Elkhatib, Wiaam

ABSTRACT Introduction Cardiogenic shock (CS) carries high morbidity and mortality. However, evidence for mechanical circulatory support (MCS) in non‐ischemic CS remains limited, as prior trials have focused on infarct‐related shock. Methods We performed a retrospective cross‐sectional study using the Nationwide Inpatient Sample (2017–2019), identifying hospitalizations with a principal diagnosis of CS and excluding acute myocardial infarction. Patients were categorized into mutually exclusive groups: no MCS, intra‐aortic balloon pump (IABP) only, Impella only, or extracorporeal membrane oxygenation (ECMO) only. Primary outcomes were in‐hospital mortality, length of stay (LOS), and total hospital cost. Survey‐weighted multivariable models adjusted for demographics, hospital characteristics, and comorbidity burden using Elixhauser and Charlson indices. Results Among 104 045 hospitalizations, 6040 received MCS. IABP was most common, followed by Impella and ECMO. Among patients receiving a single MCS strategy, overall in‐hospital mortality was 29.5%., with lower mortality in the IABP group (19.9%) compared with Impella (37.4%) and ECMO (44.3%). After adjustment, IABP was associated with lower observed in‐hospital mortality versus no MCS (aOR 0.58, 95% CI 0.53–0.64; p < 0.01), whereas Impella and ECMO showed increased aOR. IABP and ECMO were associated with longer LOS, while Impella was not. All MCS strategies were associated with higher costs, with ECMO showing the greatest increase (cost ratio 3.30, 95% CI 3.12–3.50). Conclusion In non‐ischemic CS, MCS strategies demonstrate distinct profiles of mortality and resource utilization. IABP was associated with lower observed in‐hospital mortality, whereas all MCS were linked to higher costs, highlighting heterogeneity in outcomes and the need for further research.

Racial minorities remain underrepresented among allied health providers. Pathway programs address this gap by fostering career exposure and mentorship for underrepresented students. A pilot program was designed to increase underrepresented minority (URM) students entering health professions through career exploration and mentorship. High school students were enrolled into a pre-post survey study through a healthcare magnet school having higher proportions of economically disadvantaged students. Career exploration included healthcare presentations and skills sessions. Students were matched with mentors based on career interests. 22 students participated. The program facilitated career exploration sessions, mentor-mentee meetings, and workshops with diverse healthcare professionals. Participants reported increased likelihood towards pursuing healthcare careers. Preliminary findings suggest similar pilot pathway programs may increase URM student interest in healthcare careers.

Objectives Aircrew are subject to thermal stress and heat-related illness (HRI). Published screening methods and safety thresholds remain limited. The objective of this review was to evaluate the available evidence, approaches and guidelines regarding HRI screening tools in aircrew and analogue occupational and athletic cohorts to create a broad compendium of relevant tools for aviation safety decision-makers which establish risk stratification. Design A systematic literature review was conducted through 28 July 2025, of manuscripts and technical documents that reported HRI risk screening approaches. Pairs of independent reviewers selected studies and appraised risk of bias. Data sources Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus were searched. Eligibility criteria Extrinsic and intrinsic factors checklists, protocols, diagrams, algorithms and screening approaches for HRI risk stratification and safety thresholds within occupational settings were included. Cohorts under 18 years of age and abstracts were excluded. Data extraction and synthesis 3472 reports were identified and 37 were included in the final analysis. Common approaches relied on wet bulb globe temperature (WBGT), workload assessment and personal protective equipment used. WBGT thresholds ranged 27–32°C for extreme risk and 23–31°C for high risk. Identified tools used 19 common domains to establish risk. Data were insufficient to identify a singular ideal screening approach. Conclusions This systematic review addresses knowledge gaps regarding occupational HRI risk screening protocols for use towards aviation workers. Limitations included lack of generalisability, risk definition variability and conflicting published author assumptions regarding intrinsic factors considered.

Background Pilots face significant occupational risks affecting cardiometabolic health and are subject to regulatory health screenings. Cardiometabolic risk factors, cardiac screening findings and outcomes among pilots have not been well reported. Objectives This study aimed to investigate cardiac evaluations of asymptomatic aircraft pilots and the association between clinical risk factors and outcomes. Methods Asymptomatic aircraft pilots referred for cardiac assessment between January 1991 and May 2023 were studied. Baseline characteristics, cardiac test findings and outcomes were evaluated. Major adverse clinical event (MACE) was defined as death, myocardial infarction, stroke, major arrhythmia, heart failure event or cardiac-related hospitalisation and estimated using Kaplan-Meier methods. Significant valvular disease by echocardiography was defined as stenosis, regurgitation or prolapse of moderate severity or greater. Aortic dilation by transthoracic echocardiogram (TTE) was defined as measuring ≥40 mm in diameter. Results 212 pilots met eligibility criteria for the study. The majority were white (92.9%) and male (91%) with a mean age of 58.5±10.9 years. Mean body mass index was 27.8±4.8 with comorbid hyperlipidaemia (48%), hypertension (32%), prior cancer (27%), sleep apnoea (15%), arrhythmia (12%) and known coronary artery disease (6%). Imaging revealed significant valvular disease (2.4%) and dilated aortas (16%) based on TTEs. Functional cardiac testing performed showed mean functional aerobic capacity of 109±24.6% reaching 11.89±2.65 metabolic equivalents with <8% showing positive findings per EKG or wall motion abnormalities on exercise TTE. Six patients received coronary angiography based on clinical evaluation, with two undergoing percutaneous coronary intervention. Over a 32-year period with a median (range) follow-up of 5.15 (0.1, 31.82) years, MACE incidence was 15%. Conclusions Asymptomatic aircraft pilots have underlying cardiovascular risk factors but good overall functional capacity, long-term outcomes and life expectancy. Prevalence of cardiac structural findings like aortic dilatation warrants increased attention during examination of these patients.

