Synthetic Cannabinoids-Related Cardiovascular Emergencies: A Review of the Literature.

Synthetic cannabinoids (SCBs) are a group of psychoactive compounds, known to cause a range of multisystem adverse events, including the cardiovascular system. The aim of this review is to provide an overview of the literature on cardiovascular emergencies associated with SCBs. A systematic search of electronic databases was conducted to identify relevant studies published between January 2010 and September 2022. Inclusion criteria were studies reporting on cardiovascular emergencies in individuals with SCB abuse. The search yielded a total of 43 studies, including case reports, case series, and meta-analyses. This review indicates that SCB abuse can lead to a range of cardiovascular emergencies, including acute coronary syndrome, arrhythmias, and hypertension. The onset of these emergencies is often sudden and may occur in previously healthy individuals. The severity of these complications can vary widely, with some cases resulting in cardiac arrest or death. Management strategies for SCB-related cardiovascular emergencies include supportive care, pharmacological interventions, and, sometimes, invasive procedures. There is no specific antidote against SCB to date. In conclusion, SCB abuse is associated with various cardiovascular emergencies, which can be life-threatening in some cases. Early recognition and management of these emergencies are critical for improving outcomes. Further research is needed to better understand the underlying mechanisms of SCB-related cardiovascular complications and to develop effective prevention and management strategies.

Navigating Cultural Diversity in the Selection of Cardiovascular Device Treatments: A Comprehensive Review.

In cardiology, patients' cultural beliefs, linguistic differences, lack of knowledge, and socioeconomic status can create barriers to choosing device treatment. To address this issue, we conducted a thorough literature review using online databases such as PubMed, Google Scholar, and Texas Tech University Health Sciences Center's research portal. Our review found that cultural, religious, and linguistic barriers can contribute to patients' apprehension and reservations about device placement. These barriers can also impact patients' adherence to treatment and clinical outcomes. Patients from lower socioeconomic backgrounds may have difficulty accessing and affording device-based treatments. Additionally, fear and inadequate understanding of surgical procedures can deter patients from accepting device treatment in cardiology. To overcome these cultural barriers, healthcare providers must raise awareness about the benefits of device treatment and provide better training to overcome these challenges. It is crucial to address the unique needs of patients from different cultural backgrounds and socioeconomic statuses to ensure they receive the care they need.

A Case Report of Olmesartan-Induced Enteropathy.

Chronic olmesartan use can cause a drug-induced enteropathy as a rare side effect leading to diarrhea, significant weight loss, and reduced quality of life. The mechanism of this enteropathy is poorly understood and requires further investigation. We present a case of olmesartan-induced enteropathy resulting in recurrent hospitalizations for intractable diarrhea. Significant enteropathy is more commonly related to infectious or autoimmune causes making the diagnosis of drug-induced enteropathy a challenge. In this case, the lack of significant findings on labs or imaging resulted in a thorough diagnostic work-up revealing olmesartan-induced enteropathy. We present this case to inform providers of the possibility of olmesartan-induced enteropathy and characteristics to identify in other similar cases.

Voluntary perioperative colorectal cancer registry from Kerala-An initial overview.

BACKGROUND: Although colorectal cancer (CRC) may not be uncommon in India, accurate data regarding its demographics and surgical outcomes is sparse. METHODS: With an aim to assess demographics and perioperative outcomes of CRC in Kerala, all members of Association of Surgical Gastroenterologists of Kerala (ASGK) were invited to participate in a registry. Data of operated cases of CRC were entered on a web-based questionnaire by participating members from January 2016. Analysis of accrued data until March 2018 was performed. RESULTS: From 25 gastrointestinal surgical centers in Kerala, 15 ASGK member hospitals contributed 1018 CRC cases to the database (M:F 621:397; median age-63.5 years [15-95 years]). Rectum (39.88%) and rectosigmoid (20.33%) cancers comprised the majority of the patients. Among them, preoperative bowel preparation was given to 37.68%, minimally invasive surgery (MIS) was performed in 73%, covering stoma in 47% and had an overall leak rate of 3.58%. In colonic malignancies, MIS was performed in 56.74%, covering stoma created in 13% and had a leak rate of 2.71%. Of 406 patients with rectal cancers, neo-adjuvant radiotherapy/chemoradiotherapy was given to 51.23%. The mean hospital stay for MIS in both rectal and colonic cancer patients was significantly shorter than open approach (10.46 ± 5.08 vs. 12.26 ± 6.03 days; p = 0.001and 10.29 ± 4.58 vs. 12.46 ± 6.014 days; p = <0.001). Mortality occurred in 2.2% patients. CONCLUSION: A voluntary non-funded registry for CRC surgery was successfully created. Initial data suggest that MIS was performed in majority, which was associated with shorter hospital stay than open approach. Overall mortality and leak rate appeared to be low.

