Richard Alweis

Bibliometric Analysis of the Top 100 Cited Cardiovascular Articles

The number of citations an article receives is an important indication of its impact and contribution to the clinical world. There is a paucity of literature concerning top article citations in cardiology. The main objective of this investigation was to bridge this gap and to provide readers a practical guide in evaluating the cardiovascular literature. Scopus Library database was searched to determine the citations of all published cardiovascular articles. One hundred two journals were included in our investigation under the Institute of Science Information Web of Science subject category cardiology, cardiovascular, and heart. We did not apply any time or study-type restriction in our search. The top 100 cited articles were selected and analyzed by 2 independent investigators. The journal with the highest number of top 100 cited articles was Circulation with 36, followed by 28 in the European Heart Journal. A statistically significant association was found between the journal impact factor and the number of top 100 cited articles (p <0.005). United States had the highest number of articles (49). Contrary to bibliometric analyses published in other medical fields, the largest subset of the cardiology articles (n = 42) was published in the 5-year period from 2006 to 2010. General medical journals such as The Lancet (n = 4) and The New England Journal of Medicine (n = 1) contributed only 5 articles to the list despite their extremely high impact factors. In conclusion, our analysis provides an insight on the citation frequency of top cited articles published in cardiovascular medicine to help recognize the quality of the works, discoveries, and the trends steering cardiology.

Ventricular fibrillation due to overdose of loperamide, the “poor man’s methadone”

ABSTRACT Loperamide is an over-the-counter antidiarrheal agent that is considered by many patients to be safe, but has been used as a drug of abuse due to its opioid properties. However, cardiotoxicity has been reported, prompting the FDA to release a warning regarding the arrhythmogenic potential of loperamide. We present a case of a 38-year-old female presenting with cardiac arrest thought to be secondary to abuse of the loperamide that she was using to alleviate the heroin withdrawal symptoms. Cardiac ischemia and other drug toxicities were ruled out. Loperamide induces QTc prolongation and cardiac dysrhythmias. She had recurrent ventricular arrhythmias with multiple cardiac arrests. The persistence of the cardiotoxicity for a longer duration than previously reported in the literature is unique in this clinical presentation. We also highlight the potential mechanisms for loperamide cardiotoxicity and its challenging management. Abbreviations: ACLS: Advanced cardiac life support; GI: Gastrointestinal

Is this a worrisome red eye? Episcleritis in the primary care setting

ABSTRACT Episcleritis is the inflammation of the thin, loose, highly vascular connective tissue layer that lies between the conjunctiva and sclera. Incidence is less than 1/1000. It is more common in women and those between 40 and 50 years of age. Most cases are idiopathic. It is classified into simple and nodular. Most attacks resolve within 1–3 months. The nodular type tends to be more recurrent and painful. It presents with acute onset of redness, lacrimation, and photophobia. The diagnosis of is essentially clinical, and eye pain or tenderness should raise the concern for scleritis. Ophthalmological referral is recommended to rule out scleritis. Bloodwork to diagnose associated systemic rheumatological disease may be helpful. Cold compresses and artificial tears provide symptomatic relief. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids are used for persistent symptoms. Rarely, systemic steroids may be necessary. Immunosuppressive treatment to control an underlying autoimmune disorder is the last resort for resistant cases.

Is Obstructive Sleep Apnea associated with Ventricular Tachycardia? A retrospective study from the National Inpatient Sample and a literature review of the pathogenesis Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a known independent risk factor for a multiple cardiovascular morbidities and mortality. The association of OSA and ventricular arrhythmias is less well understood. The aim of this analysis is to study the relationship between OSA and ventricular tachyarrhythmias.

Impact of delirium on patients hospitalized for myocardial infarction: A propensity score analysis of the National Inpatient Sample

Delirium is associated with worse outcomes in critically ill patients. In the subset of patients with myocardial infarction (MI), the impact on clinical outcomes of delirium is not as well elucidated.

