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Purpose: To evaluate the relative diagnostic yield of clinical germline genomic tests in a diverse pediatric cancer population., Patients and Methods: The KidsCanSeq study enrolled pediatric cancer patients across six sites in Texas. Germline analysis included both exome sequencing and a therapy-focused pediatric cancer gene panel. The results were categorized by participants demographics, the presence of pathogenic or likely pathogenic (P/LP) variants, and variants of uncertain significance (VUS) in cancer predisposition genes (CPGs). Pediatric actionable CPGs were defined as those with cancer surveillance recommendations during childhood., Results: Cancer P/LP variants were reported by at least one platform in 103 of 578 (17.8%) participants of which 76 were dominant cancer genes (13.1%) with no significant differences by self-described race or Hispanic ethnicity. However, the proportion of participants with VUS was greater in Asian and African American participants ( P = .0029). Diagnostic yield was 16.6% for exome versus 8.5% for panel ( P < .0001) with 42 participants with concordant germline results. Exome-only results included P/LP variants in 30 different CPGs in 54 participants, whereas panel-only results included seven participants with a copy number or structural P/LP variants in CPGs. There was no significant difference in diagnostic yield limited to pediatric actionable CPGs ( P = .6171)., Conclusion: Approximately 18% of a diverse pediatric cancer population had germline diagnostic findings with 50% of P/LP variants reported by only one platform because of CPGs not on the targeted panel and copy number variants (CNVs)/rearrangements not reported by exome. Although diagnostic yields were similar in this diverse population, increases in VUS results were observed in Asian and African American populations. Given the clinical significance of CNVs/rearrangements in this cohort, detection is critical to optimize germline analysis of pediatric cancer populations.

Objectives: Diagnosis-related groups (DRGs) is a patient classification system used to characterize the types of patients that the hospital manages and to compare the resources needed during hospitalization. The DRG classification is based on International Classification of Diseases diagnoses, procedures, demographics, discharge status, and complications or comorbidities and compares hospital resources and outcomes used to determine how much Medicare pays the hospital for each "product/medical condition." The All-Patient Refined DRG (APR-DRG) incorporated severity of illness (SOI) and risk of mortality (ROM) into the DRG system to adjust for patient complexity to compare resource utilization, complication rates, and lengths of stay., Methods: This study included 18,478 adult patients admitted to a tertiary care center in Lubbock, Texas during a 1-year period. We recorded the APR-DRG SOI and ROM and some clinical information on these patients, including age, sex, admission shock index, admission glucose and lactate levels, diagnoses based on International Classification of Diseases, Tenth Revision discharge coding, length of stay, and mortality. We compared the levels of SOI and ROM across this clinical information., Results: As the levels of SOI and ROM increase (which indicates increased disease severity and risk of mortality), age, glucose levels, lactate levels, shock index, length of stay, and mortality increased significantly ( P < 0.001). Multiple logistic regression analysis demonstrated that each unit increase in ROM and SOI level was significantly associated with an 11.45 and a 10.37 times increase in the odds of in-hospital mortality, respectively. The C-statistics for the corresponding models are 0.947 and 0.929, respectively. When both ROM and SOI were included in the model, the magnitudes of increase in odds of in-hospital mortality were 5.61 and 1.17 times for ROM and SOI, respectively. The C-statistic is 0.949., Conclusions: This study indicates that the APR-DRG SOI and ROM scores provide a classification system that is associated with mortality and correlates with other clinical variables, such as the shock index and lactate levels, which are available on admission.

Purpose: Genetic testing is an important diagnostic tool in pediatric genetics clinics, yet many patients face barriers to testing. We describe the outcomes of prior authorization requests (PARs) for genetic tests, one indicator of patient access to clinically recommended testing, in pediatric genetics clinics., Methods: We retrospectively reviewed PARs for genetic tests (n = 4,535) recommended for patients <18 years of age (n = 2,798) by pediatric medical geneticists at two children's hospitals in Texas, 2017-2018. We described PAR outcomes, accompanying diagnostic codes, and diagnostic yield., Results: The majority (79.9%) of PARs received a favorable outcome. PARs submitted to public payers were more likely to receive a favorable outcome compared with private payers (85.5% vs. 70.3%, respectively; p < 0.001). No diagnostic codes were associated with higher likelihood of PAR approval for exome sequencing. Among the 2,685 tests approved and completed, 522 (19.4%) resulted in a diagnosis., Conclusion: Though there was a high PAR approval rate, our findings suggest that insurance coverage remains one barrier to genetic testing. When completed, genetic testing had a high yield in our sample. Further evidence of clinical utility and development of clinical practice guidelines may inform payer medical policy development and improve access to testing in the future.

