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BACKGROUND: Gaming is a billion-dollar industry that is expanding at a compound annual growth rate of 9% to 14.3%, with the biggest market in Southeast Asian countries. The availability of low-cost smartphones and the ease at which the internet can be accessed have made gaming popular among youth, who enjoy it as a leisure activity. According to the World Health Organization, excessive indulgence in gaming can lead to gaming disorder. Medical students indulging in excessive gaming can succumb to gaming disorder, which can affect their scholastic performance. OBJECTIVE: This study aimed to assess the association between gaming practices and scholastic performance among medical students. METHODS: This study used a case-control design, where 448 medical undergraduate students (first year to prefinal) were preliminarily surveyed using universal sampling on their gaming practices in the last 6 months. Out of this sample, the 91 participants who admitted to gaming in the past 6 months were recruited as cases, while participants who never engaged in gaming in the last 6 months were recruited as controls. Both the cases and controls were matched for age and gender in a 1:1 ratio. The internal assessment scores (based on 2 midterms completed in the last 6 months) of cases and controls were compared. The Snedecor F test was used to determine the association between the number of hours spent gaming and internal assessment scores (%), while the Student t test was used to determine significant differences between the internal assessment scores of cases and controls. Odds ratios were calculated to identify the risk of poor scholastic performance among cases compared to the controls. The prevalence of gaming disorder among cases was assessed using the Gaming Addiction Scale (GAS). RESULTS: The frequency of gaming (in hours) was not associated with mean internal assessment scores (P=.13). Male cases reported significantly lower internal assessment scores compared to male controls (P=.005 vs P=.01), whereas no significant differences were observed between the internal assessment scores of female cases and controls (P=.89 vs P=.59). A negative correlation was observed between GAS scores and internal assessment scores (r=-0.02). The prevalence of gaming disorder using the GAS was observed to be 6.3% (28/448) in the study population and 31% (28/91) among cases. The risk of low scores (<50%) among gamers was observed to be 1.9 (95% CI 1.04-3.44, P=.03) times higher in the first midterm and 1.80 (95% CI 0.97-3.36, P=.06) times higher in the second midterm compared to nongamers. CONCLUSIONS: The findings suggest that excessive gaming adversely affects the scholastic performance of male participants more than female participants. Awareness about gaming disorder needs to be created among students, parents, and teachers. Treatment services should be made available to medical students with gaming disorders.
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Kaposi sarcoma is one of the acquired immunodeficiency syndrome (AIDS) defining diseases. AIDS-associated Kaposi sarcoma affects primarily the skin and the lungs. Although gastrointestinal involvement is relatively common, biliary tract involvement has rarely been reported. It has been associated mostly with extension from liver disease. We describe an uncommon presentation of disseminated Kaposi sarcoma causing extrahepatic cholestasis due to extrahepatic biliary tract involvement that resolved after sphincterotomy with biliary stenting. We present a case of a 35-year-old African American male diagnosed with human immunodeficiency virus (HIV) infection in 2005. He presented with AIDS after discontinuation of antiretroviral therapy for one year, subsequently being diagnosed with systemic Kaposi sarcoma. He presented with signs and symptoms of obstructive biliary disease, including jaundice, abdominal pain, fatigue, and fever. We encountered a rare presentation of malignant single extrahepatic biliary stenosis secondary to biliary Kaposi sarcoma. The biochemical pattern markedly improved after endoscopic retrograde cholangiopancreatography with sphincterotomy and stenting. However, and despite the resumption of combined antiretroviral therapy, deep immunosuppression caused worsening clinical condition and death five months after initial presentation. Certainly, among the multiple etiologies of biliary obstruction in AIDS, Kaposi sarcoma is one to consider.
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Introduction Irritable bowel syndrome (IBS) is a frequent cause of abdominal pain and altered bowel habits, which is associated with significant healthcare utilization. The effects of the active compound of cannabis, Δ9-tetrahydrocannabinol (THC), on gut motility and tone have been studied in several experimental models. It is unknown whether these effects correlate with improved healthcare utilization among cannabis users. The purpose of this study is to evaluate the impact of cannabis use on inpatient length of stay and resource utilization for patients with a primary discharge diagnosis of IBS. Methods Data were extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2010 to 2014 for all patients with a primary discharge diagnosis of IBS. Cannabis users (n=246) and non-users (n=9147) were directly compared for various clinical outcomes. Results Cannabis users were less likely to have the following: upper gastrointestinal endoscopy (17.9% vs. 26.1%; adjusted odds ratio [aOR]: 0.51 [0.36 to 0.73]; p<0.001) and lower gastrointestinal endoscopy (21.1% vs. 28.7%; aOR: 0.54 [0.39 to 0.75]; p<0.001). Additionally, cannabis users had shorter length of stay (2.8 days vs. 3.6 days; p=0.004) and less total charges (US$20,388 vs. US$23,624). There was no difference in the frequency of CT abdomen performed. Conclusions Cannabis use may decrease inpatient healthcare utilization in IBS patients. These effects could possibly be through the effect of cannabis on the endocannabinoid system.
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Hypernatremia is caused by a disproportionate balance of inadequate free water relative to sodium level. Frequent causes of hypernatremia include renal or gastrointestinal fluid loss, hypothalamic injury, and endocrine abnormalities. The authors describe a rare case of hypernatremia that manifested secondary to psychogenic adipsia in a 46-year-old woman presenting with intractable vomiting. Her presenting symptoms and laboratory abnormalities resolved after treatment was initiated for major depression. This case highlights the need for a holistic approach when confronted with a case of unexplained hypernatremia.
