients with spondyloarthritis. Socio-demographic, laboratory, and clinical data were collected. Patients with and without major adverse cardiovascular events (MACE) were grouped as Group 1 and Group 2. The primary outcome was the overall group’s prevalence rates of CV disease and CV risk factors. The secondary outcome was the difference in socio-demographic and clinical characteristics between the groups and predictive risk factors for CV disease. There were 1457 patients with a mean age of 45.7 ± 10.9 years. The prevalence rate for CV disease was 3% (n = 44). The distribution of these diseases was coronary artery disease (n = 42), congestive heart failure (n = 4), peripheral vascular disorders (n = 6), and cerebrovascular events (n = 4). Patients in Group 1 were significantly male (p = 0.014) and older than those in Group 2 (p < 0.001). There were significantly more patients with hypertension, diabetes mellitus, chronic renal failure, dyslipidemia, and malignancy in Group 1 than in Group 2 (p < 0.05). Smoking (36.7%), obesity (24.4%), and hypertension (13.8%) were the most prevalent traditional CV risk factors. Hypertension (HR = 3.147, 95% CI 1.461–6.778, p = 0.003), dyslipidemia (HR = 3.476, 95% CI 1.631–7.406, p = 0.001), and cancer history (HR = 5.852, 95% CI 1.189–28.810, p = 0.030) were the independent predictors for CV disease. The prevalence rate of CV disease was 3.0% in patients with spondyloarthritis. Hypertension, dyslipidemia, and cancer history were the independent CV risk factors for CV disease in patients with spondyloarthritis.

Thermal Imaging as a Method to Indirectly Assess Peripheral Vascular Integrity and Tissue Viability in Veterinary Medicine: Animal Models and Clinical Applications.

Infrared thermography (IRT) is a technique that indirectly assesses peripheral blood circulation and its resulting amount of radiated heat. Due to these properties, thermal imaging is currently applied in human medicine to noninvasively evaluate peripheral vascular disorders such as thrombosis, thromboembolisms, and other ischemic processes. Moreover, tissular damage (e.g., burn injuries) also causes microvasculature compromise. Therefore, thermography can be applied to determine the degree of damage according to the viability of tissues and blood vessels, and it can also be used as a technique to monitor skin transplant procedures such as grafting and free flaps. The present review aims to summarize and analyze the application of IRT in veterinary medicine as a method to indirectly assess peripheral vascular integrity and its relation to the amount of radiated heat and as a diagnostic technique for tissue viability, degree of damage, and wound care.

Prevalence of cardiovascular diseases and traditional cardiovascular risk factors in patients with rheumatoid arthritis: a real-life evidence from BioSTAR nationwide registry.

Patients with rheumatoid arthritis (RA) have increased morbidity and mortality due to cardiovascular (CV) comorbidities. The association of CV diseases (CVD) and traditional CV risk factors has been debated, depending on patient and RA characteristics. This study aimed to find the prevalence of CVD and CV risk factors in patients with RA. A multi-center cross-sectional study was performed on RA patients using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) in September 2022. Socio-demographic, clinical, and follow-up data were collected. Myocardial infarction, ischemic heart disease, peripheral vascular disorders, congestive heart failure, ischemic stroke, and transient ischemic attack were regarded as major adverse cardiovascular events (MACEs). CVD was defined as the presence of at least one clinical situation of MACE. Group 1 and Group 2 included patients with and without CVD. Prevalence rates of CVD and traditional CV risk factors were the primary outcomes. Secondary outcomes were the differences in the clinical characteristics between patients with and without CVD. An analysis of 724 patients with a mean age of 55.1 ± 12.8years diagnosed with RA was conducted. There was a female preponderance (79.6%). The prevalence rate of CVD was 4.6% (n = 33). The frequencies of the diseases in the MACE category were ischemic heart disease in 27, congestive heart failure in five, peripheral vascular disorders in three, and cerebrovascular events in three patients. The patients with CVD (Group 1) were significantly male, older, and had higher BMI (p = 0.027, p < 0.001, and p = 0.041). Obesity (33.4%) and hypertension (27.2%) were the two CV risk factors most frequently. Male sex (HR = 7.818, 95% CI 3.030-20.173, p < 0.001) and hypertension (HR = 4.570, 95% CI 1.567-13.328, p = 0.005) were the independent risk factors for CVD. The prevalence of CVD in RA patients was 4.6%. Some common risk factors for CVD in the general population, including male sex, older age, and hypertension, were evident in RA patients. Male sex and hypertension were the independent risk factors for developing CVD in patients with RA.

