tbuckley/cabot-search huggingface dataset:
Abstract 16758: Presence of Left Atrial Fibrosis Contributes to Aberrant Hemodynamics and Increased Risk of Stroke in Atrial Fibrillation Patients
Authors: Nikhil Paliwal, Matteo Salvador, Ryan Ohara, Rheeda Ali, Rebecca Yu, Usama A Daimee, Tauseef Akhtar, Pallavi Pandey, David D Spragg, Hugh G Calkins, Natalia Trayanova
Journal: Circulation (2020)

Introduction: Atrial fibrillation (AF) patients are at high risk of stroke, with the left atrial appendage (LAA) found to be the most common site of clot formation. Left atrial (LA) fibrosis is also associated with higher stroke risk. However, the mechanisms for increased stroke risk in patients with atrial fibrotic remodeling are poorly understood. We sought to explore these specific mechanisms using fluid dynamics analysis. Hypothesis: The presence of LA fibrosis leads to aberrant hemodynamics in the atria, contributing to increased stroke risk in AF patients. Methods: We retrospectively collected LGE-MRI images of 3 AF patients and reconstructed their 3D LA endocardial surfaces. Fibrotic regions were identified as those with intensity 3 standard deviations greater than the mean LA blood-pool intensity. Personalized computational fluid dynamic simulations were performed, and hemodynamics at the LA wall were quantified by wall shear stress (WSS, friction of blood) and oscillatory shear index (OSI, temporal directional change of WSS). For each case, WSS and OSI were compared between fibrotic and normal regions. Results: WSS was significantly lower in the fibrotic region as compared to normal region for all 3 cases. Additionally, OSI was higher in the fibrotic region as compared to normal region for all 3 cases. However, this different was statistically significant for cases 1 and 3; case 2 was not statistically significantly different. Low WSS and high OSI in the vicinity of the fibrotic wall suggest that local blood-flow was slow and oscillating, enabling pro-thrombotic conditions for circulating blood. Conclusion: LA fibrosis correlates with regions of aberrant hemodynamics, which renders it susceptible to blood thrombosis. AF patients with high LA fibrosis burden will have more pro-thrombotic regions, in addition to low flow in the LAA, providing more sites for a potential clot formation. These conditions might get exacerbated during an AF event and cause stroke.
Abstract 16259: <i>Gemella Morbillorum</i> Infective Endocarditis: A Systematic Review
Authors: Jared Steinberger, Mohamed Mohamed, Rajeev Sudhakar
Journal: Circulation (2020)

Introduction: Gemella morbillorum is a facultative anaerobic gram positive bacterium that resides as normal flora in the oral cavity and gastrointestinal system. This organism has uncommonly presented as an etiology of infective endocarditis, with varying reports of resistance and complications. Methods: Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the systematic review. A medical librarian (T.R.S) versed in evidence-based medicine systematically searched databases for studies assessing Gemella morbillorum infective endocarditis in patients. Publication year included inception until December 31, 2019. Using Rayyan software, 134 abstracts were screened for eligibility after duplicates were removed. Inclusion criteria was age greater than 18 years old, infective endocarditis with positive culture for Gemella morbillorum, and publication in English. 39 full text articles were reviewed for eligibility, and 38 were included in the final analysis. Results: A total of 40 cases of infective endocarditis caused by Gemella morbillorum were identified. The average age of the patients was 54 years old, 72.5% were male patients (29), 20% female (8), 7.5% unknown sex (3). Native valve endocarditis (NVE) was present in 28 of the cases, with prosthetic valve involvement in 5 cases. Left sided endocarditis was more common than right sided with 70% of cases (28) and 12.5% (5) respectively, with 17.5% (7) of cases not listing which valve was infected on echocardiography. The most common predisposing risk factor was thought to be poor dentition in 9 cases. The most common antibiotic regimen in penicillin susceptible NVE was concordant with most recent guidelines, a beta lactam with gentamicin or vancomycin in 57.5% of the cases (23). Complications occurred in 65% of cases (26), with most common complication being need for surgical intervention occurring in 30% of the cases (12). Conclusions: Gemella morbillorum infective endocarditis cases reported in literature had a high burden of complications with nearly two thirds of cases. Most common was the need for surgery with valve replacement. Antibiotic regimens in the most recent endocarditis guidelines were effective in treatment for a majority of the cases.
The underrepresentation of “COVID toes” in skin of color: An example of racial bias or evidence of a tenuous disease association?
Authors: Abigail Cline, Juliana Berk-Krauss, Ashley Keyes Jacobs, Maira Fonseca, Julia Wu, Falguni Asrani, Amilcar Rizzo, Janet Moy, Marian Russo, Sharon Glick, Rachel Blasiak, Beth N. McLellan, Shoshana Marmon
Journal: Journal of the American Academy of Dermatology (2020)

