Early-onset prescription drug misuse in Indiana youth.

BACKGROUND: Based on 2018 national estimates, approximately 5-10% of youth between the ages of 12-17 report past year prescription drug misuse (PDM) in the United States. PDM among adolescents is associated with negative health outcomes and risk behaviors. The current study examined both the prevalence of PDM among diverse groups of adolescents and the association of alcohol and cigarette use with early PDM. METHODS: Data came from the cross-sectional state-based 2018 Indiana Youth Survey of students from grades 6-12, ranging in age from 10 to 17 years (n = 80,926). Lifetime PDM, alcohol, and cigarettes were assessed by self-report, including ages at first use. A series of analyses were conducted separately for non-Hispanic Black, non-Hispanic White, and Hispanic students. We estimated the prevalence of PDM. Likelihood of PDM was estimated using the Kaplan-Meier survivor function. Cox proportional hazards regression models estimated age at first PDM from ages at first use of alcohol and cigarettes. RESULTS: Three percent of non-Hispanic Black, 4% of non-Hispanic White, and 5% of Hispanic students reported PDM. Onset of smoking was associated with first PDM across adolescence for all groups. Onset of drinking was associated with first PDM among Hispanic students across adolescence. For Non-Hispanic Black and Non-Hispanic White students, likelihood of PDM was most pronounced during very early adolescence. CONCLUSIONS: Onset of alcohol and cigarette use were associated with of PDM among Indiana youth, suggesting that interventions aimed at preventing early smoking and drinking may also reduce PDM among youth.

The value of ventricular gradient for predicting pulmonary hypertension and mortality in hemodialysis patients.

Pulmonary hypertension (PHT) is associated with increased mortality in hemodialysis (HD) patients. The ventricular gradient optimized for right ventricular pressure overload (VG-RVPO) is sensitive to early changes in right ventricular overload. The study aimed to assess the ability of the VG-RVPO to detect PHT and predict all-cause and cardiac mortality in HD patients. 265 selected HD patients were enrolled. Clinical, biochemical, electrocardiographic, and echocardiographic parameters were evaluated. Patients were divided into normal and abnormal VG-RVPO groups, and were followed-up for 3 years. Abnormal VG-RVPO patients were more likely to be at high or intermediate risk for PHT, were older, had longer HD vintage, higher prevalence of myocardial infarction, higher parathormone levels, shorter pulmonary flow acceleration time, lower left ventricular ejection fraction, higher values of left atrial volume index, left ventricular mass index, and peak tricuspid regurgitant velocity. Both all-cause and CV mortality were higher in abnormal VG-RVPO group. In multivariate Cox analysis, VG-RVPO remained an independent and strong predictor of all-cause and CV mortality. In HD patients, abnormal VG-RVPO not only predicts PHT, but also all-cause and CV mortality.

[Function of the left atrial appendage after electrical cardioversion of atrial fibrillation to sinus rhythm]. / Czynnosc uszka lewego przedsionka po kardiowersji elektrycznej migotania przedsionków do rytmu zatokowego.

INTRODUCTION: It is widely believed that atrial fibrillation appears in a secondly manner to atrial enlargement. Morfological alteration might be the source of disturbance of electrical activation and mechanical function to fibres that facilitate arrhythmia preservation as well as life threatening complications. THE OBJECTIVE: It is crucial to establish whether reversion of atrial fibrillation to sinus rhythm causes size diminishment and function improvement of the left atrial appendage, which creates hope to avoid dangerous complications, particularly systemic embolisation. DATA AND METHODOLOGY: 30 patients were qualified including 18 males and 12 females aged between 52 and 86 (average age was 63.81 +/- 9.22). All the patients suffered from nonrheumatic atrial fibrillation. The echocardiographic examination was conducted before reversion of atrial fibrillation, right after reaching sinus rhythm and after 6 months observation at sustained sinus rhythm. During the transesophageal echocardiographic examination the following parameters were investigated: LAApodl, LAApoprz, LAAobw, LAApole, LAAF, LAAB, LAAF intg, LAAB intg, spontaneous echocardiographic contrast, thrombus. RESULTS: Left atrial appendage size right after reversion of atrial fibrillation did not considerably differ from the values registered at the time of arrhythmia. It significantly diminished in the case of sustained stabilisation of sinus rhythm. The diminishment of the left atrial appendage size was connected with its function improvement expressed by increased maximum filling and emptying velocities as well as their integrals. SEC appearance frequency considerably increased right after reaching sinus rhythm. SEC appeared very rarely in the examination after 6 months. No single case of THR in LAA was noted. At the same time several cases of THR were disclosed both before and directly after restoration of sinus rhythm. CONCLUSIONS: Sinus rhythm restoration and its sustaining for a longer period of time results in size diminishing and function improvement of left atrial appendage. The stability of sinus rhythm is closely tied with thromboembolism risk factors.

[Usefulness of selected echocardiographic parameters at prognosing recurrence of nonrheumatic atrial fibrillation]. / Przydatnosc wybranych parametrów echokardiograficznych w prognozowaniu nawrotu migotania przedsionków.

