tbuckley/cabot-search huggingface dataset:
DISEASE SEVERITY AND TIME SINCE TRANSPLANTATION DETERMINE PATIENT MORTALITY AMONG LIVER TRANSPLANT RECIPIENTS WITH COVID-19 INFECTION: A META-ANALYSIS
Authors: M. Waleed, M. A. Arshad, M. Abdallah, Z. M. Younossi, A. K. Singal
Journal: Hepatology (2020)

Background: Liver injury is frequently reported in patients with corona virus disease 19 infection (Covid-19) Further, immune suppressed individuals including liver transplant (LT) recipients are at risk of acquiring infections including Covid-19 However, data on patient mortality and its predictors among LT recipients infected with Covid-19 are scanty Methods: A systematic search of PubMed, Science direct, Web of Science and the Cochrane Library was carried out from February 1, 2020 to June 24, 2020 All studies including case reports on LT recipients infected with Covid-19 and reporting patient outcomes were included Data were pooled using Revman-4 software for baseline characteristics and patient mortality We also examined variables associated with mortality Results: A total of 11 studies (7 correspondences, 3 case series and 7 case reports combined as one study) were included with 230 LT recipients infected with Covid-19 (mean age 57 4±2 5 years, 72% males, 49% hypertension, 36% diabetes mellitus (Table) Fever and cough were commonest symptoms in 68 (60-75) % and 59 (42-74) % respectively Tacrolimus was most frequently used immunosuppressive agent in 82% Disease severity was mild to moderate (home monitoring or admission on floor) in 87% and remaining 13% had severe Covid-19 (ICU admission or mechanical ventilation) A total of 41(17 8%) died from complications of Covid-19 Rate of severe disease and of mortality from Covid-19 in historical worldwide controls is 4 9-11 5% and 4 4% respectively Patients with severe disease had 8 7 folds risk of dying compared to those with mild to moderate disease (Figure 1 A) Further, odds of dying from Covid-19 was about 4 folds among patients transplanted over 2 years ago vs LT recipients less than 2 years ago (Figure 1B) Patient mortality was similar comparing 131 males and 52 female LT recipients, 1 58 (0 63-3 97) Similarly, mortality was similar comparing 97 patients aged >60 years vs 44 less than 60 years, 3 56 (0 83-15 30) Conclusion: LT recipients with Covid-19 have higher rate of severe disease and mortality Severe Covid-19 disease and receipt of LT over 2 years ago are associated with higher mortality Large prospective studies are needed to validate these findings and further refine predictors of mortality, as basis for stratifying acuity of care required for LT recipients who are infected with Covid-19(Figure Presented)(Table Presented)
Abstract 16257: Giant Left Circumflex (LCx) Coronary Artery Aneurysm (CAA) Presenting as a Cardiac Mass
Authors: Ahmad O Aljamal, Mohamad Raad, Sachin Parikh
Journal: Circulation (2020)

Introduction: CAAs are a rare but potentially life-threatening condition. Commonly defined as localized dilations greater than 1.5 times the adjacent artery, “giant” CAA (GCAA) is a term used to describe CAAs that have progressed to greater than four times the adjacent artery. Case: A 73-year-old male who presented with acute dyspnea was found to have a 4.5cm epicardial mass on computed tomography angiography (CTA) of the chest. Coronary angiography revealed a large partially thrombosed saccular aneurysm of the proximal LCx with diffuse ectasia of the remaining coronary arteries. He underwent percutaneous coronary intervention (PCI) with the placement of a covered stent from the left anterior descending to the left main artery, traversing and effectively occluding the LCx. He tolerated the procedure and was discharged on clopidogrel and apixaban. Discussion: Due to their insidious nature, CAAs are underdiagnosed and progress undetected. Serious complications include aneurysm rupture and fistula formation. CAAs are most commonly caused by atherosclerosis but have been associated with infectious, rheumatologic, and genetic etiologies. Drug-eluting stents are increasingly implicated in CAAs by the mechanism of direct vessel trauma and drug-induced inhibition of smooth muscle proliferation. The optimal management of CAAs remains unclear. Cardiovascular risk reduction and monitoring are recommended. Invasive management is usually reserved for giant or unstable aneurysms. Surgical resection or repair is conventional but percutaneous methods such as coiling and stent occlusion are increasingly utilized. Our patient underwent a successful vessel and aneurysm occlusion with favorable post-PCI outcomes. Conclusion: GCAAs are extremely rare and understudied. Percutaneous management appears effective in the management of GCAAs, but the study of long-term safety and outcomes is required.
Abstract 14211: Positive Predictive Value of Troponin for NSTEMI Based on Chief Complaint
Authors: Scott Kirkpatrick, Andy Hammes, Eric Rudofker, Stacy Trent, Sean Michael, Andrew Levy
Journal: Circulation (2020)