Outcomes of Septuagenarians and Octogenarians with Monoclonal Gammopathy of Undetermined Significance Admitted for Acute Pulmonary Embolism

Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is clinically defined with a serum monoclonal immunoglobulin of less than 3 g/dL and the presence of less than 10% of plasma cells in the bone marrow, in the absence of any end-organ damage that is typically seen in patients with multiple myeloma. The incidence of MGUS mostly involves the elderly, with a median age estimated at 70 years. While some studies have linked MGUS with a hypercoagulable state, there are no large studies investigating the impact and outcomes of MGUS in the elderly with pulmonary embolism(PE). We thus propose a national analysis to investigate. Methods: Our retrospective study via the National Inpatient Sample (NIS) focused on adults admitted with a primary diagnosis of Acute Pulmonary Embolism. We excluded all cases of ages &amp;lt;70 years and &amp;gt;90 years. Patient characteristics in acute PE cases with and without MGUS such as age, sex, race, and presence of various comorbidities such as diabetes, hypertension, obesity, among many, were explored via Chi-Square tests, t-tests, and Mann-Whitney U tests as appropriate. Differences in outcomes for PE in MGUS and non-MGUS patients were estimated via logistic regression models on SPSS 29.0. A p-value of &amp;lt;0.05 was considered as statistically significant. To comply with the database provider's (HCUP) guidelines, we did not report values &amp;lt;11. Results: Among the 327090 septuagenarians and octogenarians admitted primarily for acute PE in our study, there were 1095 (0.3%) patients with a diagnosis for MGUS that also reported a higher mean Charlson Comorbidity Index (CCI) score (4.26 vs. 2.90, p&amp;lt;0.01) (Table 1). While 51.1% of MGUS cases with acute PE were males, the non-MGUS group mainly consisted of females (56.1%, p&amp;lt;0.01). Medicare covered 91.3% and 90.8% of all MGUS and non-MGUS cases in our study, and 68.9% and 66.3% of all admissions involved Urban-teaching centers, respectively. Around 11.0% of MGUS cases also had a history of prior pulmonary embolism, while it was 8.0% in the non-MGUS cohort (p&amp;lt;0.01). The MGUS cohort also showed a lower prevalence of hypertension (41.1% vs.46.7%, p&amp;lt;0.01) while having a higher prevalence of peripheral vascular disease (11.4% vs. 5.1%, p&amp;lt;0.01), smoking status (40.6% vs. 37.8%, p=0.049), lipid disorders (56.6% vs. 50.6%, p&amp;lt;0.01), and chronic kidney disease (35.6% vs. 20.0%, p&amp;lt;0.01) than the non-MGUS group. MGUS patients showed lower odds of experiencing in-patient events such as myocardial infarction (aOR 0.345, 95% CI 0.221-0.538, p&amp;lt;0.01), acute kidney injury (aOR 0.843, 95% CI 0.719-0.990, p=0.037), and respiratory compromise (aOR 0.749, 95% CI 0.652-0.860, p&amp;lt;0.01). While a higher odds of cardiogenic shock (aOR 1.903, 95% CI 1.316-2.753, p&amp;lt;0.01) was also noted, patients with and without MGUS had no differences related to in-hospital mortality (aOR0.721, 95% CI 0.513-1.013, p=0.060) or the need for IVC filters (aOR 1.156, 95% CI 0.924-1.446, p=0.206). MGUS patients also experienced a longer stay (mean length of stay 4.91 vs. 4.62 days, p&amp;lt;0.01). Conclusion: This nationwide data analysis suggests a higher prevalence of a history of previous PE in MGUS cases admitted for PE than those without MGUS. Furthermore, while odds of events involving in-patient myocardial infarction, acute kidney injury, or respiratory compromise in MGUS patients were lower, they had a higher risk of cardiogenic shock. It is thus vital for physicians to be on the watch-out of such complications and provide adequate testing and care in a timely manner to improve their prognosis and outcomes.

