RESUMEN

Introduction: Although obesity and its impact on cardiovascular (CV) events have been extensively studied in the cisgender population, little is known about its impact on CV events in transgender individuals. Our study aimed to establish the prevalence of obesity and CV events in transgender adults. Methods: We conducted a retrospective cohort comparative study utilizing the U.S. National Inpatient Sample 2020 database. We identified admissions of transgender patients with administrative codes. Later, these patients were divided into obesity and non-obesity cohorts. Multivariable regression analysis was then performed for in-hospital all-cause mortality, acute myocardial infarction, acute ischemic stroke, cardiac arrest, pulmonary embolism and, major adverse cardiovascular and cerebrovascular events (MACCE). Results: In 2020, 19,345 transgender patients were admitted; 16,390 (84.7 %) had no obesity, and 2,955 (15.3 %) had obesity. The median age was 31 years in the non-obesity cohort and 37 years in the obesity cohort. Transgender men comprised 54.5 % of the non-obesity cohort and 47.9 % of the obesity cohort. Common baseline conditions in the non-obesity and obesity cohorts, respectively, included hypertension (20.7 % vs. 43.5 %), diabetes (10.2 % vs. 32.5 %), chronic pulmonary disease (18.9 % vs. 27.7 %), and hyperlipidemia (11.5 % vs. 25 %). MACCE was observed in 2.3 % of the non-obesity cohort compared to 5.4 % in the obesity cohort, and cardiac arrest occurred in 0.2 % of the non-obesity cohort versus 1.2 % in the obesity cohort. A statistically significant association was found in MACCE [odds ratio (OR) 2.1, 95 % confidence interval (CI) 1.24-3.55, p = 0.006] and cardiac arrest [OR 3.92, 95 % CI 1.11-12.63, p = 0.022] among transgender patients with obesity. Conclusion: We observed increased odds of MACCE and cardiac arrest in transgender patients with obesity, possibly due to obesity and CV risk factors like hypertension, diabetes, and hyperlipidemia. Further large-scale comparative studies are needed to better understand obesity's impact on CV outcomes in the transgender population.

RESUMEN

Background and aims: The paucity of large-scale data exploring the effect of prior bariatric surgery on recurrent stroke outcomes in older individuals with obesity who survived a stroke led us to address the gap, with an emphasis on the risk of recurrent stroke and its trends. Methods: Retrospective analysis of the National Inpatient Sample data from 2016 to 2019. Older individuals with obesity who survived a stroke (>65 years) and had a recurrent acute ischemic stroke (AIS) hospitalization, with or without prior bariatric surgery (PBS), were identified using ICD-10 codes. Recurrent stroke trends, demographic characteristics, and comorbidities between the cohorts were compared. Results: Analyzing 643,505 older individuals with obesity who survived a stroke, we identified that 11,820 had undergone PBS. Both groups (no PBS vs. PBS) were predominantly female (59.7 % vs. 73.7 %), identified as white (76.5 % vs. 83.8 %), and covered by Medicare (91.7 % vs. 90.7 %). Diabetes, hyperlipidemia, prior myocardial infarction, and peripheral vascular diseases were more common in those without PBS. In contrast, tobacco use disorder, drug abuse, and valvular diseases were more common in those with PBS. There was no significant difference in the prevalence of hypertension between groups.Between 2016 and 2019, recurrent AIS hospitalizations were less frequent in the PBS group (4 %-2.9 %, p = 0.035) while remaining stable in the other group (4.4 %-4.2 %, p = 0.064). The risk of recurrent AIS hospitalization was less frequent in the PBS cohort (aOR: 0.77, 95 % CI: 0.60-0.98). Conclusion: PBS in older individuals with obesity who survived a stroke was associated with a 23 % lower risk of recurrent AIS hospitalization with a decreasing trend of prevalence since 2016. These findings could influence clinical practice and contribute to developing secondary prevention strategies for recurrent stroke among these patients.

RESUMEN

Background: Body Mass Index (BMI) has a significant impact on Coronavirus disease (COVID-19) patient outcomes; however, major adverse cardiac and cerebrovascular outcomes in patients with severe sepsis have been poorly understood. Our study aims to explore and provide insight into its association. Methods: This is an observational study looking at the impact of BMI on COVID-19-severe sepsis hospitalizations. The primary outcomes are adjusted odds of all-cause in-hospital mortality, respiratory failure, and major adverse cardiac and cerebrovascular events (MACCE), which include acute myocardial infarction, cardiac arrest, and acute ischemic stroke. The secondary outcome was healthcare resource utilization. Coexisting comorbidities and patient features were adjusted with multivariable regression analyses. Results: Of 51,740 patients with severe COVID-19-sepsis admissions, 11.4% were overweight, 24.8% had Class I obesity (BMI 30-34.9), 19.8% had Class II obesity (BMI 35-39.9), and 43.9% had the categorization of Class III obesity (BMI >40) cohorts with age>18 years. The odds of MACCE in patients with class II obesity and class III obesity (OR 1.09 and 1.54; 95CI 0.93-1.29 and 1.33-1.79) were significantly higher than in overweight (p < 0.001). Class I, Class II, and Class III patients with obesity revealed lower odds of respiratory failure compared to overweight (OR 0.89, 0.82, and 0.82; 95CI 0.75-1.05, 0.69-0.97, and 0.70-0.97), but failed to achieve statistical significance (p = 0.079). On multivariable regression analysis, all-cause in-hospital mortality revealed significantly higher odds in patients with Class III obesity, Class II, and Class I (OR 1.56, 1.17, and 1.06; 95CI 1.34-1.81, 0.99-1.38, and 0.91-1.24) vs. overweight patients (p < 0.001). Conclusions: Patients with Class II and Class III obesity had significantly higher odds of MACCE and in-hospital mortality in COVID-19-severe sepsis admissions.

