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Background Heart failure constitutes significant morbidity and mortality among the pediatric population. Few data exist on the prevalence and mortality rate of pediatric heart failure (pHF) in the United States. Objectives This study aimed to determine the in-hospital mortality and the principal diagnoses in pediatric patients with heart failure who died while being hospitalized in the United States. Methods This is a retrospective cross-sectional study using data from the 2019 Kid Inpatient Database (KID). The KID contained data on hospitalized children below 21 years of age. Using Stata 17 software (StataCorp LLC, College Station, Texas), the data were searched for heart failure diagnoses using International Classification of Diseases 10th revision Clinical Modification (ICD-10-CM) codes. By using the "rank" command in Stata, the most common principal diagnoses were placed in descending order of frequency, and these were further divided into different ICD-10 code categories. Results There were 16,206 pHF admissions in 2019. Of these admissions, 1,023 (6.31%) patients died. The top five principal ICD 10 code categories among all pHF deaths in descending order were circulatory system (17.95%), congenital/chromosomal abnormalities (17.43%), respiratory system (10.28%), infectious diseases (9.24%, and perinatal diseases (7.90%). Among all pHF deaths, sepsis of unspecified organisms (5.14%), hypoplastic left heart syndrome (HLHS) (3.19%), and acute respiratory failure with hypoxia (3.14%) were the most common primary diagnoses. Conclusion and significance Pediatric heart failure in-hospital overall mortality is 6.31%, and sepsis of unspecified organisms, HLHS, and acute respiratory failure are the most common principal diagnoses among these children. Preventive measures and prompt treatment of infections are paramount to reducing pHF mortality.

Background and objective Database research has shaped policies, identified trends, and informed healthcare guidelines for numerous disease conditions. However, despite their abundant uses and vast potential, administrative databases have several limitations. Adjusting outcomes for comorbidities is often needed during database analysis as a means of overcoming non-randomization. We sought to obtain a model for comorbidity adjustment based on Clinical Classifications Software Refined (CCSR) variables and compare this with current models. Our aim was to provide a simplified, adaptable, and accurate measure for comorbidities in the Agency for Healthcare Research and Quality (AHRQ) databases, in order to strengthen the validity of outcomes. Methods The Nationwide Inpatient Sample (NIS) database for 2018 was the data source. We obtained the mortality rate among all included hospitalizations in the dataset. A model based on CCSR categories was mapped from disease groups in Sundararajan's adaptation of the modified Deyo’s Charlson Comorbidity Index (CCI). We employed logistic regression analysis to obtain the final model using CCSR variables as binary variables. We tested the final model on the 10 most common reasons for hospitalizations. Results The model had a higher area under the curve (AUC) compared to the three modalities of the CCI studied in all the categories. Also, the model had a higher AUC compared to the Elixhauser model in 8/10 categories. However, the model did not have a higher AUC compared to a model made from stepwise backward regression analysis of the original 21-variable model. Conclusion We developed a 15-CCSR-variable model that showed good discrimination for inpatient mortality compared to prior models.

Left ventricular noncompaction (LVNC) is a relatively rare myocardial disorder which is characterized by trabeculations and deep intertrabecular recesses within the left ventricle. LVNC is often asymptomatic but may present with heart failure, arrhythmias, or systemic thromboembolism. Uncommonly, patients with LVNC can present with syncope. In this article, we report one such presentation of this rare medical condition.

