The ideal diagnostic modality for acute chest pain is a highly debated topic in the cardiovascular community. With the rapid rise of coronary computed tomography angiography (CTA) and the fall of functional testing, stress echocardiography (SE) is at a delicate crossroads. Though there are many advantages of coronary CTA, it is not without its flaws. The exact realm of SE needs to be clearly defined, as well as which patients need diagnostic testing. The emergence of additional parameters will propel the evolution of modern SE. In this review article, we explore the role of SE, guidelines, comparison of SE versus CTA, and additional parameters in the coronary CTA era.

No abstract

Background New York City emerged as the Epicenter for Covid-19 due to novel Coronavirus SARS-CoV-2 soon after it was declared a Global Pandemic in early 2020 by the WHO. Covid-19 presents with a wide spectrum of illness from asymptomatic to severe respiratory failure, shock, multiorgan failure and death. Although the overall fatality rate is low, there is significant mortality among hospitalized patients. There is limited information exploring the impact of Covid-19 in community hospital settings in ethnically diverse populations. We aimed to identify risk factors for Covid-19 mortality in our institution. Methods We conducted a retrospective cohort study of hospitalized in our institution for Covid 19 from March 1st to June 21st 2020. It comprised of 425 discharged patients and 245 expired patients. Information was extracted from our EMR which included demographics, presenting symptoms, and laboratory data. We propensity matched 245 expired patients with a concurrent cohort of discharged patients. Statistically significant covariates were applied in matching, which included age, gender, race, body mass index (BMI), diabetes mellitus, and hypertension. The admission clinical attributes and laboratory parameters and outcomes were analyzed. Results The mean age of the matched cohort was 66.9 years. Expired patients had a higher incidence of dyspnea (P < 0.001) and headache (0.031). In addition, expired patients had elevated CRP- hs (mg/dl) ≥ 123 (< .0001), SGOT or AST (IU/L) ≥ 54 (p < 0.001), SGPT or ALT (IU/L) ≥ 41 (p < 0.001), and creatinine (mg/dl) ≥ 1.135 (0.001), lower WBC counts (k/ul) ≥ 8.42 (0.009). Furthermore, on multivariate logistic regression, dyspnea (OR = 2.56, P < 0.001), creatinine ≥ 1.135 (OR = 1.79, P = 0.007), LDH(U/L) > 465 (OR = 2.18, P = 0.001), systolic blood pressure < 90 mm Hg (OR = 4.28, p = .02), respiratory rate > 24 (OR = 2.88, p = .001), absolute lymphocyte percent (≤ 12%) (OR = 1.68, p = .001) and procalcitonin (ng/ml) ≥ 0.305 (OR = 1.71, P = .027) predicted in- hospital mortality in all matched patients. Conclusion Our case series provides admission clinical characteristics and laboratory parameters that predict in- hospital mortality in propensity Covid 19 matched patients with a large Hispanic population. These risk factors will require further validation. Disclosures All Authors: No reported disclosures

Introduction: Diabetes mellitus (DM) refers to a bunch of disorders of metabolism that share the phenotypic sign of hyperglycemia. Different variants of DM are caused due to the interaction of various genetic factors with environmental factors. Materials and Methods: This is prospective, comparative, and observational study. The study was conducted at SMBT Medical Institute and Research Centre Dhamangaon Nashik and private Diabetic clinic. Each center was 50 purposive sampling. Inclusion Criteria: All those patients who are diagnosed with Type II Diabetes and age of 18 years and above belonging to either gender were included in the study. Exclusion Criteria: Patients who are not willing to sign the informed consent were excluded from the study. Those individuals who are having Type I diabetes and suffering from co-morbid conditions such as hypertension, hyperthyroidism, and immune deficiency syndrome were excluded. Results: In our study, results revealed that mono and combination therapies for the treatment of type II DM. The present study revealed that most of the physicians initially prescribed mono therapy (25%) includes Metformin/Glibenclamide/Glimepiride/Gliclazide to control hyperglycemia followed by dual therapy (35%) FDC of Metformin + Pioglitazone/Metformin + Glipizide/Metformin + Glimepiride/Metformin + Saxagliptin/Metformin + Voglibose and triple therapy (40%) includes Metformin + Glimepiride + Pioglitazone in group A. In Group B, mono therapy (35%) and triple therapy (35%) were used more commonly over dual therapy (30%) to control hyperglycemic. Conclusion: Hence, while comparing between tertiary care versus private care hospital, Group A: Biguanide: Metformin and Sulfonylureas: Glibenclamide, Glipizide, Gliclazide, and Glimepiride was most commonly prescribed drug. In Group B: Dapagliflozin (Sodium-glucose co-transport-2 inhibitors) and Teneligliptin: Dipeptidyl peptidase-4 inhibitors were most commonly used in private hospital.

No abstract