Background: Coronavirus-2 (COVID-19) has caused a worldwide pandemic since December 2019. Since then, clinical trials with vaccines have been started and completed, and at present, 3 COVID-19 vaccines have been approved for use in the United States. Healthcare providers were among the first to get vaccinated, but the precise attitudes of healthcare workers toward vaccination are uncertain., Objective: To understand residents and fellows' attitudes toward vaccination and record any side effects after vaccination., Methods: We conducted an anonymous survey that was open from 3-1-2021 to 3-12-2021 using distribution lists from the Graduate Medical Education office on the Lubbock campus of the Texas Tech University Health Sciences Center after getting approval from the Institutional Review Board (L21-088)., Results: Eighty-one residents and fellows (26.6% out of 304) responded to our survey. Among those who responded, 63 (77.8 %) were between 25 and 35 years old, and 41 (50.6%) were males. Seventy-seven (95.1%) received the vaccine (Pfizer-BioNTech), 78 (96.3%) reported that they supported vaccination, and 3 (3.7%) reported that they did not want vaccination. Eight members (9.8%) had tested positive for COVID-19 infection before vaccination, but only 1 (1.23%) had tested positive for COVID-19 antibodies. All residents and fellows reported side effects after the vaccination, including pain at the injection site (77; 100%), local redness (9; 11.6%), local swelling (13; 16.8%), fever (25; 32.5%), fatigue (25; 32.5%), chills (34; 44.1 %), headache (38; 49.4%)., Conclusions: Most medical trainees have a high interest in COVID-19 vaccination; however, a few reported that they did not want vaccination.

Objective: Hypertension can cause significant morbidity and reduced life expectancy. Most patients with hypertension have primary hypertension; however, 10% to 15% have secondary hypertension. Endocrine disorders as a secondary cause occur in approximately 10% of patients with secondary hypertension, and thyroid disorders account for approximately 1% of all patients with hypertension. The identification of patients with hyperthyroidism has important benefits for these particular patients. The objective of this study was to examine the occurrence of high blood pressure in patients with hyperthyroidism., Methods: We reviewed the clinical information available from 414 new patients referred to an endocrinology clinic in west Texas for evaluation of hyperthyroidism. The final cohort included 96 patients who had both thyroid laboratory tests and blood pressure measurements at the time of their clinic visit. We also examined this relationship in a nationally representative sample of US adults (National Health and Nutrition Examination Survey 2007-2012), which included thyroid test results and at least one blood pressure measurement (N = 8837)., Results: Sixty-five of these clinic patients had elevated blood pressure based on criteria suggested by the American College of Cardiology/American Heart Association. These patients had similar thyroid hormone levels as patients who did not have hypertension but tended to be older. Ordinary least squares regression analysis of the National Health and Nutrition Examination Survey 2007-2012 data demonstrated a significant positive association between free T3 levels and systolic blood pressure, adjusting for age, sex, and the use of levothyroxine., Conclusions: These findings from a specialty clinic and a national sample suggest that clinicians should consider the possibility of hyperthyroidism in patients with hypertension, even in older patients.

Objectives: Personal health behavior can influence the academic development of healthcare students. This study was designed to evaluate the personal health behavior, including sleep time, of healthcare students at a large health sciences center., Methods: An anonymous online survey based on standardized questionnaires about sleep, insomnia, depression, alcohol use, and exercise was sent to all of the healthcare students (including medical, nursing, pharmacy, graduate biomedical science, and allied health students) in the Texas Tech University Health Sciences Center graduate education programs in Lubbock., Results: In total, 412 students replied to this survey. Their mean sleep duration during the weekday was 7.5 ± 1.2 hours; 16.5% were short sleepers (<7 hours) during weekdays; 33% of the students woke up "feeling tired or worn out" >15 days during the last month. Many students were either moderately or severely bothered by "the lack of energy" because of poor sleep, and 56.6% of students rated their sleep as either fair or poor. Approximately 35% of students had drinking patterns that qualified as hazardous drinking, 6.3% of students smoked, and 23% of students did not do even mild exercise during the week. Eighty-nine percent of students reported stress in their life, including family stress, job stress, financial stress, legal stress, and other stress. Thirty-five percent of students considered their health as either poor or fair. Approximately 50% of students did not expect any change in their situation during the next 3 to 6 months., Conclusions: Although most healthcare students report adequate sleep times, more than half of them rate their sleep as fair or poor. In addition, some have poor health habits, including excessive alcohol use. Health science centers should introduce programs to promote healthy behaviors and reduce stress in healthcare students.