Introduction: Serum troponin is a ubiquitous biomarker used to diagnose acute myocardial infarction (AMI). The positive predictive value (PPV) of high-sensitivity troponin for Type 1 Myocardial Infarction is approximately 15% in the United States, compared with 55% in Europe, a difference that may be explained by differences in patient selection for testing. Our objective was to examine test characteristics for contemporary troponin assays based on chief complaint in the Emergency Department (ED). Methods: In a retrospective cohort analysis, we examined all 30,833 encounters in which a troponin test was performed in any of the 14 emergency departments within a large integrated health system between 10/1/18 and 10/1/19. All hospitals used a contemporary cardiac troponin-I (cTnI) assay. We excluded patients with ST-segment elevation myocardial infarction (STEMI) since this diagnosis is made by electrocardiogram. We grouped patients by chief complaint (CC) and further stratified by pre-specified cTnI thresholds. Within each cTnI/CC category, we calculated the proportion of patients subsequently classified with a principal ICD-10 diagnosis of non-STEMI (NSTEMI). Results: For all patients selected for cTnI testing, 1.7% were diagnosed with NSTEMI. Overall, the PPV of cTnI for NSTEMI was 11%. This PPV for NSTEMI was highest among patients with chest pain (33%). Excluding patients with chest pain, the PPV for NSTEMI was 3.9%. For nearly all chief complaints, the PPV for NSTEMI increased with higher cTnI thresholds. Conclusion: In a large integrated health system, fewer than one in fifty patients undergoing cTnI testing in the ED were ultimately diagnosed with NSTEMI. The PPV of cTnI for NSTEMI was significantly higher among patients presenting with chest pain compared to other chief complaints. These data highlight the importance of selecting patients for testing and interpreting abnormalities in the context of presenting symptoms.
Abstract 14352: Staged Hybrid Atrial Fibrillation Ablation With Addition of Endoscopic Left Atrial Appendage Closure Reduces Arrhythmia Recurrence Between 3 and 12 Months Compared to Non-staged Hybrid Without Closure
Authors: David C Kress, Lynn Erickson, Ana C Perez Moreno, Imran Niazi, M. Eyman Mortada, Jodi Zilinski, David Krum, Jasbir Sra
Journal: Circulation (2020)

Introduction: The hybrid, or convergent procedure, uses a minimally invasive combined epicardial/endocardial ablation approach for patients in persistent AF. In the staged hybrid approach, the electrophysiologist performs the endocardial ablation a minimum of 30 days after the surgeon performs epicardial ablation. Placement of a left atrial appendage (LAA) closure device (AtriCure AtriClip) has been shown to electrically isolate the LAA. Added to the scar formation on the posterior wall via epicardial ablation, it eliminates additional substrate in persistent atrial fibrillation (AF). Hypothesis: Patients with persistent AF who underwent a staged hybrid approach with thoracoscopic placement of the AtriClip may have less likelihood of arrhythmia recurrence between 3 and 12 months compared with those who underwent nonstaged hybrid ablations without use of the AtriClip. Methods: Patients in persistent or long-standing paroxysmal AF underwent ablation using either a staged hybrid approach with AtriClip (n=23) or a nonstaged hybrid approach without AtriClip (n=136). Groups were compared by running a t-test (mean±SD) or Wilcoxon rank sum [median, interquartile range (IQR)]. Categorical data were compared with Pearson’s chi-squared test. Results: Significantly fewer patients who had undergone a staged hybrid with AtriClip recurred with arrhythmia (2, 8.7%) compared to those with a nonstaged, no AtriClip approach (40, 29.4%) (p=0.04) between 3 and 12 months. The staged hybrid approach also had significantly fewer patients requiring cardioversion to restore sinus rhythm during the procedure (p&lt;0.001). Conclusions: A staged hybrid approach with AtriClip placement reduced recurrent arrhythmia between 3 and 12 months compared to a nonstaged hybrid procedure without AtriClip. A benefit was also seen in a steep reduction in the need for cardioversion during the subsequent endocardial ablation to restore sinus rhythm.
Abstract 15437: Intravenous Nicorandil versus Adenosine for Fractional Flow Reserve Measurement to Assess Coronary Artery Stenosis: A Systematic Review and Meta-analysis
Authors: Nso A Nso, Kaveh Rezaei Bookani, Daniel Antwi-Amoabeng, Bryce Beutler, Sirri Atanga, Joyce Nimo-Boampong, Sostanie Enoru, Munadel Awad, Nageshwara Gullapalli, Farshid Radparvar
Journal: Circulation (2020)

