Impact of obstructive sleep apnoea on cardiovascular outcomes and mortality in young adults with congenital heart anomalies: insights from the national inpatient sample (2019).

BACKGROUND: Obstructive sleep apnoea is a common sleep disorder, and adult congenital heart disease (CHD) is also a significant burden on the population. Early diagnosis and treatment are important for improving quality of life and reducing the risk of health complications. The limited research on obstructive sleep apnoea and adult CHD highlights the need for further investigation into the relationship between these two conditions and the mechanisms underlying this relationship. METHOD: We used NIS 2019 database to identify adult CHD admissions aged 18-44 years and assess the impact of obstructive sleep apnoea on all-cause mortality, dysrhythmia, and stroke. A propensity-matched cohort of individuals with and without obstructive sleep apnoea was obtained, and the outcomes were assessed using multivariable analysis and compared in terms of resource utilisation. RESULTS: Of the 41,950 young adult CHD admissions, 6.3% (n = 2630) had obstructive sleep apnoea. The obstructive sleep apnoea+ (n = 2590) and obstructive sleep apnoea- (n = 2590) cohorts were comparable in terms of median age (35 years) and were predominantly male (63.1% versus 62.5%). The obstructive sleep apnoea+ cohort had a higher frequency of risk factors like chronic obstructive pulmonary disease, hypothyroidism, and prior venous thromboembolism than the obstructive sleep apnoea cohort. We found significant association of obstructive sleep apnoea with dysrhythmia (adjusted odds ratio 2.99, 95% confidence interval 2.13-4.19, p < 0.001), but no significant impact on the risk of all-cause mortality or stroke. The obstructive sleep apnoea+ cohort also had higher transfers to short-term facilities, prolonged stays, and higher charges (p < 0.001). CONCLUSION: Our study provides important insights into relationship between obstructive sleep apnoea and adult CHD and highlights the need for further investigation into the impact of obstructive sleep apnoea on individuals with adult CHD.

Impact of Obesity on Ventriculo-Arterial Interaction in Patients After Coarctation of Aorta repair.

Survival of patients after repair of coarctation of Aorta (CoA) has improved significantly over the decades, but patients have decreased life expectancy as compared to the general population. This has been attributed to increased hypertension, cerebrovascular disease, and coronary artery disease. There has also been an increasing concern of overweight and obesity in patients with adult congenital heart disease. While there have been studies looking at the impact of long-term hypertension on myocardial performance and outcomes in this population, this study aims to assess the impact of obesity in these patients on their myocardial performance. Ventriculo-arterial coupling is used as a measure of myocardial performance which reflects the interaction between cardiac contractility and arterial elastance. Patients after CoA repair are known to have hypertension affecting the arterial elastance. Obesity affects cardiac contractility as well. This study demonstrated that in a group of young patients after CoA repair, body mass index (BMI) has a relationship with left ventricular (LV) contractility and myocardial performance. This relationship was independent of blood pressure. BMI itself was not seen to affect the determinants of diastolic function in this study, suggesting that LV contractility may be affected before one can notice a change in the diastolic function secondary to BMI.

Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Infection (MIS-C): A Multi-institutional Study from New York City.