The severity of COVID-19 ranges from asymptomatic subclinical infections to severe acute respiratory failure requiring mechanical ventilation. Patients admitted to the hospital have increased mortality rates and patients requiring intensive care have significantly increased mortality rates. Multiple factors influence these outcomes. This study used simple demographic information available on admission to evaluate possible associations between these variables and outcomes, including mortality and length of stay. Clinical outcomes in 63 patients admitted to a tertiary care hospital in West Texas were reviewed. Older patients, patients admitted from nursing homes, and patients admitted to medical intensive care units had increased mortality. Unadjusted analysis indicated that males had increased mortality. Adjusted analysis indicated that males spent nearly 5 days longer in the hospital than females. In summary, age, chronic illness requiring nursing home placement, and acute severe illness requiring intensive care unit admission identify patients with worse prognoses. In addition, males will likely have a longer length of hospital stay.

Background: Patients with hyperglycemia during hospitalization, especially during ICU hospitalizations, often have worse outcomes, even if they do not have a premorbid diagnosis of diabetes. High glucose levels can provide insight into the underlying pathogenesis of a disease and can contribute to tissue injury. Some patients with COVID-19 have hyperglycemia during hospitalizations., Methods: The Infectious Disease and Control office at University Medical Center in Lubbock, Texas, provided a list of patients with a COVID-19 infection hospitalized between March 1 and May 15, 2020. The medical records were reviewed to collect information on age, gender, history of diabetes, and glucose levels on admission and through the first 7 days of hospitalization., Results: This study included 63 patients with a mean age of 62.1 ± 14.1 years. Thirty-five patients (55.6%) were males. The in-hospital mortality rate was 30.2%. The mean admission glucose level was 129.4 ± 57.1 mg/dL in patients who survived (N = 47) and 189.6 ± 112.2 mg/dL in patients who died during hospitalization (N = 16, P  = .007). An admission glucose greater than 180 mg/dL predicted mortality in a model adjusted for a diabetes, age, and male gender. The mean differences between the maximum and minimum glucose levels calculated over the first 7 days of hospitalization were 112.93 ± 115.4 (N = 47) in patients who survived and were 240.5 ± 97.7 (N = 15) in patients who died during hospitalization ( P  = .0003). A difference between the maximum and minimum glucose level greater than 105 mg/dL was associated with increased mortality., Conclusions: Patients who died during hospitalization for COVID-19 had higher admission glucose levels than patients who survived. Larger differences between maximum and minimum glucose levels during the first 7 days of hospitalization were associated with increased mortality. These results suggest that high glucose levels identify patients at increased risk for mortality and warrant more study.

Background: The ongoing coronavirus disease (COVID-19) pandemic has a major impact on first responders. Scarce personal protective equipment (PPE) has forced them to conserve and reuse some of their PPE. The efficacy of these practices in preventing transmission of COVID-19 from patients to first responders is unclear. There are limited data on the prevalence of antibodies specific for COVID-19 exposure in these front-line workers., Aim: Our objective was to determine the prevalence of positive immunoglobulin G antibody specific to COVID-19 among first responders in Lubbock, Texas., Methods: Blood samples were collected on 683 asymptomatic first responders who work in Lubbock, Texas and the surrounding area, after informed consents were signed. IgG antibody to SARS-CoV-2 was measured using Abbott's SARS-CoV-2 IgG Reagent Kit in combination with the SARS-CoV-2 IgG Calibrator Kit on the Abbott's ARCHITECT i 1000SR analyzer., Results: The prevalence of IgG specific antibodies to COVID-19 was 0.73%, five of the 683 participants tested positive. Four of those who tested positive had no known prior SARS-CoV-2 infection or exposure without adequate PPE., Conclusions: The prevalence of IgG specific antibodies to COVID-19 was much lower than expected in our study population despite high sensitivity and specificity of the test reagent. The most likely explanations for this finding include limited exposure, inadequate time for a IgG response, possible clearance of COVID-19 infection locally by the respiratory tract IgA defense system without eliciting a systemic IgG response, and short persistence of IgG antibodies in mild or asymptomatic cases.

