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Introduction: The purpose of this case series was to review a rare subset of tumors known as gastric lipomas, which are typically found incidentally. The motivation for this study arose from the identification of 2 cases within our institution in a short period. Case Presentation: The study involved a review of the diagnosis and management of 2 patients presenting with gastric lipomas at our institution after symptoms of gastrointestinal bleeding. With the advent of new radiologic investigations such as computed tomography and magnetic resonance imaging and advances in endoscopy, there are new approaches to identifying and managing these tumors. On further evaluation of the literature, we found that despite the availability of minimally invasive endoscopic techniques such as mucosal resection and submucosal dissection in the setting of large tumors, most patients tend to have to resort to surgical management. Conclusion: This case series underscores the rarity of gastric lipomas and their often-incidental discovery. Further investigation into endoscopic approaches for managing these tumors is needed, and additionally, there is a need to explore a potential association between gastric lipomas and malignancy, as chronic inflammation of the overlying mucosa may play a significant role. [ABSTRACT FROM AUTHOR]

A growing appreciation of the pathophysiological interrelatedness of metabolic risk factors such as obesity and diabetes, chronic kidney disease, and cardiovascular disease has led to the conceptualization of cardiovascular-kidneymetabolic syndrome. The confluence of metabolic risk factors and chronic kidney disease within cardiovascular-kidney-metabolic syndrome is strongly linked to risk for adverse cardiovascular and kidney outcomes. In addition, there are unique management considerations for individuals with established cardiovascular disease and coexisting metabolic risk factors, chronic kidney disease, or both. An extensive body of literature supports our scientific understanding of, and approach to, prevention and management for individuals with cardiovascular-kidney-metabolic syndrome. However, there are critical gaps in knowledge related to cardiovascular-kidney-metabolic syndrome in terms of mechanisms of disease development, heterogeneity within clinical phenotypes, interplay between social determinants of health and biological risk factors, and accurate assessments of disease incidence in the context of competing risks. There are also key limitations in the data supporting the clinical care for cardiovascular-kidney-metabolic syndrome, particularly in terms of early-life prevention, screening for risk factors, interdisciplinary care models, optimal strategies for supporting lifestyle modification and weight loss, targeting of emerging cardioprotective and kidney-protective therapies, management of patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically assessing and addressing social determinants of health. This scientific statement uses a crosswalk of major guidelines, in addition to a review of the scientific literature, to summarize the evidence and fundamental gaps related to the science, screening, prevention, and management of cardiovascular-kidneymetabolic syndrome. [ABSTRACT FROM AUTHOR]

Cardiovascular-kidney-metabolic health reflects the interplay among metabolic risk factors, chronic kidney disease, and the cardiovascular system and has profound impacts on morbidity and mortality. There are multisystem consequences of poor cardiovascular-kidney-metabolic health, with the most significant clinical impact being the high associated incidence of cardiovascular disease events and cardiovascular mortality. There is a high prevalence of poor cardiovascular-kidney-metabolic health in the population, with a disproportionate burden seen among those with adverse social determinants of health. However, there is also a growing number of therapeutic options that favorably affect metabolic risk factors, kidney function, or both that also have cardioprotective effects. To improve cardiovascular-kidney-metabolic health and related outcomes in the population, there is a critical need for (1) more clarity on the definition of cardiovascular-kidney-metabolic syndrome; (2) an approach to cardiovascular-kidney-metabolic staging that promotes prevention across the life course; (3) prediction algorithms that include the exposures and outcomes most relevant to cardiovascular-kidney-metabolic health; and (4) strategies for the prevention and management of cardiovascular disease in relation to cardiovascular-kidney-metabolic health that reflect harmonization across major subspecialty guidelines and emerging scientific evidence. It is also critical to incorporate considerations of social determinants of health into care models for cardiovascular-kidney-metabolic syndrome and to reduce care fragmentation by facilitating approaches for patient-centered interdisciplinary care. This presidential advisory provides guidance on the definition, staging, prediction paradigms, and holistic approaches to care for patients with cardiovascular-kidney-metabolic syndrome and details a multicomponent vision for effectively and equitably enhancing cardiovascular-kidney-metabolic health in the population. [ABSTRACT FROM AUTHOR]