OBJECTIVE: To assess clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2-associated multisystem inflammatory syndrome in children (MIS-C). STUDY DESIGN: Children with MIS-C admitted to pediatric intensive care units in New York City between April 23 and May 23, 2020, were included. Demographic and clinical data were collected. RESULTS: Of 33 children with MIS-C, the median age was 10 years; 61% were male; 45% were Hispanic/Latino; and 39% were black. Comorbidities were present in 45%. Fever (93%) and vomiting (69%) were the most common presenting symptoms. Depressed left ventricular ejection fraction was found in 63% of patients with median ejection fraction of 46.6% (IQR, 39.5-52.8). C-reactive protein, procalcitonin, d-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. For treatment, intravenous immunoglobulin was used in 18 (54%), corticosteroids in 17 (51%), tocilizumab in 12 (36%), remdesivir in 7 (21%), vasopressors in 17 (51%), mechanical ventilation in 5 (15%), extracorporeal membrane oxygenation in 1 (3%), and intra-aortic balloon pump in 1 (3%). The left ventricular ejection fraction normalized in 95% of those with a depressed ejection fraction. All patients were discharged home with median duration of pediatric intensive care unit stay of 4.7 days (IQR, 4-8 days) and a hospital stay of 7.8 days (IQR, 6.0-10.1 days). One patient (3%) died after withdrawal of care secondary to stroke while on extracorporeal membrane oxygenation. CONCLUSIONS: Critically ill children with coronavirus disease-2019-associated MIS-C have a spectrum of severity broader than described previously but still require careful supportive intensive care. Rapid, complete clinical and myocardial recovery was almost universal.

Prevalence and impact of cannabis use disorder on acute ischemic stroke and subsequent mortality in elderly peripheral vascular disease patients: A population-based analysis in the USA (2016 - 2019).

BACKGROUND: Given current evidence linking peripheral atherosclerotic disease, also known as cannabis arteritis, and acute ischemic stroke (AIS) in individuals with cannabis use disorder (CUD), we investigated the frequency and implications of CUD in relation to AIS risk and outcomes among elderly patients with peripheral vascular disease (PVD). METHODS: The National Inpatient Sample (2016-2019) was used to compare geriatric patients with PVD and cannabis use disorder CUD. CUD was correlated with AIS admissions. Adjusted multivariable regression models assessed in-hospital mortality rates. RESULTS: Of 5,115,824 geriatric admissions with PVD, 50.6 % were male and 77.5 % were white. 21,405 admissions had cardiovascular and CUD co-occurrence. 19.7 % of CUD patients had diabetes mellitus (DM), compared to 33.7 % of non-CUD patients. Smoking and HTN rates were comparable between groups. Patients with CUD used more recreational drugs concurrently than those without CUD. AIS prevalence was 5.2 % in CUD patients and 4.0 % in controls (p < 0.001). In the geriatric population with PVD, the presence of CUD was found to be associated with increased odds of hospitalizations due to AIS, with an adjusted odds ratio (aOR) of 1.34 (95 % confidence interval [CI] 1.18-1.52, p < 0.001). All-cause in-hospital mortality was not statistically significant, with an aOR of 0.71 (95 %CI 0.36-1.37, p = 0.302). In our study, older patients with PVD and hypertension (aOR 1.73) had a greater risk of AIS. Intriguingly, when we analyzed AIS predictors in elderly PVD patients with concurrent tobacco use disorder, we identified a counterintuitive protective effect (aOR 0.58, 95 % CI 0.42-0.79, p < 0.001). CONCLUSIONS: Our findings indicate that among geriatric patients with PVD and concurrent CUD, there is a notable 34 % risk of AIS. Importantly, this risk persists despite controlling for other CVD risk factors and substance use. Further investigations are warranted to elucidate and validate the intriguing phenomenon known as the smoker's paradox.

Rising trends in the burden of cardiovascular comorbidities and major adverse cardiovascular events among young female smokers in two national cohorts studied ten years apart (2017 vs. 2007).

