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Septal myectomy (SM) is offered to symptomatic patients with obstructive hypertrophic cardiomyopathy (oHCM) despite medical therapy. Frequently, patients undergo concomitant planned or ad-hoc mitral valve replacement (MVR), aortic valve replacement (SAVR), or coronary artery bypass grafting (CABG). We sought to assess characteristics and outcomes of patients with oHCM undergoing concomitant surgical interventions at the time of SM. The National Readmission Databases were used to identify all SM admissions in the United States (2010–2019). Patients undergoing SM were stratified into: isolated SM (±MV repair), SM + CABG only, SM + MVR, SM + SAVR, and SM + MVR + SAVR. Primary outcomes were in-hospital mortality, in-hospital adverse events, and 30-day readmission. 12,063 encounters of patients who underwent SM were included (56.1% isolated SM, 9.0% SM + CABG only, 17.5% SM + MVR, 13.1% SM + SAVR, and 4.3% SM + MVR + SAVR). Patients who underwent isolated SM were younger (54.3 vs. 67.1 years-old, p < 0.01) and had lower overall comorbidity burden. In-hospital mortality was lowest in isolated SM, followed by CABG only, SM + SAVR, SM + MVR, and SM + SAVR+MVR groups (2.3% vs. 3.7% vs. 5.3% vs. 6.7% vs. 13.7%, p < 0.01), respectively. SM with combined surgical interventions was associated with higher adverse in-hospital events (24.3% vs. 11.1%, p < 0.01) and 30-day readmissions (16.9% vs. 10.4%, p < 0.01). MV repair performed concomitantly with SM was not associated with increased in-hospital mortality (3.9% vs. 3.4%, p = 0.72; aOR 0.99; 95% CI: 0.54–1.80, p = 0.97]) or adverse clinical events. In SM for oHCM, patients undergoing concomitant surgical interventions were characteristically distinct. Aside from MV repair, concomitant interventions were associated with worse in-hospital death, adverse in-hospital events, and 30-day readmission. Central Illustration : Septal myectomy (SM) with or without concomitant surgical interventions between 2010–2019 (n=12,036). Isolated SM refers to myectomy without coronary artery bypass graft (CABG), surgical aortic valve replacement (SAVR), or mitral valve replacement (MVR). CABG group refers to SM with CABG, but without SAVR or MVR. [Display omitted] • Key Question: In patients with obstructive hypertrophic cardiomyopathy (oHCM) undergoing septal myectomy (SM), how are the outcomes of SM differ in those with concomitant surgical interventions (coronary artery bypass or valve replacement surgery) as compared to isolates SM? • Key Finding: In a nationwide cohort of 12,063 patients undergoing SM, SM with concomitant surgical interventions had higher in-hospital mortality (6.2% vs. 2.3%, p < 0.01), in-hospital adverse events (24.3% vs. 11.1%, p < 0.01), and 30-day readmission (16.9% vs. 10.4%, p < 0.01) compared to isolated SM. • Take Home Message: In patients undergoing SM for oHCM, concomitant surgical interventions at the time of SM were associated with worse in-hospital death, adverse in-hospital events, and 30-day readmission. Studies focusing on isolated SM underestimate complications rate of all patients with oHCM undergoing SM. [ABSTRACT FROM AUTHOR]

