Chronic Substance Abuse Research Articles

Abstract 12159: Trends in Subsequent Myocardial Infarction Hospitalizations and Inpatient Mortality Among Cancer Patients With Prior Myocardial Infarction

Background: Patients hospitalized with subsequent/recurrent myocardial infarction (MI) suffer from high morbidity and mortality burden. Owing to the lack of contemporary data on cancer patients, we aimed to study the trends of subsequent Mi in this population. recurrent MI admissions and mortality in patients with prior history of MI and active cancer diagnoses. Methods: The National Inpatient Sample (2016-2019) was queried to identify adults with an active cancer diagnosis and prior MI hospitalization for subsequent MI admissions. Primary outcomes were nationwide trends in subsequent MI admissions and in-hospital mortality with sex and racial disparities. Trend analysis was performed by linear-by-linear regression method. Results: Cancer patients with prior MI (n=470755, median age 75 [IQ 67-82 years]) had 5.6% (26320) subsequent MI admissions. Subsequent MI hospitalizations mostly had male (69.3%), white (81.5%), enrolled in Medicare (81.1%), and South (31.1%) region admissions. Subsequent MI patients had higher complicated hypertension (58.4 vs 39.3%), diabetes with chronic complications (33 vs 21.4%), drug abuse (2.3 vs 1.4%) and obesity (13.6 vs 10.6%) than patients without subsequent MI. Subsequent MI admissions had a declining trend from 2016 to 2019 for both sex and all races except Hispanics (p trend <0.05) [Fig. 1a]. All-cause in-hospital mortality showed a significant declining trend for males (p trend <0.05), but a marginal increase was seen in females [Fig. 1b]. Furthermore, stratified by race, no significant change in mortality trend was noticed. Conclusion: There were declining trends in subsequent MI hospitalizations in cancer patients with prior MI in all sex/racial groups except in Hispanics. Males had improved outcomes in terms of in-hospital mortality, however, this improvement was not evident in females and on racial stratification.

High Expressions of MicroRNA-143 in Patients With Methamphetamine Abuse Disorder: A Case-control Study

Background: Chronic drug abuse changes microRNA (miRNA) expression in the brain, which may contribute to addictive behaviors. Many miRNAs play critical roles in developing drug addiction. Methamphetamine induces various alterations in different systems by affecting gene expression, but the effects of methamphetamine on miRNA profiles need to be elucidated. This study evaluated the expression of miRNA-183 and miRNA-143 in the blood of methamphetamine abusers and controls. Methods: In this case-control study, the case group comprised 60 people with a methamphetamine addiction from Tabriz City, East Azerbaijan, Iran, and the control group comprised 60 healthy controls of comparable ages and ethnicities. Total RNA was extracted from peripheral blood samples, and then cDNA was synthesized. MicroRNA-183 and microRNA-143 expression levels were determined using real-time PCR. Results: The results indicated that methamphetamine abusers had significantly higher blood levels of miRNA-143 than healthy controls (P<0.05); however, miRNA-183 expression was comparable between the two groups (P>0.05). Conclusion: MicroRNA-143 may play a role in the pathology of methamphetamine abuse, so it may be used as an additional method to identify people with an addiction precisely.

Recurrent acute poisoning with synthetic cathinone α-pyrrolidinohexanophenone (α-PHP) in a chronic drug abuser

We aim to present a case of recurrent acute α-PHP intoxications in a chronic drug abuser documented by plasma concentration monitoring in order to describe α-PHP monointoxications. We developed and validated a specific HPLC-MS-MS method for the quantification of α-PHP in plasma and urine. Samples were extracted with a glacial acetonitrile deproteinization protocol. Quantitative analysis was performed in multiple reaction monitoring mode and the precursor-to-product ion transitions of m/z 246.2 > 91.2 (quantification), 246.2 > 140.2 (confirmation), 284.3 > 149.1 were used for α-PHP, and MDPV-D8 (IS), respectively. The authors describe the case of eight α-PHP recurrent intoxications in a 36-year-old man over 5 months. The reported ingested dose ranged from 3.5 to 10 grams of α-PHP. Interval from the last intake and the first blood sample ranged from 4 to 24 hours. Plasma α-PHP concentrations ranged from 15 to 364 ng/mL and from 8500 to 20,100 ng/mL in urine. To the best of our knowledge, this is the highest α-PHP plasma concentration measured in alive patient. We observed severe neurologic disorders (hallucinations, agitation and aggressiveness) with α-PHP plasma concentration higher than 200 ng/mL. This series describe eight α-PHP monointoxications and suggest a tolerance as well as a potential link between plasma concentration and toxicity of α-PHP that need to be confirmed on larger studies.

