Introduction
The existing literature offers limited insights into the influence of Libman-Sacks Endocarditis (LSE) on inpatient outcomes in individuals with Systemic Lupus Erythematosus (SLE). This ...study aimed to explore the characteristics and prognosis of SLE patients with LSE and the impact of LSE in patients with SLE on inpatient outcomes including inpatient mortality, length of stay, acute heart failure, atrial fibrillation, and cerebrovascular accidents (CVA).
Methods
This study included adult patients who were hospitalized with SLE between the years 2019 and 2020, using the National Inpatient Sample (NIS) database. The total number of patients with a diagnosis of SLE in the years 2019 and 2020 in the NIS database was 150,411. Of those, 349 had a diagnosis of LSE. The study population was divided into two groups: one group with SLE and LSE, and another group with SLE but without LSE.
Results
Caucasians made up 54.9% of the patients with a diagnosis of SLE in our patient population, while African Americans made up 26.9% and the Hispanics accounted for 12.2%. Of patients with LSE, Caucasians and African Americans represented 42.9% each. Patients with a diagnosis of LSE had a higher inpatient mortality than those with SLE without LSE (aOR: 9.74 CI 1.12–84.79, p 0.04). Patients with SLE with LSE were more likely to have acute heart failure than those without LSE, although this was not statistically significant (aOR 1.18 CI 0.13–11.07, p 0.88). Similarly, patients with SLE with LSE were more likely to have atrial fibrillation than those without LSE (aOR 4.45 CI: 0.77–25.57, p 0.10). CVAs were significantly higher in SLE patients with LSE than those without LSE (aOR 141.43 CI 16.59–1205.52, p < .01).
Discussion
Patients who develop LSE were found to have significantly higher risks of inpatient mortality and cerebrovascular accidents. Early and precise detection of LSE in such patients may ensure timely intervention and prevention of the associated adverse outcomes. Further studies may attempt to develop screening methods for detection of LSE to effectively reduce morbidity and mortality associated with SLE.
The objective of this review is to present evidence that supports the central role of epigenetic regulation in the pathogenesis of SSc. SSc is a complex autoimmune disease characterized by immune ...activation, fibrosis of the skin and internal organs and obliterative vasculopathy affecting predominantly the microvessels. Remarkable progress has been made in the past few years emphasizing the importance of epigenetic modifications in the pathogenesis of many disorders, including SSc. Current evidence demonstrates alterations in DNA methylation, histone code modifications and changes in microRNA (miRNA) expression levels in SSc cells. Recent reports have described the differential expression of numerous regulatory miRNAs in SSc, mainly in SSc fibroblasts, a number of which are important in TGF-β pathways and downstream signalling cascades. While studies to date have revealed the significant role of epigenetic modifications in the pathogenesis of SSc, the causal nature of epigenetic alterations in SSc pathogenesis remains elusive. Additional longitudinal and comprehensive epigenetic studies designed to evaluate the effect of environmental epigenetic factors on disease pathogenesis are needed.
Background: Heart failure, a major public health concern, significantly contributes to hospital admissions. This study evaluates the impact of malnutrition on both patient and hospital outcomes in ...heart failure admissions, with a specific focus on variations in outcomes based on the severity of malnutrition. Methods: Utilizing the National Inpatient Sample (NIS) database, this retrospective cohort study included adult patients admitted with a principal diagnosis of heart failure. Malnutrition was identified using the well-validated ICD 10 codes. We compared outcomes between patients with and without malnutrition, focusing on mortality, length of stay (LOS), hospital charges, cardiac arrest, and cardiogenic shock. Results: Out of 1,110,085 heart failure patients, 36,522 (3.29%) were malnourished. Malnourished patients exhibited significantly higher adjusted in-hospital mortality rates (aOR 3.32; 95% CI 3.03–3.64), longer LOS (mean increase of 4.67 days; p < 0.001), and higher hospital charges (mean increase of USD 77,416.9; p < 0.01). Increased rates of cardiac arrest (aOR 2.39; 95% CI 1.99–2.86; p < 0.001) and cardiogenic shock (aOR 3.74; 95% CI 3.40–4.12; p < 0.001) were also noted in malnourished patients. Severely malnourished patients faced worse outcomes compared to those with mild to moderate malnutrition. Conclusions: Heart failure patients with malnutrition experience higher mortality rates, longer hospital stays, increased hospitalization charges, and greater complication rates, including cardiac arrest and cardiogenic shock, compared to non-malnourished patients. Outcomes deteriorate with the increasing severity of malnutrition. Timely and individualized nutritional interventions may significantly improve outcomes for heart failure admissions.