Prisons in the United States have become a hotbed for spreading COVID-19 among incarcerated individuals. COVID-19 cases among prisoners are on the rise, with more than 143,000 confirmed cases to date. However, there is paucity of data addressing clinical outcomes and mortality in prisoners hospitalized with COVID-19. An observational study of all patients hospitalized with COVID-19 between March 10 and May 10, 2020 at two Henry Ford Health System hospitals in Michigan. Clinical outcomes were compared amongst hospitalized prisoners and non-prisoner patients. The primary outcomes were intubation rates, in-hospital mortality, and 30-day mortality. Multivariable logistic regression and Cox-regression models were used to investigate primary outcomes. Of the 706 hospitalized COVID-19 patients (mean age 66.7 ± 16.1 years, 57% males, and 44% black), 108 were prisoners and 598 were non-prisoners. Compared to non-prisoners, prisoners were more likely to present with fever, tachypnea, hypoxemia, and markedly elevated inflammatory markers. Prisoners were more commonly admitted to the intensive care unit (ICU) (26.9% vs. 18.7%), required vasopressors (24.1% vs. 9.9%), and intubated (25.0% vs. 15.2%). Prisoners had higher unadjusted inpatient mortality (29.6% vs. 20.1%) and 30-day mortality (34.3% vs. 24.6%). In the adjusted models, prisoner status was associated with higher in-hospital death (odds ratio, 2.32; 95% confidence interval (CI), 1.33 to 4.05) and 30-day mortality (hazard ratio, 2.00; 95% CI, 1.33 to 3.00). In this cohort of hospitalized COVID-19 patients, prisoner status was associated with more severe clinical presentation, higher rates of ICU admissions, vasopressors requirement, intubation, in-hospital mortality, and 30-day mortality. [ABSTRACT FROM AUTHOR]

Background: This meta‐analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) are limited by cost and availability. Methods: We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra‐cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random‐effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results: Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra‐cardiac sarcoidosis group as compared with controls, SMD −3.98, 95% confidence interval (CI): −5.32, −2.64, P <.001, also was significantly lower in patients who suffered major cardiac events (MCE), −3.89, 95% CI −6.14, −1.64, P <.001. GCS was significantly lower in the extra‐cardiac sarcoidosis group as compared with controls, SMD: −3.33, 95% CI −4.71, −1.95, P <.001. Conclusion: LVGLS and GCS were significantly lower in extra‐cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS. [ABSTRACT FROM AUTHOR]

Background: Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation is associated with worse outcomes. Prediction of RVF is difficult with routine transthoracic echocardiography (TTE), while speckle‐tracking echocardiography (STE) showed promising results. We performed systematic review and meta‐analysis of published literature. Methods: We queried multiple databases to compile articles reporting preoperative or intraoperative right ventricle global longitudinal strain (RVGLS) or right ventricle free wall strain (RVFWS) in LVAD recipients. The standard mean difference (SMD) in RVGLS and RVFWS in patients with and without RVF postoperatively was pooled using random‐effects model. Results: Seventeen studies were included. Patients with RVF had significantly lower RVGLS and RVFWS as compared to non‐RVF patients; SMD: 2.79 (95% CI: −4.07 to −1.50; P: <.001) and −3.05 (95% CI: −4.11 to −1.99; P: <.001), respectively. The pooled odds ratio (OR) for RVF per percentage increase of RVGLS and RVFWS were 1.10 (95 CI: 0.98–1.25) and 1.63 (95% CI 1.07–2.47), respectively. In a subgroup analysis, TTE‐derived GLS and FWS were significantly lower in RVF patients as compared to non‐RVF patients; SMD of −3.97 (95% CI: −5.40 to −2.54; P: <.001) and −3.05 (95% CI: −4.11 to −1.99; P: <.001), respectively. There was no significant difference between RVF and non‐RVF groups in TEE‐derived RVGLS and RVFWS. Conclusion: RVGLS and RVFWS were lower in patients who developed RVF as compared to non‐RVF patients. In a subgroup analysis, TTE‐derived RVGLS and RVFWS were reduced in RVF patients as compared to non‐RVF patients. This difference was not reported with TEE. [ABSTRACT FROM AUTHOR]

Fusarium is a filamentous fungus that is ubiquitous in nature and can cause severe opportunistic infections in immunocompromised hosts. The association between Fusarium and hyper-IgE syndrome is exceedingly rare and has only been documented in a single report previously. A 44-year-old male, working as marijuana grower, with prior diagnosis of hyper-IgE syndrome and recurrent infections presented with enlarging right knee ulcer that did not respond to antimicrobial treatment. The patient was diagnosed with cutaneous fusariosis, confirmed with punch biopsy and positive wound cultures. The patient was managed with extended antifungal therapy (i.e., posaconazole) and surgical debridement resulting in remarkable improvement with wound healing leaving a pale scar. Fusarium should be considered in differential for cutaneous and invasive fungal infections in presence of cutaneous manifestations. Exposure to Cannabis plants is a noticeable risk factor. Multimodal approach involving systemic antifungals and wound debridement is essential for favorable outcome. Posaconazole was demonstrated to be a highly efficacious antifungal choice. [ABSTRACT FROM AUTHOR]

