A Cross-Sectional Study of the Trends in Cardiovascular Mortality Among African Americans With Hypertension.

Background and Objective In the United States, hypertension remains a significant cause of cardiovascular disease mortality and morbidity, affecting various racial and ethnic groups. High blood pressure is a common health concern, given its high frequency among all populations and racial groups in the United States; nevertheless, the condition remains untreated in most individuals. It affects a significant number of individuals in the African American community and contributes to a notable proportion of deaths. Arguably more prevalent, severe, and tends to occur earlier in African Americans compared to some other races. This lack of blood pressure control may contribute to the increasing mortality rates associated with hypertension-related cardiovascular diseases in the United States, while notable race and sex disparities persist. This study aims to compare the number of deaths caused by each cardiovascular disease (hypertension) in African Americans to those of people of other races. Methodology To understand the impact of hypertension on mortality rates among different racial groups, this study utilized the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) dataset, which includes death certificates filed in the United States. The research focused on individuals aged 25 years or older with a mention of hypertension and cardiovascular disease as the underlying cause of death between 1999 and 2019. The study analyzed hypertension-associated deaths by different cardiovascular disease subtypes, such as ischemic heart disease, heart failure (HF), and cerebrovascular diseases that include acute ischemic attacks, which are the most frequent in the United States, with specific assessments for African Americans, White, and other races' decedents. Results The study findings indicated that African American males had higher mortality rates from cardiovascular diseases compared to African American females. The prevalence of hypertension was also higher among African Americans (87.47%) compared to Whites (30.33%), Asian/Pacific Islanders (40.26%), and American Indians/Alaska Natives (61.18%). Additionally, the study identified regional variations in mortality rates, with states like Arizona, California, Texas, Florida, and Washington having higher rates, while Vermont, North Dakota, and Wyoming had lower rates. The northwest region had lower mortality compared to the western and southwestern regions. Conclusions Within the studied period, there was an increase in the prevalence of mortality due to hypertension amongst African Americans when compared to other races. These findings underscore the pressing need to address the increasing prevalence of hypertension and mortality rates among African American. More efforts should focus on prevention of CVD and hypertension and the associated risk factors based on the World Health Organization (WHO) recommendations, which include the promotion of healthy lifestyle behaviors, improvement of access to quality healthcare, and implementation of culturally sensitive interventions tailored for African American communities.

The Value of a Negative Pleural Fluid Cytology and Biopsy in Diagnosing Malignant Pulmonary Lesions.

Over 2 million patients developed lung cancer in 2018, and lung malignancy is responsible for an estimated 1.8 million deaths worldwide. Lung cancer diagnosis usually occurs after suspicious symptoms or incidental radiologic findings on chest imaging when the cancer is probably in an advanced stage. Therefore, initial evaluation, diagnosis, staging, and prompt treatment of lung cancer are required to improve pulmonary malignancies' morbidity and mortality rate. Unfortunately, the size of the tumor, the time of imaging, the quality and quantity of pleural fluid, and pleural biopsy all contribute to diagnostic difficulties in evaluating a lung lesion, leaving even the most astute clinician occasionally perplexed. We discuss a case of a female with lung cancer whose diagnosis was challenging because of a negative pleural biopsy, despite initial radiographic imaging suggesting a lung lesion.

Cerebrovascular Accident: An Initial Presentation of Atrial Myxoma in a Young Female.

Myxomas make up roughly half of all primary cardiac tumors, with three-quarters originating in the left atrial cavity and one-quarter in the right. These tumors can occur sporadically or in families. Atrial myxomas are classified as severe based on factors such as their size, the patient's age and gender, and the tumor's proclivity to embolize or occlude coronary vessels. The case of a young female with an unusual presentation of left atrial myxoma and a new neurovascular deficit is discussed.

Median Arcuate Ligament Syndrome: Management and Literature Review.

Pain, nausea, vomiting, weight loss, diarrhea, and fatigue are common symptoms of several upper gastroenterological illnesses. However, the presence of unexplained recurring postprandial abdominal pain and vomiting increases the possibility of median arcuate ligament syndrome (MALS). MALS is an uncommon illness characterized by postprandial vomiting, abdominal pain, and weight loss. The compression of the median arcuate ligament on the celiac trunk and/or its surrounding celiac nerve plexus may explain this disease phenomenon. Comprehensive workup for other etiologies may be unrevealing except for the compression of the celiac trunk identified in imaging studies and, perhaps, occasional arterial flow rates in sonography studies in some severe cases. Due to the overlapping symptoms of upper gastroenterological disorders, misdiagnosis may be widespread. Therefore, it is essential to consider MALS while examining a patient with upper gastrointestinal disease. In this case series, we present two cases of MALS with similar clinical trajectories and differences in diagnostic techniques.

