Background: Chronic kidney disease (CKD) is becoming increasingly common in the United States, particularly among older adults. However, little is known about the mortality patterns within this demographic. Objective: This study aims to explore the demographic and regional patterns of CKD-associated mortality in the United States from 1999 to 2020 among adults >65 years old. Methods: The Centers for Disease Control and Prevention’s WONDER (Wide-Ranging Online Data for Epidemiologic Research) database’s death certificates were analyzed for CKD-related mortality in persons aged 65 and older between 1999 and 2020. Age-adjusted mortality rates (AAMRs) per 10 000 and annual percentage change were calculated, stratified by geographic region, sex, year, and race/ethnicity. Results: Between 1999 and 2020, 1 572 075 CKD-related deaths occurred among adults ≥65 years. AAMR increased significantly from 132.0 in 1999 to 216.6 in 2020. Men consistently had higher AAMRs than women. Non-Hispanic (NH) Black has the highest AAMR (312.3), followed by NH American Indian (188.8), Hispanic (178), NH White (157), and NH Asian (143.9). Additionally, there was significant regional heterogeneity in AAMR (Midwest 184.6; South: 171.6; West: 165.5; Northeast: 157.4), with CKD-related AAMR being greater in non-metropolitan areas. States with CKD-related rates in the top 90th percentile AAMR were West Virginia, North Dakota, Indiana, Ohio, South Carolina, and North Carolina. Conclusions: CKD-related mortality in US adults ≥65 years has increased from 1999 to 2020. The highest AAMRs were noticed among NH Blacks, men, and patients residing in non-metropolitan and Midwestern areas of the United States. A targeted approach is required to significantly decrease the mortality in this population group.

Introduction: Ventricular septal defect (VSD) is a severe complication following acute myocardial infarction (MI) resulting from mechanical disruption of the interventricular septum due to extensive myocardial necrosis. Despite advances in management, the mortality rate approaches 50%. We report a case of a 58-year-old male with VSD following MI who was successfully treated with a delayed surgical approach after haemodynamic support using Impella. Case description: A 58-year-old man with type 2 diabetes mellitus and hypertension presented with three days of chest pain. Testing revealed late presenting acute anterior ischaemic infarction and left-to-right shunt in the apical ventricular septum. Urgent cardiac catheterisation showed near-total occlusion of the left anterior descending artery. An Impella CP® was placed before angioplasty with a drug-eluting stent to optimise haemodynamics. After a multidisciplinary discussion, the Impella CP® was upgraded to Impella 5.5®, and surgery was delayed allowing for scar formation. The patient remained in the intensive care unit, where he underwent physical therapy, showing improvements in exercise tolerance by the time of surgery. He underwent a left ventriculotomy with a successful repair via an endocardial patch 28 days after initial presentation. Post-operative recovery was uneventful, with the patient discharged five days later, reporting no physical limitations one month post-discharge. Conclusion: The successful management of VSD post-MI relies on interdisciplinary collaboration, careful timing of surgical intervention and the strategic use of mechanical support devices such as the Impella. This case highlights the potential for favourable outcomes when tailored treatment approaches are employed.

Background: Aortic stenosis (AS) represents a prevalent valvular condition in older adults, associated with significant morbidity and mortality. The objective of the study was to examine trends in mortality related to AS in the United States (U.S.). Methods: The U.S. CDC WONDER dataset was analyzed, extracting age-adjusted mortality rates (AAMR) per 100,000 and calculating annual percentage change (APC) through Joinpoint regression. The results were stratified to identify temporal, sex-specific, racial/ethnic, and regional differences. Results: From 1999 to 2020, 267,515 deaths among older adults (>65 years old) were attributed to AS, with the AAMR declining from 28.00 to 23.69. Males had a higher AAMR (30.35) compared to females (27.42), though more deaths occurred in females (164,104 vs. 103,411). Non-Hispanic (NH) Whites exhibited the greatest AAMR (31.61), trailed by NH American Indian/Alaska Native individuals (16.62), whereas NH Asians/Pacific Islanders had the least (11.50). Significant state-wise variations were noted, with AAMRs ranging from 60.55 in Oregon to 17.23 in Mississippi, and 19 states depicting a concerning rise over the study duration. Regionally, the Northeast (32.09) had the highest AAMRs, while the South (23.06) had the lowest. Micropolitan (32.28) and noncore (28.43) areas reported higher AAMRs compared to large central metropolitan areas (24.32). Conclusions: While there is a trend towards decreased mortality due to AS in the U.S., significant disparities based on race, sex, and region persist and may be worsening. The underlying causes of these discrepancies require further investigation, and targeted strategies must be developed to address them effectively.

Objective: To assess health-related quality of life (QoL) and its associated factors among health workers (HWs) in tertiary care hospitals of Peshawar, Pakistan.Methods: This analytical cross-sectional study was conducted from February to May 2024 in Medicine & Allied and Surgical & Allied departments of three public and six private tertiary care hospitals in Peshawar. Using non-probability convenience sampling, 365 HWs, including specialists, trainee medical officers, house officers, and nurses, were recruited. Health-related QoL was assessed using World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. Data were analysed using descriptive and inferential statistics, with p<0.05 considered statistically significant.Results: Among 365 health workers, majority (n=211, 57.8%) were male, with overall mean age of 29.22±6.49 years. The WHOQOL-BREF demonstrated good internal consistency (Cronbach's α=0.883). Mean scores for the physical, psychological, social relationships, and environmental domains were 50.96±14.99, 58.31±16.40, 61.97±23.28, and 54.27±17.83, respectively. Male gender, married status, and employment in Medicine and Allied departments were significantly associated with higher social relationship scores. Nurses had higher physical health scores than other professional groups (p=0.010). Morning shifts, working <8 hours/day, and private-sector employment were associated with better QoL in selected domains. Age was weakly associated with social relationships (r=0.110, p=0.036), while commute duration had no significant impact on any domain.Conclusion: Health-related QoL among HWs varied across WHOQOL-BREF domains and was significantly associated with demographic and occupational factors, particularly gender, professional designation, department, work shift, shift duration, and hospital sector. Workplace interventions targeting modifiable occupational factors may improve well-being and QoL of HWs.