A 74-year-old male with a history of mild cognitive impairment presented to the emergency department with failure to thrive and generalized weakness. He was having difficulty swallowing leading to 30 pounds of unintentional weight loss in the last three months. His social history was significant for 12.5 pack-year smoking and drinking (two to three glasses of wine/day). The oral cavity examination revealed a large (3 × 2 cm 2 ) defect with the erythematous border that encompassed the mid-palatal structures and emanated from the hard palate into his nasal cavity. Auto-immune work-up was negative. Palatal biopsy showed squamous cell carcinoma (SCC; well-differentiated). A diagnosis of locally advanced (stage IVa) oral cavity squamous cell carcinoma (OSCC) was made based on PET scan findings. A palatal obturator (prosthesis) was placed to improve his eating, prevent regurgitation. The patient opted for palliative care and did not want to pursue further treatment. He was discharged home with a regular follow-up visit.

Despite the lack of direct evidence that hypertension increases the likelihood of new infections, hypertension is known to be the most common comorbid condition in COVID-19 patients and also a major risk factor for severe COVID-19 infection. The literature review suggests that data is heterogeneous in terms of the association of hypertension with mortality. Hence, it remains a topic of interest whether hypertension is associated with COVID-19 disease severity and mortality. Herein, we perform a multicenter retrospective analysis to study hypertension as an independent risk for in-hospital mortality in hospitalized COVID-19 patients. This multicenter retrospective analysis included 515 COVID-19 patients hospitalized from March 1, 2020 to May 31, 2020. Patients were divided into two groups: hypertensive and normotensive. Demographic characteristics and laboratory data were collected, and in-hospital mortality was calculated in both groups. The overall mortality of the study population was 25.3% (130 of 514 patients) with 96 (73.8%) being hypertensive and 34 (26.2%) being normotensive (p-value of 0.01, statistically non-significant association). The mortality rate among the hypertensive was higher as compared to non-hypertensive; however, hypertensive patients were more likely to be old and have underlying comorbidities including obesity, diabetes mellitus, coronary artery disease, congestive heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and cancer. Therefore, multivariable logistic regression failed to show any significant association between hypertension and COVID-19 mortality. To our knowledge, few studies have shown an association between hypertension and COVID-19 mortality after adjusting confounding variables. Our study provides further evidence that hypertension is not an independent risk factor for in-hospital mortality when adjusted for other comorbidities in hospitalized COVID-19 patients.

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Background and objectiveThe prevalence of heart failure (HF) is on the rise; currently, it affects around five million people in the United States (US) and the prevalence is expected to rise from 2.42% in 2012 to 2.97% in 2030. HF is a leading cause of hospitalizations and readmissions, accounting for a major economic burden to the US healthcare system. Obesity is a widely accepted risk factor of HF; however, data regarding its independent association with HF mortality and morbidity is heterogeneous. Globally, more than two-thirds of deaths attributable to high body mass index (BMI) are due to cardiovascular diseases (CVD). This study aimed to investigate the potential role of obesity (BMI >30 Kg/m 2 ) in HF patients in terms of 30-day readmissions, in-hospital mortality, and the use of noninvasive positive pressure ventilation (NIPPV). MethodsIn this single-center, retrospective study, all adult (age: >18 years) patients who were hospitalized with a primary diagnosis of HF at the Abington Jefferson Hospital from January 2015 to January 2018 were included. Demographic characteristics were collected manually from electronic medical records. Outcomes were 30day readmission due to HF, all-cause in-hospital mortality, and requirement for NIPPV. Multivariable logistic regression analysis was conducted to investigate the association of obesity with HF outcomes. ResultsA total of 1,000 patients were initially studied, of these 800 patients were included in the final analysis based on the inclusion criteria. Obese patients showed higher odds for 30-day readmissions and the use of NIPPV compared to non-obese patients. There was no significant difference in in-hospital mortality in obese vs. non-obese patients. ConclusionsBased on our findings, BMI >30 Kg/m 2 is an independent risk factor for HF readmissions. Additionally, our results highlight the importance of guidelines-directed medical therapy (GDMT) for HF exacerbation, a low threshold for use of NIPPV in obese patients, promotion of lifestyle modifications including weight loss, and early follow-up after discharge to prevent HF readmissions in the obese population.

The present study endeavors to unveil the phenomenon of racism as a social, cultural and political concept based on falsehood, and problems of ethnicity in America portrayed in Brit Bennett's (2020) "The Vanishing Half" under the theoretical framework of Frantz Fanon's (1952) "Black Skin, White Masks." Basically it is the racial prejudice and bigotry which build a battle/struggle for identity and self-determination. The under discussion work by Bennett come across to the realization of racial prejudice and inferiority faced by the African Americans. Bennett by her four main characters Stella, Desiree, Jude and Kennedy, presents racial prejudice and discrimination which affects their past and present identities. The researchers endeavor to highlight the problems of ethnicity in America under the racist study as to how the writer, Bennett, uncovers the racial inequality and injustice of America in the workings of contemporary life. The researchers examine how the character of Stella escapes from the racial prejudice and reshapes her new identity as a "White Passing". This study explores that what are the issues behind racism as a social, cultural and political construct in the light of "The Vanishing Half". The present research recommends the significance of intricateness of identity and race in racist perspective.

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Introduction: Pulmonary hypertension (PH) is common in patients with severe aortic stenosis (AS). The prevalence of PH in transcatheter aortic valve replacement (TAVR) patients is reported upto 78% and causes significant morbidity and mortality. We queried the National Inpatient Sample (NIS) database to explore the different outcomes of patients hospitalized for TAVR with and without the history of PH. Hypothesis: PH may increase mortality in hospitalized patients undergoing TAVR. Methods: This is a retrospective cohort study utilizing the 2016-2017 National Inpatient Sample. We identified patients hospitalized for TAVR with and without the history of PH using ICD10 codes. The primary outcome was inpatient mortality. The secondary outcomes were cost of hospitalization, and length of stay (LOS). Multivariate regression was used to adjust for potential confounders including age, gender, race, pulmonary embolism, acute coronary syndrome, heart block, left bundle branch block (LBBB), diabetes, heart failure, and chronic kidney disease. STATA 15.0 was utilized for data analysis. Results: A total of 18221 patients underwent TAVR in 2016-2017. Of these, 18.3% had PH. There were more women in the PH group (51% vs 46%, P<0.001). Patients were relatively younger in the PH group (79 yrs vs 80 yrs; p<0.001). The mean cost of hospitalization was 23022 USD in the PH group versus 209867 USD in the group without PH (p< 0.001). The patients in the PH group had higher inpatient mortality compared to patients without PH (2.28 % versus 1.49 %; Odds Ratio 1.54; p< 0.001; CI 1.1-2.0). The mean LOS was 6.0 days in the PH group versus 4.3 days in those without the PH group ( p:< 0.001). The mortality didn’t differ by gender, location of the hospital, and teaching status of the hospital. Conclusions: Our study showed higher inpatient mortality, length of stay, and cost of hospitalization in patients undergoing TAVR with PH as compared to those without PH.