Background: In orthotopic heart transplant recipients, surveillance with endomyocardial biopsy is crucial to detect acute cellular rejection (ACR) early. ACR is a common and serious complication of transplantation with substantial morbidity and mortality. Speckle tracking echocardiography with global longitudinal strain (GLS) assessment of the left ventricle has emerged as a possible noninvasive screening modality. We have conducted a systematic literature review and meta‐analysis to evaluate the role of GLS in diagnosing ACR. Methods: The following databases were queried: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Embase. We compiled all articles evaluating changes in GLS in comparison to endomyocardial biopsy in ACR dated prior to September 2019. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were pooled by using a random effects model. In order to determine the risk of bias, we used the revised version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool. Results: Twelve studies met inclusion criteria of which ten were chosen. These studies encompassed 511 patients and 1267 endomyocardial biopsies. There was a significant difference in GLS between patients who did and did not have ACR proven by biopsy (WMD = 2.18; 95% CI: 1.57‐2.78, P = <.001; I2 = 76%). The overall sensitivity for GLS in detecting ACR was 78% (CI: 63%‐90%, P =.123; I2 = 52.2%) while the overall specificity was 68% (CI: 50%‐83%, P = <.001; I2 = 88.3%). Conclusion: Global longitudinal strain assessment of the left ventricle by speckle tracking echocardiography is useful in detecting ACR and could potentially reduce the burden of frequent endomyocardial biopsies in heart transplant recipients. [ABSTRACT FROM AUTHOR]

Background: Cryptococcosis is an opportunistic infection caused by the encapsulated yeast Cryptococcus neoformans and most remarkably manifests in HIV-infected individuals, especially in the settings of very low CD4 count. Development of cryptococcosis in HIV-uninfected individuals is exceedingly rare and usually signifies a marked immunodeficiency. Cryptococcosis in association with myasthenia gravis or thymoma has been previously documented in only very few cases in the literature.Case Presentation: We reported a complicated case of severe cutaneous cryptococcosis in a 39-year-old Vietnamese male patient with myasthenia gravis on long-term immunosuppressive therapy. The patient presented with a five month history of recurrent and progressive skin lesions that later on progressed into cryptococcal meningitis.Conclusion: Through this case, we aimed to emphasize the importance of including cutaneous cryptococcosis in the differential diagnosis of cutaneous lesions in patients on chronic immunosuppressive therapy. The cutaneous manifestations of cryptococcosis can be the first clue for a disseminated disease, which makes early recognition crucial and life-saving. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac allograft vasculopathy (CAV) is an important cause of death after the first year following cardiac transplantation. The absence of classic signs of myocardial ischemia because of cardiac denervation and the presence of concentric hypertrophy tend to prevent early recognition. Currently, cardiac catheterization (CC) and intravascular ultrasound represent the gold standard for identifying CAV but their use is limited due to high cost, limited number of trained professionals, and risk of contrast toxicity in patients with underlying kidney disease especially those using nephrotoxic immunosuppressive medication. Hence, there is a need to find a noninvasive alternative to CC. Dobutamine stress echocardiography (DSE), a noninvasive technique, initially showed promise but later studies showed limitations in predicting CAV. Hypothesis: We conducted a systematic literature review and meta-analysis to assess the effectiveness of DSE in detecting CAV Methods: We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from inception till January 2018. Original articles that compared the diagnostic accuracy of DSE for early CAV detection were included. Relevant data were extracted and analyzed using RevMan version 5.3 for window and summary receiver-operating characteristic (SROC) curve was constructed. Results: Seven studies with 606 patients were included. The study quality ranged from low to high according to QUADAS-2 tool. The sensitivity and specificity of DSE varied greatly, the sensitivity range was 15 to 99%, and the specificity 83 to 99%. In a SROC model, the area under curve was 0.88 (SE =0.05) and index Q* value was 0.812 (SE =0.059). Overall, the pooled sensitivity of DSE was 15.27% (95% CI 11.14% to 20.20%) and the pooled specificity was 95.47 % (95% CI 92.64% to 97.44%). The pooled effect estimates were significantly heterogeneous (p <0.01). Conclusions: DSE has a limited sensitivity to detect early CAV but its specificity is very high. There remains a need for an alternative noninvasive modality which will have both high sensitivity and high specificity for detecting CAV. [ABSTRACT FROM AUTHOR]