Background: Fractional flow reserve (FFR) has become an increasingly accepted modality to assess coronary artery stenosis. Several clinical trials have been conducted to compare the effects of various pharmacologic agents, including nicorandil and adenosine, in achieving maximum coronary hyperemia. Methods: We searched PubMed, Cochrane Library, Scopus, and Web of Sciencefor randomized and observational studies comparing nicorandil with adenosine for measurement of FFR. Data were extracted from the eligible studies and pooled in a meta-analysis using the Revman software. Dichotomous data were pooled as risk ratio (RR) and continuous data were pooled as standardized mean difference (SMD) with the corresponding 95% confidence intervals (CI).We aimed to evaluate the average FFR, hyperemia, duration of hyperemia, decrease in systolic blood pressure, and pain scores assessed by visual analog scale (VAS). Results: Five studies comprising a total of 595 patients met our inclusion criteria. The combined effect estimate favored nicorandil over adenosine for mean FFR (SMD = -0.17, 95% CI [-0.28, -0.06], P = 0.004). Nicorandil was more effective in achieving adequate hyperemia as compared to adenosine (SMD = -2.06, 95% CI [-4.36, -0.84], P=0.004). However, no significant differences were reported between nicorandil and adenosine in the duration of hyperemia, the decrease in systolic blood pressure, and VAS pain scores. Conclusion: Nicorandil is associated with superior clinical outcomes and similar safety profile as compared to adenosine and should therefore be considered as an alternative agent for FFR evaluation.
Quantifying the role of neurons for behavior is a mediation question
Authors: Ilenna Simone Jones, Konrad Paul Kording
Journal: Behavioral and Brain Sciences (2019)

Many systems neuroscientists want to understand neurons in terms of mediation; we want to understand how neurons are involved in the causal chain from stimulus to behavior. Unfortunately, most tools are inappropriate for that while our language takes mediation for granted. Here we discuss the contrast between our conceptual drive towards mediation and the difficulty of obtaining meaningful evidence.
Complications in Patients With COVID-19
Authors: George A. Stavroulakis, George Koutroulis, Kourea Kallirrhoe
Journal: JAMA Cardiology (2020)

Complications in Patients With COVID-19To the Editor Madjid et al 1 recently reviewed the association between the cardiovascular system and infection with coronavirus disease 2019 (COVID-19).They point out the association between cardiovascular risk factors and the outcome of patients with COVID-19.However, the underlying risk associated with obesity was not listed among the risk factors.There are several lines of evidence that being overweight or obese is associated with risk of poor outcome (ie, admission to an intensive care unit or death) after infection with COVID-19.Recently, 72% of 775 patients with COVID-19 admitted to an intensive care unit in the UK were reported to have a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) greater than 25 and 38% had a BMI greater than 30, 2 a proportion higher than in the standard intensive care population.Obesity is also reported as a risk factor of poor outcome by the US Centers for Disease Control and Prevention. 3 A potential pathophysiological background exists linking the increasing severity of COVID-19 among patients with obesity.COVID-19 binds to angiotensin-converting enzyme 2 (ACE2), a surface molecule that allow the virus to enter the host cell.In this line, the role of angiotensin-conversing enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) in the pathogenicity of COVID-19 has been intensively debated. 4The level of ACE2 expression has been reported to be high in adipose tissue, therefore likely making the adipose tissue a reservoir for severe acute respiratory syndrome coronavirus 2. 5 In turn, the adipose tissue can trigger an increased inflammatory response to infection, potentially affecting all organs.Finally, patients with obesity can be at higher risk of hypoxemia due to altered thoracic compliance and the risk of lung atelectasis.I suggest that both BMI and treatment with ACEi or ARB be systematically reported in case series of patients with COVID-19 to further appreciate their interaction and association with outcome.Further research should then explore the impact of adipose tissue on the viral load, the systemic inflammatory response, and the outcome of patients with COVID-19.In the meantime, the potential risk of future deterioration should probably be appreciated in overweight patients developing COVID-19-related symptoms.
The necessity of diplomacy in brain health
Authors: Walter D Dawson, Kirsten Bobrow, Agustin Ibanez, Laura Booi, Maritza Pintado-Caipa, Stacey Yamamoto, Ioannis Tarnanas, Timothy Evans, Adelina Comas-Herrera, Jeffrey Cummings, Jeffrey Kaye, Kristine Yaffe, Bruce L Miller, Harris A Eyre
Journal: The Lancet Neurology (2020)
Abstract 17143: Acute Coronary Syndromes Associated With SARS-CoV-2 Infection Admissions in a Medium Size Community Hospital
Authors: Andreea-Constanta Stan, Momcilo Durdevic, Rosario Florante, Arshavir Artashesyan, Henrik Elenius, Amrah Hasan
Journal: Circulation (2020)