Review of Topical Sodium Heparin 1000 IU/g Gel in Symptomatic Uncomplicated Superficial Thrombophlebitis.

Heparin, a mixture of sulfated polymorphic polysaccharides (glycosaminoglycan) chains of variable lengths and weights and a natural anticoagulant, is widely used in medical practice to prevent intravascular blood coagulation. Heparin has demonstrated antithrombotic and anti-inflammatory activity, and it is mostly administered systemically (intravenously or subcutaneously) for primary or secondary prevention of venous thromboembolism after surgical interventions, or immobilized patients, or on short-term antithrombotic therapy of patients with atrial fibrillation who must undergo treatment. However, since systemic administration of heparin could be, in certain cases, linked to an increased risk of bleeding, topical heparin is widely used for the prevention and treatment of local symptoms of peripheral vascular disorders, such as venous insufficiency, varicose veins, or superficial thrombophlebitis. This review summarizes the main safety and efficacy characteristics of the topical formulation of Heparin in Gel form (1000 International Units of Heparin/g Gel) currently in use, which has demonstrated an excellent efficacy and tolerability profile in reducing signs and symptoms of peripheral vascular disease, e.g., varicose syndromes and their complications, phlebothrombosis, thrombophlebitis, superficial periphlebitis, varicose ulcers, for post-operative varicophlebitis, sequelae of saphenectomy, for traumas and contusions, local edemas and infiltrates, subcutaneous hematoma and for traumatic affections of musculotendinous and capsuloligamentous apparatuses.

Readmission rates and outcomes in adults with and without COVID-19 following inpatient chemotherapy admission: A nationwide analysis.

The coronavirus disease 2019 (COVID-19) pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases. However, little focus has been given to its effect on cancer treatment. To determine the effect of COVID-19 pandemic on cancer patients' care. A retrospective review of a Nationwide Readmission Database (NRD) was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy (IPCT) during the COVID-19 pandemic in 2020. Two cohorts were defined based on readmission within 30 d and 90 d. Demographic information, readmission rates, hospital-specific variables, length of hospital stay (LOS), and treatment costs were analyzed. Comorbidities were assessed using the Elixhauser comorbidity index. Multivariate Cox regression analysis was performed to identify independent predictors of readmission. Statistical analysis was conducted using Stata® Version 16 software. As the NRD data is anonymous and cannot be used to identify patients, institutional review board approval was not required for this study. A total of 87755 hospitalizations for IPCT were identified during the pandemic. Among the 30-day index admission cohort, 55005 patients were included, with 32903 readmissions observed, resulting in a readmission rate of 59.8%. For the 90-day index admission cohort, 33142 patients were included, with 24503 readmissions observed, leading to a readmission rate of 73.93%. The most common causes of readmission included encounters with chemotherapy (66.7%), neutropenia (4.36%), and sepsis (3.3%). Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts. The total cost of readmission for both cohorts amounted to 1193000000.00 dollars. Major predictors of 30-day readmission included peripheral vascular disorders [Hazard ratio (HR) = 1.09, P < 0.05], paralysis (HR = 1.26, P < 0.001), and human immunodeficiency virus/acquired immuno-deficiency syndrome (HR = 1.14, P = 0.03). Predictors of 90-day readmission included lymphoma (HR = 1.14, P < 0.01), paralysis (HR = 1.21, P = 0.02), and peripheral vascular disorders (HR = 1.15, P < 0.01). The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT. These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.

Symptomatic Benign Prostatic Hyperplasia Is Not Associated With a Higher Risk of Periprosthetic Joint Infections and Periprosthetic Joint Infection-related Revisions After Primary THA.

