Aims This study aimed to estimate the annual mortality risk and its determinants in chronic Chagas cardiomyopathy. Methods and results We conducted a systematic search in MEDLINE, Web of Science Core Collection, Embase, Cochrane Library, and LILACS. Longitudinal studies published between 1 January 1946 and 24 October 2018 were included. A random-effects meta-analysis using the death rate over the mean follow-up period in years was used to obtain pooled estimated annual mortality rates. Main outcomes were defined as all-cause mortality, including cardiovascular, non-cardiovascular, heart failure, stroke, and sudden cardiac deaths. A total of 5005 studies were screened for eligibility. A total of 52 longitudinal studies for chronic Chagas cardiomyopathy including 9569 patients and 2250 deaths were selected. The meta-analysis revealed an annual all-cause mortality rate of 7.9% [95% confidence interval (CI): 6.3–10.1; I² = 97.74%; T² = 0.70] among patients with chronic Chagas cardiomyopathy. The pooled estimated annual cardiovascular death rate was 6.3% (95% CI: 4.9–8.0; I² = 96.32%; T² = 0.52). The annual mortality rates for heart failure, sudden death, and stroke were 3.5%, 2.6%, and 0.4%, respectively. Meta-regression showed that low left ventricular ejection fraction (coefficient = −0.04; 95% CI: −0.07, −0.02; P = 0.001) was associated with an increased mortality risk. Subgroup analysis based on American Heart Association (AHA) classification revealed pooled estimate rates of 4.8%, 8.7%, 13.9%, and 22.4% (P < 0.001) for B1/B2, B2/C, C, and C/D stages of cardiomyopathy, respectively. Conclusions The annual mortality risk in chronic Chagas cardiomyopathy is substantial and primarily attributable to cardiovascular causes. This risk significantly increases in patients with low left ventricular ejection fraction and those classified as AHA stages C and C/D.

Incarceration of an umbilical hernia (UH) rarely occurs in the pediatric population. They usually resolve spontaneously or are treated after the child turns 4–5 years old [1, 2]. Risk factors for incarceration have been identified, but little is understood about how incarceration of an UH occurs.

Introduction/Purpose: Delayed treatment of acute Achilles tendon rupture is associated with worse outcomes and higher complication rates. Prior studies suggest reduced access to care among Medicaid and uninsured patients. This study examines the effect of insurance status on the timing of diagnosis and surgical treatment among patients undergoing surgical repair of acute Achilles tendon rupture. Methods: A retrospective chart review was conducted of patients aged ≥18 years with acute traumatic Achilles tendon ruptures identified by Current Procedural Terminology codes 27650 and 27654 at 2 hospitals between January 2017 and December 2023. Dates of injury, emergency department presentation, initial outpatient orthopaedic evaluation, and surgical intervention were recorded. Only patients who ultimately underwent operative repair were eligible for inclusion; because case ascertainment relied on surgical procedure codes, the cohort does not capture patients managed nonoperatively or those who never reached surgical care. Insurance status was categorized as private or Medicaid/uninsured. Postoperative complications, including re-rupture, infection, venous thromboembolism, wound dehiscence, return to the operating room, and mortality, were documented. Between-group comparisons of continuous variables were performed using the Mann-Whitney U test, given non-normal distribution of the underlying data; independent 2-tailed t-tests were performed as a secondary, confirmatory analysis. Significance was set at P < .05. Results: Thirty-eight surgically treated patients met the inclusion criteria, including 23 with private insurance and 15 who were Medicaid or uninsured. Median age was 35.2 years, and 89.5% were male. All time intervals are reported as medians. Time from injury to emergency department presentation was longer in the Medicaid/uninsured group but not statistically significant (1.0 vs 0.0 days; Mann-Whitney U P = .079). Medicaid/uninsured patients experienced significantly longer delays from injury to initial outpatient orthopaedic evaluation (17.0 vs 4.0 days; Mann-Whitney U P = .024) and from injury to surgery (30.0 vs 10.0 days; Mann-Whitney U P = .045). Time from orthopaedic evaluation to surgery did not differ significantly between groups (11.0 vs 6.0 days; Mann-Whitney U P = .206). Postoperative complications were infrequent in both groups; the study was not powered for comparison of complication rates and none was performed. Conclusion: Among surgically treated patients, those with Medicaid or no insurance experienced significantly longer delays to initial orthopaedic evaluation and to surgical repair compared with privately insured patients, highlighting disparities in access to timely orthopaedic care within this surgically treated population. Level of Evidence: III