Monmouth Medical Center

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially life-threatening complication following total shoulder arthroplasty (TSA). Despite the increased use of chemical prophylaxis, its effectiveness and safety in TSA populations remain unclear. This study evaluated the incidence of VTE, bleeding events, and related outcomes among TSA patients with and without postoperative chemical prophylaxis. A retrospective cohort study was conducted using the TriNetX database, identifying patients who underwent TSA, stratifying into two cohorts: those who received chemical VTE prophylaxis and those who did not. Propensity score matching (1:1) was employed to balance demographics, comorbidities, and other confounding variables. Outcomes, including VTE, bleeding events, prosthetic joint infection (PJI), revision, and mortality, were assessed at 30 days, 90 days, and 6 months postoperatively. After matching, 9,859 patients were included in each cohort. There was no significant difference in the incidence of VTE, PE, or DVT at any time point between the groups. Patients who received prophylaxis showed a reduced risk of ischemic stroke at 30 days (HR 0.539; 95

Background: Pulmonary heart disease (PHD), often driven by chronic pulmonary vascular remodeling (ICD-10: I27), represents a critical and under-recognized cause of cardiopulmonary mortality in the U.S. While aggregate national trends show a slow rise, this masks acute, multi-level socio-geographic inequalities in risk. Method: U.S. mortality data (ICD-10: I27) for 2018–2023 was extracted from CDC WONDER to estimate PHD deaths. Racial disparities were quantified using Average Annual Percent Change (AAPC) via log-linear regression, stratified by race, age, gender, Hispanic origin, education attainment, U.S. Census region, and 2013 urbanization classification Results: Overall AAPC acceleration was driven by Asian and Pacific Islander (API) populations: Filipino (+12.82%), Vietnamese (+9.44%), and Asian Indian (+6.91%), contrasting sharply with overall declines for White (–4.84%) and Black (–3.60%) groups. Intersecting disparities were stark. By Region/Urbanization, the steepest rises were among Western Other Pacific Islanders (+50.0%), Southern Filipinos (+19.98%), and Asian Indians in large central metros (+14.85%), while Blacks in non-core rural areas declined (–0.92%). By Age/Education, the highest AAPC was found in Asian Indians aged 65–74 (+15.39%) and Non-Hispanic Filipinos with some college (+30.93%). Conversely, Black adults aged 85+ (–13.28%) and Chinese with bachelor’s degrees (–27.78%) showed significant mortality compression. Conclusions: PHD mortality is not uniformly increasing; it is sharply accelerating in structurally marginalized API communities, younger age bands, and those in lower educational strata. These findings underscore the profound role of structural racism, differential care access, and urban-environmental exposure. Urgent disaggregation of national metrics and targeted, upstream preventive strategies for at-risk race-region-education cohorts are required.

Salmonella enterica (S. enterica) is an important pathogen responsible for bloodstream infections, particularly in developing nations. These infections often lead to bacteremia, with a few patients developing cardiac complications in high-risk populations. Myocarditis, a common manifestation, presents with fever, chest pain, and dyspnea and can lead to severe complications, such as cardiogenic shock. Salmonella endocarditis, although rare, predominantly affects the mitral valve and leads to critical complications, including valve perforation and dehiscence, with a high mortality rate. Patients with purulent pericarditis present more acutely with toxic features. Arrhythmias, notably third-degree atrioventricular block and ventricular fibrillation, are prevalent complications primarily due to myocarditis. Diagnostic methods range from isolating Salmonella from clinical samples to immunoblotting and polymerase chain reaction-based assays that target specific genes. Depending on severity, treatment includes supportive care or antibiotic therapy with fluoroquinolones in uncomplicated cases and cephalosporins in complicated cases. Timely diagnosis and appropriate management strategies are crucial for mitigating the morbidity and mortality associated with S. enterica infections.