Background: COVID-19 is a highly infectious disease which usually presents with respiratory symptoms. This virus is disseminated through respiratory droplets, and, therefore, individuals residing in close quarters are at a higher risk for the acquisition of infection. The prison population is at a significantly increased risk for infection., Methods: Prisoners from the Montford Correctional facility in Lubbock, Texas, hospitalized in the medical intensive care unit at University Medical Center between March 1, 2020 and May 15, 2020 were compared to community-based patients hospitalized in the same medical intensive care unit. Clinical information, laboratory results, radiographic results, management requirements, and outcomes were compared., Results: A total of 15 community-based patients with a mean age of 67.4 ± 15.5 years were compared to 5 prisoners with a mean age of 56.0 ± 9.0 years. All prisoners were men; 10 community-based patients were men. Prisoners presented with fever, dyspnea, and GI symptoms. The mean number of comorbidities in prisoners was 2.4 compared to 1.8 in community-based patients. Prisoners had significantly lower heart rates and respiratory rates at presentation than community-based patients. The mean length of stay in prisoners was 12.6 ± 8.9 days; the mean length of stay in community-based patients was 8.6 ± 6.5. The case fatality rate was 60% in both groups., Conclusions: Prisoners were younger than community-based patients but required longer lengths of stay and had the same mortality rate. This study provides a basis for comparisons with future studies which could involve new treatment options currently under study.

Objectives: To determine the prevalence of frailty in patients with chronic lung diseases., Methods: We studied 120 patients with chronic lung disease using Fried's criteria (gait speed, weight loss, exhaustion, grip strength, and physical activity)., Results: The study population (56% women) had a mean age of 64 ± 13 years, mean body mass index of 31± 9 kg/m(2), and a mean FEV(1) (forced expiratory volume in 1 second) of 60% ± 25% of predicted. The average gait speed was 52.1 ± 14.3 m/min; 18% were frail, 64% prefrail, and 18% robust. Gait speed correlated with frailty status and decreased as frailty worsened (57 m/min in robust subjects and 41 m/min in frail subjects). Slow gait speeds (<60 m/min) had a 95% sensitivity and 34% specificity to predict frailty., Conclusions: Patients with chronic lung disease frequently meet Fried's criteria for frailty. Gait speed can be used to screen these patients to determine if a more detailed evaluation is needed., (© The Author(s) 2015.)

Background: The Centers for Disease Control and Prevention (CDC) has developed new criteria based on a significant deterioration in oxygenation to identify ventilator-associated events (conditions). The aim of this study was to determine how frequently this happened and what caused these conditions., Methods: Electronic medical records and x-rays from 281 ventilator episodes in the medical intensive care unit were reviewed to determine the characteristics of patients requiring ventilation and the number of patients meeting the criteria for ventilator-associated conditions (VACs)., Results: This cohort included 257 patients (55.4% men) who required 281 episodes of mechanical ventilation. The mean Acute Physiology and Chronic Healthy Evaluation II score was 13.5 ± 5.9. The initial mean PaO2/FiO2 was 210 ± 110. The median number of ventilator days was 4 (interquartile range: 3-9). The overall mortality was 32.3%. Nineteen patients (11.7% of eligible episodes) met the CDC criteria for a VAC; 6 met FiO2 criteria (31.6%) and 13 met positive end expiratory pressure criteria (68.4%). Twelve patients (63.2%) had an increased white blood cell count (>12k/μL) during the event. Eleven patients had an increase in temperature (>38°C) during this period. The etiology of these conditions included pneumonia (n = 4), atelectasis (n = 4), congestive heart failure (n = 5), acute respiratory distress syndrome (n = 2), and miscellaneous reasons (n = 4)., Conclusions: VACs occurred in 11.7% of patients in our medical intensive care unit. The etiology of these events was diverse and did not usually reflect complications. These new CDC criteria for institutional reporting of complications during mechanical ventilation do not necessarily identify complications or provide a good method for comparing outcomes in hospitals.

