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BACKGROUND: Pericardial effusion requiring percutaneous or surgical-based intervention remains an important complication of a leadless pacemaker implantation. OBJECTIVE: The study sought to determine real-world prevalence, risk factors, and associated outcomes of pericardial effusion requiring intervention in leadless pacemaker implantations. METHODS: The National Inpatient Sample and International Classification of Diseases-Tenth Revision codes were used to identify patients who underwent leadless pacemaker implantations during the years 2016 to 2020. The outcomes assessed in our study included prevalence of pericardial effusion requiring intervention, other procedural complications, and in-hospital outcomes. Predictors of pericardial effusion were also analyzed. RESULTS: Pericardial effusion requiring intervention occurred in a total of 325 (1.1%) leadless pacemaker implantations. Patient-level characteristics that predicted development of a serious pericardial effusion included >75 years of age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75), female sex (OR 2.03, 95% CI 1.62-2.55), coagulopathy (OR 1.50, 95% CI 1.12-1.99), chronic pulmonary disease (OR 1.36, 95% CI 1.07-1.74), chronic kidney disease (OR 1.53, 95% CI 1.22-1.94), and connective tissue disorders (OR 2.98, 95% CI 2.02-4.39). Pericardial effusion requiring intervention was independently associated with mortality (OR 5.66, 95% CI 4.24-7.56), prolonged length of stay (OR 1.36, 95% CI 1.07-1.73), and increased cost of hospitalization (OR 2.49, 95% CI 1.92-3.21) after leadless pacemaker implantation. CONCLUSION: In a large, contemporary, real-world cohort of leadless pacemaker implantations in the United States, the prevalence of pericardial effusion requiring intervention was 1.1%. Certain important patient-level characteristics predicted development of a significant pericardial effusion, and such effusions were associated with adverse outcomes after leadless pacemaker implantations.

Background/Objectives: Heart failure presents a significant public health challenge, affecting millions in the US, with projections of increasing prevalence and economic burdens. Obstructive sleep apnea (OSA) is highly prevalent among HF patients. This study analyzes the impact of OSA on the outcomes in patients admitted with acute decompensated heart failure. Methods: We conducted a retrospective cohort study using the National Inpatient Sample database (NIS) 2020, focusing on patients admitted with acute heart failure. Patient outcomes were compared between those with and without a secondary diagnosis of OSA, identified via validated ICD-10 codes. Subgroup analysis was conducted between heart failure patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Results: Among 65,649 patients with acute heart failure, 4595 (7%) patients were found to have OSA. The patients with OSA were more likely to be male, older in age and had a higher burden of comorbidities. No significant differences were observed in mortality between heart failure patients with and without OSA. In HFrEF patients, OSA was associated with longer hospital stays (6.45 days vs. 5.79 days, p < 0.001), higher rates of acute kidney injury (AKI) (adjusted odds ratio 1.28, 95% CI: 1.07–1.54, p = 0.007), and atrial fibrillation (adjusted odds ratio 1.35, 95% CI: 1.13–1.61, p = 0.001). In HFpEF patients, an association between OSA and AF was observed (adjusted odds ratio 1.20, 95% CI: 1.01–1.42, p = 0.03). Conclusions: OSA is associated with poor in-hospital outcomes in patients admitted with acute heart failure. HFrEF subgroup is especially vulnerable, with OSA leading to a significant increase in healthcare utilization and complication rates in these patients. This nationwide study underscores the importance of timely identification and treatment of OSA in heart failure to alleviate healthcare burdens and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Catheter Ablation (CA) is an effective treatment for atrial fibrillation (AF). However, frail elderly patients have been understudied due to their exclusion from landmark trials. Objectives: Our study aims to evaluate outcomes in this population. Methods: The national readmission database (2016–2020) was queried, and frailty categories were defined based on hospital risk frailty scores ≦5 as low while >5 as intermediate/high frailty (IHF). We used multivariate regression and propensity‐matched analysis to compare outcomes in patients undergoing CA for atrial fibrillation based on frailty index. Results: Among 55 936 CAs for AF, 33,248 patients had low frailty, while 22 688 had intermediate/high frailty (IHF). After propensity matching (N 12 448), IHF patients were found to have higher adverse events, including mortality (3% vs. 0.3%, p <.001), stroke (1.9% vs. 0.2%, p <.001), acute heart failure (53.8% vs. 42.2%, p <.001), AKI (42.5% vs. 6.8%, p <.001), pericardial complications (2.8 vs. 1.6%, p <.001), respiratory complications (27.8 vs. 7.2%, p <.001), major adverse cardiovascular events (21.2 vs. 9.4%, p <.001) and net adverse events (76.7 vs. 55%, p <.001). IHF patients had higher readmissions at 30 (15.5 vs. 12.6%, p <.001), 90 (31.9 vs. 25.1%, p <.001), and 180‐day (41 vs. 34.7%, p <.001) intervals. A higher median length of stay (LOS) (7 vs. 3 days, p <.001) and cost ($44 287 vs. $27 517, p <.001) at index admission and subsequent readmissions were also observed (p <.001). Conclusion: Intermediate/high frailty patients undergoing catheter ablation had worse clinical outcomes, higher healthcare burden, and readmission rates. LOS has decreased in both groups from 2016 to 2020; however, total cost has increased. [ABSTRACT FROM AUTHOR]

