Association of opioid use disorder with outcomes of hospitalizations for acute myocardial infarction in the United States

Abstract Objective While Opioid Use Disorder (OUD) has been linked to inferior clinical outcomes, studies examining the clinical outcomes and readmission of OUD patients experiencing Acute Myocardial Infarction (AMI) remain lacking. The authors analyze the clinical and financial outcomes of OUD in a contemporary cohort of AMI hospitalizations. Methods All non-elective adult (≥ 18 years) hospitalizations for AMI were tabulated from the 2016‒2019 Nationwide Readmissions Database using relevant International Classification of Disease codes. Patients were grouped into OUD and non-OUD cohorts. Bivariate and regression analyses were performed to identify the independent association of OUD with outcomes after non-elective admission for AMI, as well as subsequent readmission. Results Of an estimated 3,318,257 hospitalizations for AMI meeting study criteria, 36,057 (1.1%) had a concomitant diagnosis of OUD. While OUD was not significantly associated with mortality, OUD patients experienced superior cardiovascular outcomes compared to non-OUD. However, OUD was linked to increased odds of non-cardiovascular complications, length of stay, costs, non-home discharge, and 30-day non-elective readmission. Conclusions Patients with OUD presented with AMI at a significantly younger age than non-OUD. While OUD appears to have a cardioprotective effect, it is associated with several markers of increased resource use, including readmission. The present findings underscore the need for a multifaceted approach to increasing social services and treatment for OUD at index hospitalization.

Nephropathic cystinosis presenting with uveitis: Report of a “Can't See, Can't Pee” situation

Nephropathic cystinosis is a rare autosomal recessive lysosomal disease characterized by accumulation of pathognomonic cystine crystals in renal and other tissues of the body. Cystinosis is caused by mutant cystinosin, the cystine transport protein located in lysosomal membranes, leading to systemic deposits of cystine and resultant end organ damage. Cystinosis is rarer in Asians than Caucasians with only a handful of cases reported from India to date. Due to its extreme rarity and clinically insidious presentation in contrast to the infantile form, the diagnosis of juvenile nephropathic cystinosis is frequently delayed or overlooked. Moreover, routine processing and sectioning of paraffin embedded tissues dissolves cystine crystals, making it difficult to diagnose this condition on light microscopic examination alone, mandating electron microscopic (EM) analysis of renal biopsies for an accurate diagnosis of this condition. We describe a case of juvenile nephropathic cystinosis presenting with uveitis and photophobia in a 17-year-old Indian male, diagnosed after EM examination of the patient's renal biopsy for evaluation of nephrotic syndrome. While highlighting the diagnostic utility of EM, we describe a few histopathologic clues which can prompt inclusion of EM analysis of renal biopsies in this setting.

Health Education Program on Leptospirosis among College Students in Chennai, South India.

Aim: To determine the level of knowledge on leptospirosis among college students in Chennai, India before and after the health education program. Study Design: Interventional study Place and Duration of the Study: Seven Arts and Science colleges in Chennai, India between January and June 2014. Methodology: After getting prior permission from the Principals of the colleges, the students who were willing to take part in the study were requested to fill serially numbered and labeled semistructured questionnaire (A&B). Questionnaire included demographics and questions on awareness of leptospirosis, risk factors, mode of transmission, symptoms and human vaccine. Questionnaire A was filled (anonymously) and collected after which the education on leptospirosis was provided as a power point presentation. At the end of the program, students filled questionnaire B and submitted. Statistical analysis was done using McNemar test. Results: Out of 501 students, 28% were males and 72% were females. Age of the students ranged from 16 to 37 years with mean of 20.46 years, SD 3.477. Seventy five percent were Hindus, 20% were Christians and 5% were Muslims. Only 36% of the students were aware that Leptospirosis was common in Chennai while after the program 84% were aware of leptospirosis (P< .001). Knowledge on the risk factors of leptospirosis increased significantly after the program (P < .001). Pre awareness assessment revealed poor knowledge on the modes of transmission of leptospirosis and on symptoms of the disease such as fever and jaundice which increased significantly after the intervention (P < .001). Knowledge on human vaccine was found to be less in the initial survey which improved significantly after the awareness program (P < .001). Conclusions: There was significant increase in the knowledge on leptospirosis among the students after the health education program. Such programs are needed to be carried out for a wider dissemination of information.