Background: The presence of cardiovascular complications were reported in small studies of critical care patients admitted with SARS-CoV-2infection There is a dearth of data regarding presence of acute coronary syndromes (ACS) in patients admitted with symptomatic SARS-CoV-2 infection, the cause of the myocardial injury and particularities of management. Objectives: The aim of the study is to describe the presence and type ACS in patients admitted with symptomatic SARS-CoV-2 infection. Secondary outcomes were contributing factors, presenting symptoms and medical management. Methods: A descriptive, retrospective study of patients with a positive COVID-19 test and symptomatic infection admitted from 10 March 2020 to 10 April 2020 in our hospital. Results: There were a total of 127 patients admitted with symptomatic SARS-CoV-2 infection. The most common ACS was Type II Myocardial Infarction (MI). 16 patients were diagnosed with type II MI, 3 patients with Non ST elevation myocardial infarction (NSTEMI) and no patient was diagnosed with unstable angina and ST elevation myocardial infarction (STEMI). The most common cause of Type II MI was hypoxia followed by congestive heart failure and new onset atrial fibrillation. One patient has chest pain as presenting symptom. Except for Aspirin loading and use of beta blocker no other antischemic, statin or ACE/ARB medication was used for management of type II MI. All patients with Type II MI were managed by primary care teams. 3 patients developed NSTEMI and were managed by primary care teams with Cardiology consults. Anti-coagulation was considered for all patients. All patients received Aspirin loading, high intensity statin and beta blockers. Conclusions: Majority of patients with ACS had symptoms related to SARS-CoV-2 infection and chest pain was absent in 95% of cases. The most common ACS was type II MI- myocardial ischemia in context of hypoxia and the treatment was focused in treating the underlying cause rather than initiation of classical guideline directed therapy or invasive management. There were no cases of unstable angina and STEMI, results consistent with previous studies underlying the low incidence of STEMI cases during this pandemic.
Abstract 13597: Association Between Antiarrhythmic Drug Therapy Prescription in the Blanking Period and Recurrent Atrial Arrhythmias After First-time Catheter Ablation for Atrial Fibrillation
Authors: Chaitanya L Malladi, Michael Eskander, Florentino Lupercio, Frederick Han, Kurt S Hoffmayer, farshad raissi, Gordon Ho, Gregory K Feld, Jonathan C Hsu
Journal: Circulation (2020)

