Improving Safety of Direct Oral Anticoagulant (DOAC) Dosing in Patients with Severe Chronic and End-Stage Renal Disease

The significance of this study is to determine the degree of inconsistency in dosing practice of DOACs at a quaternary care institution such as Thomas Jefferson University Hospital. What is the primary indication for anticoagulation in out population? What percentage is dosed correctly? Are patients primarily over or underdosed

Evaluating the Efficacy of a Nursing-Driven versus Provider-Driven Heparin Protocol

At Thomas Jefferson University Hospital patients who require heparin infusions are monitored either by nursing alone or the resident and the nurse together. This project aims to determine: Which protocol more efficiently shortens the time to therapeutic? Are patients therapeutic longer under a certain protocol? Do more patients under either protocol suffer from bleeding complications

Adverse Outcomes of Atrial Fibrillation Ablation in Heart Failure Patients With and Without Cardiac Amyloidosis: A Nationwide Readmissions Database Analysis (2015-2019)

AIMS: Atrial fibrillation (AF) in patients with cardiac amyloidosis (CA) has been linked with a worse prognosis. The current study aimed to determine the outcomes of AF catheter ablation in patients with CA. METHODS AND RESULTS: The Nationwide Readmissions Database (2015-2019) was used to identify patients with AF and concomitant heart failure. Among these, patients who underwent catheter ablation were classified into two groups, patients with and without CA. The adjusted odds ratio (aOR) of index admission and 30-day readmission outcomes was calculated using a propensity score matching (PSM) analysis. A total of 148 134 patients with AF undergoing catheter ablation were identified on crude analysis. Using PSM analysis, 616 patients (293 CA-AF, 323 non-CA-AF) were selected based on a balanced distribution of baseline comorbidities. At index admission, AF ablation in patients with CA was associated with significantly higher adjusted odds of net adverse clinical events (NACE) [adjusted odds ratio (aOR) 4.21, 95% CI 1.7-5.20], in-hospital mortality (aOR 9.03, 95% CI 1.12-72.70), and pericardial effusion (aOR 3.30, 95% CI 1.57-6.93) compared with non-CA-AF. There was no significant difference in the odds of stroke, cardiac tamponade, and major bleeding between the two groups. At 30-day readmission, the incidence of NACE and mortality remained high in patients undergoing AF ablation in CA. CONCLUSION: Compared with non-CA, AF ablation in CA patients is associated with relatively higher in-hospital all-cause mortality and net adverse events both at index admission and up to 30-day follow-up

Hyperdynamic Left Ventricular Ejection Fraction Is Associated With Higher Mortality in COVID-19 Patients

Study objective: To compare the characteristics and outcomes of COVID-19 patients with a hyperdynamic LVEF (HDLVEF) to those with a normal or reduced LVEF. Design: Retrospective study. Setting: Rush University Medical Center. Participants: Of the 1682 adult patients hospitalized with COVID-19, 419 had a transthoracic echocardiogram (TTE) during admission and met study inclusion criteria. Interventions: Participants were divided into reduced (LVEF \u3c 50%), normal (≥50% and \u3c70%), and hyper- dynamic (≥70%) LVEF groups. Main outcome measures: LVEF was assessed as a predictor of 60-day mortality. Logistic regression was used to adjust for age and BMI. Results: There was no difference in 60-day mortality between patients in the reduced LVEF and normal LVEF groups (adjusted odds ratio [aOR] 0.87, p = 0.68). However, patients with an HDLVEF were more likely to die by 60 days compared to patients in the normal LVEF group (aOR 2.63 [CI: 1.36–5.05]; p \u3c 0.01). The HDLVEF group was also at higher risk for 60-day mortality than the reduced LVEF group (aOR 3.34 [CI: 1.39–8.42]; p \u3c 0.01). Conclusion: The presence of hyperdynamic LVEF during a COVID-19 hospitalization was associated with an increased risk of 60-day mortality, the requirement for mechanical ventilation, vasopressors, and intensive care unit

Spontaneous Tumor Lysis Syndrome in Undifferentiated Pelvic Solid Tumor with Associated New Onset Atrial Flutter: A Case Report

Tumor lysis syndrome (TLS) is an oncologic emergency that is caused by electrolyte derangements from the lysis of malignant tumor cells. The syndrome consists of several laboratory abnormalities including hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia1,2. When these lab findings are associated with end-organ damage such as acute renal failure, seizures, or cardiac dysrhythmias amongst others, it is known as clinical TLS3. TLS is more commonly associated with hematological malignancies given their tendency of rapid cellular turnover. The most common culprits include acute lymphocytic leukemia and Burkitt’s lymphoma. It is, however, quite rare for TLS to occur secondary to a solid malignancy4. In fact, only 74 cases of solid-tumor TLS have been reported between 1977-20115. Furthermore, in case of solid tumors, they are almost always related to administration of cytotoxic chemotherapy leading to rapid cell death. Therefore, the case described here of spontaneous TLS leading to atrial flutter in an 89-year-old female with large pelvic mass is a rare presentation

Internal Medicine Residents’ Experience with using Handheld Ultrasound Machines in Point-of-Care Ultrasonography

Point-of-care ultrasonography (POCUS) is defined as the acquisition and interpretation of ultrasonographic images generated by the clinician at the bedside. The advent of handheld machines has increased access and practical application of ultrasound technology in internal medicine training and medical education. The most common system involves a single portable ultrasound probe that connects to a smartphone or tablet, and storage of images are stored via cloud-based technology. We discuss our experience with POCUS using handheld ultrasound machines in the Thomas Jefferson University Hospital academic setting