Non-haematopoietic malignancies metastasing to the bone marrow: A 5 year record-based descriptive study from a tertiary care centre in South India.

INTRODUCTION: Bone marrow involvement by a non-haematological malignancy gives an opportunity to identify the lodgement, invasion of metastatic cells and the response of the host to the tumor cells. The study was undertaken to assess the involvement of bone marrow with non-haematopoietic malignancies and its significance in establishing primary diagnosis in clinically unsuspected cases. MATERIALS AND METHODS: This was a descriptive study which included record review of the departmental archives for the last five years (January 2007 to December 2011). Eighty four cases were studied; which included clinically diagnosed non-haematological malignancy for staging or symptomatic cytopenias/bony lesions (group 1, n = 63), clinically suspected bone marrow metastasis of unknown primary malignancy due to symptomatic cytopenias/bony lesions (group 2, n = 07) and clinically unsuspected malignancy with incidentally detected bone marrow metastasis (group 3, n = 14). RESULTS: Bone marrow metastases of solid tumors were identified in 23 cases (27.3%) which included 9 cases from group 1, 14 cases from group 3 and nil in group 2. Of the 14 cases in group 3, in 12 cases a definitive diagnosis could be made by correlating clinicoradiological findings with morphology and immunohistochemistry. The most common tumor in pediatric cases were neuroblastoma and Ewing’s sarcoma (40%) and in adult’s adenocarcinoma of gastrointestinal tract (30.7%) was the commonest. CONCLUSION: Bone marrow metastasis can masquerade as a primary haematopoietic disorder; however its detection has both therapeutic and prognostic significance. Immunohistochemistry is a useful adjunct to morphology in reaching a definitive diagnosis.

Occurrence of leptospirosis among suspected cases in Chennai, Tamil Nadu.

Objective: To evaluate the serological profile of leptospirosis by microscopic agglutination test (MAT) and dark field microscopy (DFM) and to determine the serovar prevalence rate among patients with pyrexia of unknown origin. Materials and Methods: A total of 3830 blood samples were received from different hospitals and laboratories in and around Chennai. They were screened for leptospirosis by MAT and direct observation of live Leptospira by DFM. Results: A total of 748 (19.5%) Leptospira positive cases were identified; among these, 36.76% were Leptospira australis, 30% were Leptospira canicola, 14.57% were Leptospira autumnalis, 12% were Leptospira icterohaemorrhagiae, 4.68% were Leptospira patoc and 1.87% were Leptospira grippotyposa. Patients were in the age group of 1-86 years, with a median age of 43.5 years. 50% positive cases were in the age group of 10-35 years. Majority of the Leptospira infected cases were males (62.98%) than females (37.02%). Conclusion: Leptospirosis occurs in Chennai throughout the year although the number and positivity of cases increased during the monsoon season.

Surgical Research; Surgical Audit and Safe Surgery

N. A.

The recurrent laryngeal nerve in relation to the inferior thyroid artery in adult Filipino cadavers

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature.</p> <p style="text-align: justify;"><strong>METHODS</strong>:<br /><strong>Design</strong>: Descriptive, cross-sectional<br /><strong>Setting</strong>: University of the Philippines College of Medicine Anatomy Laboratory<br /><strong>Subjects</strong>: Fifty-four (54) preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into two variations: non-branching or branching prior to insertion at the cricothyroid joint under the inferior constrictor muscle. The ITA was also classified into non-branching and branching. The results were compared to two foreign studies using a Z-test for two proportions.<br /><br /><strong>RESULTS</strong>: Fifty four (54) cadavers (108 sides) were dissected. Among the cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA. The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA but differs from those of Brazilians where the RLN is usually between ITA branches.<br /><br /><strong>CONCLUSION</strong>: There are multiple anatomical variations regarding the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon's knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery.</p>

The use of dried blood spots on filter paper for the diagnosis of HIV-1 in infants born to HIV seropositive women.

