In sepsis, an overwhelming immune response, as mediated by the release of various inflammatory mediators, can lead to shock, multiple organ damage, and even death. Pneumonia is the leading cause of sepsis. In animal septic models, sepsis could induce uncontrolled calcium (Ca²⁺) leaking, raising cytosolic Ca²⁺to a toxic level, causing irreversible cellular injuries and organ failure. All types of calcium channel blockers (CCBs), by inhibiting Ca²⁺influx, have been shown to decrease overall mortality in various septic animal models. However, to our best knowledge, no clinical study had been conducted to investigate the beneficial effect(s) of CCBs in sepsis. We conducted a retrospective propensity-matched cohort study after screening 2214 patients hospitalized for pneumonia from year 2012 to 2014 at our institution. We identified 387 preadmission CCB users and 387 nonusers by propensity score matching. Logistic regression analysis was then used to determine the association between preadmission CCB use and outcomes in pneumonia. Our study showed that the odds for development of severe sepsis was significantly lower in the CCB user group [odds ratio (OR), 0.466; 95% confidence interval (CI), 0.311–0.697;P= 0.002]. Preadmission CCB use was associated with a lower risk of contracting bacteremia (OR, 0.498; 95% CI, 0.262–0.99;P= 0.0327), lower risk of acute respiratory insufficiency (OR, 0.573; 95% CI, 0.412–0.798;P= 0.001), lower risk of intensive care unit admission (OR, 0.602; 95% CI, 0.432–0.840;P= 0.0028). In conclusion, our study suggested preadmission CCB use was associated with a reduction in the risks of development of respiratory insufficiency, bacteremia, and severe sepsis in patients admitted to the hospital with pneumonia.

The absence of comprehensive education on hospital value-based purchasing during undergraduate medical education may lead to inadequate comprehension of healthcare finance during Graduate Medical Education and subsequent medical practice. Medicine residents and junior hospitalists (defined as those who completed their residency in the last 5 years) may lack essential healthcare financial skills to address the needs of their patients and the healthcare system effectively. To assess healthcare financial literacy among medical students, medicine residents, and junior hospitalists, we conducted a survey at an academic Internal Medicine residency affiliated with a US Medical School. Participants completed a 40-item questionnaire sourced from federal government healthcare system websites, providing demographic data and indicating prior formal healthcare finance education. Of the 126 respondents, only 15.6% reported receiving formal healthcare financial education, with merely 4 out of 34 junior hospitalists having prior education. Notably, there were no significant differences in correct answer percentages between 3rd and 4th-year medical students, medicine residents, and junior hospitalists across 3 domains: Medicaid/Medicare insurance, US healthcare systems & insurance, and healthcare access, quality and value-based purchasing. However, participants performed better in the domain of Medicaid/Medicare insurance compared to the other domains. This study underscores the potential deficiency in financial skills among junior healthcare providers, highlighting the importance of addressing this gap to ensure effective patient care.

The obesity paradox in patients with coronary artery disease is well established, but the role of the metabolic syndrome associated with obesity is not well studied. Our study aims to evaluate the in-hospital outcomes of percutaneous coronary intervention (PCI) in metabolically healthy individuals with obesity (MHO) and metabolically unhealthy (MUHO) individuals with obesity over 65 years of age with acute coronary syndrome (ACS) between 2016 and 2020. This was a retrospective and observational study. Patients were identified through utilizing the National Inpatient Sample (NIS) Database (2016–2020) and ICD-10 codes. By employing a t-test and Pearson's Chi-square test, we assessed and contrasted the initial attributes, concurrent conditions, and results pertaining to all-cause mortality (ACM), cardiogenic shock (CS), length of stay (LOS), and hospitalization expense. Moreover, propensity score matching was conducted in a 1:1 ratio with respect to age, gender, and race. We also utilized multivariable logistic regression to compare MHO and MUHO in terms of the impact on all-cause mortality. Out of a total of 135,395 patients identified, 2995 patients with MUHO were matched with 2995 MHO patients. Patients in the MUHO group had a higher prevalence of chronic pulmonary disease (24.9 % vs. 19.5 %), peripheral vascular disease (9.3 % vs. 6.7 %), hypothyroidism (16 % vs. 11.5 %), prior myocardial infarction (15.9 % vs. 6.2 %), and prior stroke (7.5 % vs. 2.8 %). Patients in the MHO group had a higher ACM (12.4 % vs. 2.8 %, p < 0.001), CS (18.55 % vs. 7 %, p < 0.001), stroke (2.2 % vs. 1 %, p < 0.001), ventricular assist device insertions (5.2 % vs. 2.7 %, p < 0.001), and IABP insertions (8.8 % vs. 3.8 %) compared to the MUHO cohort. Our study revealed an obesity paradox in individuals over 65 years of age undergoing PCI demonstrating worse outcomes, including higher in-hospital mortality, CS, stroke, Ventricular assist device and IABP insertion in MHO patients compared to the MUHO cohort.

Gastrointestinal signs and symptoms are common in the early stages of Lyme disease. However, hyperbilirubinemia from Lyme disease is extremely uncommon. There are only two case reports in literature attributing Lyme disease to hyperbilirubinemia. Here we report a case of severe hyperbilirubinemia as the presenting symptom of Lyme disease. Other plausible etiologies have been ruled out after extensive workups, including liver biopsy. His hyperbilirubinemia gradually resolved after being started on doxycycline. With high incidence of Lyme disease, it should be considered for patients who present with hyperbilirubinemia in endemic areas with possible tick exposure.

The impact of prediabetes on outcomes in chronic total occlusion (CTO) hospitalizations remains unclear. We evaluated the association between prediabetes a