Symptomatic benign prostatic hyperplasia (sBPH) is a potential risk factor for periprosthetic joint infection (PJI), a leading cause of implant failure and revision THA. However, the available evidence is mixed on whether this is the case. (1) What is the prevalence of sBPH in male recipients of primary THA by age group? (2) Do patients with sBPH compared with those without sBPH have higher 30-day, 90-day, and 2-year odds of PJI and higher 30-day and 90-day odds of urinary catheterization, urinary tract infection (UTI), and sepsis after primary THA? (3) Do patients with sBPH compared with those without sBPH have lower survivorship free from PJI-related revision at 5 years after THA? The PearlDiver database was used as it provided the largest sample of patients across all payer types to perform longitudinal research. Between January 2010 and April 2021, 1,056,119 patients who underwent primary THA were identified. After applying the inclusion criteria (that is, male sex, minimum age of 18, and diagnosis of hip osteoarthritis) and exclusion criteria (that is, history of asymptomatic BPH or any other joint arthroplasty), 16% (172,866) of patients remained. A further 6% (59,500) of patients were excluded as they did not meet the minimum study follow-up of 2 years, leaving 11% (113,366) for analysis. Of those, patients with sBPH were matched to those without in a 1:4 ratio by age and comorbidities, including alcohol abuse, anemia, cardiovascular disorders, chronic pulmonary disease, diabetes mellitus, depression, obesity, peripheral vascular disorders, renal failure, and rheumatoid arthritis. Age and comorbidities of the two groups postmatch were balanced. Logistic regression was performed to analyze the odds for 30-day, 90-day, and 2-year postoperative complications. Survivorship free from PJI-related revision at 5 years after THA was estimated using the Kaplan-Meier method and compared with the log-rank test. Among male recipients of primary THA ages 65 or older, 24% (11,319 of 47,426) had a medical history of sBPH. We found no difference in the odds of PJI at 30 days, 90 days, and 2 years after primary THA between the two groups. PJI occurred in 0.5% (62 of 11,819), 0.8% (97 of 11,819), and 1.3% (150 of 11,819) of patients with sBPH versus in 0.5% (227 of 47,103), 0.8% (360 of 47,103), and 1.2% (570 of 47,103) of those without sBPH within 30 days (OR 1.09 [95% CI 0.82 to 1.43]), 90 days (OR 1.07 [95% CI 0.85 to 1.34]), and 2 years (OR 1.05 [95% CI 0.87 to 1.25]) after THA, respectively. Patients with sBPH compared with those without had higher odds of 30-day and 90-day urinary catheterization (OR 5.00 [95% CI 3.64 to 6.88] and OR 5.36 [95% CI 4.04 to 7.13], respectively), 30-day and 90-day UTI (OR 2.18 [95% CI 1.88 to 2.54] and OR 2.55 [95% CI 2.26 to 2.87], respectively), and 30-day and 90-day sepsis (OR 1.55 [95% CI 1.11 to 2.13] and OR 1.43 [95% CI 1.10 to 1.83], respectively). We found no difference in survival free from PJI-related revision at 5 years after THA between patients with and without sBPH (98.3% [95% CI 98.1% to 98.6%] versus 98.1% [95% CI 98.1% to 98.2%]; p = 0.10). sBPH is common among THA recipients, and surgeons should be aware of the added risk of postoperative urinary complications and sepsis in this subset that could lead to additional postoperative care requirements. Surgeons may consider perioperative measures such as preoperative use of short-form questionnaires to assess urinary symptoms, urology clearance or referral, and closer follow-up to improve care of sBPH patients undergoing THA. As currently available tools for assessing sBPH are limited and lack sensitivity as well as specificity, future studies may develop validated tools that can be used to quickly assess risk in sBPH patients before surgery. Level III, therapeutic study.

Overview of Antibiotic Sensitivity Patterns in Diabetic Ulcers at Gatot Soebroto Army Hospital and Fatmawati General Hospital and The Review According to Islamic Perspective