Polymerase chain reaction (PCR) is the most sensitive test to diagnose HIV-1 infection among infants born to HIV seropositive mothers. The purpose of this study was to evaluate the use of dried blood spot (DBS) specimens for PCR and to compare it with whole-blood stored in tubes for HIV-1 DNA PCR. Five hundred and seventy-seven whole-blood infant samples were tested using HIV-1 qualitative in-house nested DNA PCR. Three hundred and fifty-nine samples were from infants at 48 hours of birth and 218 samples at second month. All positive samples tested from whole-blood and every fifth negative sample were coated onto filter paper. DNA was extracted from the filter paper and was amplified using in-house nested PCR. Among the whole-blood samples tested using HIV-1 DNA PCR, 19 of 359 (5.29%) samples were HIV-1 positive and 340 (94.7%) were negative at 48 hours of birth. At second month, 19 (8.7%) of the 218 samples were positive and 199 (91.2%) were negative. Using dried filter paper, 18 samples (95%) tested positive from 19 positive samples (using whole-blood) and 1 tested negative at 48 hours of birth. The 68 negative samples tested using whole-blood were also negative in the DBS test (sensitivity 95% and specificity 100%). At second month, 19 were positive and 40 samples (every fifth sample of 199) were negative (sensitivity and specificity, 100%). PCR performed using DNA extracted from filter paper permits the diagnosis of HIV-1 infection among infants born to HIV-1 seropositive mothers. This assay is simple, rapid, sensitive and specific and can be used in resource limited settings.

Massive chondroid hamartoma of the lung clinically masquerading as bronchogenic carcinoma.

Chondroid hamartomas of the lung are uncommon lesions which are generally small sized and asymptomatic. Herein we describe a case of a large-sized pulmonary chondroid hamartoma which clinically mimicked bronchogenic carcinoma. A large hilar growth was detected in the left lung on radiological studies. Left upper lobectomy was done. The growth was well defined with a lobulated bluish cut surface. Histopathology disclosed lobules of mature cartilage rimmed by long slit-like epithelial channels admixed with mature adipose tissue.

Identificação de pontos críticos de controle em uma linha de abate proposta para avestruz Struthio camelus / Identification of critical control points in the abates proposal for Struthio camelus ostrich

A qualidade da carne é influenciada pela tecnologia empregada na produção dos animais e do abate, passando pelo processamento, armazenamento, transporte e condições de comercialização. A inspeção sanitária de carnes representa ação preventiva da mais alta relevância para a Saúde Pública, visando a proteção da saúde da população. As ações de inspeção e a garantia da qualidade de produtos cárneos podem ser facilitadas através da implementação da metodologia da Análise dos Perigos e Pontos Críticos de Controle (APPCC) em todas as etapas da cadeia de produção. Este trabalho se propôs a identificar os principais perigos associados a cada etapa do fluxograma da linha de matança de avestruz, determinando também os limites críticos, as medidas preventivas, monitoramento, ações corretivas e sistemas de registro para cada Ponto Crítico de Controle. De acordo com o observado, pôde-se concluir que os pontos-chave identificados para controlar os perigos envolvidos na linha de abate de avestruz foram: treinamento de pessoal, principalmente os envolvidos na evisceração; uso de metodologia de higiene e sanitização adequados; controle de qualidade da água, manutenção e utilização correta de equipamentos.

Peritoneal adhesions: pathogenesis, assessment and effects.

BACKGROUND: As modem surgery has evolved, there has been an increase in iatrogenic peritoneal adhesions. Most surgeons manage adhesions and their related complications on a regular basis. Studies in recent years have improved the understanding of the pathogenesis and impact of adhesions, which are discussed. METHODS: A systematic search of literature was performed to identify publications addressing the etiopathogenesis, clinical spectrum and effects of adhesions, using the following database: Medline (1966 to April 2005), Embase (1974 to April 2005), and the Cochrane controlled trials register. The reference lists of key publications so identified were in addition scrutinized for additional articles of relevance. RESULTS: Adhesions occur in more than three fourths of patients following laparotomy. Perironeal trauma results in a unique inflammatory process in which fibrin formation and fibrinolysis play a central role. The effects of adhesions are unpredictable but are wide ranging, causing a significant health care burden. Intestinal obstruction, infertility, problems at reoperative surgery and cumulative costs of care over many years are the key concerns. While adhesiolysis is beneficial in adhesive intestinal obstruction and infertility, its value in chronic pain is uncertain. CONCLUSION: Every violation of the peritoneum carries a potentially lifelong risk of a range of complications. Data available on the epidemiology and natural history of adhesions call for a wider acknowledgement of the problem in the planning of services and greater attention to preventive strategies.

