Emergency Department Presentation of Retinal Artery Occlusion

Purpose: To determine how frequently patients who present to an emergency department (ED) with a retinal artery occlusion (RAO) undergo brain imaging and cardiovascular testing and are hospitalized.

Design: Retrospective cross-sectional study.

Participants: Patients who presented to an ED with an RAO in the National Emergency Department Sample (NEDS), a nationally representative United States database.

Methods: The NEDS was queried to identify patients who presented to an ED with the primary diagnosis of RAO between 2006 and 2014. Patient and hospital characteristics were evaluated, and a multivariable regression was performed to determine predictors of hospitalization. Testing was categorized into 3 groups: (1) brain imaging performed using computed tomography or magnetic resonance; (2) carotid imaging performed using ultrasound, computed tomography, or magnetic resonance; and (3) cardiac testing performed using electrocardiogram or echocardiogram. The number of tests performed for each category was recorded.

Main outcome measures: Proportions of patients undergoing brain imaging, carotid imaging, or cardiac testing. Rate and predictors of hospitalization.

Results: Among 259 343 582 ED visits, 2802 had a primary diagnosis of RAO. Patients were mostly aged ≥65 years (59%) and male (54%). Hypertension (59%), dyslipidemia (36%), and diabetes (20%) were the most common preexisting cardiovascular diseases. Brain imaging, carotid imaging, and cardiac testing were performed in 20.3%, 7.1%, and 23.8% of the patients, respectively; at least 1 test from each of these 3 categories was performed in 4.1% of the patients. Half of the patients were hospitalized. Factors that increased the chances of hospitalization included the following (P < 0.05): age of <45 years; female sex; a history of smoking; presenting to a metropolitan hospital and having giant cell arteritis, carotid artery disease, atrial fibrillation, cardiac valve disease, obesity, dyslipidemia, hypertension, diabetes, and chronic ischemic heart disease.

Conclusions: Most patients who presented to an ED with an RAO did not receive emergency brain imaging, carotid imaging, or basic cardiac testing. A multidisciplinary approach is needed to raise awareness that RAOs should be treated as a precursor of stroke or a stroke equivalent.https://pubmed.ncbi.nlm.nih.gov/34742898/

Global uptake of fertility preservation by women undergoing cancer treatment: An unmet need in low to high-income countries

Although the incidence of cancers is on the rise globally, mortality has continued to decrease due to advances in early detection and treatment. Cancer treatments such as chemotherapy and radiotherapy can impact the reproductive capacity of survivors by inducing premature ovarian failure and subsequent infertility causing significant psychological distress with decreased quality of life. Despite the increasing need for fertility preservation services for the rising number of cancer survivors and the recent advances in assisted reproductive technology, many women with cancers in low, middle, and to a lesser extent, high-income countries have no access to these services. This article, therefore, presents an overview of the effect of cancer treatment on fertility, options of fertility preservation, and factors influencing fertility preservation utilization by women who had a cancer diagnosis. In addition, we discuss the availability, practices, and outcomes of fertility preservation services in low, middle, and high-income countries and highlight pragmatic steps to improving access to oncofertility care for women with cancers globally.https://pubmed.ncbi.nlm.nih.gov/35605436/

Predictors of Completed Suicides Among Emergency Department Visits for Attempted Suicides

Background: The objective of this study was to identify predictors of mortality among patients presenting to the emergency department (ED) with attempted suicides.

Methods: We analyzed data on emergency department (ED) visits for attempted suicides from the Nationwide Emergency Department Sample (NEDS) database from January 2010 to December 2017. The predictors of mortality were determined in multivariate analysis including age, sex, insurance, annual income, region of the country, mechanism of injury, mental health conditions (schizophrenia; depression; and anxiety, bipolar, and personality disorders), chronic illnesses (hypertension, diabetes, obesity, and dementia), and social risk factors such as alcohol addiction, smoking, and substance abuse.

