6501 research outputs found
Sort by
Chilling Complications: A Case of COVID-Associated Cold Autoimmune Hemolytic Anemia (AIHA)
Get PDFCold Agglutinin disease (CAD) also known as Cold Autoimmune Hemolytic Anemia (AIHA) is a form of autoimmune hemolytic anemia wherein cold agglutinins (IgM autoantibodies against red blood cell (RBC) antigens) bind during cold temperatures causing clinical symptoms related to RBC agglutination resulting to hemolytic anemia. Clinicians should recognize that Cold Agglutinin disease can be secondary to an underlying pathology such as COVID-19. Here we describe an unusual case of Cold Agglutinin Autoimmune Hemolytic Anemia which was diagnosed in the Emergency Department with the presence of COVID-19 and with a hospital course complicated by acute deep vein thrombosis (DVT) and bilateral pulmonary embolisms (PE’s)
Clinical Outcomes for Impella Procedure in Octogenarians, Nonagenarians, and Centenarians: A Retrospective Cohort Study
Get PDFThe Impella, a vital ventricular assist device, has seen extensive use in managing severe heart failure and cardiogenic shock. However, the impact of this procedure on older individuals remains poorly understood. To address this gap, we scrutinized the National Inpatient Sample Database from 2019 to 2020 to elucidate in-hospital outcomes among older patients who underwent the Impella procedure. Among the 8233 patients who underwent Impella insertion, 1389 (16.8%) were in the older population, aged 80 years or older. This subgroup exhibited a higher prevalence of comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease compared to younger patients. Alarmingly, in-hospital mortality was significantly elevated among the older population. Multivariate regression analysis underscored that older patients undergoing the Impella procedure faced substantially higher inpatient mortality rates. Additionally, advanced age correlated with increased mortality. Moreover, older patients incurred greater total hospital charges and endured longer hospital stays compared to their younger counterparts. Further analysis revealed that older Impella patients were at heightened risk of experiencing complications including ventricular arrhythmia, stroke, acute kidney failure, deep vein thrombosis, and sepsis. In conclusion, our nationally representative retrospective cohort study highlights the elevated mortality and poorer outcomes associated with the Impella procedure among older patients. These findings emphasize the need for tailored approaches and enhanced vigilance when managing older individuals undergoing this intervention to improve patient outcomes and optimize care
Clinical Outcomes for Patients with NAFLD and Acute Hepatitis: An Analysis of the National Inpatient Sample
Get PDFIntroduction: Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the United States and has been found to play a significant role in cardiovascular disease risk through several mechanisms including dyslipidemia, insulin resistance, coagulability, and inflammation. Acute-on-chronic liver disease continues to contribute to worse health outcomes via acute hepatitis.
Methods: This case-control study investigated the relationship between NAFLD and acute hepatitis using data extracted from the National Inpatient Sample (NIS) Database for the years 2019 and 2020. The NIS was searched for hospitalizations of adult patients with acute hepatitis with and without NAFLD. Using multivariate logistics to adjust for confounders, the primary outcome was inpatient mortality, and the secondary outcomes were hospital length of stay (LOS), and total hospital charges.
Results:This study included 208,145 patients with acute hepatitis, of which 12,406 patients had NAFLD. The study found a statistically significant higher inpatient mortality (OR:1.041, 95% CI:1.1.036-1.046, p
Conclusion: In this nationally representative population‐based case-control study, acute hepatitis with NAFLD was associated with higher inpatient mortality and worse outcomes compared to those with acute hepatitis alone
Community Healthcare Workers (CHW) High-Risk Stabilization Study: Does the Ability of CHWs at Mobile COVID Clinics to Link patients with Uncontrolled Diabetes to a Physician Improve Short Term Outcomes?
Get PDFUncontrolled diabetes may cause preventable but significant effects. One major preventative measure is early screening; there are hopes that community healthcare workers can increase awareness and screening availability, especially in underserved populations. We hosted and recorded logs of patients at mobile COVID health clinics, educating those with uncontrolled diabetes and connecting them to healthcare. We then looked to see if any patients had improvements in blood glucose to non-diabetic levels. 378 patients were logged, but only 138 were in events that had a significant amount of repeat visits. Twenty-five of them had blood sugar indicative of uncontrolled diabetes. Out of those, there were six patients with uncontrolled diabetes and multiple visits. Four of them had improvements in blood glucose on their most recent visit, with two maintaining persistently high levels of blood glucose. While these preliminary studies show promise in the potential efficacy of CHWs in improving screening and outcomes of uncontrolled diabetes, there is a very limited sample size. Future studies should incorporate more patient logs and explore other chronic conditions commonly undiagnosed in underserved populations such as chronic kidney disease and hypertension
Cost-Effectiveness and Outcomes of Utilizing Tisagenlecleucel Therapy (CAR T-cell) in Pediatric Acute Lymphoblastic Leukemia in Comparison to Standard of Care (SoC) Therapies: A Scoping Review
Get PDFAims
This review aims to assess the correlations between outcomes and cost of treatment methods for pediatric acute lymphoblastic leukemia patients, specifically comparing CAR T-cell therapy and Standard-of-Care (SoC) therapy. The socioeconomic background of patients will also be taken into consideration to see if there are differences in their outcomes.