Impairment of glutamate homeostasis in the nucleus accumbens core underpins cross-sensitization to cocaine following chronic restraint stress.

Though the facilitating influence of stress on drug abuse is well documented, the mechanisms underlying this interaction have yet to be fully elucidated. The present study explores the neurobiological mechanisms underpinning the sensitized response to the psychomotor-stimulating effects of cocaine following chronic restraint stress (CRS), emphasizing the differential contribution of both subcompartments of the nucleus accumbens (NA), the core (NAcore) and shell (NAshell), to this phenomenon. Adult male Wistar rats were restrained for 2 h/day for 7 days and, 2 weeks after the last stress exposure (day 21), all animals were randomly assigned to behavioral, biochemical or neurochemical tests. Our results demonstrated that the enduring CRS-induced increase in psychostimulant response to cocaine was paralleled by an increase of extracellular dopamine levels in the NAcore, but not the NAshell, greater than that observed in the non-stress group. Furthermore, we found that CRS induced an impairment of glutamate homeostasis in the NAcore, but not the NAshell. Its hallmarks were increased basal extracellular glutamate concentrations driven by a CRS-induced downregulation of GLT-1, blunted glutamate levels in response to cocaine and postsynaptic structural remodeling in pre-stressed animals. In addition, ceftriaxone, a known GLT-1 enhancer, prevented the CRS-induced GLT-1 downregulation, increased basal extracellular glutamate concentrations and changes in structural plasticity in the NAcore as well as behavioral cross-sensitization to cocaine, emphasizing the biological importance of GLT-1 in the comorbidity between chronic stress exposure and drug abuse. A future perspective concerning the paramount relevance of the stress-induced disruption of glutamate homeostasis as a vulnerability factor to the development of stress and substance use disorders during early life or adulthood of descendants is provided.

Drug alcohol interactions-a review

Chronic Alcoholics can induce interactions with various drugs. Mainly the pharmacokinetic and pharmacodynamics interactions between drugs and alcohol plays an important role. Alcohol can cause potentiallyl harmful effects When people are unaware of known drug interactions, Knowingly combine due to negligence, As a tool to facilitate a crime. Most of the drugs involved are benzodiazepines, cocaine, NSAIDS, metronidazole caution, awareness, and education about the consequences should be enhanced within the alcoholic abusers who are in medication which can cause potential interactions and secondary effects. The elderly and chronic drug abusers are at risk mostly.

A Retrospective Investigation of Determining the Factors of Dental Implant Survival Rate

Aim: Dentists have developed as both a novel potential treatment for the majority of the patients, and they are projected to play aa significant part in oral rehabilitation in future. The latest research was carried out to evaluate several parameters influencing the chance of survival of dental work. Methods: The current investigation was carried out in Services Hospital, Lahore. This study includes 5300 individuals who had dental implants implanted between June 2020 and May 2021. Individuals with hormonal imbalances, chronic infectious illnesses, immunosuppressive medication, pregnant women, drug and alcohol abusers, and suffering from chronic periodontal disorders have also been excluded. Name, age, gender, length of implant, diameter of implant, placement of implant, and biomechanical properties were among the parameters reported. Results: There were 2900 men and 2500 women among 5400 individuals. Highest implantation losses (56) were observed in patients above the age of 59 (males – 560, females – 740). There were 21 unsuccessful implantations in the 41-year-old age category (males 760, women 560). There were 46 unsuccessful implants in the age category 40–61 years (males – 1600, women – 1100). The change remained not statistically substantial (P = 0.22). Implant with a length of more than 12.6 mm (44/720) failed the most, followed by implant with a length of 11 mm (23/1670) and 11–11.6 mm (63/2870). The increase was statistical implication (P 0.06). Fasteners with just a diameter of 4.77 mm (17/1640) and implantation with a length of 5.77–3.6 mm (53/2700) failed the most (33/1050). Conclusion: The existence rate of prostheses is resolute by limitations just like age, entrenched length, diameter, bone quality, also implanted location. Researchers discovered that implants more than 12.6 mm in height and 4.76 mm in diameter, put in the mandibular posterior area of Type III bones, had the highest failure rate. Keywords: Dental Implant Survival Rate, potential treatment.