in skin of color: An example of racial bias or evidence of a tenuous disease association? COVID-19, coronavirus disease 2019; COVID19BRL, COVID BioReference Laboratory; COVIDLR, COVID laboratory reference; PCR, polymerase chain reaction.
Abstract 15483: A Clinic-based Intervention Achieves Target Doses of Guideline-directed Medical Therapy in Heart Failure
Authors: Ann Rogerson, marvin R Allen, Renea L Beckstrand, Bradi B Granger
Journal: Circulation (2020)

Introduction: Target doses of guideline-directed medical therapy (GDMT) reduce morbidity and mortality, and yet, are challenging to achieve in patients with heart failure and reduced ejection fraction (HFrEF). Long-term, relationship-based approaches are not well described. Methods: We implemented a person-centered approach in a nurse-managed multidisciplinary heart failure clinic. We used repeated measures analysis to prospectively evaluate patient satisfaction, appointment attendance, dose optimization of GDMT for renin-angiotensin inhibitors, beta-blockers (BB), mineralocorticoid antagonists (MRA), and anticoagulation, and ICD placement and cardiac rehab participation at 12 months. GDMT was scored 0-6, with one point for each guideline-indicated therapy. Composite scores were compared using ANOVA at baseline, 6-months, and 12-months. Results: Participants (n=102) were age 68 (± 14.95) years on average, predominantly white (95.1%), male (62.75%), and high school graduates (88.24%). At 12-months, the proportion of patients on ≥50% of target doses improved: renin-antiotensin inhibitors from 27% to 41%, beta-blockers from 46% to 64%, and MRA from 35% to 65%. Cardiac rehab attendance improved from 25% to 84%. Patient satisfaction with care improved; four (3.9%) patients did not attend scheduled follow-up in the 12-month period. Though overall composite scores of GDMT improved (F=51.74, p &lt;0.001), only 12% of patients achieved target doses for all 3 medication classes concomitantly. No participants were readmitted within 30 days of HF-hospitalization; all-cause 30-day readmission was 10.5%. Conclusion: A persistent patient-provider relationship and person-centered approach to HF management may improve GDMT.
Predictive Modeling for Perinatal Mortality in Resource-Limited Settings
Authors: Vivek V. Shukla, Barry Eggleston, Namasivayam Ambalavanan, Elizabeth M. McClure, Musaku Mwenechanya, Elwyn Chomba, Carl Bose, Melissa Bauserman, Antoinette Tshefu, Shivaprasad S. Goudar, Richard J. Derman, Ana Garcés, Nancy F. Krebs, Sarah Saleem, Robert L. Goldenberg, Archana Patel, Patricia L. Hibberd, Fabian Esamai, Sherri Bucher, Edward A. Liechty, Marion Koso-Thomas, Waldemar A. Carlo
Journal: JAMA Network Open (2020)

