Background and Objectives: Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure hospitalizations and disproportionately affects women, who present with distinct risk profiles and pathophysiologies compared to men. Prior studies exploring sex differences have been limited by small sample sizes and have often focused on index hospitalizations. We aimed to examine sex differences in risk factors, causes of readmission, and mortality following HFpEF hospitalization using a large, nationally representative cohort. Methods: We performed a retrospective cohort study using the 2016–2019 National Readmissions Database. Adults hospitalized with a primary diagnosis of HFpEF were included. Patients were followed for 90-day readmissions, and multivariable logistic regression was used to identify predictors of readmission and readmission-related mortality, stratified by sex. The final sample included 353,536 patients (217,354 women and 136,182 men). Results: Women were older at admission, more likely to live in lower-income areas, and more often presented with uncomplicated hypertension, while men had a higher burden of ischemic heart disease. Advancing age was associated with increased risk of readmission in women.Women were more frequently readmitted with respiratory failure, diastolic heart failure, and atrial fibrillation, suggesting a greater burden of vascular stiffness and symptom severity. Chronic kidney disease and diabetes were key predictors of readmission and mortality in both sexes. Conclusions HFpEF manifests with distinct sex-specific risk factors, clinical trajectories, and outcomes. These findings underscore the need for sex-informed, individualized treatment strategies and equitable resource allocation to reduce disparities and improve outcomes in HFpEF care.

In the context of ARVC, a systematic review of the validation of the ARVC risk score can provide insights into the accuracy and reliability of this score in identifying patients at high risk of ARVC. Digital databases were searched to identify the relevant studies using Medical Subject Headings (MeSH). A total of 8 studies were included in this systematic review. A total of 8 studies were included in this review. The review found that the sensitivity of the ARVC risk scores ranged from 80 to 95%, and the specificity ranged from 31 to 79%. The PPV was 55%, and the NPV was 88%. The ARVC score provided a C-index for a 5-year VA risk prediction of 0.84 [95% CI (0.74–0.93)] and a Harrell C-index of 0.70 (95% CI 0.65–0.75). The calibration slope was 1.01 (95% CI 0.99–1.03). ARVC score demonstrated a significant event 5-year threshold between 15 and 20% and the classical ARVC 5-years/freedom-from-VA rate was 0.76(0.66–0.89) and the non-classical form 5-years/freedom-from-VA rate was 0.58 (0.43–0.78). In conclusion, the validation of ARVC risk scores is an essential step toward improving the accuracy of ARVC diagnosis and risk stratification. Further studies are needed to establish the accuracy and reliability of ARVC risk scores and to address the limitations of the current evidence.

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the prevalence of lumbar spondylolysis and spondylolisthesis in a general adult population unrelated to lower back pain as evaluated by multidetector computed tomography. OVERVIEW OF LITERATURE: There is a significant paucity of information related to the prevalence of spondylolysis and spondylolisthesis and its degenerative changes in a general adult population unrelated to lower back pain in developing countries. METHODS: A retrospective study was conducted on abdominopelvic computed tomography (CT) scans performed between January 1st 2015 and December 31st 2015 for various clinical indications. Patients with lower back pain, with a history of trauma or road traffic accident, or referred from orthopedic or neurosurgery departments were excluded to avoid any bias. CT scans were reviewed in axial, sagittal, and coronal planes using bone window settings for evaluating spondylolysis and spondylolisthesis. RESULTS: Of 4,348 patients recruited, spondylolysis and spondylolisthesis were identified in 266 (6.1%) and 142 (3.3%) patients, respectively. Age was significantly higher in both spondylolysis and spondylolisthesis patients than in those without spondylolysis and spondylolisthesis (47.19±15.45 vs. 42.5±15.96, p<0.001 and 53.01±15.31 vs. 42.44±15.88, p<0.001, respectively). Gender was significantly associated with spondylolisthesis (p=0.029) but not spondylolysis. Of patients who were >60 years old, both spondylolysis (p=0.018) and spondylolisthesis (p=0.025) were significantly more prevalent in females. CONCLUSIONS: The prevalence of pars interarticularis fracture observed higher with gradual increase in the prevalence with advancing age. In particular, preponderance was significantly higher among older females.
Accidents, Traffic ; Adult* ; Bias (Epidemiology) ; Cross-Sectional Studies ; Developing Countries* ; Female ; Humans ; Low Back Pain ; Multidetector Computed Tomography* ; Neurosurgery ; Orthopedics ; Prevalence ; Retrospective Studies ; Spine ; Spondylolisthesis* ; Spondylolysis ; Spondylosis ; Tomography, X-Ray Computed