Septic arthritis is an important concern for rheumatologists in the evaluation of joint disease. Very few studies have addressed the microbiologic epidemiology and outcomes of septic arthritis in the USA since the year 2000. We performed a retrospective study of septic arthritis in a tertiary hospital in West Texas from the year 2000 to 2013. We recorded data on patient demographics, microbiologic etiology, treatment patterns, and outcomes. The most common causative organisms were Staphylococcus aureus and Streptococcus spp. Methicillin-resistant Staphylococcus aureus (MRSA) caused septic arthritis in 22.6 % of the cases. MRSA septic arthritis was associated with low rates of adequate empiric antimicrobial therapy. The mortality due to sepsis in our study was 5.5 %. Patients with septic arthritis had a mean length of stay of 13.5 ± 12.1 days and required 2.1 ± 1.4 joint operations. Many patients (29.2 %) had readmissions due to complications, and these patients had high rates of home health utilization and transfers to other facilities post hospital discharge. In our logistic regression analysis model, factors associated with poor outcomes in septic arthritis were MRSA, older age, and prosthetic joint infection. Septic arthritis is associated with significant mortality, morbidity, and health care costs, and more studies are needed to improve outcomes, especially considering the increasing rates of MRSA as the pathogen.

The highest prevalence of tuberculosis (TB) occurs in foreign born immigrants in the United States. Contact investigations at work sites with mostly immigrant workers present multiple practical problems. Recently 402 contacts were investigated at a meat packing plant in rural Texas by the Texas Department of State Health Services (DSHS). Our objective was to study the approach and effectiveness of this intensive investigation. We reviewed information, including symptoms, BCG status, TB history, X-rays, and treatment, on the sentinel case and 47 contacts managed by the Texas DSHS TB Division in Lubbock, TX. We used a gamma interferon release assay (T-SPOT.TB) to identify contacts with TB infection. The sentinel case was foreign born and had cavitary TB with acid-fast positive smears. Forty-two work site contacts were foreign born, and five were US born. The foreign born contacts were from Sudan, Somalia, Mexico, Burma, and Haiti; 18 contacts had a history of BCG vaccination. T-SPOT.TB tests were positive in 20 contacts, borderline in four, and negative in 23. Contacts with borderline results had negative repeat tests. Twenty-three contacts with negative T-SPOT.TB tests were scheduled for repeat tests in 4 weeks, but only four returned for this testing. Chest X-rays were abnormal in two contacts who were started on treatment. Sputum was collected in three individuals; one was culture positive for pan-sensitive Mycobacterium tuberculosis. Twelve contacts were treated for latent TB. Our investigation established an infection rate of 42.5% in this work site contact cohort, which is similar to the 39% prevalence reported by the Center for Disease Control. The use of T-SPOT.TB assays simplified testing in immigrants with high rates of BCG vaccination. Our investigation was complicated by language barriers, varying and uncertain levels of exposure, and a high rate of drop outs in the negative T-SPOT.TB contacts. This concerted effort provides a model for investigating work site contacts, especially with numerous immigrants, and illustrates the problems associated with these investigations.

Background: Obstructive sleep apnea (OSA) may have an association with bradyarrhythmias but often remains undiagnosed. Our aim was to determine if patients with a high risk of OSA attending our cardiology clinics had an association with symptomatic bradyarrhythmias, as this information might lead to changes in management strategy., Methods: The Berlin questionnaire was used to assess risk of OSA in 190 patients, and they were divided into high-risk or low-risk groups. Demographic data and medical histories were recorded and patients groups were compared with t-tests and chi-square tests. A multivariate regression analysis was done to correct for confounding variables., Results: The mean age of our sample population was 63.0 ± 14.7 years with a mean BMI of 29.5 ± 7.8 kg/m2. Using the Berlin questionnaire, 41.3% of the patients were classified as high risk; 15.7% of the patients had a known diagnosis of OSA. Between high-risk and low-risk groups, there was no significant difference in the prevalence of bradyarrhythmias (22.5 vs. 15.2% P = 0.21), symptomatic sinus node dysfunction (14.4 vs. 11.4% P = 0.66) or atrioventricular block (10.8 vs. 6.3% P = 0.33). A multivariable logistic regression analysis demonstrated that dyslipidemia had the strongest association with a high risk for OSA, but not bradyarrhythmias., Conclusions: Based on the Berlin questionnaire, patients at a high risk for OSA did not have an increased prevalence of bradyarrhythmias. More studies are needed to assess the utility of evaluating patients with bradyarrhythmias for OSA prior to implanting permanent pacing devices.