Background While obesity has been clearly established as a risk factor for osteoarthritis (OA), there is a scarcity of studies comparing outcomes between obese and non-obese patients with hip OA who underwent hip arthroplasty. Methods This study involved adults with hip OA who had hip replacement procedures. Data was sourced from the Nationwide Inpatient Sample (NIS) database for 2016 and 2017. The primary outcome was inpatient mortality. Secondary outcomes included the development of non-ST segment elevation myocardial infarction (NSTEMI), sepsis, post-procedure site infection, pneumonia, acute kidney failure, deep vein thrombosis (DVT), pulmonary embolism, need for transfusion of blood products, complications involving orthopedic devices as well as mean length of hospitalization and mean total hospital charges. Results Obese patients did not have higher odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.65, 95% CI 0.303-1.381, p=0.260), had increased mean length of hospitalization (0.11, 95% CI 0.083-0.134, p

Introduction Hypertriglyceridemia (HTG)-induced pancreatitis is the third most common cause of acute pancreatitis after gallstone disease and alcohol. We analyzed data from the National (Nationwide) Inpatient Sample (NIS) with the aim of evaluating the outcomes of patients with HTG-induced pancreatitis when compared to those with biliary-induced pancreatitis. Methods The NIS database was sourced for data involving adult hospitalizations for HTG-induced pancreatitis in the United States between January 1, 2016 and December 31, 2017. The main outcome was mortality in patients with biliary pancreatitis vs HTG pancreatitis. Secondary outcomes were the incidence of sepsis, septic shock, non-ST-elevation myocardial infarction (NSTEMI), blood transfusion requirements, acute kidney failure, acute respiratory distress syndrome (ARDS), and length of hospital stay. Results A total of 575,230 patients were admitted with a diagnosis of acute pancreatitis, 18.2% of which were classified as having HTG pancreatitis. The in-hospital mortality for pancreatitis was 0.59%. Patients with HTG pancreatitis had lower odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.74, 95% CI 0.582-0.934, p=0.012) compared to those with biliary pancreatitis. Patients with HTG pancreatitis had less odds of developing comorbid sepsis (aOR: 0.52, 95% CI 0.441-0.612, p

Objectives This study aimed to compare the outcomes of patients primarily admitted for atrial fibrillation (AF) with and without a secondary diagnosis of rheumatoid arthritis (RA). The primary outcome of interest was inpatient mortality. Hospital length of stay (LOS), total hospital charges, and odds of undergoing ablation and pharmacologic cardioversion were the secondary outcomes of interest. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 databases. The NIS is the largest hospitalization database in the United States (US). The NIS was searched for hospitalizations for adult patients with AF as principal diagnosis with and without RA as secondary diagnosis using the International Classification of Diseases, 10th Revision (ICD-10) codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,630 AF hospitalizations, 17,020 (2.1%) had RA. Hospitalizations for AF with RA had 0.18 days' decrease in adjusted mean LOS (p=0.014), and lower total hospital charges ($38,432 vs $39,175, p=0.018) compared to those without RA. AF hospitalizations with RA had similar inpatient mortality [1.1% vs 0.91%, adjusted odds ratio (AOR): 0.90, 95% CI: 0.63-1.27, p=0.540] and odds of undergoing ablation (3.5% vs 4.2%, AOR: 1.1, 95% CI: 0.87-1.30, p=0.549) and pharmacologic cardioversion (0.38% vs 0.38%, AOR: 1.00, 95% CI: 0.53-1.89, p=0.988) compared to those without RA. Conclusions Patients admitted for AF with coexisting RA were found to have lesser adjusted mean LOS and lower total hospital charges compared to those without RA. However, inpatient mortality and the odds of undergoing ablation and pharmacologic cardioversion were similar between both groups.