BACKGROUND: Ample evidence suggests that female smokers face a greater risk of smoking-related health problems than male smokers. Due to the growing number of young smokers in the United States, there has been limited information on the effects of smoking on young female smokers over the past decade. METHODS: Hospitalizations of young (18-44 years) female tobacco smokers were identified using the National Inpatient Sample datasets from 2007 and 2017. We compared differences in admission frequency, comorbidity burden, in-hospital outcomes [all-cause mortality and major adverse cardiac events (MACE)], and resource utilization between two young cohorts separated by 10 years. RESULTS: In 2007, there were 665,901 admissions among young female smokers (median age: 35), compared to 1,224,479 admissions (median age: 32) in 2017. In both cohorts, white female smokers accounted for most admissions, followed by blacks. In 2017, the prevalence of alcohol abuse, hyperlipidemia, uncomplicated diabetes, and chronic pulmonary disease decreased relative to the 2007 cohort, whereas the prevalence of deficiency and chronic blood loss anemias, diabetes with complications, drug abuse, hypertension, congestive heart failure, depression, liver disease, and obesity increased significantly (p<0.001). The 2017 cohort had significantly higher odds of all-cause mortality [aOR 1.25 (95%CI: 1.16-1.35)] and a higher risk of MACE [aOR 1.17 (95%CI:1.14-1.20)] upon multivariable adjustment. (p<0.001). Comparatively, the 2017 cohort had fewer routine discharges and higher home healthcare needs than the 2007 cohort. CONCLUSIONS: In this decade-apart analysis, the study reveals rising trends in the burden of comorbidities, MACE, and healthcare resource utilization in admissions (regardless of the primary cause) among relatively younger female smokers. It is crucial to educate young female smokers about the detrimental effects of tobacco and polysubstance abuse on cardiovascular outcomes.

Is dependent cannabis use in adult hospitalizations with inflammatory bowel disease associated with major adverse cardiovascular and cerebrovascular events? Insights from National Inpatient Sample Analysis.

BACKGROUND: Inflammatory bowel disease (IBD) and dependent cannabis use or cannabis use disorder (CUD+) are independent risk factors for cardiovascular diseases. Usage of cannabis for pain increased in IBD patients. However, associated cardiovascular safety remains unclear. This study aims to investigate the major adverse cardiac and cerebrovascular events (MACCE) associated with CUD + in hospitalized IBD patients. METHODS: We analyzed the National Inpatient Sample 2020 using ICD-10-CM codes; hospitalized IBD patients were identified and divided based on CUD's presence or absence. Multivariable regression models were performed to evaluate MACCE [in-hospital mortality, acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS)] odds after adjusting for baseline demographics, hospital-level characteristics, and relevant cardiac/extra-cardiac morbidities. RESULTS: Among the 302,770 hospitalized adult IBD patients, 3.1% (9,490) had CUD+. The majority of patients in the CUD + cohort were white (67.7%), male (57.5%), and aged between 18 and 44 years (66.2%). Cardiovascular risk factors like hypertension, diabetes, hyperlipidemia, and prior myocardial infarction were higher in the CUD - cohort (p <0.001) compared to the CUD + cohort. The CUD + cohort had a lower rate of MACCE (3.1% vs. 5.8%), crude in-hospital mortality (0.7% vs. 2.2%), AMI (1.7% vs. 2.6%), CA (0.3% vs. 0.7%), and AIS (0.6% vs. 1.2%) with statistical significance (p <0.001). However, after adjusting for baseline characteristics and comorbidities, the adjusted odds ratios (aORs) did not show a statistically significant difference for MACCE (aOR = 0.9, 95% CI = 0.65-1.25, p = 0.530), CA (aOR = 0.54, 95% CI = 0.2-1.47, p = 0.227), and AIS (aOR = 0.86, 95% CI = 0.43-1.73, p = 0.669). CONCLUSION: Our study did not find a statistically significant difference in MACCE among hospitalized IBD patients with and without CUD. This emphasizes the need for more extensive prospective studies focusing on the quantity, method, and duration of cannabis use (recreational or medicinal) in patients with IBD.

Assessing Impact of Health Education in Improving Knowledge of Children on Child Sexual Abuse.