Background: Dobutamine stress echocardiography (DSE) is a well‐established imaging modality used to screen patients with mild‐to‐moderate risk for coronary artery disease. In heart transplantation recipients, cardiac allograft vasculopathy (CAV) is a common and lethal complication. The use of DSE to detect CAV showed promising results initially, but later studies showed limitation in its use to detect CAV. It is unclear if this cohort of patients derives benefit from DSE. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Scopus from inception through March 2018 for studies examining the accuracy of DSE in correlation to coronary angiography (CA) or intravascular ultrasound (IVUS) to detect CAV. Original studies comparing the ability of DSE to detect CAV in comparison with CA or IVUS were included. Relevant data were extracted and hierarchical summary receiver operating characteristic analysis was conducted to test the overall diagnostic accuracy of DSE for patients with CAV. Results: Eleven studies (749 participants) met the inclusion criteria. The sensitivity of DSE varied from 1.7% to 93.8%, and specificity, from 54.8% to 98.8%. Pooled sensitivity was 60.2% (95% confidence interval (CI), 33.0%–82.3%) and specificity 85.7% (95% CI, 73.8%–92.7%). DSE had an overall diagnostic odds ratio (OR) of 9.1 (95% CI, 4.6–17.8), positive likelihood ratio (LR+) of 4.1 (95% CI, 2.8–6.1), negative likelihood ratio (LR−) of 0.47 (95% CI: 0.23–0.73), and area under curve (AUC) of 0.73 (95% CI, 0.72–0.75). Heterogeneity among studies was not statistically significant (τ2 = 0.32, Cochran's Q = 9.5, P = 0.483). Conclusion: Dobutamine stress echocardiography has a limited sensitivity to detect early CAV but its specificity is much higher. There remains a need for an alternative noninvasive modality which will have both high sensitivity and high specificity for detecting CAV. [ABSTRACT FROM AUTHOR]

Background: Carotid artery stenosis (CAS) is being recognized as an effective alternative for carotid endarterectomy (CEA). CAS is especially preferred over CEA in high-risk surgical patients with severe carotid stenosis. However, CAS carries an increased risk of stroke and transient ischemic attack (TIA).Objective: To assess the association between periprocedural stroke/TIA and 30-day mortality in carotid stenosis patients undergoing CAS.Methods: We searched PubMed, Embase, and World Science for relevant publications. Studies reporting on perioperative neurologic status (stroke/TIA) and 30-day mortality in patients undergoing CAS were included. Sensitivity, specificity, pooled odds ratio (OR), and relative risk (RR) of perioperative stroke in predicting 30-day mortality following CAS were calculated.Results: 146 studies with 156,854 patients were included in the meta-analysis. The mean patient age was 70.7 years, and 57.6% were males. Only 26.5% of the CAS cohort were symptomatic and 15.2% had bilateral carotid disease. The incidence of perioperative TIA and stroke were 2.4 and 2.7 per 100 CAS procedure, respectively. Around 11.8% of stroke-events were fatal. The pooled OR of 30-day mortality after perioperative stroke was 24.58 (95% CI, 19.92-30.32) and the pooled RR was 21.65 (95% CI, 17.87-26.22). Perioperative stroke had a sensitivity of 42.0% (95% CI 37.8-46.4%) and specificity of 97.0% (95% CI 96.7-97.3%) in predicting 30-day mortality.Conclusions: Perioperative stroke drastically increases the risk of 30-day mortality. The occurrence of perioperative stroke exhibited high specificity but modest sensitivity in predicting 30-day mortality following CAS. This highlights the importance of neurophysiologic monitoring to detect intraoperative cerebral ischemia and perform timely interventions. [ABSTRACT FROM AUTHOR]