Women’s Pathways: Replication and Generalizability Across State Prison Systems

This study demonstrates the replication and validation of a prior model of women’s pathways to prison that was initially developed in California Women’s prisons and subsequently implemented in the Massachusetts Department of Correction (MADOC) women’s prison in 2013. The following four main pathways were identified: (1) Quasi-normal, least disturbed, drug and situational offending; (2) lifelong abused and depressed drug abusing women; (3) socialized subcultural women, with chronic crimes and drug abuse; and (4) abused and aggressive, early onset and multi-need women with severe drugs, crime, and mental health issues. Since 2013, this model has routinely functioned in MADOC women’s prison as an internal classification (IC) for women detainees. Using a newly extracted sample of approximately 1,800 cases from MADOC, several forms of replication and validation were conducted; these demonstrated cross-sample stability, cross-method stability, and stability across time and region. Implications for theory, treatment planning, and implementation are discussed.

Comorbidity and comedication burden among people living with HIV in the United States

Objective To describe the burden of comorbid conditions and comedications among people living with HIV (PLWH) vs. people living without HIV (PLWoH). Methods This was a case–control study conducted among insured patients using administrative claims data. Adult PLWH were identified by antiretroviral therapy (ART) claims or HIV/AIDS diagnosis codes from 1 January 2018 to 31 December 2018 (index date was set by the earliest claim). Continuous enrollment was required for ≥12 months pre-index (baseline) and ≥30 days post-index (follow-up). Patients were required to have ≥1 HIV diagnosis during baseline or follow-up. Those with only HIV prophylaxis were excluded. PLWoH were matched 2:1 to PLWH on demographic characteristics. Study outcomes were compared using z-tests with robust standard errors in an ordinary least squares regression or Rao–Scott tests. Results The study included 20,256 PLWH and 40,512 matched PLWoH, mean age 52 years. PLWH vs. PLWoH had higher mean (SD) Charlson comorbidity index scores (0.93 [1.59] vs. 0.61 [1.28]; p < .001) and a greater proportion had ≥1 comorbidity (69.1% vs. 54.5%, p < .001). The most prevalent comorbidities included hypertension (33.9% vs. 32.2%; p < .001), hyperlipidemia (29.4% vs. 24.6%; p < .001), chronic kidney disease (13.6% vs. 9.4%, p < .001), depression (13.1% vs. 7.3%, p < .001) and substance abuse (12.8% vs. 7.1%, p < .001). Mean (SD) non-ART prescription fills were higher among PLWH vs. PLWoH (11.9 [10.1] vs. 9.2 [9.4]; p < .001). Conclusions Multimorbidity and polypharmacy were more prevalent among PLWH vs. matched PLWoH. Findings support the need to consider comorbidities and comedications when choosing ART and to minimize drug–drug interactions and adverse events to improve patient outcomes.

PO-701-05 ASSOCIATION OF ILLICIT DRUG POISONING WITH DYSRHYTHMIA - A PROPENSITY WEIGHTED ANALYSIS OF THE NATIONAL INPATIENT SAMPLE

Substance abuse is a progressive global epidemic requiring a complex multisystem approach to improve patient outcomes. While many studies have sought to evaluate outcomes of chronic substance abuse, there remains a paucity of literature to characterize the cardiovascular outcome of acute poisoning. We sought to evaluate the correlation between illicit drug poisoning and dysrhythmia. Objective: A composite database of National Inpatient Sample (NIS) for 2016 and 2017 was queried using ICD-10 codes[RG1] to identify patients with poisoning from several commonly abused substances including: cannabis, cocaine, heroin, amphetamines, hallucinogens, and LSD. A propensity weighted logistic regression analysis was performed controlling for age, gender, and comorbidities. Propensity weighted cohorts were compared for correlation with dysrhythmias [atrial fibrillation/flutter (AF/AFL), sick sinus syndrome (SSS), bradyarrhythmia, AV block (AVB1, AVB2, CHB), supraventricular tachycardia (SVT), ventricular tachycardia (VT), and ventricular fibrillation (VF)]. [RG1]Were ICD-10 codes available in 2016, 2017? The study cohort of 22,485 patients with hospitalization forillicit drug poisoning was evaluated.Average age was 40+ 0.2 years, 32% of whom were female. A propensity weighted logistic regression model using each dysrhythmia category as a dependent variable was performed using Stata 17.0 controlling for age, gender, and comorbidity (presence of AICD, Pacemaker, history of chronic heart failure, diabetes, ischemic stroke, COPD, PVD, CKD, OSA, hypertension, CAD). Using a Bonferroni correction for 15 variables, a p value threshold of 0.003 was used. As covariates were chosen based on prior available evidence to suggest harm, negative Z statistics were assumed to be erroneous. [RG1] Cannabis poisoning was found to have a strong correlation to bradyarrhythmia, AVB1. Cocaine poisoning was found to be strongly associated with SSS, AF/AFL, bradyarrhythmia, AVB1, AVB2, CHB, SVT, VF, and VT (Table 1). [RG1]These should be under methods. Patients with cannabis and cocaine poisoning were found to be strongly correlated with concurrent dysrhythmia.