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the frequency of lumbosacral transitional vertebrae (LSTV) in patients with low back pain (LBP) and the role of iliolumbar ligament (ILL) origin from L5 in LSTV cases. OVERVIEW OF LITERATURE: Transitional vertebrae are developmental variants of the spine. LSTV is a common congenital abnormality, and failure to recognize this anomaly may result in serious consequences during surgery. METHODS: All patients aged 11–90 years of either gender with LBP for any duration, who presented for X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine, were included. X-rays of the lumbosacral spine in anteroposterior and lateral views were acquired. In addition, T1- and T2-weighted sagittal and axial MRI was performed. Images were evaluated on a workstation. RESULTS: Of 504 patients, transitional vertebrae were observed in 75 patients (15%). Among them, 39 (52%) patients had Castellvi type III and 36 (48%) patients had Castellvi type II. However, on MRI, 42 (56%) patients had O'Driscoll type II, 18 (24%) patients had O'Driscoll type IV, and 15 patients (20%) had O'Driscoll type III. ILL origin from L5 was significantly higher (n=429, 100%) among patients with a normal lumbosacral junction than among patients with a transitional lumbosacral junction (n=22, 29.3%) (p < 0.001). CONCLUSIONS: LSTV occurs at a high frequency in patients with LBP. Furthermore, in the presence of LSTV, the ILL is not a reliable marker for the identification of L5.
Congenital Abnormalities ; Cross-Sectional Studies ; Humans ; Ligaments ; Low Back Pain* ; Lumbar Vertebrae ; Magnetic Resonance Imaging* ; Prevalence* ; Radiography* ; Spine*

PURPOSE: In patients with erectile dysfunction, it is important to differentiate psychogenic from organic causes. Penile Doppler ultrasonography is a relatively inexpensive and minimally invasive tool for this purpose. This study was conducted to evaluate the causes of erectile dysfunction in an adult male population, using penile Doppler ultrasonography. MATERIALS AND METHODS: A retrospective study was conducted in a single center. All patients who presented with complaints of erectile dysfunction and underwent penile Doppler ultrasonography between July 2014 and June 2016 were included in this study. All examinations were performed using GE Voluson S6 and GE Logiq P5 devices. Following baseline scans, an intracavernosal injection of 20 µg of prostaglandin E1 was given. Peak systolic and end diastolic velocities were measured in each cavernosal artery. Patients with a peak systolic velocity of <25 cm/s were considered to have arterial insufficiency, while an end diastolic velocity of >5 cm/s was considered to indicate venous incompetence. RESULTS: Out of 97 patients (mean age, 37.09±11.59 years; range, 19~69 years), 50 patients (51.5%) had normal findings, 24 patients (24.7%) had arterial insufficiency, 15 patients (15.5%) had a venous leak, and 8 patients (8.2%) patients had arterial insufficiency with a venous leak. Psychogenic erectile dysfunction was significantly higher among patients aged ≤40 years, while arterial insufficiency with or without a venous leak was significantly higher among patients aged >40 years (p=0.022). CONCLUSIONS: A majority of the studied individuals demonstrated no organic cause of erectile dysfunction, thus confirming a high prevalence of the psychogenic etiology, particularly in relatively young individuals.
Adult ; Alprostadil ; Arteries ; Erectile Dysfunction* ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Pakistan* ; Prevalence ; Retrospective Studies ; Ultrasonography ; Ultrasonography, Doppler*

BACKGROUND: The diagnostic criterion for beta thalassemia trait (BTT) is elevated Hb-A2 levels. Iron deficiency anemia (IDA) reduces the synthesis of Hb-A2, resulting in reduced Hb-A2 levels, so patients with co-pathological conditions BTT with IDA, may have a normal level of Hb-A2. Many socio-economic factors like unawareness, poor diagnostic facilities, and cost of molecular diagnosis (for screening purposes) result in interpretation of these subjects as normal. METHODS: Venous blood samples from 200 unmarried females having a family history of thalassemia were collected, and basic hematological parameters, hemoglobin electrophoresis, and molecular analysis for beta thalassemia were done. Patients with IDA and patients with co-pathological conditions BTT and IDA were treated with oral iron. These subjects were then followed for a period of 20 weeks. RESULTS: Of the 200 females, 34 were found to be anemic. Hemoglobin electrophoresis identified 16 of these patients as BTT. Molecular analysis of all patients confirmed this diagnosis, but identified 8 additional patients with BTT. Eight patients that were not detected with hemoglobin electrophoresis were found to have co-pathology of BTT with IDA. CONCLUSION: Patients with the co-pathological condition BTT with IDA may be interpreted as being normal, as they have normal Hb-A2 levels. These misdiagnosed subjects when marry with BTT have the potential to produce beta thalassemia major in offspring. This is one of the factors playing a major role in the propagation of beta thalassemia gene in Pakistani population, and become a serious hindrance for the thalassemia prevention program in Pakistan.
Anemia, Iron-Deficiency ; beta-Thalassemia ; Electrophoresis ; Female ; Hemoglobins ; Humans ; Iron ; Mass Screening ; Pakistan ; Single Person ; Thalassemia