Despite advances in the diagnosis and therapeutics strategies for pulmonary hypertension (PH) in patients with end-stage liver disease (ESLD), the impact of hemodynamic patterns among ESLD patients identified through right heart catheterization (RHC) on clinical outcomes remains poorly understood. This single-center retrospective cohort study identified patients diagnosed with ESLD who underwent RHC from August 2018 to June 2023. Demographic and clinical data, including comorbidities, transthoracic echocardiography, and RHC findings, were obtained. Our outcomes of interest were all-cause mortality and the chance of receiving orthotopic liver transplantation (OLT) within a year after RHC. Kaplan–Meier with log-rank test was employed to generate survival curves. We identified 415 ESLD patients with the RHC results. The median (IQR) age was 59 years (52–66), and 62% were male. Caucasians accounted for 43%, followed by African Americans (30%). Up to 89% had a diagnosis of portal hypertension. Median MELD-Na score was 30 (19–36). The etiology of ESLD was mainly from alcohol use (55%). Patients were classified based on RHC results as pre-capillary PH (19%), post-capillary PH (28%), and non-PH (53%) groups. Overall, one-year mortality post-RHC was 22%, with no significant difference in mortality regardless of hemodynamic group. However, the pre-capillary PH group was less likely to receive OLT compared to other groups (P < 0.001). We observed no difference in all-cause mortality among hemodynamic groups. However, pre-capillary PH group were less likely to undergo OLT compared to others. Further investigations are necessary to determine how this should be addressed in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: This systematic review aims to assess the safety profile of oxcarbazepine during pregnancy. Methods: Observational studies that included women who took oxcarbazepine anytime during pregnancy were included in our systematic review. The review did not include non‐English articles, reviews, meta‐analyses, case reports and animal studies. Different online sources such as MEDLINE, Cochrane library, Virtual Health Library, etc., were searched for published and unpublished literature. Assessment of the risk of bias in observational studies was carried out using the Newcastle‐Ottawa Scale. The meta‐analyses were performed using a random‐effect model. GRADE was used for the evaluation of the quality of evidence for the primary outcomes. Results: We included 19 cohort studies with a total of 5 071 137 patients, of which 2450 were exposed to oxcarbazepine either as monotherapy or polytherapy. The summary odds ratio (OR) was 1.69 (95% CI, 0.95–2.98) for congenital malformations following in‐utero exposure to oxcarbazepine as compared to the control group of unexposed patients (seven studies [n = 625]), and was 1.19 (95% CI, 0.67–2.12) when compared to those following lamotrigine (LTG) exposure during pregnancy (3 studies [n = 591]). In total, three studies (n = 770) reported the association between in‐utero oxcarbazepine exposure and fetal/perinatal deaths. The meta‐analysis yielded a summary OR of 3.33 (95% CI, 1.70–6.51). Conclusion: Our systematic review will help healthcare providers and guideline developers regarding the treatment of epilepsy and other neurological disorders during pregnancy. More cohort studies with a higher sample size concerning oxcarbazepine use in pregnant patients are required to truly assess the in‐utero safety profile of the drug. [ABSTRACT FROM AUTHOR]

Introduction: Infective endocarditis (IE) poses a great challenge to the field of cardiology due to high mortality, approaching 30% at 1-year, despite optimal care. Hypothesis: We studied causative organisms, in-hospital mortality and predictors of 30-day hospital readmission after a diagnosis of IE. Methods: Nationwide Readmissions Database was utilized to identify patients with a primary discharge diagnosis of IE using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9, CM), procedural code 421.0. Primary outcome was 30-day readmission. Hierarchical multivariable logistic regression was used to adjust for confounders. Results: Over 6 years (2010-2015), 187,438 patients were admitted with a primary diagnosis of IE. Twenty four percent were readmitted within 30 days. Staphylococcus aureus (27%), streptococcus viridians (22%), gram negative species (6%) and fungal species (0.24%) were identified as causative organisms. Predictors of increased readmissions were female sex (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.02 to 1.1, p<0.001), staphylococcus aureus infection (OR 1.06, 95% CI 1.02 to 1.1, p <0.001), diabetes (OR 1.11, 95%CI 1.07 to 1.63, p<0.001), chronic lung disease (OR 1.16, 95%ci 1.11 TO 1.2, P<0.001), chronic liver disease (or 1.06, 95%CI 1.1 to 1.23, p<0.001), acute kidney injury (OR 1.32, 95%CI 1.26 to 1.37, p<0.001), acute heart failure (OR 1.17, 95%CI 1.12 to 1.22, p<0.001) and anemia (OR 1.09, 95%CI 1.06 to 1.13, p<0.01). In-hospital mortality was 13% and average length of stay (LOS) was 12 days. Thirty-six percent patients were discharged to a facility. Conclusions: We identified high in-hospital mortality and 30-day readmission rates for IE patients between 2010 and 2015. Females, staphylococcus aureus infection, anemia, acute heart failure, chronic lung disease, chronic liver disease, acute kidney injury and diabetes were independently associated with increased 30-day readmissions in IE patients. [ABSTRACT FROM AUTHOR]

Introduction: Infective endocarditis (IE) is a frequent cause of morbidity and mortality in patients with intracardiac devices, prosthetic valves and unrepaired congenital anomalies. Hypothesis: We aim to look for comorbidities, etiologies and trends of 30-day hospital readmission after the diagnosis of IE. Methods: Nationwide Readmissions Database (2010-2015) was utilized to identify patients with primary discharge diagnosis of IE using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9, CM), procedural code 421.0. Primary outcome was 30-day readmission. Etiologies were identified using ICD-9 codes in primary diagnosis field. Results: Among 187,438 patients admitted with the primary diagnosis of IE, 44,151 patients (24%) were readmitted within 30 days (60% Male, average age 60 years). Most prevalent comorbidities included hypertension (56%), anemia (41%), chronic kidney disease (31%), diabetes (30%), valvular heart disease (22%), heart failure (21%) and intravenous drug abuse (15%). Most common etiologies included sepsis (14%), acute heart failure (HF) (8%), acute kidney injury (6%), intracardiac device infection (5.6%) and recurrence of IE (2.7%). Neurological complications and mechanical valvular dysfunction accounted for 2.7% and 1.6% of total 30-day readmissions. Half of the readmissions (51%) happened in first 11 days of discharge. Among the readmitted patients, 86% had 1 readmission, 13% had 2 readmissions and 1.5% of patients had 3 readmissions in 30 days after discharge. Conclusions: We identified sepsis, acute HF, acute kidney injury and intracardiac device infection as the most common etiologies of readmission. Identifying high risk patients during index admission can help reduce the high readmission rate. Prospective trials are warranted to identify these high-risk patients. [ABSTRACT FROM AUTHOR]