127 Reciprocal Innovation Workshops: Identify Shared Health Challenges for Mutual Benefit in Global Health

OBJECTIVES/GOALS: Our concept of reciprocal innovation (RI) supports global health (GH) research partnerships that address shared health challenges for mutual benefit in both high and low- and middle-income (LMIC) settings. To advance this GH approach, the Indiana CTSI launched a RI program building on longstanding global health partnerships in East Africa METHODS/STUDY POPULATION: A core component of the program is annual RI workshops to promote reciprocal approaches in GH, identify priority areas for reciprocal research, and link investigators and stakeholders across settings. The first meeting in 2019 was in-person and focused on identifying health priority areas from the perspective of Indiana stakeholders. The second meeting was held virtually and focused on priority areas in East Africa. The third meeting focused on shared priority areas and discussing potential RI research projects. Agenda sessions include (1) presenting successful examples of funded RI projects; (2) breakout groups to share proposal ideas in preparation for the RI grants program; (3) building partnerships with colleagues in similar fields RESULTS/ANTICIPATED RESULTS: As of 2021, three RI workshops have been held with an average of 60 attendees at each workshop. Participants identified several overlapping priority areas for research and RI in Indiana and East Africa, including research in chronic disease, substance abuse, infant and maternal health, and access to healthcare. A Global Health Innovation Exchange of RI projects was created to support connections between locally- and globally-focused investigators. The repository is used to share updates on project progress, outcomes, and published materials. Workshops have also been used to explore a reciprocal innovation virtual platform to facilitate and foster more regular collaborations between globally and locally-focused investigators and pursue research projects on shared health challenges for mutual benefit DISCUSSION/SIGNIFICANCE: The collaboration at the stakeholder meetings set the foundation for continued partnership building, strong proposals for RI grants, and dissemination and translation of successful RI projects. To leverage momentum from the meetings, we are building a virtual RI platform to connect PIs across multiple CTSAs and increase the footprint of RI efforts

28 Risk Factors and Outcomes of Opioid Dependence After Burn Injury: A Single Center Study

IntroductionPatients with severe burns often have a prolonged recovery course and frequently opioid pain medications. Several studies showed patients who receive frequent and high doses of opioid medications are at elevated risk of developing opioid dependence. Risk factors for opioid dependence have been established in several fields, including in trauma patients, however opioid dependence within the burn population has not been well studied. In this study we identify risk factors and outcomes for burned patients with opioid dependence.MethodsWe performed a review of a deidentified database that covers our institution comprising over 1.9 million patients. ICD-10 codes were used to identify those with burns. We identified 9150 patients who received treatment for a burn injury between January 1, 2010 and December 31, 2020. From this cohort 130 patients (1.4%) developed documented opioid dependence. Patients from each cohort were balanced by propensity score matching. The database was then examined to determine treatment type and concomitant diagnoses.ResultsPrior to matching we found a significant increase in mortality, chronic pain, non-opioid substance abuse, depression, and use of opioid and non-opioid medication (p< 0.05) for those with opioid dependence. After propensity score matching, we found no significant increase in mortality or depression (p >0.05). Chronic pain and non-opioid substance abuse remained elevated (OR 2.7, CI 1.6, 4.4; OR 2.4, CI 1.3, 4.5, p< 0.05, respectively). Those who developed opioid dependence were more likely to receive opioid and non-opioid pain medication (p< 0.05), but these were not more likely to receive IV opioid pain medication (p >0.05). However, they were more likely to receive IV opioid pain medication more frequently (p< 0.05). Interestingly, patients who developed opioid dependence were more likely to follow up post-operatively and to receive anti-depressant and anti-epileptic (gabapentin and pregabalin) medications (p< 0.05).ConclusionsHere we presented data on patients who developed opioid dependence following burn injury. These patients appear to receive more pain medication and receive it more frequently. We did not find a correlation of opioid dependence to depression or patient compliance. Characterizing the patient who develops opioid dependence will better help clinicians to identify patients at risk and direct their care accordingly. Further investigation is indicated to determine the impact these factors have and how these might be mitigated.

