Influenza and coronavirus disease 2019 (COVID-19) are both contagious respiratory illnesses, but they are caused by different viruses. COVID-19 pandemic is caused by a novel virus - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Influenza is an infectious respiratory disease, caused by influenza A and influenza B viruses. We describe the three cases of influenza and COVID-19 co-infection.

Background and objectives: To describe the clinical characteristics and outcomes of hospitalized coronavirus disease 2019 (COVID-19) patients with diabetic ketoacidosis (DKA) -- a single center tertiary hospital experience. Materials and Methods: A retrospective study was conducted among patients admitted to our hospital in the United States between March 1^st and June 15^th, 2020 with DKA and severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection known as COVID-19. We compared the baseline characteristics, laboratory data, and clinical course between survivors and nonsurvivors to identify the risk factors associated with mortality in the patients with DKA. Results: A total number of 43 patients were included in this study. The median age was 52 years. Thirty-three (76.7%) patients were male. Median value of initial glucose on presentation was 553 mg/dL (300.0-1927.0 mg/dL). On admission, 33 (76.7%) patients had glycated hemoglobin (HbA1c) ≥ 8% (64 mmol/mol) and HbA1c was not obtained in 10 (23.3%) patients. Acute kidney injury (AKI) was seen in 37 (86.0%) patients, 6 (14%) patients required renal replacement therapy and 22 (51.2%) required mechanical ventilation. Among the 43 patients, 25 (58.1%) died. Out of 25 patients who died 15 (60.0%) were Hispanics, 6 (24.0%) were White, 3 (12.0%) were African American, 1 (4%) was Arabic, and 1 (4%) was Asian. The patients who died were older in age than who survived (mean age 58 ± 6.13 vs 46 ± 9.39; p = 0.023). Some 95% of the patients requiring mechanical ventilation died (odds ratio [OR]: 89.25; 95% confidence interval [CI]: 9.10-874.96); p = 0.001). Compared to survivors, nonsurvivors had significantly higher d-dimer (13.00 ± 3.20 mcg/mL vs 6.15 ± 3.66 mcg/mL; p < 0.006) and peak ferritin values (2763.66 ± 1105.32 ng/mL vs 835.16 ± 257.07 ng/mL; p = 0.016). Conclusion: Our retrospective study shows COVID-19 infection may present as DKA in patients with diabetes mellitus (DM). Older age, mechanical ventilation, elevated d-dimer, and ferritin are associated with poor prognosis in these patients. Our study shows that COVID-19 is associated with substantial mortality in DKA patients and adds to the limited literature available regarding poor risk factors associated with mortality in these patients.

Background: Cardiac arrest remains a significant public health challenge with variable mortality trends across different demographics and regions, affecting healthcare planning and intervention strategies. We conducted this study to analyze cardiac arrest-related mortality trends from 1999 to 2023 and predict future trends up to 2035. Methods: This study analyzed data from 1999 to 2023, focusing on cardiac arrest as the primary cause of death (ICD-10: I46). Age-adjusted mortality rates (AAMRs) were standardized according to the 2000 U.S. Census. Joinpoint regression was utilized to calculate annual percentage change (APC), and an ARIMA model with Python 3.10 was used for mortality predictions. Results: A total of 365,608 cardiac arrest-related deaths were recorded in the USA from 1999 to 2023. There was a sharp decline in mortality rate until 2001 (APC: −10.35, p < 0.05), followed by a slowed decline until 2013 (APC: −2.91, p < 0.05), and then a gradual uptrend. Males exhibited a higher AAMR (5.8, 95% CI: 5.8–5.9) compared to females (4.2, 95% CI: 4.1–4.2). African Americans had the highest AAMR (8.9, 95% CI: 8.9–9), followed by Caucasians (4.8, 95% CI: 4.8–4.9) and American Indians (3.5, 95% CI: 3.3–3.7). The South region of the US had the highest AAMR, followed by the Northeast, Midwest, and West. Alabama exhibited the highest AAMR, followed by Nevada and Hawaii. Predictive analysis suggests a potential stable slow downtrend in mortality rates by 2035 (AAMR: 4.28, 95% CI: −1.8–10.4). Conclusions: The observed trends and future predictions underscore the importance of targeted public health interventions and healthcare planning to address cardiac arrest mortality.

Patent foramen ovale (PFO) is a common congenital abnormality of the heart. It results from incomplete closure of foramen ovale that persists in adulthood. Most individuals with PFO are asymptomatic and are discovered incidentally. The left atrial pressure is generally higher than the right atrial pressure, which prevents blood flow against the gradient; however, any medical condition that increases the pulmonary artery pressure can lead to reversal of blood flow from right to left by elevating right atrial pressure. We present a case of a 59-year-old female who presented with complaints of shortness of breath associated with bilateral lower-extremity edema and was found to have acute decompensated heart failure and atrial fibrillation. Transesophageal echocardiogram (TEE) with cardioversion was performed. Propofol was given for conscious sedation; however, the procedure was terminated as patient became hypoxemic and was noted to have moderately dilated right ventricle (RV) with hypokinesia and PFO with right-to-left shunting. It also demonstrated mild mitral regurgitation, mild left ventricular hypertrophy, and a left ventricular ejection fraction of 55-60%. In contrast to TEE findings, while the patient was having normal oxygen saturation, transthoracic echocardiogram showed left-to-right shunting instead of right-to-left and no RV hypokinesia was noted. In conclusion, this case draws attention to the relationship between acute hypoxemia and rightto-left shunting in a patient with PFO. This case illustrates and highlights the need for more prospective studies to establish a relationship between acute hypoxemia and right-to-left shunting in the presence of PFO.

This study aimed to examine global hypertensive heart disease (HHD) trends (1990–2019). Methods: We extracted data from the Global Burden of Disease (GBD) 2019 Study, encompassing 204 countries and territories. We analyzed the age-adjusted mortality rates (AAMRs), crude mortality, prevalence, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life years (DALY). Joinpoint Regression Analysis was used to calculate the Annual Percentage Change (APC), with p < 0.05 indicating statistical significance. Results were stratified by region, Socio-Demographic Index (SDI), and gender. Results: Globally, the crude mortality rate for HHD rose from 12.2 (95% UI 9.9–13.6) to 14.9 (95% UI 16.5–11.1) deaths/100,000 population (1990–2019), whereas the AAMR declined from 19.3 (95% UI 5.8–21.6) to 15.1 (95% UI 11.1–16.7). A Joinpoint Analysis revealed significant APC shifts: a decrease of −1.53% (p < 0.05) from 1990 to 2006, an increase of +0.60% (p < 0.05) from 2006 to 2015, and a subsequent decrease of −1.28% (p < 0.05) from 2006 to 2019. Eastern Europe showed the highest annual rate of change in AAMR at 0.9 (95% UI: −0.1 to 1.2), whereas the high-income Asia Pacific region experienced the largest decline at −0.66 (95% UI −0.27–−0.72). Central Asian males had an AAMR of 31.1 (95% UI 35.3–22.9) in 2019, and Sub-Saharan African females reached 38.5 (95% UI 48.4–26.3). YLL trended downward in both sexes (APC: −1.94, p < 0.05 in males; −1.81, p < 0.05 in females), yet YLD rose steadily in recent years, underscoring a growing chronic burden. The AAMR was highest in 2019 among Sub-Saharan African females, which is a particularly important area. Conclusions: Targeted strategies are essential to mitigate the escalating HHD burden.