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ANTERIOR LEFT VENTRICULAR WALL FREE WALL RUPTURE: A RARE COMPLICATION OF LATE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
No full textEfficacy and Safety of Lorundrostat in Uncontrolled Hypertension: A Pooled Analysis of Randomized Controlled Trials
No full textHypertension and Its Influence on Cardiovascular Health in HIV: Insights from a Real-World Study
No full textComparative Impact of Hypertension on Cardiovascular Outcomes in Non-Ischemic Versus Ischemic Cardiomyopathy: A Retrospective Cohort Study
No full textEffects of Age at Surgery and Laterality of Cataract on Visual Acuity 5 Years after Surgery in Infants Left Aphakic.
No full textPURPOSE: To evaluate 5-year visual acuity (VA) outcomes by age at surgery and laterality among infants left aphakic at initial lensectomy.
DESIGN: Prospective Pediatric Eye Disease Investigator Group cataract registry.
PARTICIPANTS: A total of 149 infants (203 eyes; 123 with bilateral surgery) underwent surgery before 12 months of age (median, 1.8; range, 0.6-11.6 months) for nontraumatic cataract without preexisting glaucoma or anterior/posterior segment anomalies who were left aphakic.
METHODS: Records were reviewed annually for 5 years after surgery. Children were grouped by age at first surgery (\u3c 2 months, 2 to \u3c 6 months, and 6 to \u3c 12 months). Analyses accounted for nonindependence of eye pairs.
MAIN OUTCOME MEASURES: Mean VA and proportion of eyes with VA better than 20/200.
RESULTS: Eighty-nine (60%) infants were female, 114 infants (77%) were White, 17 infants (11%) were Black, and 21 infants (14%) were Hispanic or Latino. In unilateral cases (N = 80), surgery before 2 months of age was associated with better mean VA at 5 years than with surgery between 2 and \u3c 6 months of age (0.79 vs 1.13 logarithm of the minimum angle of resolution [logMAR], difference = 0.34 [95% CI, 0.08-0.59], P = 0.01). In bilateral cases (N = 123), age at surgery was not associated with 5-year VA outcomes (P = 0.18). A larger proportion of bilaterally operated eyes had VA better than 20/200 compared with undergoing unilateral surgery before 2 months (87% vs 61%; difference = 26% [95% CI, 8%-43%]; P = 0.004) and 2 to \u3c 6 months of age (95% vs 23%; difference = 72% [95% CI, 55%-90%]; P \u3c 0.001).
CONCLUSIONS: For bilateral surgery in the first year of life, 5-year VA did not differ by age at surgery. However, for unilateral cataract, 5-year VA was better with surgery before 2 months of age compared with 2 to \u3c 6 months. These observations may inform surgical decision-making when treating a cataract in the first 2 months of life. Given the increased risk for glaucoma with early cataract surgery, the surgeon may choose a modest delay in the timing of surgery, accepting a decrease in the VA outcome for unilateral cases.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references
Hemodialysis Initiation During Pregnancy for Advanced CKD Due to ANCA-Associated Glomerulonephritis
No full textDescribing the Uniquely Vulnerable Patients Served by an Outpatient Non-Oncologic Palliative Clinic.
No full textCONTEXT: Outpatient nononcologic palliative care is a growing field with an evolving identity.
OBJECTIVES: The objective of this study was to assess patient demographics and clinical utilization of an outpatient nononcologic palliative care clinic.
METHODS: We collected and analyzed data from the first two years of an urban, nononcologic palliative care clinic within a quaternary academic center.
RESULTS: The diagnoses with highest clinic utilization were heart failure (46.2%) and end-stage lung disease (16.6%). The medical complexity of these patients was high, with geriatric patients comprising 55% of the clinic population and 95.3% of patients meeting criteria for polypharmacy. Insurance data demonstrated a socially vulnerable population served with 65.6% of patients on a Medicare product, 36.7% on a Medicaid product, and 4.7% uninsured. 21.3% of new clinic visits were for medical cannabis certification. Patients elected for telehealth visits more often than age matched patients in the general primary care setting and were less likely to no-show to telehealth visits. Primary diagnosis impacted frequency of follow up, with patients with end stage lung disease returning more regularly than patients with heart failure.
CONCLUSION: Nononcologic palliative care serves a uniquely medical vulnerable population and can be supported through utilization of clinical infrastructure that is already in place, establishing multidisciplinary collaborations, and utilizing telehealth
Understanding Primary Care Providers\u27 Attitudes and Practices for Hearing Loss Screening, Diagnosis, and Treatment.
No full textIdeal Body Weight Ratio for Donor-to-Recipient Size Matching in Heart Transplantation.
No full textBACKGROUND: While various models are useful for donor-recipient size matching, the optimal approach for predicting the correct match remains unclear. We sought to determine the association between ideal body weight (IBW) ratio and post-transplant survival.
METHODS: The United Network for Organ Sharing (UNOS) database was queried for all patients who underwent isolated heart transplantation between July 2000 and July 2023. Donor-recipient size matching was assessed using predicted heart mass (PHM), ideal predicted heart mass (IPHM), and IBW. Ratios were stratified as undersized (≤0.8), properly sized (\u3e0.8 to \u3c 1.2), and oversized (≥1.2). Stratified Kaplan-Meier analysis was conducted using the log-rank test. Restricted cubic splines (RCS) were constructed to evaluate the association with mortality.
RESULTS: A total of 46 721 donor-recipient matches were identified. PHM demonstrated higher survival for properly sized and oversized patients compared to undersized (p \u3c 0.01). For IPHM, survival was highest in the properly sized patients, lower in the oversized, and lowest in the undersized patients (p \u3c 0.01). For IBW, survival was superior in properly sized group compared to undersized and oversized patients (p \u3c 0.03). Non-linear analysis of PHM showed increased mortality risk with undersizing and decreased risk with oversizing (p \u3c 0.01). IPHM demonstrated higher mortality risk with undersizing but no notable risk with oversizing (p \u3c 0.01), whereas IBW showed increased risk with both undersizing and oversizing (p \u3c 0.01).
CONCLUSION: The IBW model appears to be non-inferior to PHM. IBW penalized equally for both undersizing and oversizing, making it potentially an additional useful metric in the evaluation of donor-recipient size matching