127 Anxiety Disorder Symptomology Found to Be Prevalent in Burn-injured Youth

IntroductionAnxiety Disorder (AD) is common in inpatient pediatric burn patients and likely related to pain/stress associated with acute care. This study ascertained if burn survivors reported higher anxiety levels based on sex, visibility of scars, or TBSA ≥ 50%.MethodsBurn-injured youth completed the Screen for Child Anxiety Related Disorders (SCARED) with parental consent. This 41 item self-report measures DSM-IV pediatric anxiety disorder symptoms: panic disorder (PD), separation anxiety (SA), generalized anxiety disorder (GAD), social phobia (SP) school phobia (SCP) and total anxiety (TA). The percentage of respondents above threshold for each disorder was calculated.Results112 survivors, mean age of 13, included boys (51%) & girls (49%). 83 reported visible scars. Females had higher percentages for TA (53%) vs. males (21%) (p < 0.001), PD (47%) vs. (7%) (p< 0.001), GAD (40%) vs. (16%) (p < 0.005), & SA (51%) vs. (21%) (p < 0.001). Youth with TBSA ≥ 50% (n=22) had higher precents for GAD (46%) vs. < 50% (24%) (p < 0.01). The visibly scarred had higher percent for GAD (38%) vs. hidden (7%) (p< .01).ConclusionsFemale, visibly scarred, and patients with burns > 50% revealed increased AD symptoms. AD may be chronic, interfere with a child’s home & school function and lead to chronic distress, substance abuse, and isolation. Screening for anxiety in burn-injured youth is recommended.

Incidence and risk factors associated with hospital-acquired pressure ulcers following total hip arthroplasty: A retrospective nationwide inpatient sample database study

AimTo examine the incidence and risk factors associated with hospital-acquired pressure ulcers (HAPUs) following total hip arthroplasty (THA) using a large-scale national database. Material and methodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005 to 2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), total charges during hospitalization, in-hospital mortality, preoperative comorbidities, and perioperative complications were assessed. ResultsThe general incidence of HAPUs after THA was 0.05%, with a fluctuating trend annually. Patients suffered from HAPUs were older, less likely through elective admission, more likely in large hospital, more usage of Medicare, and less possibly paying via Private insurance. Additionally, the occurrence of HAPUs was associated with more preoperative comorbidities, longer LOS, extra total charges, and higher in-hospital mortality. Risk factors associated with HAPUs included advanced age (≥75 years), large hospital, multiple comorbidities (n ≥ 3), diabetes with chronic complications, drug abuse, liver disease, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disorders, psychoses, chronic renal failure, peptic ulcer disease, and weight loss. Besides, HAPUs were associated with inflammatory arthritis and femoral neck fracture (compared with primary/secondary osteoarthritis), frailty/senility, osteoporosis, acute renal failure, pneumonia, postoperative delirium, urinary tract infection, deep vein thrombosis, sepsis/septicemia, wound dehiscence/non-healing surgical wound, periprosthetic joint infection, and mechanical prosthesis-related complications. Conclusion: It is beneficial to study the risk factors associated with HAPUs after THA to ensure the preventive management and optimize outcomes although a low incidence was identified.

Super-High-Utilizer Patients in an Urban Academic Emergency Department: Characteristics, Early Identification, and Impact of Strategic Care Management Interventions.

Patients who visit the emergency department (ED) with high frequency are typically categorized as super users, high utilizers, or super-high utilizers (SHUs) based on the relative frequency of hospital care they require, compared with other ED patients (Chambers et al., 2013; Rinehart et al., 2018). Common characteristics of patients with frequent utilization of emergency services are well described in the literature, including high chronic disease burden, substance abuse, and psychiatric disorders (LaCalle & Rabin, 2010; Sandoval et al., 2008; Szekendi et al., 2015). There has been relatively less focus on the characteristics of high utilizers who are frequently admitted to inpatient services following their ED encounters (Boonyasai et al., 2012; Raven et al., 2011). Healthcare spending attributed to the highest utilizers of the ED, categorized as SHUs, is disproportionately high (Bergenstal et al., 2020; Jiang et al., 2006...

