Association Between Cannabis Use and Complications Related to Crohn's Disease: A Retrospective Cohort Study.

BACKGROUND: Crohn's disease is an idiopathic inflammatory process that is occasionally associated with complications, which cause significant morbidity and mortality. The anti-inflammatory effect of cannabis in intestinal inflammation has been shown in several experimental models; it is unknown whether this correlates with fewer complications in Crohn's disease patients. AIMS: To compare the prevalence of Crohn's disease-related complications among cannabis users and non-users in patients admitted with a primary diagnosis of Crohn's disease or a primary diagnosis of Crohn's related complication and a secondary diagnosis of Crohn's disease between 2012 and 2014. METHODS: We used data from the Healthcare Cost and Utilization Project-National Inpatient Sample. Cannabis users (615) were compared directly after propensity score match to non-users, in aspects of various complications and clinical end-points. RESULTS: Among matched cohorts, Cannabis users were less likely to have the following: active fistulizing disease and intra-abdominal abscess (11.5% vs. 15.9%; aOR 0.68 [0.49 to 0.94], p = 0.025), blood product transfusion (5.0% vs. 8.0%; aOR 0.48 [0.30 to 0.79], p = 0.037), colectomy (3.7% vs. 7.5%; aOR 0.48 [0.29-0.80], p = 0.004), and parenteral nutrition requirement (3.4% vs. 6.7%, aOR 0.39 [0.23 to 0.68], p = 0.009). CONCLUSION: Cannabis use may mitigate several of the well-described complications of Crohn's disease among hospital inpatients. These effects could possibly be through the effect of cannabis in the endocannabinoid system.

What Did Obergefell Change? Clearance of Intimate Partner Violence Before and After the Legalization of Same-Sex Marriage.

Historically, same-sex intimate partner violence (IPV) was ignored, and victims often experienced high rates of harassment and intimidation from police, leading to low reporting of same-sex IPV incidents, victims' unwillingness to cooperate with the police, and common arrests in such incidents. Although the Supreme Court's decision in Obergefell v. Hodges (2015) legalized and legitimized same-sex marriages and relationships in the U.S., mandating the inclusion of same-sex partners in protective order laws and yielding collateral benefits for victims of same-sex IPV, it is unclear if the decision has had a positive effect on same-sex IPV clearance rates. This study uses National Incident-Based Reporting System data to compare IPV clearance (arrest, dual arrest, victim noncooperation, and prosecution declined) pre (2013/2014) and post (2016/2017) Obergefell v. Hodges (2015). Regression results show no substantial changes in same-sex IPV clearance after Obergefell v. Hodges (2015). Compared to opposite-sex IPV, same-sex IPV was less likely to be cleared by arrest but much more likely to be cleared by dual arrest, victim noncooperation, and prosecution declined. Same-sex IPV involving Black couples and married partners were also less likely to be cleared by arrest but more likely to be cleared by dual arrest than Black/White same-sex IPV and incidents involving unmarried partners, respectively. Moreover, same-sex IPV victims experience unfavorable criminal justice outcomes in states with mandatory arrest policies but fare better in states that supported same-sex relationships prior to Obergefell. The implications of these findings for practice and research are discussed.

Dystrophic Calcinosis Cutis in Systemic Lupus Erythematosus.

Calcinosis cutis is a disorder of pathologic calcium deposition in the cutaneous and subcutaneous layers of skin. While common in dermatomyositis and scleroderma, calcinosis cutis less frequently occurs in systemic lupus erythematosus (SLE) and is infrequently described in literature. In this report, we discuss the case of a 36-year-old patient with SLE, presenting with vascular compromise, ulceration, and superimposed infection of her left hand as a consequence of severe calcinosis cutis. This report includes a review of the current literature, and highlights the importance of early detection and intervention in preventing disease complications.

Wound Myiasis in Severe Venous Stasis Ulcer.

Although myiasis infestation of wounds presents with significant psychological discomfort to patients, studies have shown that it can be beneficial in the management of recalcitrant ulcers resistant to standard management. Here we report a patient with persistent ulcers unresponsive to standard management who was lost to follow-up for five months and presented with ''maggots in his wound''. This however proved beneficial to the patient as the ulcer showed healthy granulation tissue on presentation and improved healing on follow-up. Our case presents the beneficial effect of myiasis infestation in the 21st century and helps to highlight a time-tested therapy with further encouragement of the use of biotherapy (sterile maggots) for the management of recalcitrant ulcers.

A Cardioversion and Renal Dysfunction Cascade: Cardioversion for Atrial Fibrillation, Acute Kidney Injury, and Recurrence of Atrial Fibrillation.

A 62-year-old woman with hypertension presented with progressively worsening shortness of breath due to acute decompensated heart failure with atrial fibrillation in rapid ventricular response. During admission, she was managed with diuretics, goal-directed medical therapy for heart failure with successful DCCV (Direct current cardioversion) for first episode atrial fibrillation. However, one day after discharge, the patient presented with a recurrence of dyspnea with atrial fibrillation in rapid ventricular response and a reduction in urine output with elevated serum creatinine. In this case report, we describe the syndrome of acute kidney injury following cardioversion for atrial fibrillation known as AFCARD (Atrial Fibrillation Cardioversion Associated with Renal Dysfunction), highlight its incidence and reflect on renal dysfunction subserving the recurrence of atrial fibrillation after successful DCCV.

Association Between Cannabis Use and Healthcare Utilization in Patients With Irritable Bowel Syndrome: A Retrospective Cohort Study.

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.

Association between cannabis use and complications related to ulcerative colitis in hospitalized patients: A propensity matched retrospective cohort study.

Ulcerative colitis (UC) is a chronic inflammatory process that is occasionally associated with complications that cause significant morbidity and mortality. Studies in experimental animal models have demonstrated a beneficial effect of cannabis on intestinal inflammation. It is however unknown if this corresponds to fewer complications for patients with Ulcerative Colitis.We aimed to compare the prevalence of UC related complications and certain key clinical endpoints among cannabis users and nonusers hospitalized with a primary diagnosis of UC, or primary diagnosis of a UC-related complication with a secondary diagnosis of UC.Using data from the Healthcare Cost and Utilization Project-National Inpatient Sample (NIS) during 2010-2014, a total of 298 cannabis users with UC were compared to a propensity score matched group of nonusers with UC. We evaluated several UC-related complications and clinical endpoints.Within our matched cohort, prevalence of partial or total colectomy was lower in cannabis users compared to nonusers (4.4% vs 9.7%, P = .010) and there was a trend toward a lower prevalence of bowel obstruction (6.4% vs 10.7%, P = .057). Cannabis users had shorter hospital length-of-stay (4.5 vs 5.7 days P < .007) compared to their nonuser counterparts.Cannabis use may mitigate some of the well described complications of UC among hospitalized patients. Our findings need further evaluation, ideally through more rigorous clinical trials.