Acute Ischemic Stroke Among Cannabis Users in the United States and Possible Risk Factors for Mortality.

BACKGROUND: With changes in state laws, cannabis is now more accessible in many parts of the United States. The drug has previously been associated with a higher incidence of acute ischemic stroke (AIS). Our study analyzed the effect of cannabis use on AIS outcomes. METHODS: The 2019 National Inpatient Sample from Healthcare Cost and Utilization Project and Agency for Healthcare Research and Quality was used to evaluate the AIS patients ages 25 and more. Cannabis users were compared with nonusers. Their mortality risks were also assessed. RESULTS: Five hundred thirty-nine thousand eight hundred eighty patients with AIS were in our study and 8850 used cannabis. Among the cannabis users with AIS, 69.8% were males, 50.6% were white, 61.8% were aged 46 to 65, 32.1% used Medicaid, 86.1% were nonobese, 72.0% were nondiabetics, 81.7% had hypertension, 80.7% did not have a history of alcohol abuse, and 77.5% were smokers (nicotine). Only 12.8% of cannabis users reported any cardiac dysrhythmia, whereas 5.4% required mechanical thrombectomy, and 8.0% received intravenous tissue plasminogen activator (tPA).After adjusting the variables, cannabis users covered by Medicare, with diabetes, a history of alcohol abuse, cardiac dysrhythmias, and who underwent mechanical thrombectomy had a higher risk of dying. The overall adjusted odds ratio of dying among cannabis users with AIS was 0.603 (95% CI, 0.504-0.722, P <0.01). CONCLUSIONS: Although the overall mortality risk seems to be lower among cannabis users, those with certain risk factors still present higher mortality risks. Patients with cannabis use should therefore be monitored closely for possible complications and mortality after AIS.

Acute myocardial infarction among teenagers in the United States between 2016 and 2020: a retrospective analysis from the National Inpatient Sample.

Introduction: There is a lack of data on the characteristics of teenagers admitted with acute myocardial infarction (AMI). Recent studies have hinted that with changes in lifestyle and easier access to substances of abuse, people may be prone to several cardiovascular complications at an earlier age. Material and methods: Our analysis was based on the 2016-2020 National Inpatient Samples. Logistic models allowed us to investigate the adjusted odds ratios (aOR) of AMI among teenagers. We explored outcomes and complications such as cardiogenic shock, extracorporeal membrane oxygenation (ECMO), coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), and mortality in these patients. Results: A total of 2170 cases of AMI were recorded between 2016 and 2020 (53.3 cases per 100,000 admissions among teenagers). Weekend admissions (26.3% vs. 20.9%, aOR = 1.298, p < 0.001), smokers (15.9% vs. 10.1%, aOR = 1.198, p = 0.007), cannabis users (18.9% vs. 8.4%, aOR = 1.558, p < 0.001), or cocaine users (5.3% vs. 0.6%, aOR = 4.84, p < 0.001) showed increased odds of recording a diagnosis of AMI. Females showed lower odds than males (32.7% vs. 65%, aOR = 0.264, 95% CI: 0.24-0.291, p < 0.001). Admissions were more likely among teenagers with hypertension (9.9% vs. 2.5%, aOR = 3.382, p < 0.001). Those not covered by Medicaid or private insurances were more likely to be admitted for AMI than Medicaid beneficiaries (12.4% vs. 8.2%, aOR = 1.278, p < 0.001). Finally, teenagers classified as Blacks showed higher odds than whites of being admitted for AMI (aOR = 1.37, p < 0.001). A total of 270 (12.5%) deaths were also noted. Conclusions: Various characteristics among teenagers influence their risk for AMI. Further studies and campaigns on educating teenagers about risk factors may provide long-term benefits.

Cardiac arrhythmias and mortality risk among patients with obstructive sleep apnea following admission for acute myocardial infarction or acute ischemic stroke.

Introduction: Obstructive sleep apnea (OSA) can cause several cardiovascular changes that increase the risk of various complications such as acute myocardial infarction (AMI) and acute ischemic stroke (AIS). Material and methods: We used the 2019 National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP), the Agency for Healthcare Research and Quality (AHRQ), and their many collaborators to study the differences in characteristics and outcomes of OSA patients following AMI or AIS and the presence of several cardiac arrhythmias and their associated mortality risks. Results: A lower mortality rate was seen among OSA patients with AIS (2.5% compared to 3.8% in non-OSA), and AMI (2.8% compared to 4.7% in non-OSA). OSA patients with AIS had a higher risk of dying if they were aged 66 or over, of Hispanic origin, or if they reported ventricular tachycardia, or paroxysmal atrial fibrillation. For those with OSA and admitted for AMI, they were more at risk of dying if they were aged 66 or over, not classified as "White, Black, or Hispanic", with a history of diabetes, reported ventricular tachycardia, or ventricular fibrillation. Lower adjusted odds ratios were noted among OSA patients with hypertension in both AMI and AIS cases. Conclusions: Further studies comparing these characteristics based on the severity of OSA are therefore encouraged.

An Update on the Burden of Neonatal Abstinence Syndrome in the United States.