Background: Although protocol registration of systematic reviews/meta-analysis (SR/MA) is still not mandatory, it is highly recommended that authors publish their SR/MA protocols prior to submitting their manuscripts for publication as recommended by the Cochrane guidelines for conducting SR/MAs. our aim was to assess the awareness, obstacles, and opinions of SR/MA authors about the protocol registration process.Methods: A cross-sectional survey study included the authors who published SR/MAs during the period from 2010 to 2016, and they were contacted for participation in our survey study. They were identified through the literature search of SR/MAs in Scopus database. An online questionnaire was sent to each participant via e-mail after receiving their approval to join the study. We have sent 6650 emails and received 275 responses.Results: A total of 270 authors responses were complete and included in the final analysis. Our results has shown that PROSPERO was the most common database used for protocol registration (71.3%). The registration-to-acceptance time interval in PROSPERO was less than 1 month (99.1%). Almost half of the authors (44.2%) did not register their protocols prior to publishing their SR/MAs and according to their opinion that the other authors lack knowledge of protocol importance and mandance to be registered, was the most commonly reported reason (44.9%). A significant percenatge of respondents (37.4%) believed that people would steal their ideas from protocol databases, while only 5.3% reported that their SR/MA had been stolen. However, the majority (72.9%) of participants have agreed that protocol registries play a role in preventing unnecessary duplication of reviews. Finally, 37.4% of participants agree that SR/MA protocol registration should be mandatory.Conclusion: About half of the participants believes that the main reason for not registering protocols, is that the other authors lack knowledge concerning obligation and importance to register the SR/MA protocols in advance. Therefore, tools should be available to mandate protocol registration of any SRs beforehand and increasing awareness about the benefits of protocol registration among researchers. [ABSTRACT FROM AUTHOR]

Introduction Microvascular decompression (MVD) is the surgical treatment of choice for hemifacial spasm (HFS). During MVD, monitoring of the pathognomonic abnormal lateral spread muscle response (LSR), an evoked electromyographic response to CN VII stimulation, has been traditionally used to monitor adequacy and success of facial nerve decompression and postoperative relief of HFS. In this study, we aim to assess the utility of LSR monitoring in predicting the surgical outcomes after MVDs at discharge, three-months, and one-year. Methods We searched PubMed, Web of Science, and Embase for relevant publications. We included studies reporting on intraoperative LSR monitoring during MVD for HFS and the spasm-free status after the procedure. We calculated the sensitivity, specificity, diagnostic odd ratio, and conditional probability of HFS persistence after post-operative LSR persistence. Forest plot and a summary ROC curve were used for presentation of sensitivity and specificity. Newcastle-Ottawa Scale (NOS) tool was used to assess the quality of included articles. Publication bias was assessed using funnel plots. Results From 146 studies, 24 studies with 7821 patients were ultimately included in the meta-analysis. The mean age of patients was 53 years. At discharge, postoperative LSR status predicted the clinical outcome of MVD with a specificity (95% CI) of 0.93 (0.87–0.96) and a sensitivity of 0.45 (0.31–0.59). The specificity at three-months and one-year was 0.90 (0.83–0.94) and 0.90 (0.85–0.93) respectively. The sensitivity was found to be 0.43 (0.32–0.55) at three-months and 0.41 (0.29–0.53) at one-year. In addition, the diagnostic odds ratio was found to be 4.71 (3.88–5.71) at discharge, 3.85 (2.96–5.01) at three-months, and 3.18 (2.49–4.08) at one-year. When LSR persisted after MVD, the probability for HFS symptoms persistence was 40% (95% CI, 0.20–0.61) at discharge, 37% (0.14–0.59) at three-months, and 27% (0.11–0.42) at one-year. Conclusion Intraoperative EMG monitoring for LSR resolution has high specificity but modest sensitivity in predicting the spasm-free status following MVDs for HFS. Post-operative LSR persistence carries a high risk for HFS persistence, therefore, adequacy of decompression should be investigated before closing in cases where intraoperative LSR fails to disappear. [ABSTRACT FROM AUTHOR]