<h3>Importance</h3> The overwhelming majority of fetal and neonatal deaths occur in low- and middle-income countries. Fetal and neonatal risk assessment tools may be useful to predict the risk of death. <h3>Objective</h3> To develop risk prediction models for intrapartum stillbirth and neonatal death. <h3>Design, Setting, and Participants</h3> This cohort study used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research population-based vital registry, including clinical sites in South Asia (India and Pakistan), Africa (Democratic Republic of Congo, Zambia, and Kenya), and Latin America (Guatemala). A total of 502 648 pregnancies were prospectively enrolled in the registry. <h3>Exposures</h3> Risk factors were added sequentially into the data set in 4 scenarios: (1) prenatal, (2) predelivery, (3) delivery and day 1, and (4) postdelivery through day 2. <h3>Main Outcomes and Measures</h3> Data sets were randomly divided into 10 groups of 3 analysis data sets including training (60%), test (20%), and validation (20%). Conventional and advanced machine learning modeling techniques were applied to assess predictive abilities using area under the curve (AUC) for intrapartum stillbirth and neonatal mortality. <h3>Results</h3> All prenatal and predelivery models had predictive accuracy for both intrapartum stillbirth and neonatal mortality with AUC values 0.71 or less. Five of 6 models for neonatal mortality based on delivery/day 1 and postdelivery/day 2 had increased predictive accuracy with AUC values greater than 0.80. Birth weight was the most important predictor for neonatal death in both postdelivery scenarios with independent predictive ability with AUC values of 0.78 and 0.76, respectively. The addition of 4 other top predictors increased AUC to 0.83 and 0.87 for the postdelivery scenarios, respectively. <h3>Conclusions and Relevance</h3> Models based on prenatal or predelivery data had predictive accuracy for intrapartum stillbirths and neonatal mortality of AUC values 0.71 or less. Models that incorporated delivery data had good predictive accuracy for risk of neonatal mortality. Birth weight was the most important predictor for neonatal mortality.
Abstract 16332: Novel Risk Model for Predicting Cardiovascular Outcome in Breast Cancer Survivors
Authors: Do Young Kim, Jong-chan Youn, Myung-Soo Park, Sunki Lee, Jae Hyuk Choi, Jung Mi-Hyang, Kyu-Hyung Ryu, Seongwoo Han
Journal: Circulation (2020)

Introduction: Both conventional cardiovascular (CV) risk factors and breast cancer (BC) therapy-related CV risk factors play an important role in CV mortality among BC survivors. Hypothesis: A risk stratification scheme which is based on both conventional CV risk factors and cancer treatment-related risk factors may have a good performance toward estimating the risk of CV the event among these survivors. Methods: The cohort of the study consists of 1,256 female BC patients from 4 medical centers in South Korea with a mean follow up duration of 51.6 ± 30.8 months. The cohort was randomized on a 1:1 ratio into the derivation group and validation group. A competing risk analysis model was used to derive the risk scheme. The primary endpoint was the composite of CV mortality, myocardial infarction (MI), congestive heart failure (CHF), and transient ischemic attack (TIA)/stroke. Results: We developed the CHEMO-RADIAT score (CHF [2 point], Elderly [age≥60; 1 point], prior MI/peripheral artery disease [2 points], Obesity [body mass index ≥30 kg/m 2 ; 1 point], Renal failure [glomerular filtration rate &lt;60 ml/min/1.73 m2; 1 point], Abnormal lipid profile [1 point], Diabetes mellitus [1 point], Irradiation to left side breast [1 points], Anthracycline dose [1 point per 100mg/m 2 doxorubicin equivalent dose], TIA /stroke [2 points]) from the development group. The time-dependent C-index improved significantly when conventional CV risk factor data was incorporated into the BC treatment-related factors in the development (0.739 vs. 0.582, p=0.017). The time-dependent C-index of the CHEMO-RADIAT score at 5 years was 0.739 (95% confidence interval [CI] 0.615-0.864), and 0.848 (95% CI 0.721-0.976) in the derivation and validation group, respectively. Conclusions: A simple score for predicting CV risk in breast cancer patients was developed and validated well in this multi-center cohort. The CHEMO-RADIAT score may provide overall CV risk stratification in breast cancer.
Abstract 16159: Pacemaker in the Elderly: A Nationwide Cohort to Determine Complications Associated With Pacemakers
Authors: Chaitanya Rojulpote, Abhijit Bhattaru, Karthik Gonuguntla, Shivaraj Patil, Pranav Karambelkar, Tapan Buch, Kiranmayi Vuthaluru, Sanskriti Shrivastava, Nikola Perosevic
Journal: Circulation (2020)