Results: From 2010 to 2017, there were 979,383 ED visits for attempted suicides in the NEDS database. Among these patients, 10,301 (1.1%) died. Of these completed suicides, 73.9% were male with the median age of 43 years (IQR, 30) while the unsuccessful suicide attempt group had a median age of 30 years (IQR, 24) and were 42.7% male. The most common mechanisms of suicide attempt were poisoning (58.8%) and cut injury (25.6%). Gunshot was the most lethal mechanism accounting 40.3% of the completed suicides despite representing 1.3% of the attempts who came to ED. After controlling for common risk factors for attempted suicide, significant predictors of completed suicide include higher income status, uninsured status, male sex, and higher age.

Discussion: Among US patients presenting to the ED following attempted suicide, factors associated with suicide completion include increasing age, male sex, higher income, gunshot injuries, and uninsured status.https://pubmed.ncbi.nlm.nih.gov/36853915/

Racial Disparities in Survival Among Non-Hodgkin Lymphoma Patients: An Analysis of the SEER Database (2007-2015)

Introduction Although disparities in cancer survival exist across different races/ethnicity, the underlying factors are not fully understood. Aim To identify the interaction between race/ethnicity and insurance type and how this influences survival among non-Hodgkins lymphoma (NHL) patients. Methods We utilized the SEER (Surveillance, Epidemiology, and End Results) Registry to identify patients with a primary diagnosis of NHL from 2007 to 2015. Our primary outcome of interest was the hazard of death following a diagnosis of NHL. In addition, we utilized the Cox regression model to explore the interaction between race and insurance type and how this influences survival among NHL patients. Results There were 44,609 patients with NHL who fulfilled the study criteria. The mean age at diagnosis was 50.9 ± 10.8 years, with a mean survival of 49.8± 34.5 months. Among these patients, 64.8% were non-Hispanic Whites, 16% were Hispanics, and 10.8% were Blacks. In addition, 76.5% of the study population had private insurance, 16.6% had public insurance, and 6.9% were uninsured. Blacks had the worst survival (HR=1.66; 95% = 1.55-1.78). Patients on private insurance had better survival compared to those with public insurance (HR=2.11; 95% CI=2.00-2.24) Conclusion The racial and socioeconomic disparity in survival outcomes among patients with NHL persisted despite controlling for treatment modalities, age, and disease stage.https://pubmed.ncbi.nlm.nih.gov/35836466/

Intimate Partner Violence: An Independent Predictor of Emergency Department Visits for Attempted Suicides and Self-inflicted Injuries among American Women

Introduction: Intimate Partner Violence (IPV) is becoming a significant public health issue and has been associated with adverse health outcomes such as mental health disorders, medical conditions, and devastating lifestyle behaviors. The lifetime cost estimated with IPV has been estimated to be $3.6 trillion. Intimate partner violence (IPV) has been associated with attempted suicide and self-inflicted injuries.

Aim: To determine if IPV is an independent predictor of attempted suicides and self-inflicted injuries among American women.

Methods: We analyzed data on emergency department visits for attempted suicides and self-inflicted injuries from the National Emergency Sample database from January 2016 to December 2017. In a multivariate analysis, we determined the association between IPV and attempted suicides and self-inflicted injuries, controlling for covariates such as schizophrenia and other psychotic symptoms, anxiety disorders, depression, bipolar disorder, dementia, alcohol and substance abuse disorder, hospital region, insurance, and annual income. Samples were weighed to generate nationally representative estimates.

Results: We identified 64,152 women who visited the ED on account of attempted suicide and self-inflicted injuries between January 2016 and December 2017. Among this population, 0.19% have a background history of IPV. IPV increased the risk of attempted suicides/ self-inflicted injuries by 4 folds (OR= 4.34, 95% CI 1.56-12.13, p < 0.01).

Conclusion: Intimate partner violence is an independent predictor of increased risk of attempted suicides and self-inflicted injuries.https://hphr.org/62-article-akinyemi/

Postoperative atrial fibrillation following non-cardiac surgery: Predictors and risk of mortality

Background: Postoperative atrial fibrillation (POAF) is a major complication that follows both cardiac and non-cardiac procedures. Many studies have explored POAF after cardiac procedures, however POAF following non-cardiac procedures has been understudied.