OBJECTIVES: To provide an estimate on the most recent burden of neonatal abstinence syndrome (NAS) in the United States. METHODS: The 2016 Kids' Inpatient Database, provided by the Healthcare Cost and Utilization Project and Agency for Healthcare Research and Quality and its partners, was used to identify patients with NAS in the United States. The data consisted of pediatric admissions from 4200 US hospitals recorded between January 1, 2016, and December 31, 2016. Data were converted to weighted form to project a national estimate on the possible number of neonates affected by NAS. Differences in sex, race, location, household income, primary payer form, length of stay, and total charges were studied. RESULTS: The sample contained 32 128 patients with NAS (0.8%), among whom 17 164 (53.5%) were boys and 14 935 (46.5%) were girls (P < .001); 23 027 (80.4%) were white (P < .001), and 13 583 (42.3%) were from the southern parts of the United States (P < .001). Medicaid covered 83.8% of patients, and 40.2% had an income within the first quartile of national averages (P < .001). The overall mean and median length of stay were 16.45 and 12.00 days, respectively, and the mean and median total charges were calculated as $79 937.75 and $38 537.00, respectively. The total charges of NAS were $2 549 098 822. CONCLUSIONS: The incidence of NAS is on a constant rise; the number of cases rose from 21 732 in 2012 to 32 128 in 2016. Hospital charges have also tripled over the last 7 years to $2.5 billion in 2016.

An update on admissions of cystic fibrosis children in the United States based on national databases.

We read the article posted by Vadagam et al. with great interest and would like to provide a brief update based on the 2016 KID database to understand the trend in hospitalization among cystic fibrosis children.

Nocturnal enuresis in children from Santo Domingo, Dominican Republic: a questionnaire study of prevalence and risk factors.

OBJECTIVE: To determine the prevalence of paediatric nocturnal enuresis in Santo Domingo, Dominican Republic. DESIGN: A cross-sectional study was performed using a pretested questionnaire. SETTING: Three different schools in Santo Domingo, Dominican Republic. PARTICIPANTS: 700 children aged 5-11 years attending one of the different schools in Santo Domingo, Dominican Republic. INTERVENTION: The study was carried out from November 2017 to December 2017. MAIN OUTCOME MEASURES: Prevalence of nocturnal enuresis. RESULTS: 700 questionnaires were sent to be filled and 682 were returned. 655 fully filled questionnaires met the requirements of the study. 183 children were identified with nocturnal enuresis among which 88 were boys and 95 were girls. Only 11% of children with enuresis sought medical help. The prevalence of nocturnal enuresis was 27.9%. No statistical significance was found between gender, order in the family, constipation and breast feeding (p>0.05). Age, deep sleep and family history of enuresis were strongly associated with nocturnal enuresis. CONCLUSIONS: The prevalence of nocturnal enuresis in Santo Domingo was found to be 27.9% and it was higher compared with some Asian countries but lower than Morocco and Jamaica. Only 11% of children with enuresis sought medical help. Nocturnal enuresis is an important problem in the paediatric population of Santo Domingo, but very few children receive treatment due to the financial costs of healthcare in the Dominican Republic.

Prevalence of peripheral arterial disease among diabetic patients in Santo Domingo, Dominican Republic and associated risk factors.

INTRODUCTION: Peripheral arterial disease (PAD) is a major risk factor of coronary artery disease and a major complication of atherosclerosis. Peripheral arterial disease can be diagnosed with simple and low cost techniques. There are major risk factors of PAD that have been studied for different countries. However, no such study has been done for the Dominican Republic. We conducted a cross-sectional study to determine the prevalence of PAD and the risk factors among patients with diabetes in Santo Domingo, Dominican Republic. MATERIAL AND METHODS: Six hundred randomly chosen patients with previously diagnosed diabetes were enrolled in our study. Their blood pressure and ankle brachial index were calculated and a questionnaire was provided to gather information regarding gender, age, weight, ethnicity, known duration of diabetes along with any history of smoking, hypertension and hyperlipidemia. A physical examination was also done to assess for any active diabetic ulcers, previous foot ulcers and non-traumatic amputation. A microfilament test was conducted to check for peripheral neuropathy. RESULTS: Eighty-four diabetic patients were diagnosed with PAD with a prevalence of 14% in Santo Domingo, Dominican Republic. Statistically significant associations (p < 0.05) was found for female gender, presence of active foot ulcers, history of past foot ulcer, non-traumatic amputation, hypertension, hyperlipidemia and peripheral neuropathy. Glycated hemoglobin (HbA1c), age and smoking were not statistically significant in our study. CONCLUSIONS: Diabetic patients who are either female, have active foot ulcers, a history of past foot ulcer, non-traumatic amputation, hypertension, hyperlipidemia or peripheral neuropathy are more at risk of developing PAD.

Kawasaki disease: a comprehensive review.

Kawasaki disease is an acute systemic vasculitis that was first reported in 1961. Over the last 5 decades multiple papers have been published to further understand this disease. The diagnosis of Kawasaki disease is made based on the clinical findings. Atypical Kawasaki disease includes patients who do not meet all the criteria for diagnosis. The main complication of Kawasaki disease is coronary aneurysm, and the treatment is intravenous immunoglobulin and aspirin. A second dose of immunoglobulin is given if the patient does not improve, and several other treatment options have been proposed over the last few years as second and third line options.