This paper explores the influence of the risk–return relationship and volatility spillover on stock market returns of emerging economies, with a particular focus on the BRICS countries. This research is undertaken in a context where discussions on de-dollarization and the expansion of BRICS membership are gaining momentum, making it a novel and distinct exercise compared to prior studies. Utilizing econometric techniques to investigate daily market returns from 1 April 2008 to 31 March 2023, a period that witnessed major events like the global financial crisis, the COVID-19 pandemic, and the Russia–Ukraine conflict, linear and non-linear models like ARCH, GARCH, GARCH-M, EGARCH, and TGARCH, are employed to assess stock return volatility behaviour, assuming a Gaussian distribution of error terms. The diagnostic test confirms that the distribution is non-normal, stationary, and heteroscedastic. The key findings indicate a lack of the risk–return relationship across all BRICS stock markets, except for South Africa; a more pronounced effect of unpleasant news over pleasant news; a slow mean-reverting process in volatility; the EGARCH model is the best fit model as evidenced by a higher log likelihood and lower Akaike information criterion and Schwardz information criterion parameters; and finally, the presence of significant bidirectional and unidirectional spillover effects in the majority of instances. These findings are valuable for investors, regulators, and policymakers in enhancing returns and mitigating risk through portfolio diversification and informed decision making. [ABSTRACT FROM AUTHOR]

Hospital-acquired infections (HAIs) are a major global healthcare challenge, contributing to increased morbidity, mortality, and healthcare costs. Despite advancements in infection prevention and control (IPC), these infections remain prevalent, particularly in resource-limited settings. This article explores the burden of HAIs, the role of infection control teams (ICTs), key IPC practices, challenges and barriers to implementation, and actionable recommendations to improve outcomes. Effective IPC relies on evidence-based practices such as hand hygiene, antimicrobial stewardship, environmental cleaning, and adherence to standard precautions. Infection control teams play a pivotal role in developing policies, conducting surveillance, managing outbreaks, and fostering a culture of safety within healthcare facilities. However, barriers such as resource limitations, poor compliance, antimicrobial resistance, and organizational challenges hinder the consistent application of IPC measures. Recommendations to address these issues include strengthening surveillance systems, investing in education and training, enhancing resource availability, promoting antimicrobial stewardship, and leveraging innovative technologies. By addressing these challenges and prioritizing infection control, healthcare facilities can reduce the burden of HAIs, improve patient outcomes, and combat the growing threat of antimicrobial resistance. This comprehensive approach underscores the importance of collaboration, accountability, and sustained commitment to infection prevention efforts globally. [ABSTRACT FROM AUTHOR]