Backgorund : One of the complications of DM is diabetic ulcers which occur due to reduced pain sensation due to neuropathy. Diabetic ulcers are a state of finding infection, destruction to the deepest skin tissue in the feet in patients with diabetes mellitus (DM) due to nerve abnormalities and peripheral arterial vascular disorders, so an overview of the pattern of antibiotics is very important in overcoming the severity of ulcers that can expand.Methodolgy : This research used secondary data from medical records on the antibiotic sensitivity of diabetic foot ulcer patients at the Gatot Subroto Army Hospital and Fatmawati General Hospital from January 2018 to December 2021.Results : There are ten types of antibiotics that sensitive to diabetic foot ulcer patients at Gatot Soebroto Army Hospital, including tigecycline, cefepime, piperacillin tazobactam, amikacin, aztreonam, ceftazidime, ciprofloxacin, gentamicin, meropenem, and ceftriaxone. While the types of antibiotics at Fatmawati General Hospital, include amikacin, piperacillin tazobactam, imipenem, meropenem, ertapenem, gentamicin, trimethophrim sulfamethoxazole, tigecycline, fosfomycin, and cefepime.Conclusion : Sensitive antibiotics in the two hospitals include tigecycline, cefepime, piperacillin tazobactam, amikacin, gentamicin and meropenem. In the view of Islam treatment is a form of effort to seek healing, after which surrender everything to Allah SWT.Keywords : Antibiotic, diabetic ulcer, Army hospital, Fatmawati

Risk Factors for Premature Coronary Heart Disease in Women Compared to Men: Systematic Review and Meta-Analysis.

Background and Aim: We aimed to systematically examine literature on the prevalence of known modifiable and nonmodifiable risk factors for premature coronary heart disease (PCHD) in women compared with men. Materials and Methods: PubMed, CINAHL, Embase, and Web of Science databases were searched. Review protocol is registered in PROSPERO (CRD42020173216). Quality was assessed using the National Heart, Lung, and Blood Institute tool. Review Manager 5.3 was used for meta-analysis. Effect sizes were expressed as odds ratio (OR) and mean differences/standardized mean differences (SMD) with 95% confidence intervals (CIs) for categorical and continuous variables. Results: In this PCHD cohort (age <65 years), the mean age of presentation in women was 3 years older than men. Women had higher total cholesterol (SMD 0.11; 95% CI 0.00 to 0.23) and higher high-density lipoprotein cholesterol (SMD 0.49; 95% CI 0.29 to 0.69). Women were more likely to have hypertension (OR 1.51, 95% CI 1.42 to 1.60), diabetes mellitus (OR 1.78, 95% CI 1.55 to 2.04), obesity (OR 1.33, 95% CI 1.24 to 1.42), metabolic syndrome (OR 3.73, 95% CI 1.60 to 8.69), stroke (OR 1.63, 95% CI 1.51 to 1.77), peripheral vascular disorder (OR 1.67, 95% CI 1.43 to 1.96), and depression (OR 2.29, 95% CI 1.96 to 2.67). Women were less likely to be smokers (OR 0.60, 95% CI 0.55 to 0.66), have reported alcohol intake (OR 0.36, 95% CI 0.33 to 0.40), and reported use of illicit drug (OR 0.32, 95% CI 0.16 to 0.62). Conclusions: Risk factor profile in PCHD has a clear sex difference that supports early, aggressive, holistic, but sex-specific, approach to prevention.

Previous Emergency Department Admission Is Associated With Increased 90-Day Readmission Following Cervical Spine Surgery: Evidenced Using Propensity Score Matching.

This was a retrospective case-control study. The objective of this study was to evaluate whether prior emergency department admission was associated with an increased risk for 90-day readmission following elective cervical spinal fusion. The incidence of cervical spine fusion reoperations has increased, necessitating the improvement of patient outcomes following surgery. Currently, there are no studies assessing the impact of emergency department visits before surgery on the risk of 90-day readmission following elective cervical spine surgery. This study aimed to fill this gap and identify a novel risk factor for readmission following elective cervical fusion. The 2016-2018 Nationwide Readmissions Database was queried for patients aged 18 years and older who underwent an elective cervical fusion. Prior emergency admissions were defined using the variable HCUP_ED in the Nationwide Readmissions Database database. Univariate analysis of patient demographic details, comorbidities, discharge disposition, and perioperative complication was evaluated using a χ 2 test followed by multivariate logistic regression. In all, 2766 patients fit the inclusion criteria, and 18.62% of patients were readmitted within 90 days. Intraoperative complications, gastrointestinal complications, valvular, uncomplicated hypertension, peripheral vascular disorders, chronic obstructive pulmonary disease, cancer, and experiencing less than 3 Charlson comorbidities were identified as independent predictors of 90-day readmission. Patients with greater than 3 Charlson comorbidities (OR=0.04, 95% CI 0.01-0.12, P <0.001) and neurological complications (OR=0.29, 95% CI 0.10-0.86, P =0.026) had decreased odds for 90-day readmission. Importantly, previous emergency department visits within the calendar year before surgery were a new independent predictor of 90-day readmission (OR=9.74, 95% CI 6.86-13.83, P <0.001). A positive association exists between emergency department admission history and 90-day readmission following elective cervical fusion. Screening cervical fusion patients for this history and optimizing outcomes in those patients may reduce 90-day readmission rates.