INTRODUCTION: Recurrence of atrial fibrillation (FA) is very important problem after sinus rhythm (SR) restoration. The aim of study was to determinate a correlation between FA recurrence and echocardiographic parameters. MATERIAL AND METHODS: In 98 patients (40 women and 58 men, age 36 do 86, mean 64.72 +/- 10.43 years) with nonrheumatic FA the SR was restored. For left atrium (LA) and its appendage (LAA) assessment the transthoracical (TTE) and transesophageal (TEE) echocardiography were performed during first hour of SR. At the TTE the following parameters were measured: LAmax, LAshort, LAlong, LAarea, LAcirc. During TEE were recorded: LAAshort, LAAlong, LAAcirc, LAAarea, LAAF, LAAB, LAAFintg, LAABintg. Immediately after reversion of FA the Holter recording was started. RESULTS: In 14 patients FA recurred during 24 hours after cardioversion. In 6 patients FA only short episodes were noted, in the others 8 patients arrhythmia was remained at the end of Holter recordings. Among patients with arrhythmia recurrence during first 24 hours significantly larger LA max, LA short, LAA short and LAA area were measured when compared with patients who maintained sinus rhythm. Most of Doppler echocardiographic parameters measured after SR restoration evidenced better LA performance collarated with improved LA hemodynamic function. LA max and LA short were significantly smaller in patients with sustained SR 6 months follow up than in patients who had recurrence of FA. Most of Doppler echocardiographic parameters characterising LA function were meaningly higher in patient who maintained SR after arrhythmia termination. Similarly LAAF, LAAB, LAAF intg and LAAB intg had significantly greater values than in patients with recurrence of FA during 6-months observation. Spontaneous echocardiographic contrast occurrence both before and after SR restoration coexisted with arrhythmia return either during first 24 hours and 6-months follow-up. CONCLUSIONS: FA recurrence is connected with LA and LAA enlargement. The LAA function assessed just after SR restoration is not a good predictor of SR stabilization. Long term SR stabilization is related to smaller LA an LAA diameters and theirs better hemodynamic function as well during FA as after arrhythmia termination.

[Left ventricle function after the reversion of atrial fibrillation]. / Czynnosc rozkurczowa lewej komory po umiarowieniu migotania przedsionków.

INTRODUCTION: Atrial fibrillation could be a consequence of heart failure as well as arrhythmia may cause deterioration of left ventricle systolic function. There are also studies suggested that atrial fibrillation promote left ventricle diastolic dysfunction. AIM OF STUDY: Assessment of left ventricle diastolic function in patients with sustained sinus rhythm during six months observation after reversion of atrial fibrillation. MATERIAL AND METHODS: The study group comprised 30 patients, which had stabilized sinus rhythm at least six months after successful reversion of atrial fibrillation. Transthoracical and transesophageal echocardiography in all patients was performed during atrial fibrillation, immediately after reversion of arrhythmia and after six months observation without reoccurrence of atrial fibrillation. The transthoracical echocardiographic parameters characterising left ventricle diastolic function was measured: E ampl LV, E acct LV, E dcct LV, E time LV, E intg LV. Consequently TEE was performed with Doppler probe in left superior pulmonary vein and following parameters were recorded: PVD, PVD intg, PVD dcct. RESULTS: The E ampl LV immediately after sinus rhythm restoration significantly decreased and was similar to values recorded during atrial fibrillation. After six months observation further significant decreasing of this parameter was noted. The E intg LV was markedly smaller after arrhythmia reversion and did not changed during six months period of sustained sinus rhythm. The E acct LV remained almost the same in all points of study. Whereas the E dcct LV and E time LV were only slightly longer just after reversion the values recorded after six months observation were significantly greater compared to both values before and immediately after sinus rhythm restoration. PVD and PVD intg increased just after sinus rhythm restoration but not significantly. During six months observation their values markedly decreased compared to measurements during atrial fibrillation and were slightly smaller than at first hour of sinus rhythm. PVD dcct insignificantly decreased just after sinus rhythm restoration. Stabilization of sinus rhythm for six months has allowed for significant increasing of this parameter. CONCLUSIONS: Left ventricle diastolic parameters in patients with atrial fibrillation do not significantly change immediately after sinus rhythm restoration. Maximal mitral early diastolic flow velocity and maximal diastolic flow velocity in pulmonary veins markedly decrease at six months observation after reversion of atrial fibrillation, whereas both deceleration time of early diastolic mitral flow and deceleration time of diastolic pulmonary flow became longer and than this indices don't differ from control group without arrhythmia in anamnesis.

[Noninvasive transcutaneous cardiac pacing]. / Nieinwazyjna przezskorna stymulacja serca.

The method of Noninvasive Transcutaneous Cardiac Pacing (NTCP) is presented in this paper. The authors describe the history of this stimulation type and difficulties during the first clinical attempts at pacing. Then they focus on cardiac activation by noninvasive cardiac pacing. Subsequently they analyse the effect of electric field on the myocardium and skeletal muscles. The hemodynamic aspects of NTCP take an important place. A the end the authors review the clinical application of NTCP.