Molecular Markers of Pancreatic Cancer: A 10-Year Retrospective Review of Molecular Advances.

Pancreatic cancer remains the third leading cause of death amongst men and women in the United States. Pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer maintains its reputation of being the most aggressive with a poor prognosis. One of the contributing factors to the high mortality of PDAC is the absence of biomarkers for early detection of disease and the complexity of tumor biology and genomics. In this review, we explored the current understanding of epigenetics and diagnostic biomarkers in PDAC and summarized recent advances in molecular biology. We discussed current guidelines on diagnosis, prognosis, and treatment, especially in high-risk individuals. We also reviewed studies that have touched on identifying biomarkers and the role they play in making early diagnosis although there are currently no screening tools for PDAC. We explored the recent understanding of epigenetic alterations of PDAC and the future implications for early detection and prognosis. In conclusion, the new and emerging advances in the detection and treatment of PDAC can lead to an improvement in the current outcome of PDAC.

Percutaneous Coronary Intervention Outcomes Among Patients With Alcoholic Cardiomyopathy: An Analysis of the National Inpatient Sample.

Introduction High consumption of alcohol has an enormous toll on the health status of individuals. A direct affectation of cardiac integrity concerns cardiologists, primary care physicians, and the healthcare system because this increases the disease burden. Alcoholic cardiomyopathy (ACM) results from the enormous consumption of alcohol over a long period of time. The prevalence varies between regions and sex and ranges between 4% and 40%. Viewing the entire spectrum of cardiomyopathies, ACM makes up about 4% of all cardiomyopathies. However, it causes dilated-type cardiomyopathy and is the second most common cause of dilated cardiomyopathy. We sought to explore the outcomes of percutaneous coronary intervention (PCI) among patients with ACM. Methods This was a retrospective, cross-sectional study of the National Inpatient Sample (NIS) for hospital discharges in the United States between 2012 and 2014. We identified the number of patients with a primary or secondary diagnosis of ACM using the International Classification of Diseases, Ninth Revision (ICD-9) code of 4.255. Using the ICD-9 codes for PCI (00.66, 36.01, 36.02, 36.05, 36.06, 36.07, and 17.55), we identified patients diagnosed with ACM who underwent a PCI (ACPCI). The racial and sexual prevalence, hospital length of stay (LOS), mortality, cost of hospitalization, and cardiovascular outcomes (ventricular fibrillation (VF) and atrial fibrillation (AF)) were compared between patients with and without ACM who underwent a PCI. Results A total of 2,488,293 PCIs were performed between 2012 and 2014. Of these, there were a total of 161 admissions for ACM. About 93% (151) of the ACM PCI group were men. Ethnic distribution revealed a majority of Caucasians with 69% (98), and blacks and Asians at 13.4% (19) and 11.3% (16), respectively. The mean age was 59.8 (SD = 9). The patients with ACPCI were likely to stay longer in the hospital, with an average stay of 6.6 days (SD = 6.2) compared to patients without ACM undergoing PCI (NOACPCI) (3.7 days; SD = 5.0) (p = 0.0001). The mean cost of hospital admission for patients with ACPCI was $120,225 (SD = 101,044), while that of those without ACM who underwent PCI (NOACPCI) was $87,936 (SD = 83,947) (p = 0.0001). A higher death rate during hospitalization (3.7%) was recorded in the ACPCI category vs. 2.3% in patients without ACM who underwent PCI (p = 0.0001). Patients with ACPCI had a higher prevalence of AF (30.4%) than VF (7.5%). Conclusion The ACPCI group had overall poorer hospital outcomes. The majority affected were older Caucasian men with an increased prevalence of AF, higher cost of hospitalization, and longer hospital stays. Further studies are needed to explore the burden of long-term alcohol consumption on cardiovascular disease treatment outcomes.

The Use of Cannabis and Its Effects on Postpartum Depression.