Cohort Profile: Chengdu Positive Child Development (CPCD) survey.

Childhood is a critical developmental stage affecting future health, competence and capacity. According to theories of child development (physical and behavioural development risk process theories), some preventable outcomes include chronic illness, mental illness, obesity, myopia, developmental injury, substance abuse, antisocial behaviour, social alienation and school failure.1,2 Positive Child Development (PCD) is a positive psychological approach which focuses on the growth, cultivation and nurturing of developmental assets, abilities and potentials in children.3,4 It focuses on each child’s unique talents, strengths, interests and potential. It aims to understand children and engage them in productive activities rather than correct or cure for maladaptive tendencies.5 It has been highlighted as potentially supporting better health and social outcomes throughout the life course.6–9 Many US development programmes have shown positive changes in children’s and adolescents’ behaviours (such as interpersonal skills and quality of peer and adult relationships) and significant improvements in problem behaviours (e.g. drug and alcohol use, school misbehaviour).10 Other studies have found similar findings where, for example, children with positive development were more satisfied with life and had fewer problem behaviours.11–14

Type 2 Myocardial Infarction in Young Adults: Insights From the National Readmission Database.

IntroductionType 2 myocardial infarction (T2MI) is an ischemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. T2MI is often diagnosed in patients with a higher risk of morbidity and mortality. T2MI in young adults is poorly understood due to limited available data.MethodsThe Nationwide Readmission Database 2017-2018 was queried for admission with T2MI diagnosis in young adults (age ≤ 45 years). Index admissions with T2MI were identified. Other types of myocardial infarction and observations with missing data were excluded. December admissions were excluded to allow the 30-day follow-up. Cox proportional hazard multivariate regression model was used to determine predictors of readmissions. All P-values were two-sided, with 0.05 as the threshold for statistical significance.ResultsA total of 11,750 patients with a secondary diagnosis of T2MI were admitted between October 2017 and November 2018. The main primary etiologies of index admission were sepsis (14%) followed by hypertensive heart disease with heart failure (11%) and hypertensive emergency (7%), while main etiologies of readmission were hypertensive heart disease with heart failure (12%) followed by sepsis (9%) and acute kidney injury (3%). Valvular heart disease, chronic pulmonary disease, drug abuse, and depression were amongst the predictors of all-cause readmission.ConclusionWe identified primary etiologies of admission and readmission, and predictors of readmissions in young adults presenting with T2MI. Further studies are needed to guide the management of T2MI in this age group.

Atypical longitudinal self-inflicted incised wounds as a cause of death in an ecstasy user.

A 32-year-old chronic drug abuser was found dead at the entrance to his home, covered in blood. Pools of blood, bloody footprints and bloodstains were found across the apartment. A double-edged razor was recovered from the scene. Autopsy revealed multiple incised wounds: two on the palmar aspect of both forearms (37cm and 33cm long, oriented longitudinally). The cuts extended into the subcutaneous adipose tissue, muscles and blood vessels. There was an additional 30cm cut extending across the middle of the torso anteriorly and two more cuts on the anteromedial aspect of the lower legs, set symmetrically (about 23 and 25cm long). These three cuts were more shallow than the upper extremity wounds. No hesitation wounds were identified. Toxicological analysis identified MDMA (ecstasy). The cause of death was exsanguination. The deceased has been using ecstasy for the previous five years and had a history of inpatient psychiatric treatment due to psychosis with delusions and hallucinations. These self-inflicted incised wounds had many atypical features: location (torso, legs and arms), longitudinal orientation and symmetrical distribution, absence of hesitation injuries, use of both dominant and non-dominant hand. The absence of previous suicide attempts and suicide note suggest that these self-inflicted injuries were not planned beforehand, but were abrupt. We hypothesize that this injury pattern is associated with both acute and chronic effects of MDMA.