Introduction: Antiarrhythmic drugs (AAD) are often prescribed in the blanking period (BP) after catheter ablation of atrial fibrillation (AF) to reduce risk of early recurrence (ER) and late recurrence (LR). There are limited data on which AAD to use during the BP. Hypothesis: We hypothesize that specific AADs may be associated with reduced risk of ER and/or LR after ablation. Methods: A total of 478 consecutive patients (mean age 64.2 years, 67.2% male) undergoing first-time pulmonary vein isolation (PVI) ablation at a single institution were included. Outcomes of interest were: freedom from ER, freedom from LR, initial discontinuation of AAD less than 90 days after ablation, and freedom from second ablation. ER was defined as AF, atrial flutter (AFL), or atrial tachycardia (AT) &gt; 30 seconds within the BP. LR was defined as AF/AFL/AT &gt; 30 seconds occurring after the BP. Results: Of 478 patients, 14.9% (n = 71) were on no AAD, 26.4% (n = 126) were on propafenone/flecainide, 34.5% (n = 165) were on sotalol/dofetilide, 10.7% (n = 51) were on dronedarone, and 13.6% (n = 65) were on amiodarone. Patients on amiodarone were older, had higher BMI, and were more likely to have persistent AF, hypertension, diabetes, heart failure, and coronary artery disease. In unadjusted analyses, there were no differences between groups with regards to the risk of ER (log rank P = 0.171), discontinuation of AAD before ninety days post-ablation (log rank P = 0.235), or freedom from second ablation (log rank P = 0.147). After multivariable adjustment, patients on amiodarone or dronedarone were more likely to experience LR than those on no AAD [Adjusted Hazard Ratio (AHR) 1.83, 95% CI 1.10-3.04, p=0.02 for amiodarone; AHR 1.79, 95% CI 1.05-3.05, p=0.03 for dronedarone]. Conclusions: Following first-time AF catheter ablation, there were no differences between the presence or absence of AAD and risk of ER, while those prescribed amiodarone or dronedarone in the BP were more likely to experience LR than those on no AAD.
FRI0215 SjÖgren’s syndrome manifestations in primary biliary cirrhosis
Authors: C Geli, J Enriquez, C Diaz, JM Llobet, M Moreno, C Diaz-Torne, A Rodriguez de la Serna, G Vazquez
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> <h3>Objectives</h3> Study the Sjögren’s Syndrome (SS) manifestations in a sample of patients with Primary Biliary Cirrhosis. <h3>Methods</h3> From October 1999 to May 2000 81 patients from the hepatology outpatient department were studied. We used the european criteria for the diagnostic of SS. Extraglandular clinical manifestations, analitical and inmunological study was evaluated using the unity protocol. <h3>Results</h3> 90% were women. The mean age was 61 ± 11 y. Clinical evolution was of 6 years. Ocular dryness was present in 60(74%) and oral dryness in 60(76%). Schirmer and/or bengal´s rose were positive in 21(26%). The most common extraglandular manifestations were: Fibromialgy in 42(51%), Raynaud´s phenomenom in 21(26%), CREST´s syndrome in 13(16%), thyropathy in 21(26%), antythyroidal antibodies were positive in 19(24%)(Ten of them had hipothyroidism and two of them goitres), arthritis in 7(9%)(Two of them were erosive), inflammatory osteoarthritis in 5(6%), vasculitis in 3(4%), ANA &gt;80 in 47(58%), Rheumatoid factor in 27(33%), SS-A/Ro antibodies in 14(17%) and SS-B/La in 8(10%). 9 CREST´s patients were positive for anticentromere antibodies. 41(50%) had 4 or more SS European criteria. A minor salival gland biopsy was realised in 53 patients. 39 of them were positive (73%). 41 of the biosed patients had 3 or more criteria. 31 of this 41 patients has a positive biopsy (75%). The other 12 patients had 2 or less criteria, just 5 of them had a positive biopsy (41%). <h3>Conclusion</h3> There is a high prevalence of SS (50%) in patients with CBP. Keratoconjuctivitis sicca´s prevalence is 66%. Subjective involvement of oral and ocular dryness are 74% and 76% respectively. Fibromialgy is the rheumatological clinic more frequent, appearing in more than 50% of the patients.
Abstract 17153: Race/Ethnicity, Education, and Health Status Predict Shared Decision Making in Hypertension Care in the Rich Life Project
Authors: Sabrina S Elias, Yvonne Commodore-Mensah, Lisa A Cooper, Cheryl Himmelfarb
Journal: Circulation (2020)

Introduction: In shared decision making (SDM), clinicians and patients make decisions together using the best evidence, along with patients’ preferences and values. Though SDM is a strategy recommended in guidelines to improve hypertension (HTN) control, SDM likely varies by individual characteristics such as race/ethnicity. Hypothesis: SDM and its determinants will vary by race/ethnicity. Methods: Within a pragmatic trial (The RICH LIFE Project) to reduce HTN disparities among individuals with uncontrolled HTN, we examined individual characteristics at baseline (ie, systolic and diastolic blood pressure (BP), age, sex, race/ethnicity, education, health literacy, subjective numeracy, and health status) to identify determinants of SDM at 12 months using multivariable logistic regression. SDM was measured using CollaboRATE; “top score” reflected highest possible score of 27. Results: Participants (n=1,266) were non-Hispanic (NH) Black (57%), NH White (35%) and Hispanic (8%); 41% male; with mean age 61 (±11.68). At baseline, Hispanics were more likely to have ≤ high school education (87%), &lt;15,000 household income (44%), poor health status (24%), poor HTN knowledge (26%), and inadequate health literacy (59%) compared to NH Blacks and Whites (p&lt;0.001). Mean systolic (153.6±13.1) and diastolic (87.5±12.24) BP were highest among NH Blacks. At 12 months, SDM mean scores were higher among NH Blacks, 7.5± 2.4, than Hispanics, 6.9±3, and NH Whites, 6.6± 2.9. Black race, higher education, and better health status predicted higher SDM (highest score of 27 on CollaboRATE scale) (Table). Conclusion: Race/ethnicity, education, and health status predict SDM among individuals with uncontrolled hypertension. Further research is needed to understand factors influencing SDM and opportunities for cultural-tailoring of interventions to improve SDM and HTN control.