Dermal and Transdermal Macromolecule Delivery Using Enhancer Molecules and Colloidal Carrier Systems – Part 2: Percutaneous Administration of Heparin

Introduction: Heparin is a commonly used anti-coagulant administered either by intravenous or subcutaneous injection for a systemic effect or topically for the treatment of peripheral vascular disorders. Objective: This study aimed to formulate heparin in non-ionic colloidal carrier systems (CCSs) having enhanced percutaneous absorption for systemic and topical administration. Methods: Five CCSs were developed and characterized for their rheological properties, droplet size, and drug loading. The percutaneous absorption of heparin was evaluated in vitro using Franz diffusion cells with rats’ skin and with the aid of a developed high-pressure chromatography method. Furthermore, the efficacy of two developed heparin CCSs was tested percutaneously in rats by measuring the response against the time in comparison to subcutaneous administration. Results: The rheograms and droplet size measurements showed that the developed drug delivery systems have Newtonian properties with a droplet size between 109 and 460 nm. As much as 500 mg of heparin could be loaded in around 5 mL of CCS. Furthermore, using Franz diffusion cells, a diffusion rate of 19.216 ± 2.01 USP U/cm².h could be achieved for heparin-loaded CCSs. Moreover, the estimated percutaneous in vivo relative bioavailability in comparison to subcutaneous administration could reflect that at least more than 50% of the drug passed through the skin. Conclusion: The developed novel non-toxic CCSs containing heparin can be good candidates for percutaneous administration as alternative delivery systems for subcutaneous and intravenous invasive administration.

Economic Burden of Comorbidities in Patients with Psoriasis in the USA.

This study assessed the comorbidity burden, healthcare resource utilization (HCRU), and costs associated with patients with moderate to severe psoriasis (PsO) compared with a matched cohort of the general population without PsO in the USA. Comorbidity-related HCRU (incidence rate ratios [IRRs]) and direct medical cost burden (per patient per month [PPPM] 2020 USD) in patients with moderate to severe PsO in the USA, previously apremilast- and biologic-naive, but currently treated, versus the general population were assessed through a retrospective cohort study using IBM (now Merative) MarketScan Commercial and Medicare Claims data (1 January 2006 to 31 December 2019). Comorbidities included cardiovascular, mental health, pulmonary, diabetes, hyperlipidemia, hypertension, peripheral vascular, liver, obesity, and other autoimmune disorders. There are increased all-cause HCRU and costs in patients with PsO compared with the general population. These differences (PsO-general population) in HCRU and costs (IRR visits; PPPM) are associated with specific comorbidities, including mental health (1.08; $372), chronic pulmonary disease (1.07; $135), diabetes (1.10; $159), hyperlipidemia (1.13; $203), hypertension (1.13; $305), liver disease (1.21; $360), and obesity (1.12; $145, all P < 0.01). Patients with PsO experience a higher economic burden of comorbidities than the general population despite using currently available systemic treatments for PsO.