Background Community-acquired pneumonia due to viral pathogens is an under-recognized cause of healthcare-associated mortality and morbidity worldwide. We aimed to compare mortality rates and outcome measures of disease severity in obese vs non-obese patients admitted with viral pneumonia. Methods Adult patients admitted with viral pneumonia were selected from the Nationwide Inpatient Sample of 2016 and 2017. The arms were stratified based on the presence of a secondary discharge diagnosis of obesity. The primary outcome was inpatient mortality. Secondary outcomes included sepsis, acute respiratory failure, acute respiratory distress syndrome, acute kidney injury, and pulmonary embolism. Results and interpretation In total, 89,650 patients admitted with viral pneumonia were analyzed, and 17% had obesity. There was no significant difference in mortality between obese and non-obese patients (aOR: 0.98, 95% CI: 0.705 - 1.362, p < 0.001). Compared to non-obese patients, obese patients had higher adjusted odds of developing acute hypoxic respiratory failure (aOR: 1.37, 95% CI: 1.255 - 1.513, p < 0.001), acute respiratory distress syndrome (aOR: 2.29, 95% CI: 1.554 - 3.381, p < 0.001), need for mechanical ventilation (aOR: 1.50, 95% CI: 1.236 - 1.819, p < 0.001), and pulmonary embolism (aOR: 1.69, 95% CI: 1.024 - 2.788, p = 0.040). Conclusions Obesity was not found to be an independent predictor of inpatient mortality in patients admitted with viral pneumonia. However, obesity is associated with worse clinical outcomes and disease severity as defined by the presence of complications, greater incidence of acute respiratory failure (ARF), acute respiratory distress syndrome (ARDS), need for mechanical ventilation, acute kidney injury (AKI), pulmonary embolism (PE), stroke, and sepsis.

Pancreatic pathology is one of the causes of abdominal ascites. The estimated prevalence of pancreatic ascites is 3.5% in patients with chronic pancreatitis and it is mostly caused by pancreatic duct dehiscence in the setting of chronic pancreatitis. Other etiologies include pancreatic pseudocysts, trauma, severe acute pancreatitis and rupture to the pancreas. Management of this condition includes conservative management like holding feeds, total parenteral nutrition, administering somatostatin analogues or sometimes invasive procedures like endoscopic retrograde cholangiopancreatography (ERCP) and surgery. ERCP is an unusual cause of pancreatic ascites and only one other case report has linked an association between ERCP and the development of pancreatic ascites. Our case report contributes to this literature and aims to shed light on this under-reported cause of pancreatic ascites.

Objectives: This study aims to compare the outcomes of patients admitted primarily for acute coronary syndrome (ACS) with and without a secondary diagnosis of rheumatoid arthritis (RA). Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalizations of adult patients with ACS as principal diagnoses, with and without RA as a secondary diagnosis. The primary outcome was inpatient mortality. Secondary outcomes were hospitalization characteristics and cardiovascular therapies. Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders. Results: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Out of 1.3 million patients with ACS, 22,615 (1.7%) had RA. RA group was older (70.4 vs 66.8 years, P

Introduction Systemic sclerosis (SSc) is known to increase the risk of ischemic stroke and other cerebrovascular events. It is, however, unclear if SSc negatively impacts the outcomes of ischemic stroke hospitalizations. This study aims to compare the outcomes of patients primarily admitted for ischemic stroke with and without a secondary diagnosis of SSc. Methods Data were extracted from the National Inpatient Sample (NIS) 2016 and 2017 database. NIS is the largest hospitalization database in the United States. We searched the database for hospitalizations of adult patients admitted with a principal diagnosis of ischemic stroke, with and without SSc as the secondary diagnosis using International Classification of Diseases, Tenth Revision (ICD-10) codes. The primary outcome was inpatient mortality, and secondary outcomes were hospital length of stay (LOS), total hospital charge, odds of undergoing mechanical thrombectomy, and receiving tissue plasminogen activator (TPA). Multivariate logistic and linear regression analysis was used to adjust for confounders. Results Over 71 million discharges were included in the NIS database for the years 2016 and 2017. Out of 525,570 hospitalizations for ischemic stroke, 410 (0.08%) had SSc. Hospitalizations for ischemic stroke with SSc had similar inpatient mortality (6.10% vs 5.53%, adjusted OR 0.66, 95% CI (0.20-2.17); p=0.492), length of stay (LOS) (5.9 vs 5.7 days; p=0.583), and total hospital charge ($74,958 vs $70,197; p=0.700) compared to those without SSc. Odds of receiving TPA (9.76% vs 9.29%, AOR 1.08, 95% CI (0.51-2.27), P=0.848) and undergoing mechanical thrombectomy (7.32% vs 5.06%, AOR 0.75, 95% CI (0.28-1.98), P=0.556) was similar between both groups. Conclusions Hospitalizations for ischemic stroke with SSc had similar inpatient mortality, LOS, total hospital charge, odds of receiving TPA, and mechanical thrombectomy compared to those without SSc.