Introduction: Leadless pacemakers (LPM) have established themselves as the important therapeutic modality in management of selected patients with symptomatic bradycardia. To determine real‐world utilization and in‐hospital outcomes of LPM implantation since its approval by the Food and Drug Administration in 2016. Methods: For this retrospective cohort study, data were extracted from the National Inpatient Sample database from the years 2016−2020. The outcomes analyzed in our study included implantation trends of LPM over study years, mortality, major complications (defined as pericardial effusion requiring intervention, any vascular complication, or acute kidney injury), length of stay, and cost of hospitalization. Implantation trends of LPM were assessed using linear regression. Using years 2016−2017 as a reference, adjusted outcomes of mortality, major complications, prolonged length of stay (defined as >6 days), and increased hospitalization cost (defined as median cost >34 098$) were analyzed for subsequent years using a multivariable logistic regression model. Results: There was a gradual increased trend of LPM implantation over our study years (3230 devices in years 2016−2017 to 11 815 devices in year 2020, p for trend <.01). The adjusted mortality improved significantly after LPM implantation in subsequent years compared to the reference years 2016−2017 (aOR for the year 2018: 0.61, 95% CI: 0.51−0.73; aOR for the year 2019: 0.49, 95% CI: 0.41−0.59; and aOR for the year 2020: 0.52, 95% CI: 0.44−0.62). No differences in adjusted rates of major complications were demonstrated over the subsequent years. The adjusted cost of hospitalization was higher for the years 2019 (aOR: 1.33, 95% CI: 1.22−1.46) and 2020 (aOR: 1.69, 95% CI: 1.55−1.84). Conclusion: The contemporary US practice has shown significantly increased implantation rates of LPM since its approval with reduced rates of inpatient mortality. [ABSTRACT FROM AUTHOR]

Background: Benign prostatic hyperplasia (BPH) is a common disorder amongst older men, and is accountable for significant disability. Objective: The aim of the study is to determine the prevalence of benign prostatic hyperplasia in urology department of Prince Mutaib hospital in Sakaka, Aljouf. Methods: Via recoding, 345 patients attended the urology department. They were asked about their ages, if they are smokers and if they have chronic diseases. Results: The total number of patients diagnosed as having benign prostatic hyperplasia (BPH) was 82. This showed a prevalence rate of 23%. The age distribution of the patients was found to be above 60 years old. While regarding the symptoms: 23 (28%) of the patients showed mild BPH, 39 (48%) with moderate BPH, and 20 (24%) with severe BPH. Conclusion and recommendation: BPH seemed to be a problem of elderly patients, as within the studied patients, those with BPH were above 60 years. Chronic diseases such as diabetes mellitus, hypertension may be acting as risk factors for BPH. Further studies are recommended to study the prevalence of prostatic carcinoma in elderly patients. [ABSTRACT FROM AUTHOR]

Objectives: There have been cases of cardiotoxicity induced by osimertinib in patients with non-small-cell lung cancer (NSCLC). However, limited data exist for a comprehensive cardiotoxicity profile analysis for osimertinib use in NSCLC patients. The aim of this study was to report the entire profile of cardiotoxicities after the initiation of osimertinib in consecutive patients with epidermal growth factor receptor (EGFR) mutation at a single health system., Methods: The data were retrospectively collected from electronic medical records for all patients who were started on osimertinib for NSCLC at West Virginia University Health System. Prevalence of heart failure (HF), atrial fibrillation, and prolonged QT before and after starting osimertinib were calculated., Results: This study had 116 participants and the median age was 72 years. The frequency of each new cardiotoxicity was between 6% and 9%, and the overall percentage of patients who had developed any of the four cardiotoxicities while on osimertinib was 19.9%. The median time of follow-up was 477 days and the median time on osimertinib for all patients was 390 days. The strongest risk factor in predicting a new onset cardiac event was hypertension with a hazard ratio (HR) of 6.35 (confidence interval (CI) 1.48 to 27.23, p=0.013) and HR 5.36 (CI 1.23 to 23.39, p=0.025) in univariate and multivariate analysis respectively., Conclusion: Osimertinib appears to be associated with an increase in cardiac abnormalities. Given the association between this medication exposure and the observed cardiac toxicities, use of osimertinib may entail closer cardiac monitoring of electrocardiogram (ECG) and echocardiogram abnormalities., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)