No abstract

No abstract

Introduction: Atherosclerotic Cardiovascular disease ( ASCVD) in women remains understudied, under-diagnosed, and under-treated. It is known that traditional risk factors have varied effects on men's vs. women's hearts. However, the current risk stratification tools tend to underestimate or not consider such sex-specific factors. We aimed to investigate the utility of bone mineral density (BMD) with DEXA scoring as a predictor of ASCVD in women. Methods: Patients who underwent DEXA scanning from 2012 to 2014 at multiple centers within our health system were collected and categorized using International Classification of Diseases (ICD) diagnosis codes to identify comorbidities and outcomes. Age, Sex, Race, history of hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), body mass index (BMI), and smoking status were noted. Results: Of the 2,254 patients who underwent DEXA scanning, 1,995 participants were female (88.5%), and 1,929 were white (85.6%) with an average age of 72.8 years. The primary outcome was any ASCVD event (stroke, MI and cardiac death). During the mean follow-up of 9 years, 245 patients (10.8%) experienced ASCVD events. Patients with osteoporosis defined by a T score <-2.5 had higher odds of ASCVD events (OR - 3.82 [2.370-6.172], P<0.0001). Osteopenia was defined by a T score between -1 and -2.5 and was not associated with an increased risk of ASCVD events (OR 1.2 [0.782-1.957] P <0.36). Conclusions: BMD measurement with DEXA scanning may be useful for the stratification and prediction of risk for ASCVD events in women, with no additional economic strain on the healthcare system. Further wide-scale studies are needed to utilize this potentially promising predictor and commonly used diagnostic test. .

A 69-year-old male with a history of prior admissions of heat exhaustion presented with non-specific symptoms including fatigue, diarrhea, and dehydration. The workup revealed a positive legionella urine antigen. He was treated with levofloxacin with symptom resolution within 48 hours.

Rib fractures are an infrequent consequence of severe cough. In some patients, undetected rib fractures can lead to life-threatening outcomes. This is a case of a 73-year-old male who presented with shortness of breath and a worsening dry cough for four weeks. In the ED, he was found to be hypoxic, and hypotensive. Imaging studies revealed a large right pleural effusion, multiple rib fractures, and right-sided herniation of the colon into the chest. He was admitted to the cardiothoracic ICU where he underwent a flexible bronchoscopy, right VATS, evacuation of hemothorax, complete decortication, and repair of diaphragmatic hernia. This case is an unusual presentation of an amalgamation of rare complications resulting from an unrelenting, poorly controlled SARS-CoV-2 infection cough that prompted rapid recognition and swift action.