Methods
Peer-reviewed publications were collected from PubMed and Web of Science. The keyword strings used were “acute lymphoblastic leukemia,” “pediatric acute lymphoblastic leukemia,” “pediatric,” “CAR T-cell therapy,” and “cost-effectiveness.” 27 citations were obtained. Titles were screened by 6 authors. Articles met the inclusion criteria including potential Quality-Adjusted Life Year (QALY) gains, mean price of CAR T-cell therapy and SoC therapy. The outcomes measured were presented in terms of total treatment cost for both CAR T-cell therapy and SoC treatments such as chemotherapy and/or hematopoietic stem-cell transplant.
Results
In the 6 comparative studies used, the overall cost and QALY of CAR T-cell therapy was higher than the SoC. In 4 of 6 studies, the price per QALY for CAR T-cell therapy was lower than the SoC treatment, ranging from 304,611 less per QALY. In the other 2 studies, the price per QALY for CAR T-cell therapy was higher by 18,874 per QALY.
Conclusions
Overall, CAR T-cell therapy was more expensive; however, it provided more QALY than other SoC’s. Future studies could determine if and how socioeconomic status, region, and race impact QALY for CAR T-cell, and how to mitigate barriers to access
Dense Colon Scarring After Infliximab for Acute Severe Ulcerative Colitis
Get PDFIntroduction: Infliximab is a monoclonal antibody against tumor necrosis factor alpha used in the treatment of ulcerative colitis. It has been shown to be efficacious in patients with moderate to severe ulcerative colitis and/or those who have failed intravenous steroids. We present a unique finding of profoundly dense colonic scarring after a year of infliximab therapy in a patient with acute severe ulcerative colitis.
Case: A female in her early 60s presented to the hospital with a three month history of rectal bleeding and intermittent fevers. A colonoscopy was done which demonstrated severe Mayo 3 left-sided colitis, consistent with a diagnosis of acute severe ulcerative colitis. After failing mesalamine and intravenous methylprednisolone, she was started on infliximab resulting in marked symptom improvement. She then had a repeat colonoscopy one year later which showed no active ulcerative colitis with a mayo score 0 but profound scarring correlating to the severe initial ulcerations from the previous year.
Discussion: During normal pathogenesis of ulcerative colitis, inflammation and ulceration causes the bowel walls to swell and thicken with scar tissue. After treatment with monoclonal antibodies, the mucosa should normally heal without evidence of scar tissue or fibrosis. Despite being at high risk for colectomy, this patient responded well to infliximab. However, further studies and follow ups are needed to determine if the scar tissue in this patient has long term effects. Research is ongoing on how to prevent fibrosis in inflammatory bowel disease
Doxazosin Immediate Release as Alternative Treatment for Nightmares in Post-Traumatic Stress Disorder: A Case Report
Get PDFNightmares and flashbacks are common debilitating symptoms of post-traumatic stress disorder (PTSD) that can disrupt daily functioning in patients. Prazosin, an alpha-1 adrenergic antagonist, has been commonly used off-label for the treatment of PTSD intrusion symptoms, although its short half-life is limiting. Doxazosin, another alpha-1 antagonist, is starting to be investigated in the treatment of PTSD-related nightmares due to its smaller side effect profile and longer half-life. In our case report, we present a case of a patient with PTSD-related nightmares who was successfully treated with doxazosin following relapse of symptoms after discontinuation of prazosin. The success of doxazosin immediate release for PTSD-related nightmares warrants further studies into its efficacy and use as an alternative treatment to prazosin
Evaluation of Unexplained Bone Fractures in a 3-Month-Old Infant – A Case Report
Get PDFChild physical abuse is a significant cause of injury in infants and young children and can present in a variety of ways. Failure to recognize abuse in infants and young children can be life-threatening and is often recurrent until safety interventions occur. Consequently, it is of paramount importance that providers strongly consider child physical abuse on the differential, along with metabolic bone disease and accidental traumatic injury, when evaluating fractures in young children and infants. This case report will focus on the evaluation of a 3-month-old male infant who was admitted to the hospital with irritability and decreased right arm movement. Multiple unexplained bone fractures were found on skeletal survey, which led to concerns for suspected child abuse and the infant underwent a comprehensive medical evaluation by child abuse pediatricians. Ultimately, it was ruled that the infant’s numerous injuries were most consistent with a medical diagnosis of child physical abuse
Exploring Geriatric Self Management of Type 2 DM: A Systematic Review
Get PDFThis review explores diabetic self-management in geriatric individuals, focusing on positive attitudes and support from family/friends as crucial for self-care optimization. A comprehensive search in health databases was conducted, which involved screening 248 participants across eight qualitative research studies. Themes emphasizing the importance of listening to one’s body, acknowledging hidden issues, and recognizing the impact of various factors on diabetes self-care were established. A holistic approach to self management, emphasizing the significance of positive attitudes, cultural sensitivity, and individual values in healthcare practices is recommended. Embracing cultural diversity and addressing barriers can enhance self-management and quality of life for geriatric individuals with diabete
Resection and Reconstruction of Ewing Sarcoma of the Cuboid Utilizing Vascularized Fibular Autograft: A Case Report
Get PDFEwing Sarcoma (EWS) rarely presents in the bones of the foot, and particularly in the cuboid, making it an exceedingly rare occurrence. We present the case of a 7-year-old female diagnosed with EWS of the right cuboid, detailing the management and outcomes of this rare presentation. The patient, now almost 5 years post-initial local control, exhibits restored foot function, a normalized gait, and no evidence of disease recurrence. This case underscores the potential for preserving lower extremity function and improving postoperative quality of life in rare presentations of EWS through innovative reconstruction strategies