There is growing evidence that implicates epigenetic modification in the pathogenesis of systemic sclerosis (SSc). The complexity of epigenetic regulation and its dynamic nature complicate the ...investigation of its role in the disease. We will review the current literature for factors that link epigenetics to SSc by discussing DNA methylation, histone acetylation and methylation, and non-coding RNAs (ncRNAs), particularly microRNA changes in endothelial cells, fibroblasts (FBs), and lymphocytes. These three cell types are significantly involved in the early stages and throughout the course of the disease and are particularly vulnerable to epigenetic regulation. The pathogenesis of SSc is likely related to modifications of the epigenome by environmental signals in individuals with a specific genetic makeup. The epigenome is an attractive therapeutic target; however, successful epigenetics-based treatments require a better understanding of the molecular mechanisms controlling the epigenome and its alteration in the disease.
There has been a tremendous interest to understand the mechanisms that regulate gene expression in autoimmunity and their effect on disease phenotypes by exploring different epigenetic mechanisms. In ...this review, we will introduce lupus epigenetics through reviewing historical key findings, then we will focus on the most recent and relevant findings in this field reflecting our own and naturally biased opinion.
In addition to uncovering more methylation-sensitive loci in critical genes and proposing a role for these genes in the pathogenesis of lupus, there has been a great interest in high-resolution unbiased genome-wide epigenetic studies to investigate aberrant methylation and histone code patterns, the two major epigenetic markers. In recent years, we have also witnessed an increasing interest in the role of microRNAs in the pathogenesis of lupus, and as candidate molecules with intriguing therapeutic potentials.
Epigenetics is an exciting field that is serving as a link, as we currently understand, between genetic susceptibility and the environment in predisposing to lupus. Certainly, epigenetic aberrancies play a fundamental role in propagation of the lupus phenotype. Whether the available epigenetic-modifying agents would be useful treating human lupus is still an open question, but is unlikely in our opinion. Indeed, gene-specific epigenetic modifiers will be a challenging and an exciting area for future research.
The crystalloid fluid of choice in sepsis remains debatable. We aimed to perform a comprehensive meta-analysis to compare the effect of balanced crystalloids (BC) vs. normal saline (NS) in adults ...with sepsis. A systematic search of PubMed, EMBASE, and Web of Sciences databases through 22 January 2022, was performed for studies that compared BC vs. NS in adults with sepsis. Our outcomes included mortality and acute kidney injury (AKI), need for renal replacement therapy (RRT), and ICU length of stay (LOS). Pooled risk ratio (RR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) were obtained using a random-effect model. Fifteen studies involving 20,329 patients were included. Overall, BC showed a significant reduction in the overall mortality (RR 0.88, 95% CI 0.81-0.96), 28/30-day mortality (RR 0.87, 95% CI 0.79-0.95), and AKI (RR 0.85, 95% CI 0.77-0.93) but similar 90-day mortality (RR 0.96, 95% CI 0.90-1.03), need for RRT (RR 0.91, 95% CI 0.76-1.08), and ICU LOS (MD -0.25 days, 95% CI -3.44, 2.95), were observed between the two groups. However, subgroup analysis of randomized controlled trials (RCTs) showed no statistically significant differences in overall mortality (RR 0.92, 95% CI 0.82-1.02), AKI (RR 0.71, 95% CI 0.47-1.06), and need for RRT (RR 0.71, 95% CI 0.36-1.41). Our meta-analysis demonstrates that overall BC was associated with reduced mortality and AKI in sepsis compared to NS among patients with sepsis. However, subgroup analysis of RCTs showed no significant differences in both overall mortality and AKI between the groups. There was no significant difference in the need for RRT or ICU LOS between BC and NS. Pending further data, our study supports using BC over NS for fluid resuscitation in adults with sepsis. Further large-scale RCTs are necessary to validate our findings.
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