Patel, Urvish

e20010 Background: For the year 2019, the United States age-adjusted rate of new Multiple Myeloma (MM) cases was 6.8 per 100,000 people and the age-adjusted death rate was 3 per 100,000 people. Vitamin D Deficiency (VDD) and associated complications are very common in MM patients. Aim of our study was to evaluate the prevalence and risk of VDD in patients with MM and VDD associated disability and mortality in the VDD patients. Methods: We performed a cross-sectional retrospective analysis of Nationwide Inpatient Sample data 2016-2018. Adults hospitalizations with MM were identified using ICD 10 code. Hospitalized patients were grouped into patients with VDD and without VDD. We ran chi square, unpaired-t test and mixed-effect survey logistic regression analysis to find out odds ratio and 95%CI showing outcomes of VDD in MM patients. Results: We found 330,175 hospitalizations with MM. Of these 11,480 were noted to be patients with VDD with higher prevalence (0.64% vs 0.37%) of and strong association (aOR:1.41, 95%CI:1.35-1.47) with MM in comparison without MM. Amongst MM, females [1.50, 1.49-1.51], black race [1.23, 1.22-1.24], urban teaching hospitals [1.22, 1.22-1.23], and hospitals in mid-west region [1.30, 1.29- 1.32] had higher prevalence odds of VDD compared with males, white race population, rural hospitals and hospitals in northeast region. (p<0.0001) Patients with VDD had higher prevalence and strong association with higher morbidity [5.1% vs 3.9%, 1.24,1.14-1.36; c-value=0.67], severe/extreme disability [77.2% vs 73.3%, 1.26, 1.20-1.33; c-value=0.73], and discharge to locations other than home [51.15% vs 45.69%, 1.29, 1.23-1.34; c-value=0.69] in comparison without VDD. (p<0.0001) [Table]. Conclusions: Significant poor outcomes warrant early identification of VDD and role of same hospitalization vitamin D replacement amongst MM patients with higher risk. [Table: see text]

Introduction: Tobacco use is a known risk factor for stroke and other cardiovascular diseases. However, the relationship between e-cigarette smoking and stroke is largely unknown. Hypothesis: This study aims to assess the effect of e-cigarettes among people who have had a history of stroke. Methods: A cross-sectional survey was performed using the NHANES database from 2015 to 2018 in the US population. We identified participants 18 or older with a history of stroke and their smoking habits (e-cigarette, traditional, and dual smoking). The chi-square test, unpaired t-test, and multivariable logistic regression models were used to examine the association of e-cigarette consumption among the stroke population. Results: Out of a total of 266,058 respondents, 79,825 were smokers [E-cigarette: 7,756 (9.72%); Traditional: 48,625(60.91%), Dual smokers: 23,444 (29.37%)] Overall prevalence of stroke was 5.41% (n=4194) amongst various types of smokers. Amongst females with stroke, the prevalence of e-cigarette use was higher compared to traditional smoking. (36.36% vs 33.91%; p<0.001) Mexican Americans (21.21% vs. 6.02%) and other Hispanics (24.24% vs. 7.70%) had a higher prevalence of e-cigarette use than traditional smoking. (p<0.001) E-cigarette smokers were having an early onset of stroke in comparison with dual and traditional smokers. (Median age in years: 48 vs. 50 vs. 59, respectively; p<0.001). Stroke was more prevalent amongst traditional smokers compared to e-cigarette and dual smokers (6.75% vs. 1.09% vs. 3.72% p<0.001). In multivariable logistic regression analysis, the odds of having a history of stroke were higher amongst e-cigarettes in comparison with traditional smokers. (aOR:1.15; 95%CI: 1.15-1.16; p<0.001). Conclusion: Although stroke was more prevalent in traditional smokers, e-cigarette smokers had early-onset and higher odds of stroke compared to traditional smokers. More prospective studies are needed to evaluate the long-term effects and safety of e-cigarettes to mitigate the risk of cardio and cerebrovascular disorders.