Methods: National Inpatient Sample database was utilized to conduct a retrospective study of hospitalizations with diagnosis of POAF following non-cardiac procedures between 2010 and 2015.

Results: 294,112 patients met the inclusion criteria. Advanced age, male gender, colonic resections, coagulopathy, fluid and electrolyte disorders and history of congestive heart failure are major predictors of POAF and in-hospital mortality. Race, type of insurance, income quartile and weekend admissions are independent determinants of mortality following POAF.

Conclusions: Development of POAF and mortality is dependent upon a wide range of factors not limited to age and medical comorbidities. Although a patient may be at an increased risk for POAF this does not mean they are at an increased risk for mortality.https://www.sciencedirect.com/science/article/abs/pii/S0002961022004573

Color or money?: The impact of socioeconomic status and race/ethnicity on breast cancer mortality

Background: Although the incidence of breast cancer is highest in White women, Black women die at a higher rate. Our aim was to compare the relative association between race/ethnicity and socioeconomic status on breast cancer mortality.

Methods: We identified female breast cancer patients diagnosed between 2007 - 2011 and followed through 2016 in the SEER database. Patients were grouped into socioeconomic quartiles by a prosperity index. The primary outcome of interest was 5-year cancer-specific survival.

Results: A total of 286,520 patients were included. Five-year survival was worst for Black women compared to other races/ethnicities in each socioeconomic quartile. When compared to White women in the lowest quartile, Black women in the lowest quartile, 2nd quartile, and 3rd quartile experienced the lowest 5-year survival rates (Hazard ratio 1.33, 1.23, 1.20; P < 0.01).

Conclusion: Regarding cancer mortality, only in the most prosperous quartile do Black women achieve a similar outcome to the poorest quartile White women.https://www.sciencedirect.com/science/article/abs/pii/S0002961022004561

Retina Fellowship Match Outcomes and Trends in Program Characteristics

https://www.sciencedirect.com/science/article/abs/pii/S2468653022003141?via%3Dihub

Increasing Pre-pregnancy Body Mass Index and Pregnancy Outcomes in the United States

Introduction: As many Americans are becoming overweight or obese, increased body mass index (BMI) is fast becoming normalized. There is a need for more research that highlights the association between pre-pregnancy obesity and adverse pregnancy outcomes.

Aim: To determine the association between increasing pre-pregnancy BMI and adverse pregnancy outcomes.

Methods: We utilized the United States Vital Statistics records to collate data on all childbirths in the United States between 2015 and 2019. We determined the association between increasing pre-pregnancy BMI and adverse pregnancy outcomes using multivariate analysis. Neonatal outcomes measures include the five-minute Apgar score, neonatal unit admission, neonates receiving assisted ventilation > six hours, neonatal antibiotics use, and neonatal seizures. Maternal outcomes include cesarean section rate, mothers requiring blood transfusion, unplanned hysterectomy, and intensive care unit admission. In addition, we controlled for maternal parameters such as race/ethnicity, age, insurance type, and pre-existing conditions such as chronic hypertension and prediabetes. Other covariates include paternal race, age and education level, gestational diabetes mellitus, induction of labor, weight gain during pregnancy, gestational age at delivery, and delivery weight.

Results: We studied 15,627,572 deliveries in the US Vital Statistics records between 2015 and 2019. Among these women, 3.36% were underweight, 43.19% were with a normal BMI, 26.34% were overweight, 14.73% were in the obese class I, 7.23% were in the obese class II, and 5.14% were in the obese class III. Increasing pre-pregnancy BMI was associated with significant adverse outcomes across all measures of maternal and neonatal outcomes.

Conclusion: A strong association exists between increasing pre-pregnancy BMI and adverse maternal and neonatal outcomes. The higher risk of adverse pregnancy outcomes among overweight and obese women remained even after controlling for other traditional risk factors of adverse maternal and neonatal outcomes.

Keywords: cesarean section; classes of obesity; gestational weight gain; macrosomia; obesity prevention; perinatal outcomes; pre-pregnancy body mass index; pregnancy outcomes.https://pubmed.ncbi.nlm.nih.gov/36196279/