Introduction: The geriatric population represents over half of the patients who receive permanent pacemakers (PPM). There are complications associated with the use of PPM in the elderly. Hypothesis: There is limited data on the use of PPM in the elderly population. We aimed to analyze complications and trends associated with various PPM device implantations in the geriatric population over the age of 80. Methods: We used the National Inpatient Sample Database for the years 2010 to 2014 using the International Classification of Diseases-9 procedure code for PPM Implantation and diagnosis codes for complications associated with pacemaker use in patients above the age of 80 years. Results: We identified a total of 265,001 hospitalizations from 2010 to 2014 where patients above the age of 80 years received PPM implantation. Among those who received the PPM, 68 % of patients had Sinus Node Dysfunction (SND) and in-hospital mortality associated with PPM implantation of 1.8%. The majority of this cohort consisted of Caucasians (83%) and males (50%). They had a mean length of stay of 4.4±4.2 (mean ± SD) days. Various types of pacemakers implanted included dual chamber (72 %), single chamber (15 %), and biventricular (13 %). Complications associated with PPM implantation were venous thromboembolism (1%), cardiac tamponade (0.2%), sepsis and severe sepsis (1.1%), septic shock (0.3%), pneumothorax (0.2%), pacemaker hematoma (1.4%). Conclusion: As observed in our study, dual chamber pacemaker is the most commonly used implantable device in age 80+ geriatric patient population. This study identified a variety of PPM-related complications, of which pacemaker hematoma was the most common. Although there are associated complications with the use of this device, the benefits outweigh the risks as age should not be considered a barrier to receive a PPM.
Long-term Follow-up of Glycemic and Neurological Outcomes in an International Series of Patients With Sulfonylurea-Treated <i>ABCC8</i> Permanent Neonatal Diabetes
Authors: Pamela Bowman, Frances Mathews, Fabrizio Barbetti, Maggie H. Shepherd, Janine Sanchez, Barbara Piccini, Jacques Beltrand, Lisa R. Letourneau-Freiberg, Michel Polak, Siri Atma W. Greeley, Eamon Rawlins, Tarig Babiker, Nicholas J. Thomas, Elisa De Franco, Sian Ellard, Sarah E. Flanagan, Andrew T. Hattersley, Fauzia Mohsin, Elizabeth Cummings, Laurent LeGault, Zubin Punthakee, John Van Der Meulen, Ethel Codner, Vivian Gallardo, Meena Rafiq, Jayne Houghton, Kashyap Amratlal Patel, Tamsin Ford, Janani Kumaraguru Pillai, Roisin Finn, Ali Chakera, Klemens Raile, Martin Schebek, Andrea Werner, Vandana Jain, Emmeline Heffernan, Brunella Iovane, Lucia Russo, Bastiaan De Galan, Paul Voorhoeve, Pal Njolstad, Asta Sulen, Adriana Dankovcikova, Daniela Gasperikova, Juraj Stanik, Banu Aydin, Firdevs Bas, Ruveyde Bundak, Feyza Darendeliler, Stanca Raceala-Motoc, Juan C. Sanchez, Katherine E. Bauer, Kara W. Greeley
Journal: Diabetes Care (2020)

OBJECTIVE ABCC8 mutations cause neonatal diabetes mellitus that can be transient (TNDM) or, less commonly, permanent (PNDM); ∼90% of individuals can be treated with oral sulfonylureas instead of insulin. Previous studies suggested that people with ABCC8-PNDM require lower sulfonylurea doses and have milder neurological features than those with KCNJ11-PNDM. However, these studies were short-term and included combinations of ABCC8-PNDM and ABCC8-TNDM. We aimed to assess the long-term glycemic and neurological outcomes in sulfonylurea-treated ABCC8-PNDM. RESEARCH DESIGN AND METHODS We studied all 24 individuals with ABCC8-PNDM diagnosed in the U.K., Italy, France, and U.S. known to transfer from insulin to sulfonylureas before May 2010. Data on glycemic control, sulfonylurea dose, adverse effects including hypoglycemia, and neurological features were analyzed using nonparametric statistical methods. RESULTS Long-term data were obtained for 21 of 24 individuals (median follow-up 10.0 [range 4.1–13.2] years). Eighteen of 21 remained on sulfonylureas without insulin at the most recent follow-up. Glycemic control improved on sulfonylureas (presulfonylurea vs. 1-year posttransfer HbA1c 7.2% vs. 5.7%, P = 0.0004) and remained excellent long-term (1-year vs. 10-year HbA1c 5.7% vs. 6.5%, P = 0.04), n = 16. Relatively high doses were used (1-year vs. 10-year dose 0.37 vs. 0.25 mg/kg/day glyburide, P = 0.50) without any severe hypoglycemia. Neurological features were reported in 13 of 21 individuals; these improved following sulfonylurea transfer in 7 of 13. The most common features were learning difficulties (52%), developmental delay (48%), and attention deficit hyperactivity disorder (38%). CONCLUSIONS Sulfonylurea treatment of ABCC8-PNDM results in excellent long-term glycemic control. Overt neurological features frequently occur and may improve with sulfonylureas, supporting early, rapid genetic testing to guide appropriate treatment and neurodevelopmental assessment.
Students forced to travel across UK to sit compulsory exams
Authors: Nikki Nabavi
Journal: BMJ (2020)

Final year medical students will have to travel across the country to sit a compulsory test because of a lack of available slots at local testing centres.