Abstract BACKGROUND Uncertainty remains over the relationship between blood pressure (BP) variability (BPV), measured in hospital settings, and clinical outcomes following acute ischemic stroke (AIS). We examined the association between within-person systolic blood pressure (SBP) variability (SBPV) during hospitalization and readmission-free survival, all-cause readmission, or all-cause mortality 1 year after AIS. METHODS In a cohort of 862 consecutive patients (age [mean ± SD] 75 ± 15 years, 55% women) with AIS (2005–2018, follow-up through 2019), we measured SBPV as quartiles of standard deviations (SD) and coefficient of variation (CV) from a median of 16 SBP readings obtained throughout hospitalization. RESULTS In the cumulative cohort, the measured SD and CV of SBP in mmHg were 16 ± 6 and 10 ± 5, respectively. The hazard ratios (HR) for readmission-free survival between the highest vs. lowest quartiles were 1.44 (95% confidence interval [CI] 1.04–1.81) for SD and 1.29 (95% CI 0.94–1.78) for CV after adjustment for demographics and comorbidities. Similarly, incident readmission or mortality remained consistent between the highest vs. lowest quartiles of SD and CV (readmission: HR 1.29 [95% CI 0.90–1.78] for SD, HR 1.29 [95% CI 0.94–1.78] for CV; mortality: HR 1.15 [95% CI 0.71–1.87] for SD, HR 0.86 [95% CI 0.55–1.36] for CV). CONCULSIONS In patients with first AIS, SBPV measured as quartiles of SD or CV based on multiple readings throughout hospitalization has no independent prognostic implications for the readmission-free survival, readmission, or mortality. This underscores the importance of overall patient care rather than a specific focus on BP parameters during hospitalization for AIS.

Introduction: Tobacco use is one of the most significant risk factors for stroke. Besides traditional cigarettes and combustible products, the use of e-cigarettes and electronic nicotine delivery products has been widespread among young adults in the recent era. Furthermore, the trend of vaping has increased over the last decade. However, the relationship between e-cigarettes and stroke is largely unknown. The aim of this study was to evaluate the prevalence and identify the relationship between e-cigarette smoking and stroke. Methods: A cross-sectional study was performed using the NHANES database of the US population. Adults with a history of smoking were considered in our study and divided into three groups, e-cigarette users, traditional, and dual smokers. The Chi-squared test, Wilcoxon rank-sum test, and multivariable logistic regression analysis were used to identify the prevalence and association of e-cigarette consumption and stroke. Results: Out of a total of 266,058 respondents from 2015 to 2018, we found 79,825 respondents who smoked e-cigarettes (9.72%) or traditional (29.37%) or dual smoking (60.91%). Stroke prevalence among e-cigarette smokers was 1.57%. Stroke was more prevalent among traditional smokers than among e-cigarette smokers. (6.75% vs. 1.09%; p < 0.0001) E-cigarette smokers had early onset of stroke in comparison with traditional smokers. (median age: 48 vs. 59 years; p < 0.0001). Among females with stroke, the prevalence of e-cigarette use was higher in comparison with traditional smoking (36.36% vs. 33.91%; p < 0.0001). Among the stroke population, the prevalence of e-cigarette use was higher among Mexican-Americans (21.21% vs. 6.02%) and other Hispanics (24.24% vs. 7.70%) compared with traditional smoking (p < 0.0001). The regression analysis found higher odds of stroke history among e-cigarette users than traditional smokers [aOR: 1.15; 95% CI: 1.15–1.16)]. Conclusion: Though stroke was more prevalent in traditional smokers, the incidence of stroke was early-in-onset and was strongly associated with e-cigarette use compared to traditional smokers. We have also identified vascular effects of e-cigarettes components as possible triggers for the stroke.

Introduction: Redo-Surgical valve replacement (Redo-SAVR) is the gold standard treatment for failed degenerated bioprosthetic valves. Recently approved less invasive Valve-In-Valve Transcatheter Aortic Valve Implantation (ViV-TAVI) procedure is becoming more popular but with limited evidence of its safety and efficacy compared to redo-SAVR. Hypothesis: We aimed to conduct the meta-meta analysis to evaluate the outcomes of ViV-TAVI compared to redo-SAVR. Methods: We conducted a systematic search of meta-analysis studies assessing outcomes of ViV-TAVR vs redo-SAVR using PubMed search engine and following PRISMA guidelines from inception to May 2021. A meta-meta-analysis was performed by obtaining a pooled odds ratio, 95% confidence interval (95%CI) using random-effects models to analyze outcomes of 30-day all-cause mortality and procedural mortality. Results: Nine meta-analysis studies were included. We found that there was a significantly lower odds of 30-day all-cause mortality (pooled OR:0.60; 95%CI:0.53-0.68; p<0.00001) with 0% heterogeneity (I2= 0%;p=0.53) in the ViV-TAVI compared to redo-SAVR. We also found a reduced risk of procedural mortality with ViV-TAVI compared to redo-SAVR (pooled OR:0.52; 95%CI:0.27-0.98; p=0.04) with 0% heterogeneity (I2= 0%;p=0.69) (Figure). Conclusions: ViV-TAVI is significantly associated with reduced risk of 30-day all-cause mortality, and procedural mortality compared to redo-SAVR. Our meta-meta-analysis supports that minimally invasive ViV-TAVI is a safe and better procedure for degenerated bioprosthetic valves in high-risk candidates.