Introduction: Peak oxygen uptake (VO 2 peak), standardized to total body mass (ml/kg/min) is a predictor of morbidity and mortality in cardiovascular disease patients. However, subsets of individuals undergoing exercise based cardiac rehabilitation (CR) show no improvement or reduction in VO 2 peak despite improvement in other functional measures. Hypothesis: Change in peak VO 2 post-CR, adjusted for lean mass rather than total mass better reflects peak VO 2 improvements. Aim : To assess the influence of CR on lean mass and the effect of lean mass compared to total body mass changes on peak VO 2 following CR. Methods: This observational cohort study included adults >18 years old who completed CR between 2015-2022 at Mayo Clinic, Rochester. All patients completed both dual energy X-ray absorptiometry (DXA) and cardiopulmonary exercise testing (CPET) for measurement of body composition (total mass and lean mass) and VO 2 peak pre- and post-CR. Improvement in VO 2 peak was defined as >% increase. Paired t-tests, one-way ANOVA, and descriptive statistics were performed. Results: Of 145 subjects, 81% were male and 63% Caucasian with a mean (SD) age of 62.8±12.6 years, BMI of 30.3±5.7, and 33.4±8.2 of 36 prescribed (92.8%) CR sessions completed. Pre-CR, patients demonstrated absolute VO 2 peak of 1,997.0±693.5 mL/min, relative of 22.1±6.2 mL/kg/min, and relative to lean mass of 35.2±9.6 mL/kg lean/min. After CR, patients demonstrated 1.2±3.1 kg reduction in total mass (p<0.05) and 0.4±1.7 kg increase in lean mass (p<0.05). Post-CR VO 2 peak increased by 17.1±117.0% absolute units (mL/min) (p<0.05), 9.0±16.1 % relative units (mL/kg/min) (p<0.05), and 15.9±111.9% units relative to lean mass (mL/kg lean/min) (p<0.05). Absolute and relative to lean mass units demonstrated greater improvements in VO 2 peak compared to relative units (p<0.05). Dependent on units, 70.3% of patients demonstrated an improvement in absolute VO 2 , 75.2% patients improved relative VO 2 , and 62.8% patients improved VO 2 relative to lean mass. Conclusions: These data demonstrate significant increases in lean mass and VO 2 following CR, with larger improvements reflected in units adjusted for lean mass compared to traditional relative units. In contrast, the largest proportion of patients showed positive improvements in VO 2 peak relative units with the smallest proportion relative to lean mass. These data suggest the reporting methodology for change in VO 2 following CR may impact overall findings.

Introduction: Hyponatremia is a common electrolyte abnormality that has been associated with poor outcomes in several conditions including acute myocardial infarction (AMI). However, those studies were performed in the era before percutaneous coronary intervention (PCI), focused mostly on ST-elevation myocardial infarction (STEMI), and sodium levels up to 72 h of admission. Aim: The purpose of this study was to identify the prognostic importance of hyponatremia in patients with acute myocardial infarction. Methods: We performed a cross sectional and retrospective analysis of 100 patients with a diagnosis of non-ST-elevation myocardial infarction (NSTEMI) and STEMI presenting at PSH, Vadodara, Gujarat, India from January 2022 to May 2024. Our independent variables were sodium levels on the day of admission. Dependent variables were in-hospital mortality, 30-day mortality, length of hospital stay, intensive care admission, new heart failure diagnosis, and ejection fraction. Infarct size was determined by echocardiographic examination that was performed on admission, day 2 or 3 of hospitalization Results: Hyponatremia, defined as a plasma sodium level <135 mmol/L (<135 mEq/L). 32% of patients had hyponatremia up to 7 days of admission. Intensive care admission was higher in patients with hyponatremia up to7 days (70% vs 383%), they had worse 30-day mortality (15% vs to 3%), in hospital mortality (12% vs 2%), and new heart failure diagnosis (32% vs 16%). Hyponatremia on admission was associated with in-hospital mortality (15% vs 4%), 30-day mortality (19% vs 6 %). Conclusions: This study suggests that hyponatremia on admission and at any point during the first seven days of hospitalization are associated with in-hospital and 30-day mortality and prognosis worsens with the severity of hyponatremia. Further studies are required to determine if plasma sodium levels may serve as a simple marker to identify patients at high risk.

Cryptococcal species endocarditis is infrequently described, carries high mortality and nearly always occurs in immunocompromised states or on prosthetic valves. We report the case of a man in his 70s with multiple recent hospitalisations for pneumonia, hypercalcaemia and septic tank exposure who presented with intermittent fevers, progressive weakness,and worsening encephalopathy, manifested as confusion and word-finding difficulties for 3 weeks. Workup revealed cryptococcal species on blood serum gram stain, native aortic valve endocarditis and meningitis. Cerebrospinal fluid analysis demonstrated lymphocytosis, ultimately found to be secondary to chronic lymphocytic leukaemia. Surgical valve replacement was deemed medically contraindicated and antifungal therapy was initiated. Though poorly understood with very few documented cases, management of cryptococcal endocarditis relies on prompt diagnosis, early surgery when indicated, long-term antifungal therapy and treatment of underlying immunocompromising states where possible.