PREVALENCE AND PREDICTORS OF TYPE 2 MYOCARDIAL INFARCTION IN COPD-RELATED HOSPITALIZATIONS: A NATIONWIDE ANALYSIS

PREVALENCE AND PREDICTORS OF TYPE 2 MYOCARDIAL INFARCTION IN COPD-RELATED HOSPITALIZATIONS: A NATIONWIDE ANALYSIS

A Rare Case of Intermittent Calf Pain: Gastrocnemius Fatty Degeneration

Intermittent calf pain is also called claudication. It is common in patients with spinal canal stenosis or those with peripheral vascular occlusion disorders. It is rarely found in local muscle pathology. We herein report a case of a 50-year-old man who presented with left-sided calf pain on mild exertion. On evaluation, the systemic review was normal, with no spondylosis or vascular pathology, but with local fatty degeneration in the gastrocnemius, which was causing the calf pain. He was given analgesics and underwent physiotherapy and counseling, and his condition improved over 6 months.

Intravascular ultrasound guidance for lower extremity arterial and venous interventions.

This review details the utility of intravascular ultrasound (IVUS) for the management of peripheral artery and venous disease. The purpose of this document is to provide an update in the use of IVUS in peripheral arterial and venous pathology and demonstrate the use of IVUS as a practical diagnostic imaging procedure to evaluate and treat peripheral vascular disorders. IVUS, a diagnostic tool that relies on sound waves to produce precise images of the vessel being evaluated, was originally introduced to the medical community for the purposes of peripheral artery imaging, though it was quickly adapted for coronary interventions with positive outcomes. The utility of IVUS includes vessel measurement, pre- and post-procedural planning, treatment optimisation, and detection of thrombus, dissection or calcium severity. While angiography remains the standard imaging approach during peripheral intervention, multiple observational studies and small prospective trials have shown that in comparison, IVUS provides more accurate imaging detail, which may improve procedural outcomes. IVUS can also address limitations of angiography, including the need to administer contrast medium and eliminate the ambiguity associated with other forms of imaging. This review provides contemporary examples of where IVUS is being used during peripheral intervention as well as representative imaging to serve as a resource for the practising clinician.

Clustering of 31 health conditions among multimorbid people in Fife and Tayside, Scotland: E-cohort analysis.

BackgroundA deeper understanding of the clustering of multimorbidity (2+) (MM) conditions by age, sex, and deprivation could help prepare health systems for adequate and effective preventive intervention. We identified the commonest conditions and their clusters contributing to MM stratified age, sex, and deprivation.&#x0D; MethodsRetrospective cohort of 431,772 patients aged &gt;25 years, registered with a general practice in Fife/Tayside, Scotland and alive in January 2000 were followed till December 2019. We developed Multimorbidity e-Cohort for Fife/Tayside (MCFT), Scotland. MCFT combined anonymised Scottish demographic dataset, prescribing information systems records from 2009 and secondary care: hospital admission and day-case records, mental health inpatient and accident and emergency attendances from 2000 from the Scottish Safe Havens Health Informatics Centre. Elixhauser comorbidity classifications were used to identify the presence of 31 conditions. Besides descriptive statistics, dissimilarity algorithm in association rule mining techniques were used for the analysis.&#x0D; Results33.6% and 13.3% had MM and complex MM (4+) respectively, which varied across age, sex and deprivation of the patients. The commonest condition among &lt;50 years with MM are alcohol abuse (32%), chronic pulmonary disease and depression (24% each) compared with uncomplicated hypertension (57%), and cardiac arrhythmia (40%) among those aged 80+ years. We identified four unique clusters among multimorbid individuals (a) liver disease, alcohol, other neurological disorders and depression; (b) weight loss, Rheumatoid Arthritis/collagenm, hypothyroidism, deficiency anemia; (c) solid tumor and metastatic cancer; (4) peripheral vascular disorders, renal failure, fluid &amp; electrolyte disorders, chronic pulmonary disease, uncomplicated hypertension/diabetes, pulmonary circulation disorders, valvular disease, congestive heart failure and cardiac arrhythmias. The clusters varied across sex, age and deprivation.&#x0D; ConclusionClusters of disease conditions in the MM population varied mostly by age. Alcohol misuse contributed to MM among a third of under-50. Almost half of the oldest age group have hypertension and cardiac arrythmia. When considering clustering of conditions, it is important to consider age, sex and deprivation.

Evaluation of hand-arm vibration(HAV) exposure levels among grounds maintenance workers: An observational human exposure measurement study.

Evaluation of hand-arm vibration(HAV) exposure levels among grounds maintenance workers: An observational human exposure measurement study.