Objectives: The objective of this study was to determine the incidence, associations, evaluation, and management of pyuria in patients admitted to the hospital with nonurinary infections.Methods: This study abstracted inpatient records of consecutive patients hospitalized for pneumonia, intra-abdominal infections, female genital tract infections (GYN infections), bacterial septicemia, and enteritis in the pediatric and adult medical and surgical units at an academic medical center.Results: The study population included 210 patients (66 children; 144 adults). Nearly one-third had >5 white blood cells (WBCs) per high-power field (pyuria). Pyuria was more common in women (P < .001) and in patients with GYN infections (P ‫؍‬ .001) and less common in patients with pneumonia (P < .

Superior vena cava syndrome has typically been associated with malignant conditions; however, the number of benign cases has started to grow as the use of upper-extremity venous lines and implantable cardiac devices increases. Whereas endovascular techniques are standardly used to treat patients with malignancies, the optimal care of patients with benign causes is less clear because they typically have longer life expectancies. We describe 2 cases of benign superior vena cava syndrome successfully managed with endovascular stenting, and we review the relevant literature. Of 145 cases in 10 series (average follow-up time, 24 mo), 96% of patients experienced symptomatic relief after endovascular management, with a primary patency rate of 66% and a secondary rate of 93%. Although few data exist to compare open surgical and endovascular techniques directly, both approaches appear to produce similar rates of patency. Both approaches frequently necessitate secondary intervention to maintain patency, but endovascular management is associated with fewer complications. We conclude that endovascular management of benign superior vena cava syndrome is a safe, effective, and reasonable initial management approach.

Critical limb ischemia (CLI) is a prevalent condition associated with cardiovascular mortality and limb loss. Areas covered: This review discusses the epidemiology of CLI, revascularization options, and drug-elution therapies. Expert commentary: Drug-eluting stents (DES) and drug-coated balloons (DCB) improve patency rates in the femoropopliteal segment, and are generally used as first-line therapies. For below-knee disease, angioplasty is the default strategy unless lesions are focal whereby DES can be used to reduce restenosis risk.

Introduction: Patients admitted with heart failure have a guarded prognosis and a wide range of mortality risk. Identifying that risk as early as possible will help to optimize use of resources and streamline care decisions; for example, triggering a referral to palliative care services. Our organization is a tertiary medical center located in a rural area of the northeastern United States. We compared two established mortality prediction models by applying them to our population. Purpose: The purpose of this investigation was to compare the accuracy of the ADHERE criteria and the Lim criteria (University of Hawaii) in predicting inpatient mortality. Methods: The patient population included all patients admitted to our facility who subsequently had a discharge diagnosis of Heart Failure (HF) for the period of April 2011 to September 2015. Data gathered from the Electronic Medical Record (EMR) included demographics (age, gender, race, ethnicity), admission and discharge date/time, length of stay, type and result of lab tests in the first 24 hours, and vital signs. We calculated the ADHERE score with BUN, Creatinine, and blood pressure. Using the methodology in Lim, we counted the number of abnormal (outside of the normal hospital range) lab tests and grouped them into three categories: one to six, seven to twelve, and thirteen or greater. We used univariate analyses, conducted logistic regressions, and compared the proportions of inpatient deaths in the highest risk group of each model. Results: 1553 patients were admitted to our facility with HF during our review period: 1381 had sufficient data to be scored under the ADHERE criteria and 1548 under the Lim criteria. We created logistic regression models based on the ADHERE and the Lim criteria to predict inpatient mortality. For both the ADHERE and the Lim models, results from univariate analyses indicated that the respective ADHERE/Lim criteria and patient age were significant. Specifically, age group 80 and greater was significant OR 4.4 95% C.I. (1.6, 15.0) in the ADHERE model and OR 6.1 95% C.I. (2.2, 21.3) in the Lim Model. Results from the ADHERE and Lim criteria are found in Table. Conclusions: The Lim criteria seem to provide the better predictor of inpatient mortality, though either model would be acceptable for inpatient mortality prediction. The model is neither over-nor under-fitted as demonstrated by the AUC. As these data are easily extracted from an EMR, they can be used to provide an alert to providers as to patients at greatest risk of mortality. Since our population is demographically homogeneous, these results may not be generalizable to other organizations.

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