BACKGROUND: Every year, millions of children around the world face sexual abuse and exploitation. Sexual and reproductive health education is an important form of health promotion action against it. This study aims to assess the impact of health education program in improving knowledge of the children on child sexual abuse. METHODS: A school based pre-experimental study was done among 120 lower secondary level students of a private school in Bharatpur municipality of Chitwan District, Nepal during March 2021. An interventional health education program imparting knowledge on child sexual abuse and its preventive measures was given to the children. Their knowledge was assessed and compared before and after intervention using paired t-test. Data analysis was done using SPSS version 17 software. RESULTS: The mean age of children was 13.77±0.65 years with 1:1.18 girls to boys ratio. The level of knowledge of the children on child sexual abuse and its preventive measures increased significantly post-intervention as compared to pre-intervention. The mean scores of post-test (29.80±4.53) was higher than pre-test (17.04±6.96). The intervention was proved effective with statistically significant t-test values (t=20.996, p=<0.001). About 6.7% children disclosed an experience of child abuse post-intervention. CONCLUSIONS: The school based health education program effectively increased the knowledge of the children on child sexual abuse, thus helping in preventing and protecting them from child sexual abuse and its harmful effects.

Pattern of suspicious deaths of married females brought for medico-legal autopsy at teaching institute of India.

Background: Death is unnatural and suspicious when it is caused by external causation like injury or poisoning or other than natural course. In such deaths of married females, the inquest is carried out, and a medico-legal autopsy is conducted to ascertain the cause of death and manner of death. Materials and Methods: This record-based, retrospective study was carried out at RVRS Medical College, Rajasthan in the year 2021 (1st January, 2021 to 31st December, 2021) to know the pattern of the suspicious death of married females brought for medico-legal autopsy. The inquest report, medico-legal autopsy report, histopathological examination report, and chemical analysis report findings were tabulated and analyzed. Results: The maximum number (31.62%) of female deaths belonged to the age group of 18-22 years of age. A total of 33.82% of females died during a marriage duration of less than 5 years of married life. A total of 22.79% of female deaths were related to dowry and 60.2% of females belonged to rural areas. A total of 59.56% of females were died due to poisoning and 75% of female deaths considered suicidal. Conclusion: Suspicious deaths of married women brought for medico-legal autopsy must be dealt with due to precaution to determine the cause and manner of death. One must be vigilant that the suspicious death of a married female may be associated with dowry in the Indian scenario.

Rising Burden of Cardiovascular Disease Risk Factors and Acute Cardiac Events in Young Adults With Comorbid Depression: A Comparison Nationwide US Cohorts Hospitalized 10-years Apart.

Depression and coronary artery disease are leading causes of mortality in adults in high-income countries. Due to the paucity of data on the young, we aimed to investigate the prevalence of cardiovascular disease (CVD) risk factors and associated major adverse cardiac and cerebrovascular events (MACCE) in young adults hospitalized with comorbid depression a decade apart. We conducted a retrospective analysis of the National Inpatient Sample Database for the years 2007 and 2017. Young adults (18-44 years) hospitalized with comorbid depression were identified using ICD-9 CM/ICD-10 codes. Frequency and trends in demographics, comorbidities including CVD risk factors, and MACCE have been compared between the 2017 vs 2007 cohorts. A total of 1,274,118 admissions with a median age of 34 years and 68.7% of females were recorded with comorbid depression. When the 2007 cohort was compared with the 2017 cohort, a rising trend in depression was observed (5.5% vs 8.2%, P < 0.001). The 2017 cohort of young adults with depression more often consisted of male, non-white patients. The burden of CVD risk factors such as hypertension, diabetes with chronic complications, smoking, and obesity was also greater in the 2017 cohort. Although the all-cause mortality remained comparable (0.3%) in both cohorts, there was a significantly higher rate and risk of MACCE including acute myocardial infarction (aOR 1.18, 95%CI:1.10-1.26), atrial fibrillation or flutter (aOR 1.47, 95%CI:1.40-1.54) and stroke (aOR 1.33, 95%CI: 1.26-1.40) (P < 0.001) in the 2017 cohort. In conclusion, this nationwide study reveals an alarmingly increased prevalence of CVD risk factors and an increase in the rate and risk of MACCE in 2 cohorts of young adults with comorbid depression studied a decade apart. The burden of mental disorders in young adults has been rising in the last decade and warrants extra vigilance by clinicians to recognize and manage depression to curtail CVD risk and improve MACE-associated outcomes.