Impact and outcomes of patients with congestive heart failure complicating non-ST-segment elevation myocardial infarction, results from a nationally-representative United States cohort

INTRODUCTIONnCongestive heart failure (CHF) is seen in up to 13-25% of patients with NSTEMI. Recent data describing the impact of congestive heart failure (CHF) on in-hospital outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) in the United States is limited. We sought to examine the in-hospital outcomes, and management of CHF in patients admitted to the hospital with NSTEMI.nnnMETHODSnNational Inpatient Sample (NIS) database (2010-2014) was analyzed to identify patients with NSTEMI using ICD-9-CM codes. The primary outcome was in-hospital mortality. Propensity score-matching analysis compared mortality in CHF patients to matched controls without CHF.nnnRESULTSnOf 247,624 patients with NSTEMI, 84,115 (34%) had CHF. Patients with CHF were less likely to receive percutaneous coronary intervention (PCI) [20.48% vs. 40.9%, Pu202f<u202f0.001] or coronary artery bypass grafting (CABG) [8.2% vs 9.6%, Pu202f<u202f0.001] during hospitalization. Also, they had longer lengths of stay and higher risk for in-hospital adverse outcomes. CHF was the strongest predictor of in-hospital death. The increased mortality risk was persistent after propensity matching (RR 1.27; 95% CI 1.22 to 1.33).nnnCONCLUSIONnCHF among patients with NSTEMI is associated with increased risk for in-hospital mortality and adverse outcomes.

Relation of Obstructive Sleep Apnea to Risk of Hospitalization in Patients With Heart Failure and Preserved Ejection Fraction from the National Inpatient Sample

Obstructive Sleep Apnea (OSA) increases the risk of diastolic dysfunction and heart failure. The impact of OSA on hospitalization for heart failure with preserved ejection fraction (HFpEF) is not well elucidated. We used data from the National Inpatient Sample for the years 2012 to 2014. We identified discharges (age ≥18 years) associated with OSA and HFpEF using the International Classification of Diseases, Ninth Revision, Clinical Modification codes (327.23 and 428.3x), respectively. Propensity score analysis, adjusting for age, gender, race, and comorbidities, compared the rates of admission for HFpEF in patients with OSA to those without OSA. Out of 12,608,637 discharges included, there were 147,463 patients with HFpEF, and 653,762 or 5.2% of all discharges had OSA. The prevalence of OSA in patients with HFpEF was 16.8%. Patients with OSA were older, more likely to be men, more likely to have diabetes, hypertension, history of coronary artery disease, chronic kidney disease, obesity, atrial fibrillation, African-American race, and smoking status. In patients with OSA, HFpEF occurred in 3.8% versus 1.0%, with adjusted odds ratio: 2.2 (95% confidence interval 2.16 to 2.23), p <0.001. Subgroup analysis showed similar results in men and women. After propensity score matching, OSA was associated with increased risk of admission with HFpEF, relative risku202f=u202f2.2 (95% confidence interval 2.12 to 2.21). In conclusion, OSA was associated with increased risk of hospitalization for HFpEF.

Abdominal injury after a fall.

CASE A 20-year-old man was brought to the ED after a fall. He had been leaning against an old railing that broke under his weight; he fell about 20 feet to the ground below, landing on his left side. His only past medical history is a wrist fracture 2 years ago. Physical examination showed stable vital signs and diffuse abdominal tenderness without peritoneal signs. He had no evidence of spinal or skeletal injury. No blood was visualized at the urethral meatus but gross hematuria was seen upon insertion of an indwelling urinary catheter. A FAST examination was positive for free fluid in the Morrison pouch. A CT of the abdomen and pelvis was obtained (Figure 1). The most significant finding is: • free fl uid in the abdomen • free air under the diaphragm • aortic injury • kidney laceration • retroperitoneal hematoma.