Background: Morbidity associated with stress ulcer-related bleeding, the cost of medications, and the possible complications associated with stress ulcer prophylaxis are important considerations when prescribing prophylaxis. We prospectively studied the prescription patterns for stress ulcer prophylaxis in patients admitted to our ICU., Methods: We prospectively recorded the indications for stress ulcer prophylaxis and prescription patterns for use based on the American Society of Healthcare Pharmacists criteria and other indications for 99 new intensive care unit (ICU) admissions to a tertiary referral center., Results: In all 51 patients had no indication for stress ulcer prophylaxis, 32 had 1 indication, 14 had 2 indications, and 2 patients had 3 indications for receiving stress ulcer prophylaxis in the ICU. Eighty-two percent of patients without any indications received stress ulcer prophylaxis; 81% of patients with 1 indication, 79% of patients with 2 indication, and 50% of patients with 3 indications received stress ulcer prophylaxis. Overall, 53% of patients either received stress ulcer prophylaxis when none was indicated or did not receive stress ulcer prophylaxis when it was indicated. We also review the recent literature on stress-related mucosal disease and the use of prophylaxis for stress-related mucosal disease., Conclusions: Stress ulcer prophylaxis administration in this ICU is inconsistent and includes both underutilization and overutilization. Educating physicians and implementing hospital protocols could improve use patterns.

Background: Screening for and treatment of latent tuberculosis infection (LTBI) have been essential components of the TB elimination strategy., Methods: To estimate the rate of and to identify risk factors for reactivation TB in patients in Texas with LTBI, we retrospectively analyzed 51,959 patients with LTBI identified in Texas Department of State Health Services TB clinics from 1995 to 2008., Results: We identified 200 cases of reactivation TB among the 51,959 patients in this database. The overall rate of reactivation TB was 0.038 cases per 100 person-years (95% confidence interval [CI]: 0.032-0.043). The reactivation rate in patients who did not receive a complete treatment was 0.058. The relative risk (RR) for reactivation was higher in men (RR = 1.15; 95% CI: 0.86-1.54), patients older than 50 years (RR = 1.13; 95% CI: 1.04-1.22), African American (RR = 1.21; 95% CI: 1.09-1.34), U.S.-born referrals (RR = 1.4; 95% CI: 1.11-1.76), referrals with abnormal X-rays (RR = 1.07; 95% CI: 1.03-1.12) and patients receiving treatment other than isoniazid (RR = 1.08; 95% CI: 1.03-1.13)., Conclusions: The current rate of reactivation TB in Texas is much lower than rates reported in the United States in the 1950s. Certain patients are at increased risk for reactivation and should be monitored more closely during LTBI therapy.

The Centers for Medicare and Medicaid Services has identified early rehospitalization of patients with chronic obstructive pulmonary disease (COPD) exacerbations as a performance measure for hospital care. We retrospectively reviewed patients with COPD who were admitted to University Medical Center, Lubbock, Texas, USA, between October 2010 and March 2011. There were 81 COPD patients with 103 hospitalizations. The mean age was 73.9 years. Pulmonary function tests using the Global initiative for chronic Obstructive Lung Disease criteria had been done in 36 patients (44.4%) and revealed 1 mild (2.8%), 7 moderate (19.4%), 20 severe (55.6%), and 8 very severe (22.2%) cases. Only 38.4% of the patients had prior influenza vaccine. Most patients were treated with antibiotics (81.8%) and corticosteroids (87.9%). The mean length of stay was 4.9 days, and 4 patients died. Most of the patients were discharged home (63.6%) with a median follow-up interval of 14 days. Thirty-two percent did not have long-acting bronchodilators and/or inhaled corticosteroids prescribed on discharge. There were 14 early rehospitalizations within 30 days. Logistic regression analysis indicated that a history of coronary artery disease (odds ratio (OR) 6.4, 95% confidence interval (CI) 1.1-37.4) and unilateral pulmonary infiltrates (OR 12.8, 95% CI 1.9-86.4) significantly increased the early rehospitalization rates. Acute exacerbations of COPD in patients with a history of ischemic heart disease or unilateral pulmonary infiltrates are at increased risk for early readmission. These risk factors should be identified during hospitalization; early follow-up or other interventions may reduce readmissions. Influenza vaccine, maintenance bronchodilators and/or inhaled corticosteroids, and pulmonary function tests were underused, and these standards of care should be provided to improve care.