Assessment of physiological stress in periparturient cows and neonatal calves.

Pregnancy is considered to be one of the physiological stressors. The stress hormone, cortisol is significantly involved in various events during periparturient period including initiation of parturition. The study was conducted to estimate the serum cortisol concentration in cows and the neonatal calves in order to correlate the effect of cortisol on certain haematological and biochemical parameters such as blood glucose level (BGL), total plasma protein (TPP), lymphocyte:neutrophil ratio and mitogen induced lymphocyte proliferative response. Blood samples were collected from six cows in four periods, namely., 3 days prior to parturition, on the day of parturition, and 7 days after parturition. Blood samples were also collected from neonatal calves in the period 0, 7 and 14 days of age. Calves above two months of age and non-pregnant dry cows were considered as the controls. The serum cortisol concentration in cows on the day of parturition was significantly higher (P < 0.01) than controls and the value in calves was also significantly higher (P < 0.01) at 0 day than their controls. On the day of parturition BGL level of the dam and calves were significantly higher (P < 0.01), whereas the proliferative response of lymphocytes to mitogen was significantly lower (P < 0.01) than controls. However TPP levels did not differ significantly. This confirmed that the dam at the time of parturition and neonatal calf before taking colostrum are under a high risk of infection because of the low profile of immune status. The lymphocyte:neutrophil ratio also justified the above suggestion.

Pregnancy in women with epilepsy : preliminary results of Kerala registry of epilepsy and pregnancy.

Eighty-five women with epilepsy were followed up for reproductive functions under the registry of epilepsy and pregnancy. 32 of them had completed the pregnancy. Their mean age was 26 years and mean seizure frequency was 0.7 during current pregnancy. Nineteen of them (59.4%) had generalized epilepsy. Nine of them were not on any anti epileptic drugs (AED), 23 women were on various AEDs, 19 being on monotherapy. Only 40% of the women were taking folic acid during pregnancy. Pregnancy ended as spontaneous abortion in one patient. Nearly one third required cesarean section. Majority (87.5%) had term babies. Three (10.7%) babies had birth asphyxia. Six babies (21.4%) had low birth weight. Congenital malformations were detected in four cases (12.5%). Malformations included neural tube defects, talipes equinovarus and other minor anomalies. These babies were exposed to sodium valproate, carbamazepine or phenobarbitone. The risk of malformation was significantly greater (p<0.05) when the mother had generalized epilepsy. The odds ratio for risk of malformation was much higher with sodium valproate (6) than that with carbamazepine (1.2) or phenobarbitone (0.8). Majority of women with epilepsy had safe pregnancy and childbirth without any aggravation of epilepsy.

Mechanics of tarsal disintegration and plantar ulcers in leprosy by stress analysis in three dimensional foot models.

This paper describes three dimensional two arch models of feet of a normal subject and two leprosy subjects, one in the early stage and the other in the advanced stage of tarsal disintegration, used for analysis of skeletal and plantar soft tissue stresses by finite element technique using NISA software package. The model considered the foot geometry (obtained from X-rays), foot bone, cartilages, ligaments, important muscle forces and sole soft tissue. The stress analysis is carried out for the foot models simulating quasi-static walking phases of heel-strike, mid-stance and push-off. The analysis of the normal foot model shows that highest stresses occur at push-off over the dorsal central part of lateral and medial metatarsals and dorsal junction of calcaneus and cuboid and neck of talus. The skeletal stresses, in early state leprosy with muscle paralysis and in the advanced stage of tarsal distintegration (TD), are higher than those for the normal foot model, by 24% to 65% and 30% to 400%, respectively. The vertical stresses in the soft tissue at the foot-ground interface match well with experimentally measured foot pressures and for the normal and leprosy subjects they are the highest in the push-off phase. In the leprosy subject with advanced TD, the highest soft tissue stresses and shear stresses (about three times the normal value) occur in push-off phase in the scar tissue region. The difference in shear stresses between the sole and the adjacent soft tissue layer in the scar tissue for the same subject is about three times the normal value. It is concluded that the high bone stresses in leprosy may be responsible for tarsal distintegration when the bone mechanical strength decreases due to osteoporosis and the combined effect of high value of footsole vertical stresses, shear stresses and the relative shear stresses between two adjacent soft tissue layers may be responsible for plantar ulcers in the neuropathic leprosy feet.