Heart failure is characterized by complex interactions between systemic inflammation and impaired nutritional status, both of which contribute to adverse clinical outcomes. The neutrophil percentage-to-albumin ratio (NPAR), derived from routinely available laboratory parameters, integrates these pathways; however, its prognostic significance in heart failure has not been systematically evaluated. We conducted a systematic review and meta-analysis to examine the association between baseline NPAR and all-cause mortality in adult patients with heart failure. A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Central was performed to identify relevant studies. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Dose-response, sensitivity, and publication bias analyses were conducted, and risk of bias was assessed using the Quality in Prognosis Studies tool. Seven studies comprising 11,543 patients were included. Higher baseline NPAR was significantly associated with increased all-cause mortality (HR, 1.65; 95% CI, 1.44-1.90; P < 0.001), with moderate heterogeneity (I2 = 59%). A graded dose-response relationship was observed, with progressively higher mortality risk across increasing NPAR categories (P for trend < 0.001). Results remained robust in sensitivity analyses, with no evidence of significant publication bias (Egger P = 0.11). Certainty of evidence was rated as moderate using Grading of Recommendations Assessment, Development and Evaluation criteria. In conclusion, elevated NPAR is associated with increased mortality risk in heart failure. As a zero-cost biomarker derived from routine admission laboratories, NPAR captures the inflammation-malnutrition axis and may complement existing risk stratification frameworks, particularly in resource-limited settings.

Infective endocarditis (IE) is an infection of the endocardial surface of the heart, with Staphylococcus aureus as the leading cause in the United States. Identified risk factors include advanced age, male sex, intravenous drug use (IVDU), prior IE, structural or valvular heart disease, HIV infection, and chronic hemodialysis. In IVDU, IE most commonly affects the right-sided valves, while bivalvular involvement is uncommon but associated with more severe disease and increased risk of rapid deterioration. Multiple complications arise from IE, including variable vascular phenomena and systemic embolic complications. A 62-year-old male with a history of polysubstance abuse and intravenous drug use (heroin) presented with altered mental status. He was febrile and tachycardic, with laboratory studies revealing a white blood cell count (WBC) of 24.8 × 10³/µL, an elevated erythrocyte sedimentation rate (ESR) of 130 mm/hr, and a C-reactive protein (CRP) of 248 mg/L. Blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). Transesophageal echocardiography revealed vegetations on both the mitral and tricuspid valves, confirming bivalvular IE. His disease course was complicated by a cardioembolic stroke, L1-L2 osteomyelitis, bilateral psoas abscesses, septic pulmonary emboli, and splenic infarctions. During hospitalization, he developed a ruptured splenic artery pseudoaneurysm (SAPA), successfully managed with selective endovascular embolization requiring multiple blood transfusions and ICU-level monitoring for hemodynamic instability. Following stabilization, he returned to the medical floor to continue intravenous antibiotics and supportive care, but subsequently developed an enlarging abdominal aortic mycotic aneurysm (MA). Patient underwent mitral and tricuspid valve replacements, which were complicated by second-degree atrioventricular block progressing to complete heart block, necessitating permanent pacemaker placement. His hospital course was further complicated by bilateral pleural effusions requiring thoracentesis and a pericardial effusion requiring emergent subxiphoid pericardial window creation. He was discharged to a rehabilitation facility on chronic suppressive therapy with oral cephalexin and levofloxacin for a concomitant Serratia infection and subsequently underwent endovascular aortic repair. This case highlights the aggressive and disseminated course of S. aureus IE in IVDU, with bivalvular involvement, which may be associated with an increased risk of systemic embolization. Large, mobile vegetations exceeding 10 mm in size, especially when located on the left-sided valves, are strong indications for early surgical intervention. While the brain and spleen are common embolic sites, this case demonstrates rare vascular complications such as SAPA and MA, which can be life-threatening due to the risk of rupture and hemorrhage. The patient ultimately required bivalvular replacement, which also increases the risk of heart block due to the proximity of the valves to the conduction system. Early detection through imaging, timely multidisciplinary management, and consideration of surgical or endovascular intervention even during active infection are critical for improving outcomes in patients with complex, disseminated IE.