77. Perioperative outcomes of concomitant shoulder diagnoses for patients undergoing cervical spine procedures

<h3>BACKGROUND CONTEXT</h3> For patients undergoing a cervical spine procedure, the effect of a shoulder injury on perioperative outcomes is not well understood. Our study aimed to investigate the impact shoulder injuries have on perioperative outcomes for elective cervical spine surgery patients. <h3>PURPOSE</h3> To evaluate the effect of concomitant shoulder injuries on perioperative outcomes of elective cervical spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of a national patient database between 2007-2017. <h3>PATIENT SAMPLE</h3> A total of 1,482,311 elective cervical spine surgery patients. <h3>OUTCOME MEASURES</h3> Comorbidity burden, invasiveness, perioperative complications, length of stay (LOS), total hospital charges. <h3>METHODS</h3> Patients undergoing elective cervical spine surgery were isolated with ICD-9 diagnosis codes. Cervical procedure (CP) patients with concurrent shoulder diagnosis(S-Dx) were further isolated. Means comparison tests compared differences in demographics, surgical, and perioperative outcomes between those who had a cervical procedure and a concurrent shoulder diagnosis (CP/S-Dx) and those who had a cervical procedure with no shoulder diagnosis (CP). Logistic regression analysis assessed the odds of complication associated with a shoulder diagnosis, controlling for age and surgical invasiveness. <h3>RESULTS</h3> 1,482,311 elective cervical spine surgery patients were included. Overall, 17,873(1.2%) patients underwent a CP and had a concurrent S-Dx. CP and S-Dx patients compared to only CP patients were significantly younger and male (both p<0.05). CP/ S-Dx patients presented with higher rates of alcohol abuse, anemia, rheumatoid arthritis, congestive heart failure, chronic pulmonary disease, drug abuse, hypertension, and liver disease (all p <0.05). CP/S-Dx patients underwent more invasive procedures (p<0.001) including spinal fusions and osteotomies (both p<0.05) but less decompressions (p<0.001). CP/S-Dx patients had higher overall perioperative complication rates, including higher rates of anemia, cardiac, respiratory, DVT and experienced a longer LOS (5.97 days vs 3.71 days) (all p<0.05). CP/S-Dx patients had higher rates of nonhome discharge (36.7% vs 25.8%) and incurred greater total hospital charges ($101,899 vs $73,572; both p<0.001). Adjusting for age and invasiveness, patients undergoing a cervical procedure with a shoulder diagnosis were associated with increased odds of any complication (OR:1.3[1.3-1.4]; p<0.001). <h3>CONCLUSIONS</h3> Patients with a concurrent shoulder diagnosis undergoing a cervical spine procedure were 30% more likely to experience a perioperative complication compared to those without a shoulder injury. Prior to proceeding with surgery, providers should consider the effect of shoulder injuries on outcomes of cervical spine procedures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Updates in teenage acute intentional self-poisonings

Acute intentional poisonings represent an important part of emergency pediatric pathology, as well as a psychiatric one, with an escalation tendency over the past years. The current paper consists of a descriptive prospective study, which took place over 12 months, and included 342 children within the age range 6-18 years, that presented in the Emergency Unit, being subsequently treated as in-patients of the Pediatric Poisoning Center of “Grigore Alexandrescu” Emergency Clinical Hospital for Children. The number of pediatric acute intentional poisonings hospitalized within the time frame of the study was 819 cases. Of these, 342 were intentional, which constitutes a percentage of 41.75%, and 477 were accidental, i.e. 58.24%. The etiology of the acute intentional poisonings is varied; however, medication (54.38%), ethanol (28.65%), and drugs of abuse (12.28%) were predominant. A higher frequency of acute intentional poisonings was noticed in girls (65.49%) as compared to boys (34.50%), probably due to the particularities the psychological profile of this sex shown at this age, i.e. higher emotional instability and display tendency. Out of the total number of acute intentional poisonings, we identified 20 cases of suicide attempts, which represent 5.83% of the total acute voluntary poisonings. Moreover, some of these cases constitute a repeated suicide attempts. The studied group included 30 cases of chronic substance abuse and 6 chronic alcohol abuse cases, with ages within the 13-17 years range, 12 of which were females and 24 males. Out of the 36 chronic substance/alcohol abuse patients, 4 were social cases. Pediatric acute intentional self-poisoning is an important public health issue, alarming through its consequences and its hidden neuropsychiatric and behavioral substrate. This is because adolescence is a period of marked emotional fragility, sensitive to all sorts of influences.

Surgical treatment of infective endocarditis in intravenous drug abusers

BackgroundDespite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients.MethodsBetween 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years.ResultsStaphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis.ConclusionIn patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.