Cannabis use and depression management have been studied, with a preponderance of exacerbating effects, but there are few studies on postpartum depression (PPD). Depression affects a significant number of women, with a portion of it manifesting as PPD in childbearing women in the United States each year. The pharmacologic management approaches have disadvantages such as side effects, cost-benefit ratio, contraindications, use reluctance, medication adherence, and stigmatization in patients. Anecdotal claims of medical cannabis' therapeutic benefits have led to widespread legalization in several regions, making cannabis and its extracts a possible alternative. Cannabis is widely used during pregnancy and in general. Even though substance use disorders exacerbating depression symptoms have been reported, there are increasing reports and evidence about the therapeutic benefit of dose-dependent cannabis or its extracts in some depression symptoms, such as acute psychosocial stress relief, its purported anxiolytic effect, appetite, and sleep quality, thus stimulating more interest that may be inferred to depression. PPD marijuana use is unclear. This paper reviewed works of literature that claimed cannabis' therapeutic benefit in treating depression and, by extension, PPD. Our findings show the link between cannabis and PPD has not been fully explored. Self-reported studies link marijuana uses to positive mood, anxiety relief, sleep regulation, nausea and vomiting reduction, and appetite stimulation-all PPD symptoms. Others opposed postpartum marijuana use.

Antibiogram at a Rural Hospital Against the Background of COVID-19: A Five-Year Retrospective Review.

Background and objective The role of the antibiogram in reducing hospital length of stay (LOS), mortality rate, health care costs, and, by extension, patients' social, physical, and emotional wellness has a significant impact on the medical community. Hospitals in large cities serve a dynamic population of diverse ethnic groups. Many scholarly works and publications have shown that the antimicrobial pattern in rural settings has significant variability annually. Over the last two years, the spread of coronavirus disease 2019 (COVID-19) has brought about many unknowns in the sphere of healthcare. The pattern of pathology accompanying COVID-19 has affected hospital policies and direct patient management, leading to a paradigm shift in approaches, policies, and resource utilization. The years 2019 to 2021 were marked by many admissions due to COVID-19, and the effects of COVID-19 are still being studied. In light of this, this study examined the changes in sensitivity patterns, new trends, and nature of bacteria isolates, antimicrobial rates, and susceptibility based on a rural hospital's annual antibiogram pertaining to its central departments: the intensive care unit (ICU), patient care unit (PCU), the outpatient unit, and emergency department (ED). Methods This five-year retrospective antibiogram review compared antibiogram patterns two years before the first case of COVID-19 was reported in the hospital and those two years after the initial outbreak. Results The organism comparative susceptibility tests for Escherichia coli (E. coli) were not significant except for increased susceptibility toward nitrofurantoin (p=0.003); Klebsiella pneumoniae (K. pneumoniae) was also not significant except for the increased susceptibility to ciprofloxacin (p=0.003). Pseudomonas aeruginosa (P. aeruginosa) had no changes in susceptibility patterns, while Proteus mirabilis (P. mirabilis) had increased susceptibility to imipenem (p=0.05), aztreonam (p=0.00), and meropenem (p=0.004), with reduced susceptibility to gentamicin (97.47% vs. 88.24%, p=0.006). There was a whopping decrease in the sensitivity of methicillin-resistant Staphylococcus aureus (MRSA) to clindamycin (75.93% vs. 50.7%, p=0.000), linezolid (99.54% vs. 88.73, p=0.004), trimethoprim/sulfamethoxazole (92.59% vs. 74.65%, p=0.001), and vancomycin (99.54% vs. 88.73%, p=0.004). Staphylococcus aureus (S. aureus) had no significant variation except an increase in susceptibility to nitrofurantoin (p=0.023), and perhaps ironically, Streptococcus pneumoniae (S. pneumoniae) had no significant changes in susceptibility pattern. Conclusion Our data demonstrate that the susceptibility of different drugs against different bacterial pathogens varied. However, some antibiotic drugs were found to have high susceptibility against different isolated organisms, and these drugs include amikacin, levofloxacin, vancomycin, cefotaxime, nitrofurantoin, and ceftriaxone. Some organisms showed a significantly declined antibiotic susceptibility, while others showed a significant improvement. The role of COVID-19 regarding these changes is unknown. COVID-19 may not be the cause of the observed differences. We believe that further research on antibiotic legislation and prescribing trends is required. Other non-significant study findings may be attributed to the limited data available to us.