Identifying prevalence and inpatient outcomes of anemia and hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a multifactorial inflammatory disorder. Previous studies have ascertained an association between anemia and HS; however, they were limited by low sample size and lack of demographic information. The objective of this study is to address the concerns of prior research and identify specific subgroups and subtypes of anemia present in HS patients and evaluate how these subgroups impact hospital outcomes. We analyzed HS hospitalizations using the National Inpatient Sample from the years 2016 to 2019. HS was associated with the nutritional anemia, aplastic anemia, and acute posthemorrhagic anemia subgroups. Within these subgroups, HS was specifically associated with iron deficiency anemia, anemia of chronic disease, and other anemia subtypes. HS patients also displayed a lower risk of having aplastic anemia, also described as anemia from bone marrow failure. Our findings build upon previous studies evaluating HS and anemia and provide a clearer understanding of the association as well as how it impacts inpatient outcomes.

Sustained cannabis use does not predispose clinical hypertension: Findings from a national survey.

Cannabis is among the most used recreational and medicinal drugs in the United States. The effects of chronic use on hypertension remain poorly understood. Our study retrospectively evaluated data collected by the National Health and Nutrition Examination Survey from 2017 to 2018. Cannabis use was measured with five metrics: (1) sustained use at any point in the past, (2) sustained use within the past year, (3) frequency of use, (4) age of first cannabis use, and (5) current use. Hypertension status was determined by individuals reporting having been diagnosed in the past. Multivariable logistic regressions were performed, controlling for age, race, and gender. A total of 4565 respondents were identified, of which 867 (19.0%) reported sustained cannabis use in the past. Participants who reported past sustained cannabis use did not have statistically different odds of having hypertension (OR: 1.12; 95% CI: .66-1.91; p = .6). Moderate (OR: 1.08; 95% CI: .36-3.25; p = .8) and highly-frequent users (OR: 1.30; 95% CI: .56-3.03; p = .4) did not have different odds of having hypertension than infrequent users. No relationship between the age of first cannabis use and hypertension was observed. The recency of sustained cannabis use was not associated with hypertension status. Current cannabis users had similar odds of hypertension as past users (OR: 1.03; 95% CI: .59-1.79; p = .9). The findings of this study indicate that neither past nor current cannabis use is associated with clinical hypertension.

Impacts of Anxiety and Depression on Clinical Hypertension in Low-Income US Adults.

INTRODUCTION: Depression and anxiety are common leading causes of disability and are associated with systemic effects including cardiovascular comorbidities. Low-income populations may experience higher frequencies of depressive or anxiety-related symptoms, and be at greater risk for developing hypertension. AIM: We performed a cross-sectional study of low-income participants who completed hypertension and disability questionnaires as part of the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES) to identify associations between depressive/anxiety-related symptoms and hypertension status. METHODS: Multivariable logistic regressions were performed to identify whether (1) frequency of depressive symptoms, (2) frequency of anxiety-related symptoms, (3) self-reported depression medication use, or (4) self-reported anxiety medication use predicted previous hypertension diagnosis. RESULTS: A total of 74,285,160 individuals were represented in our cohort. Participants that reported taking depression (OR 2.72; 95% CI 1.41-5.24; P = 0.009) and anxiety (OR 2.50; 95% CI 1.42-4.41; P = 0.006) medications had greater odds of hypertension. Individuals with depressive feelings daily, monthly, and few times per year were more likely to have hypertension. Respondents with daily (OR 2.28; 95% CI 1.22-4.24; P = 0.021) and weekly (OR 1.88; 95% CI 1.05-3.38; P = 0.040) anxiety symptoms were more likely to have hypertension. CONCLUSIONS: Low-income adults in the United States with symptoms of anxiety or depression have higher likelihood of hypertension than those with no symptoms. Respondents who indicated taking medication for anxiety disorders or depression were more likely to have been diagnosed with hypertension.

Methotrexate-induced acute cardiotoxicity requiring veno-arterial extracorporeal membrane oxygenation support: a case report.

BACKGROUND: Methotrexate is an antifolate antimetabolite that inhibits the activity of dihydrofolate reductase by acting as a false substrate, which leads to defects of DNA synthesis, specifically the inhibition of purine and pyrimidine synthesis. Thus, methotrexate is a powerful agent for treating autoimmune diseases and cancer. In general, methotrexate is thought to be cardioprotective and reports of methotrexate-induced cardiomyopathy are rare. We present a case of methotrexate-induced severe cardiotoxicity diagnosed by exclusion of all other potential causes. CASE PRESENTATION: The patient was a 54-year-old Caucasian man presenting to an outside hospital with a chief complaint of abdominal pain and bloating who reported taking methotrexate up to 20 mg per week for systemic sclerosis. After a transthoracic echocardiogram found a left ventricular ejection fraction of 10% and coronary catheterization demonstrated no significant disease, he was transferred to our hospital for advanced heart failure therapies. His condition deteriorated, and he was eventually placed on veno-arterial extracorporeal membrane oxygenation. Owing to a lack of an identifiable etiology of cardiac failure, toxicology consultation recommended 24 hours of intravenous leucovorin therapy to overcome any residual and potentially cardiotoxic methotrexate still in his system. Over the next 5 days, his cardiac function improved daily, such that on day 5 of extracorporeal membrane oxygenation, he had a left ventricular ejection fraction of 40% and was able to be decannulated. Two days later, his ejection fraction improved to 60% and normal right ventricular function. Initially, his renal function improved while on extracorporeal membrane oxygenation, but over the next week deteriorated such that he required intermittent hemodialysis until hospital discharge. CONCLUSIONS: After a process of elimination, the most likely cause of this patient's acute decline and rapid recovery of bi-ventricular function was methotrexate toxicity. Leucovorin may have aided the reversal of methotrexate toxicity.

Takotsubo Syndrome and COVID-19: Associations and Implications.

Incidence of cardiovascular complications has increased during the COVID-19 (Coronavirus disease 2019) pandemic, both population-wide and in patients diagnosed with the disease. This increase has presented complications in patient care, leading to increased hospitalizations, adverse outcomes, and medical costs. A condition of interest is takotsubo syndrome, which may be associated with the novel coronavirus. To understand this connection, a narrative review was performed by analyzing primary studies and case reports available. The findings showed increased incidence of takotsubo cardiomyopathy in both the general population and COVID-19 patients. Proposed mechanisms for the linkage include generalized increases in psychological distress, the cytokine storm, increased sympathetic responses in COVID-19 patients, and microvascular dysfunction. Moreover, natural disasters are noted as likely being associated with increases of takotsubo syndrome. As the pandemic continues, treating COVID-19 as a systemic condition is imperative, with the increase in takotsubo syndrome marking a significant impact of the novel coronavirus.