The situational judgement test (SJT) is a compulsory exam for entry to the UK Foundation Programme designed to test the attributes needed to work as a foundation doctor.1 This year students will sit the exam at Pearson VUE testing centres rather than at their university.

Testing slots for the SJT were released on the morning of …
18F-PSMA-1007 PET/CT for Initial Staging of Renal Cell Carcinoma in an End-Stage Renal Disease Patient
Authors: Fahad Marafi, Arun Sasikumar, Mariam Aldaas, Abdulredh Esmail
Journal: Clinical Nuclear Medicine (2020)

Abstract A 46-year-old man with end-stage renal disease and renal cell carcinoma underwent 18 F-FDG PET/CT for initial staging followed by 18 F-PSMA-1007 PET/CT. Unlike 18 F-FDG, which undergoes renal clearance, 18 F-PSMA-1007 undergoes hepatobiliary clearance and thus generates superior quality images. 18 F-PSMA-1007 PET/CT showed intense tracer-avid left renal mass lesion (FDG nonavid); lytic bone lesions (FDG avid) and single liver lesion (FDG nonavid). This case highlights the superiority of 18 F-PSMA-1007 over 18 F-FDG PET/CT in identifying primary lesion as well as metastatic sites in case of renal cell carcinoma even in the presence of end-stage renal disease.
Abstract 16353: Effects of Dapagliflozin on Physical and Social Activity Limitations in Patients With Heart Failure and Reduced Ejection Fraction: An Analysis of DAPA-HF
Authors: Kieran Docherty, Mikhail N Kosiborod, Silvio E Inzucchi, Lars Kober, Anna Maria Langkilde, Felipe A Martinez, Olof Bengtsson, Piotr Ponikowski, Marc S Sabatine, Mikaela SjÃ¶strand, Scott Solomon, Pardeep S Jhund, John J McMurray
Journal: Circulation (2020)

Background: Patients with heart failure and reduced ejection fraction (HFrEF) suffer limitations in physical and social activities. We examined whether the SGLT2 inhibitor dapagliflozin improved the degree of physical and social activity limitation measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) in DAPA-HF. Hypothesis: Dapagliflozin, compared with placebo, would reduce the limitations of physical and social activity experienced by patients with HFrEF. Methods: We examined the effect of dapagliflozin on the physical and social limitation domains of the KCCQ at 8 months (prespecified analysis time point). Mean change from baseline was calculated using a linear regression model adjusted for baseline values with no imputation for missing data. Scores range from 0-100, with higher scores indicating better health status. Findings: At baseline, 4443 (94%) patients had available KCCQ data. Mean baseline physical limitations and social limitations scores were 66.0±24.0 and 65.5±27.4, respectively. Of the 10 individual domains that constitute these scores, the greatest limitations reported by patients at baseline were in doing gardening or housework or carrying groceries, hurrying/jogging and sexual relationships. Dapagliflozin improved physical and social limitations scores at 8 months (placebo-corrected mean difference +1.88 [95%CI 0.66,3.10] and +1.60 [0.18,3.01], respectively). Each individual domain reflecting physical and social limitations improved with dapagliflozin with the exception of sexual relationships (Table); the greatest improvements were seen in doing gardening or housework or carrying groceries (+2.48 [0.63,4.33]), hobbies and recreational activities (+2.46 [0.75-4.17]), and walking 100yd on level ground (+2.29 [0.62,3.96]). Interpretation: In DAPA-HF, dapagliflozin, compared with placebo, improved physical and social limitations as measured by the KCCQ in patients with HFrEF.
Assessing Alternative Payment Models
Authors: Suhas Gondi, Rishi K. Wadhera
Journal: JAMA (2020)

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