Utility of inquest and medico-legal autopsy in community deaths at tertiary care hospital of India.

Background: In India, inquest is carried out by police or magistrate depending upon the type of death and medico-legal autopsy is carried out by doctor. In some cases, inquest is sufficient to make out necessary information related to death and medico-legal autopsy can be avoided in such death, but medico-legal autopsy has its own value. Materials and Methods: A retrospective record-based study was carried out at RVRS Medical College, Bhilwara, Rajasthan, regarding the correlation of inquest and medico-legal autopsy findings in community deaths which were brought dead to hospital in the year 2020. Results: A total of 467 cases of community deaths were brought dead for medico-legal autopsy in the year 2020. As per inquest, 7.28% died due to hanging, 3.85% died due to burns, 3.43% died due to electrocution, 16.27% died due to poisoning, and the same was established via medico-legal autopsy without any difference from inquest report. After inquest, in 3% of cases, the cause of death remained undetermined, while after the medico-legal autopsy, it was only 0.86%. The manner of death was undetermined in 3% of cases after inquest, while after the medico-legal autopsy, only in 0.86% of cases. Conclusion: We recommend proper training of the investigating officers who conduct inquest to overcome the discrepancies observed between the investigating officer and the doctor in ascertaining the cause of death and manner of death in all unnatural deaths in India. If well-trained person will conduct in depth inquest, then medico-legal autopsies can be avoided in certain types of death.

Unusual Cause of Heart Failure in a Patient with Marfan Syndrome: A Late Complication of Bioprosthetic Valved Graft Replacement.

A high-velocity gradient across the left ventricular outflow tract is most often caused by aortic valve stenosis. We describe the unusual case of a high-velocity gradient caused by a kinked ascending aortic graft in a 69-year-old man who had Marfan syndrome. The patient had a history of ascending aortic aneurysm and had previously undergone replacement of the aortic root and ascending aorta with use of a bioprosthetic valved graft. The kinking was caused by dilation of the native aortic arch. The patient underwent successful hemi-arch replacement and repair of the kinked graft. Late complications and reoperation after proximal aortic surgery in patients with Marfan syndrome are rare, and a high-velocity left ventricular outflow tract gradient caused by the kinking of the aorta is unusual.

Exoelectrogens Leading to Precise Reduction of Graphene Oxide by Flexibly Switching Their Environment during Respiration.

Reduced graphene oxide (RGO) has been prepared by a simple, cost-effective, and green route. In this work, graphene oxide (GO) has been reduced using Gram-negative facultative anaerobe S. dysenteriae, having exogenic properties of electron transfer via electron shuttling. Apparently, different concentrations of GO were successfully reduced with almost complete mass recovery. An effective role of lipopolysaccharide has been observed while comparing RGO reduced by S. dysenteriae and S. aureus. It was observed that the absence of lipopolysaccharide in Gram-positive S. aureus leads to a disrupted cell wall and that S.aureus could not survive in the presence of GO, leading to poor and inefficient reduction of GO, as shown in our results. However, S. dysenteriae having an outer lipopolysaccharide layer on its cell membrane reduced GO efficiently and the reduction process was extracellular for it. RGO prepared in our work has been characterized by X-ray diffraction, ζ potential, X-ray photoelectron spectroscopy, and Raman spectroscopy techniques, and the results were found to be in good agreement with those of chemically reduced GO. As agglomeration of RGO is the major issue to overcome while chemically reducing GO, we observed that RGO prepared by a bacterial route in our work has ζ potential value of -26.62 mV, good enough to avoid restacking of RGO. The role of exoelectrogens in electron transfer in the extracellular space has been depicted. Toxin released extracellularly during the process paves the way for reduction of GO due to its affinity towards oxygen.