Matrix metalloproteinases degrade the collagen content of atherosclerotic plaque and reduce plaque stability. In tissue sections of atherosclerotic plaque, the expression of matrix metalloproteinases is increased. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) decrease the tissue expression of matrix metalloproteinases-1, -2, -3, and -9 in atheromatous plaque by attenuating the inflammatory process that leads to increased expression. However, it is not known whether statins decrease levels of matrix metalloproteinase-13--an enzyme crucial to the initiation of collagen degradation-as part of their plaque-stabilizing effect.We prospectively examined the effect of statin therapy on serum levels of matrix metalloproteinase-13, tissue inhibitor of metalloproteinase-1, and low-density-lipoprotein cholesterol in 14 patients with hypercholesterolemia. All were at low risk for adverse cardiovascular events and were given 20 mg/d of rosuvastatin for 4 weeks. Post-therapy levels of matrix metalloproteinase-13 and tissue inhibitor of metalloproteinase-1 were compared with baseline levels. Although low-density-lipoprotein cholesterol levels were significantly decreased in the 14 patients (mean baseline level, 152 ± 21 mg/dL vs mean post-therapy level, 73 ± 45 mg/dL; P < 0.001), matrix metalloproteinase-13 and tissue inhibitor of metalloproteinase-1 levels were unchanged (matrix metalloproteinase-13, 0.295 ± 0.06 ng/mL vs 0.323 ± 0.11 ng/mL, P = 0.12; and tissue inhibitor of metalloproteinase-1, 400.8 ± 43.4 ng/mL vs 395.3 ± 47.5 ng/mL, P = 0.26). We conclude that even though there was a decrease in low-density-lipoprotein cholesterol, short-term, high-dose rosuvastatin therapy has no effect on matrix metalloproteinase-13 and tissue inhibitor of metalloproteinase-1 levels in hypercholesterolemic patients. However, further investigation is warranted.

Transradial access for coronary interventions provides increased patient comfort, fewer access site complications, and reduced hospital stay and costs. However, the potential benefits favoring transradial access may be even more than these apparent advantages. Major bleeding after coronary interventions is an important factor contributing to mortality rates and can be dramatically reduced with the selection of the radial artery as the access site. Recent evidence suggests that the decrease in bleeding complications with transradial access may translate into a short- and long-term decrease in mortality in patients undergoing elective or urgent coronary interventions. In the era of complex coronary interventions with use of multiple antiplatelet and antithrombotic treatment regimens, the simple choice of transradial access for increasing patient comfort and decreasing bleeding complications and mortality is promising.

Study Objectives: Epidemiological studies have demonstrated an association between short sleep times and obesity as defined by body mass index (BMI). We wanted to determine whether this association occurs in patients with chronic medical diagnoses since the number of confounding factors is likely higher in patients than the general population., Methods: Two hundred patients attending internal medicine clinics completed a survey regarding sleep habits, lifestyle characteristics, and medical diagnoses. An independent surveyor collected the information on the questionnaires and reviewed the medical records. Height and weight were measured by clinic personnel. Data were analyzed with multivariate logistic regression., Results: Subjects with short sleep times (< 7 hours) had an increased likelihood of obesity as defined by a BMI > or = 30 kg/m2 when compared to the reference group of (8, 9] hours (odds ratio 2.93; 95% confidence interval, 1.06-8.09). There was a U-shaped relationship between obesity and sleep time in women but not in men. Young age (18 to 49 years), not smoking, drinking alcohol, hypertension, diabetes, and sleep apnea were also associated with obesity in the overall model., Conclusions: This study demonstrates an association between short sleep times and obesity in undifferentiated patients attending an internal medicine clinic using models adjusting for age, lifestyle characteristics, and some medical diagnoses. The U-shaped relationship in women suggests that sleep patterns may have gender specific associations. These observations provide the background for therapeutic trials in weight loss in patients with established medical problems.