Background: According to past studies, recovery and survival following severe vascular events such as acute myocardial infarction and stroke are negatively impacted by vitamin D deficiency. However, the national estimate on disability-related burden is unclear. We intend to evaluate the prevalence and outcomes of vitamin D deficiency (VDD) among patients with cardiovascular disease (CVD) and cerebrovascular disorder (CeVD). Methods: We performed a cross-sectional study on the Nationwide Inpatient Sample data (2016–2017) of adult (≥18 years) hospitalizations. We identified patients with a secondary diagnosis of VDD and a primary diagnosis of CVD and CeVD using the 9th revision of the International Classification of Diseases, clinical modification code (ICD-10-CM) codes. A univariate and mixed-effect multivariable survey logistic regression analysis was performed to evaluate the prevalence, disability, and discharge disposition of patients with CVD and CeVD in the presence of VDD. Results: Among 58,259,589 USA hospitalizations, 3.44%, 2.15%, 0.06%, 1.28%, 11.49%, 1.71%, 0.38%, 0.23%, and 0.08% had primary admission of IHD, acute MI, angina, AFib, CHF, AIS, TIA, ICeH, and SAH, respectively and 1.82% had VDD. The prevalence of hospitalizations due to CHF (14.66% vs. 11.43%), AIS (1.87% vs. 1.71%), and TIA (0.4% vs. 0.38%) was higher among VDD patients as compared with non-VDD patients (p < 0.0001). In a regression analysis, as compare with non-VDD patients, the VDD patients were associated with higher odds of discharge to non-home facilities with an admission diagnosis of CHF (aOR 1.08, 95% CI 1.07–1.09), IHD (aOR 1.24, 95% CI 1.21–1.28), acute MI (aOR 1.23, 95% CI 1.19–1.28), AFib (aOR 1.21, 95% CI 1.16–1.27), and TIA (aOR 1.19, 95% CI 1.11–1.28). VDD was associated with higher odds of severe or extreme disability among patients hospitalized with AIS (aOR 1.1, 95% CI 1.06–1.14), ICeH (aOR 1.22, 95% CI 1.08–1.38), TIA (aOR 1.36, 95% CI 1.25–1.47), IHD (aOR 1.37, 95% CI 1.33–1.41), acute MI (aOR 1.44, 95% CI 1.38–1.49), AFib (aOR 1.10, 95% CI 1.06–1.15), and CHF (aOR 1.03, 95% CI 1.02–1.05) as compared with non-VDD. Conclusions: CVD and CeVD in the presence of VDD increase the disability and discharge to non-home facilities among USA hospitalizations. Future studies should be planned to evaluate the effect of VDD replacement for improving outcomes.

Introduction: Previous studies had provided evidence that vitamin D deficiency is a strong negative predictor for survival and recovery after severe vascular events but national estimate on disability related burden is not clear. Hypothesis: We evaluate the prevalence of vitamin D deficiency (VDD) amongst patients with cardiovascular disease (CVD) and cerebrovascular disorders (CeVD) and to find out whether or not CVD and CeVD in the presence of VDD increases the disability. Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample data (years 2016-2017) in adults (≥18 years) hospitalizations. We identified patients with secondary diagnosis of VDD and primary diagnosis of CVD (AFib, CHF, IHD, acute MI, and angina) and CeVD (AIS, TIA, ICeH and SAH) using ICD-10-CM codes. We performed a chi-square test and multivariable survey logistic regression to analyze disability of patients with CVD and CeVD in presence of VDD. Disability/loss of function was investigated by APRDRGs severity using 3M Health Information Systems software. (Score 1-4 indicates minor to extreme loss of function) Results: Among 58,259,589 US hospitalizations, 3.44%, 2.15%, 0.06%, 1.28%, 11.49%, 1.71%, 0.38%, 0.23% and 0.08% had primary admission of IHD, acute MI, angina, AFib, CHF, AIS, TIA, ICeH and SAH, respectively and 1.82% had VDD. Prevalence of hospitalizations due to CHF (14.66% vs 11.43%), AIS (1.87% vs 1.71%) and TIA (0.4% vs 0.38%) was higher; and IHD (2.62% vs 3.45%), acute MI (1.58% vs 2.16), angina (0.05% vs 0.06%), AFib (1.14% vs 1.28%), ICeH (0.17% vs 0.23%) and SAH (0.05% vs 0.08%) was lower among VDD patients in compare to non-VDD. (p<0.0001) In regression analysis, VDD was associated with higher odds of severe or extreme disability amongst patients hospitalized with AIS (OR:1.1; 95%CI:1.06-1.14), ICeH (1.22; 1.08-1.39), TIA (1.36; 1.25-1.47), IHD (1.37; 1.33-1.41), acute MI (1.44; 1.38-1.49), Afib (1.10; 1.06-1.15), and CHF (1.03; 1.02-1.05) in comparison to without VDD. Conclusions: CVD and CeVD in presence of VDD increase the disability amongst US hospitalizations. Future studies should be planned to evaluate the discharge outcomes as well as the effect of identification and in-hospital management of VDD on improvement of the outcomes.