Impella Use in Cardiogenic Shock Due to Takotsubo Cardiomyopathy With Left Ventricular Outflow Tract Obstruction.

Cardiogenic shock (CS) due to Takotsubo cardiomyopathy (TCM) is often managed with cautious fluid administration and inotropic support; however, the co-existence of a left ventricular outflow tract obstruction (LVOTO) can complicate this management approach. This report describes a case of CS due to TCM and LVOTO. It was successfully managed with the Impella 2.5. (Level of Difficulty: Intermediate.).

Laparoscopic appendicectomy for complicated appendicitis: is it safe and justified?: A retrospective analysis.

BACKGROUND: Although laparoscopic appendectomy has some advantages over open appendectomy, the literature suggests conflicting results regarding postoperative complications for complicated appendicitis. METHODS: A retrospective review of patients with complicated appendicitis managed surgically at Meenakshi Mission Hospital and Research Center, Madurai, Tamilnadu, India was undertaken. A total of 497 patients were admitted with acute appendicitis and operated during the study period of 10 years from January 1999 to July 2009, out of which 119 (24%) patients had complicated appendicitis whereas 378 (76%) had uncomplicated acute appendicitis. The mean age of patients included in the study was 33.42 years (range, 4 to 80 y) with a male: female ratio of 2:1. RESULTS: Ninety-nine patients (83.19%) underwent laparoscopic appendicectomy and 1 patient underwent laparoscopic-assisted right hemicolectomy for suspected mass lesion of the cecum. Eleven patients (9.24%) underwent open appendicectomy because of preoperative clinical features of peritonitis in 10 patients and mass in 1 patient. Seven patients (5.88%) had conversion from laparoscopic to open procedure. The overall mean operating time was 68 minutes (25 to 180 min). For laparoscopic appendicectomy, 66 minutes (25 to 180 min), for open appendicectomy 76 minutes (50 to 110 min), for lap to open conversion 85 minutes (40 to 135 min), and for drainage procedure 67 minutes (60 to 75 min). A total of 28 patients developed complication in the form of wound infection (7), pneumonia (8), intra-abdominal abscess (11), and enterocutaneous fistula (2) after percutaneous drainage of intra-abdominal collection. All were managed conservatively and no mortality occurred. CONCLUSIONS: The morbidity rates, particularly for intra-abdominal abscesses and wound infection were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

Retroperitoneal leiomyosarcoma infiltrating the inferior vena cava (IVC)--a case report.

Retroperitoneal soft tissue sarcomas are difficult to treat because the retroperitoneal organs and great vessels are often involved by the time the patients come to a surgeon. We present the case of a 48 year old woman with a retroperitoneal leiomyosarcoma that had infiltrated the IVC and the renal veins.

Clinical and angiographic outcomes of cardiac transplant patients treated with intracoronary beta-radiation for in-stent restenosis: a case series.

BACKGROUND: Vascular brachytherapy (VBT) is effective for the treatment of in-stent restenosis (ISR), however, the effect of VBT clinical and angiographic outcomes of patients with ISR who have undergone orthotopic heart transplantation (OHT) requires further study. METHODS: All OHT patients with ISR treated with VBT using the Novoste Beta-Cath System at Rush University Medical Center were identified, and the clinical and angiographic outcomes were evaluated. RESULTS: Four OHT patients with ISR who underwent VBT were identified. The mean age was 48.5 years, and the mean duration posttransplantation was 7.5 years. The mean reference coronary vessel diameter was 3.06 mm. The primary interventional device utilized prior to VBT was cutting balloon angioplasty (CBA) in 75% and percutaneous balloon angioplasty in 25%. The mean duration of follow-up after VBT was 11 months. There were no deaths attributable due to cardiac disease, no myocardial infarction, and no target vessel revascularization on follow-up. Overall survival during this period was 75%, with one mortality due to stroke 8 months after VBT. CONCLUSIONS: VBT for the treatment of ISR in patients who have undergone OHT appears safe and feasible and is associated with acceptable clinical and angiographic outcomes.