RESUMEN

BACKGROUND: Obstructive sleep apnea (OSA) is associated with an increased risk of major cardiac and cerebrovascular events (MACCE). However, data on the burden and predictors of MACCE in geriatric patients with OSA (G-OSA) remain limited. METHODS: Using the National Inpatient Sample from 2018, we identified G-OSA admissions (age ≥ 65 years) and divided them into non-MACCE vs. MACCE (all-cause mortality, stroke, acute myocardial infarction, and cardiac arrest). We compared the demographics and comorbidities in both cohorts and extracted the odds ratio (multivariate analysis) of MACCE and associated in-hospital mortality. RESULTS: Out of 1,141,120 geriatric obstructive sleep apnea G-OSA admissions, 9.9% (113,295) had MACCE. Males, Asians, or the Pacific Islander/Native American race, and patients from the lowest income quartile revealed a higher MACCE rate. Significant clinical predictors of MACCE in elderly OSA patients on multivariable regression analysis in decreasing odds were pulmonary circulation disease (OR 1.47, 95% CI 1.31-1.66), coagulopathy (OR 1.43, 95% CI 1.35-1.50), peripheral vascular disease (OR 1.34, 95% CI 1.28-1.40), prior sudden cardiac arrest (OR 1.34, 95% CI 1.11-1.62), prior myocardial infarction (OR 1.27, 95% CI 1.22-1.33), fluid and electrolyte imbalances (OR 1.25, 95% CI 1.20-1.29), male sex (OR 1.22, 95% CI-1.18-1.26), hyperlipidemia (OR 1.20, 95% CI 1.16-1.24), low household income (OR 1.19, CI 1.13-1.26), renal failure (OR 1.15, 95% CI 1.12-1.19), diabetes (OR 1.14, 95% CI 1.10-1.17), metastatic cancer (OR 1.14, 95% CI 1.03-1.25), and prior stroke or TIA (OR 1.12, 95% CI 1.07-1.17) (All p value < 0.05). CONCLUSIONS: This study emphasizes the significant association between obstructive sleep apnea (OSA) and major cardiac and cerebrovascular events (MACCE) in the geriatric population. Among the elderly OSA patients, a substantial 9.9% were found to have MACCE, with specific demographics like males, Asian or Pacific Islander/Native American individuals, and those from the lowest income quartile being particularly vulnerable. The study sheds light on several significant clinical predictors, with pulmonary circulation disease, coagulopathy, and peripheral vascular disease topping the list. The highlighted predictors provide valuable insights for clinicians, allowing for better risk stratification and targeted interventions in this vulnerable patient cohort. Further research is essential to validate these findings and inform how tailored therapeutic approaches for geriatric OSA patients can mitigate MACCE risk. CLINICAL IMPLICATIONS: Elderly individuals with a high risk for MACCE should undergo routine OSA screening using tools like the sensitive STOP-BANG Questionnaire. Implementing CPAP treatment can enhance cardiovascular outcomes in these patients.

Asunto(s)

Infarto del Miocardio , Enfermedades Vasculares Periféricas , Apnea Obstructiva del Sueño , Accidente Cerebrovascular , Humanos , Masculino , Anciano , Pacientes Internos , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/diagnóstico , Infarto del Miocardio/epidemiología , Accidente Cerebrovascular/complicaciones , Enfermedades Vasculares Periféricas/complicaciones

RESUMEN

Acute disseminated encephalomyelitis (ADEM) is a rare autoimmune demyelinating disorder that primarily affects the central nervous system (CNS). It is characterized by an acute inflammatory response targeting the myelin sheath surrounding nerve fibers in the brain and spinal cord. The exact mechanism of ADEM is not fully understood, but it is believed to involve an abnormal immune response that leads to the activation of immune cells and subsequent inflammation within the CNS. This immune-mediated attack results in the destruction of myelin, impairing the transmission of nerve signals and causing a wide range of neurological symptoms. This is a case of a six-year-old girl with no notable medical history presented with complaints of a fever and headache for the last month, in addition to difficulty walking for 20 days and speaking for 14 days. On CNS examination, the right upper and lower limbs' power was reduced, and the Babinski sign was seen in both lower limbs. Both sides of the triceps and knee showed increased reflexes, whereas both sides of the ankle showed decreased reflexes. Magnetic resonance imaging (MRI) showed multiple T1 hypointensities and T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) hyperintensities in the subcortical white matter of the bilateral frontal and parietal lobes, bilateral cerebellar peduncles, corpus callosum, pons, and midbrain. Our case report aims to raise awareness and aid in the early recognition of ADEM because prompt recognition, accurate diagnosis, and appropriate management are essential to minimizing neurological damage and promoting favorable outcomes in affected individuals.