Introduction: COVID-19 has multiorgan involvement and it is believed that outcomes are poor amongst patients with hypertension (HTN) and pre-existing cardiovascular disorders (CVD). Hypothesis: The objective of this meta-analysis is to evaluate outcomes [mortality and invasive mechanical ventilation (IMV) utilization] of COVID-19 in patients with pre-existing HTN and CVD. Methods: English full-text-observational studies having data on epidemiological characteristics of patients with COVID-19 were identified searching PubMed using MeSH-terms from December 1, 2019, to April 30, 2020. Studies having CVD or HTN as one of the pre-existing comorbidities and described outcomes including IMV and mortality were selected with a consensus of three reviewers. 29 studies met these criteria. Following MOOSE protocol, data on patients’ characteristics especially age and history of CVD, HTN, IMV, and mortality were pooled using a random-effects model. The pooled prevalence of CVD and HTN were calculated. Meta-regression was performed and correlation coefficient (r) and odds ratio (OR) were estimated to evaluate the effects of pre-existing CVD and HTN on outcomes of COVID-19 patients. Results: Out of 29 studies with COVID-19 epidemiology data, 21, 17, 18 and 19 studies have details on mortality, IMV, HTN, and pre-existing CVD, respectively. Pooled prevalence of HTN was 28.2% [95%CI:22.1%-35.1%; p<0.001; 4858/11626 patients; Heterogeneity (I 2 ):97.8%] and pre-existing CVD was 12.2% [8.9%-16.6%; p<0.001; 2044/11664 patients; I 2 :96.8%]. In age-adjusted meta-regression analysis, IMV was significantly higher among COVID-19 patients with pre-existing CVD [r:0.28; OR:1.3 (1.1-1.6); I 2 :89.7%; p=0.0028] without significant association with HTN [r:0.01; OR:1.0 (0.9-1.1); I 2 :95.9%; p=0.8161]. HTN [r:0.001; OR:1.0 (0.9-1.1); I 2 :96%; p=0.9685] and pre-existing CVD [r:-0.01; OR:0.9 (0.9-1.1); I 2 :96.3%; p=0.8772] had no significant association with mortality amongst COVID-19 patients. Conclusion: In the age-adjusted analysis, though we identified pre-existing CVD as a risk factor for higher utilization of IMV, pre-existing CVD and HTN had no independent role in increasing mortality.

Background/objective Nummular headache (NH) is a primary headache disorder characterised by intermittent or continuous scalp pain, affecting a small circumscribed area of the scalp. As there are limited data in the literature on NH, we conducted this review to evaluate demographic characteristics and factors associated with complete resolution of the headache, and effectiveness of treatment options. Methods We performed a systematic review of cases reported through PubMed database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and ‘nummular headache’, ‘coin-shaped headache’ and ‘coin-shaped cephalalgia’ keywords. Analysis was performed by using χ2 test and Wilcoxon rank-sum test. For individual interventions, the response rate (RR%) of the treatment was calculated. Results We analysed a total of 110 NH cases, with median age 47 years and age of pain onset 42 years. Median duration to make correct diagnosis was 18 months after first attack. The median intensity of each attack was 5/10 on verbal rating scale over 4 cm diameter with duration of attack <30 min. Patients with NH had median three attacks per day with frequency of 9.5 days per month. 40 (57.97%) patients had complete resolution of the headache after treatment. Patients with complete resolution were younger, more likely to be female, and were more likely to have diagnosis within year. Patients with complete resolution more likely to have received treatment with onabotulinum toxin A (botulinum toxin type A (BoNT-A)), and gabapentin compared with patients without complete resolution. Most effective interventions were gabapentin (n=34; RR=67.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (n=32; RR=65.6%), BoNT-A (n=12; RR=100%) and tricyclic antidepressant (n=9; RR=44.4%). Conclusion Younger patients, female sex and early diagnosis were associated with complete resolution. NSAIDs, gabapentin and BoNT-A were most commonly used medications, with significant RRs.