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.

Assessment and clinicopathological correlation of p16 expression in head and neck squamous cell carcinoma.

INTRODUCTION: Oral squamous cell carcinoma is a major cause of death throughout the developed world. It is associated with smoking and alcohol consumption. Human papillomavirus (HPV) type 16 has also been suggested to play a role in etiology of head and neck squamous cell carcinoma (HNSCC). p16 expression is now being used as a surrogate marker of HPV infection in squamous cell carcinoma and provides important prognostic information and future therapy planning. MATERIALS AND METHODS: In this prospective study, total of 75 cases of HNSCC were taken. Tumor grade was determined according to World Health Organization (WHO) criteria. p16 expression was determined by immunohistochemical staining. The obtained results were analyzed and evaluated using Chi-square test (Statistical Package for Social Sciences (SPSS) version 20), value of P <0.05 was taken significant. RESULTS: Out of 75 cases, 78.7% cases were positive for p16 (inclusive of all grades), while 21.3% cases were negative. Expression of p16 was higher in nonsmokers and nonalcohol consumers and significantly associated with paan chewing habit. No significant correlation was seen with history of abnormal sexual habits, but p16 expression was significantly correlated in cases with multiple sexual partners (P = 0.003), with increasing histological grade (P = 0.045) and in cases with lymph node metastasis (P = 0.03). CONCLUSION: As HPV integration with transcription of viral oncoprotein induces overexpression of p16, immunohistochemical expression of p16 can be used as a surrogate marker of HPV. This approach can be implemented in diagnostic laboratories and can provide support for vaccination program in high risk group.