Trinity Health Mid-Atlantic was formed in October 2018 by the joining together of Mercy Catholic Medical Center—Mercy Fitzgerald Campus in Darby, Pennsylvania; Mercy Catholic Medical Center Mercy Philadelphia Campus; Nazareth Hospital in Philadelphia, Pennsylvania; Saint Francis Healthcare in Wilmington, Delaware; St. Mary Medical Center in Langhorne, Pennsylvania; and their associated programs and services.
BACKGROUND:Frailty profoundly influences procedural outcomes in cardiovascular interventions. Although its effect is well established in transcatheter aortic valve replacement (TAVR), data remains limited for mitral transcatheter edge-to-edge repair (TEER). We evaluated the impact of frailty (defined by the Johns Hopkins Adjusted Clinical Groups Indicator) and the prevalence of associated comorbidities on in-hospital outcomes after TEER. METHODS:Adults (≥18 years) undergoing TEER were identified from the National Inpatient Sample (NIS) 2021-2022. Frailty was defined per the Adjusted Clinical Group (ACG) criteria, and patients were categorized as frail or nonfrail. The primary endpoint was in-hospital mortality. The secondary endpoints included: length of stay (LOS), hospitalization costs, and comorbidities associated with mortality. Univariate and multivariable logistic and linear regressions adjusted for demographics and comorbidities were conducted where appropriate. RESULTS:Among 26,196 weighted TEER hospitalizations, 2,130 (8.13 %) met frailty criteria. Frailty was associated with four-fold higher odds of in-hospital mortality (OR 4.03, 95 % CI 2.97-5.44, p < 0.001). Independent predictors of mortality included end-stage renal disease (ESRD, OR 13.67), heart failure (OR 3.38), chronic liver disease (OR 2.60), and CKD stage 3-5 (OR 1.92). Obesity showed no association with mortality. Frail patients had longer LOS (10.9 vs 3.3 days, p < 0.001) and higher mean costs ($377,688 vs $230,650, p < 0.001). CONCLUSIONS:Frailty is present in approximately 8 % of TEER patients and is strongly associated with increased mortality and resource utilization. Routine frailty screening may help optimize patient selection and post-procedural care.
De Garengeot hernias are femoral hernias that contain the appendix. They represent a rare subtype of femoral hernias, which are themselves a small portion of all inguinal hernias. A 55-year-old female with a history of type 2 diabetes mellitus complaining of right inguinal bulge and acute onset right lower quadrant pain. Computed tomography (CT) showed right groin soft tissue mass and surrounding fat inflammation within the femoral sac, consistent with incarcerated appendix. The patient underwent urgent appendectomy with hernia repair and was discharged from the hospital without further complication. De Garengeot hernias have nonspecific presentations but may develop severe complications such as incarceration, strangulation, and bowel necrosis. Preoperative diagnosis is paramount in prompt treatment.
BACKGROUND:Studies in the past have demonstrated an association between sarcoidosis and pulmonary embolism (PE), but little is known about its impact, especially in young adults. We aim to determine the burden and impact of PE in young adults hospitalized with sarcoidosis. METHODS:This study investigates the prevalence and consequences of PE in young adults aged 18-44 years hospitalized with sarcoidosis using data from the National Inpatient Sample (2016-2020) with relevant International Classification of Diseases (ICD)-10 codes. This study aims to address the primary outcomes of the burden and trends of PE and its associated impact on in-hospital mortality. Additionally, it explores secondary outcomes such as healthcare resource utilization and discharge patterns. RESULTS:Among 50,385 young adults (median age 37 years) hospitalized with sarcoidosis, 1120 had PE, showing a linear increase from 2% in 2016 to 2.9% (P < 0.001) in 2020. The sarcoidosis-PE+ group, predominantly in young blacks, exhibited a higher prevalence of comorbidities such as obesity, smoking, drug use, peripheral vascular disease, hypothyroidism and prior history of venous thrombus embolism. In contrast, the sarcoidosis-PE- group had a higher prevalence of diabetes (with/without chronic complication), hyperlipidemia and chronic pulmonary disease. Multivariable regression analysis adjusted for all potential sociodemographic and comorbid variables showed higher odds of all-cause mortality (odds ratio [OR]: 2.92, 95% confidence interval [CI]: 1.18-7.24, P < 0.02) in the sarcoidosis-PE+ group as compared to the sarcoidosis-PE- group. The sarcoidosis-PE+ group also had higher hospital costs and length of stay. CONCLUSION:The higher odds of in-hospital mortality with an increased length of stay and hospital cost observed in the sarcoidosis-PE+ group highlight the often underreported complications of sarcoidosis, particularly in a younger demographic. The relevance of this study stems from its potential to uncover trends that could lead to improved diagnostic and therapeutic strategies.
A 46-year-old woman without traditional vascular risk factors presented with one week of persistent vertigo and a nonfocal neurologic examination. Brain MRI revealed an acute to early subacute infarct in the left paramedian pons. CT angiography of the head and neck demonstrated no large-vessel disease, and a thrombophilia panel was unremarkable. Further evaluation identified a patent foramen ovale (PFO) with an atrial septal aneurysm and septal bowing, with a large right-to-left shunt on transthoracic echocardiography and a moderate shunt on transesophageal echocardiography bubble study. She had a Risk of Paradoxical Embolism (RoPE) score of 7 and met PFO-Associated Stroke Causal Likelihood (PASCAL) "Probable" criteria. Isolated paramedian pontine infarction is classically attributed to branch atheromatous disease, but the absence of small-vessel disease markers, the posterior circulation lesion location, and high-risk PFO anatomy together favored a paradoxical embolic mechanism. She received dual antiplatelet therapy followed by aspirin monotherapy, with referral for percutaneous PFO closure. This case illustrates how RoPE and PASCAL can help estimate whether a detected PFO is likely pathogenic rather than incidental in a perforator-territory stroke, and underscores that persistent vertigo without focal deficits warrants timely stroke imaging.