Acute rheumatic fever (ARF) describes the non-suppurative and autoimmune inflammation of joint, muscle, and fibrous tissue that occurs after group A streptococcal (GAS) pharyngitis. This report describes a rare case of a 39-year-old male with migratory arthralgias as a presenting sign of ARF. Through this case, we review the current literature on ARF and highlight clinical and objective findings that differentiate ARF from similar presenting arthralgias, specifically post-streptococcal reactive arthritis (PSRA). With this report, we hope to increase clinical suspicion for ARF in patients with acute joint pain, as differentiating ARF from other arthritides, PSRA specifically, determines management strategy and need for secondary prophylaxis against rheumatic heart disease.

Background Knee arthroplasty is one of the most common reasons for hospitalizations in the United States. Diabetes mellitus is thought to be associated with adverse perioperative outcomes. We sought to demonstrate the effect of comorbid diabetes on hospitalizations involving patients with knee osteoarthritis who had knee arthroplasty. Materials and methods Data was obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. ICD-10 codes were used to obtain a cohort of patient who were principally admitted for knee osteoarthritis who underwent knee arthroplasty. The patients were further divided according to diabetic status. The primary outcome compared inpatient mortality. Secondary outcomes included mean length of hospital stay, total hospital charges, presence of secondary diagnoses on discharge of acute kidney injury, surgical site infection, sepsis, thromboembolic events, non-ST segment elevation myocardial infarction (NSTEMI). Results Patients with diabetes mellitus had a lower adjusted odds ratio for mortality (aOR: 0.45 95% CI: 0.221 - 0.920, p = 0.029), with no significant difference in total hospital charges and length of hospital stay. Interestingly, patients with diabetes had lower odds of NSTEMI; 0.53 (95% CI: 0.369 - 0.750, p < 0.001) sepsis; 0.64 (95% CI: 0.449 - 0.924, p = 0.017) and DVT; 0.67 (95% CI: 0.546 - 0.822, p < 0.001). Conclusion Uncomplicated diabetes mellitus is not associated with adverse outcomes in patients hospitalized with knee osteoarthritis who had knee arthroplasty.

Hypercalcemia is a common paraneoplastic syndrome that is associated with many malignancies. Hypercalcemia develops in malignancies through various mechanisms. Parathyroid hormone-related protein (PTHrP) is secreted by malignancy involving the lungs, breast, colorectum, bladder, and, rarely, neuroendocrine tumors. This is a rare case of severe hypercalcemia as the initial presentation of a high-grade metastatic neuroendocrine tumor of an unknown primary site.

Scombroid poisoning, also known as histamine fish poisoning, typically occurs after eating dark meat fish. Higher levels of histidine, which is converted to histamine, causes anaphylaxis-like symptoms upon ingestion. There are few reported cases of scombroid in humans secondary to light meat fish. We present a case secondary to tilapia consumption.

Acute compartment syndrome (ACS) is an emergency. The majority of cases are caused by underlying trauma, especially fractures. Idiopathic atraumatic ACS of the leg is very rare. The diagnosis and management of ACS should focus on the clinical presentation to avoid delay in fasciotomy for limb salvage. ACS of the leg can be caused by massive proximal iliofemoral thrombosis and rarely occlusive popliteal vein thrombosis with total or near total occlusion. Nonocclusive distal popliteal vein thrombosis, especially if chronic, does not cause ACS and when seen in a patient with ACS, it is likely an incidental finding rather than the cause of the compartment syndrome. This is a case of idiopathic ACS of the right leg occurring in the presence of an incidental right chronic nonocclusive distal popliteal vein thrombosis.