History Of Drug Abuse Research Articles

Developmental Outcomes among Children within the Context of Maternal Incarceration: Findings from a Study of Family Inequality

This research addresses behavior difficulties and maladaptive coping among African American children and adolescents, and the manner in which these outcomes differ among those with incarcerated mothers. The study also provides an in-depth analysis of the experiences of mothers during and after their incarceration. Earlier investigations suggested that mothers’ victimization and offending, including drug use, are related to children’s emotional and behavioral outcomes. Hence, this research extends an ongoing project by investigating the nature of this relationship using aggregate data on adolescent health outcomes. Generally, most research addresses parental incarceration, typically followed by negative responses of male youth. Less research has evaluated the outcomes of parents’ incarceration on African American children and adolescents specifically. This is particularly true among those with incarcerated mothers. Additionally, examinations have highlighted the role of fathers’ incarceration on negative family functioning, yet we know less about the impact of mothers’ imprisonment and re-entry on children’s behavior. Many of these mothers are single and live in poverty, and their economic situations lead to higher risks of recidivism, deleteriously affecting their children. Moreover, several of them are raising children while experiencing traumatic mental health concerns amid drug usage with minimal support or treatment. For the current project, special attention is also placed on the mothers’ experiences with contact with children, prior history of substance abuse, mental illness, treatment for drug and alcohol problems, and coping with separation from children in an attempt to reveal the subsequent, harmful impact on children’s behavioral adjustment.

The Association Between Non-Clinically Apparent Liver Fibrosis and Pulmonary Arterial Hypertension in Hispanic Patients.

Pulmonary arterial hypertension (PAH) is a deadly cardiopulmonary disease with multi-organ involvement including impaired liver function. Liver dysfunction in PAH is poorly understood but significantly associated with morbidity and mortality. Hispanics have a significantly higher prevalence of non-alcoholic fatty liver disease (NAFLD) and evidence of more advanced disease in comparison to other ethnic groups. The clinical impact of NAFLD in Hispanic PAH patients is unknown. We aimed to investigate the impact of a validated scoring system, non-alcoholic fatty liver disease fibrosis score (NFS), to predict the degree of liver fibrosis in a Hispanic PAH population and its relationship to hemodynamics, functional class, and outcomes. A retrospective review of all treatment-naive Hispanic patients with group I World Health Organization (WHO) pulmonary hypertension (PH) at a single academic center between February 2016 and March 2021 was performed. Patients with history of substance or alcohol abuse, non-group I WHO PH, pre-existent liver disease, chronic kidney disease, atrial fibrillation, thyroid disease, and warfarin use were excluded from the study. The diagnosis of group I WHO PH was determined by cardiac catheterization after the exclusion of other etiologies. NFS was calculated for each patient and correlated with functional capacity, hemodynamics, N-terminal-pro-B-type natriuretic peptide (NT-proBNP), and survival. A total of 96 Hispanic patients were included in our study. The median age of patients in our cohort was 49 years (interquartile range: 15) and 69% of our cohort were females. Higher NFSs indicating advanced hepatic fibrosis (F3-F4) were found to correlate with elevated right-sided cardiac filling pressures (r = 0.27, P = 0.03), elevated levels of NT-proBNP (r = 0.32, P = 0.01), lower 6-minute walk distance (6MWD) (r = -0.49, P = 0.001), lower functional capacity (World Health Organization functional class, WHO-FC, r = -0.35, P = 0.051), a higher prevalence of diabetes (21.1% versus 51.9%, P = 0.001), a higher prevalence of risk factors for metabolic syndrome (81.5% versus 65.0%, P = 0.035), and worse 5-year survival rates. In Hispanic patients with PAH, NFSs correlate with the degree of right-sided pressure overload. In addition, advanced NFSs were independently associated with lower 5-year survival rates and added prognostic information to other established risk parameters in PAH. This study suggests that screening for liver disease in this vulnerable patient population can aid in earlier detection leading to discussion of lifestyle modifications and possible escalation of PAH-targeted therapies, thus leading to potential improvement in survival rates.

Intravenous Drug Abuser Treated for Chronic Infected Open Forearm Fracture with Shortening and Primary Wound Closure

Summary: Neglected and open forearm fracture wounds accompanied by shortening are complex injuries that are seldom reported in the known literature. We describe a patient with a history of chronic intravenous drug abuse (IVDA) and a neglected forearm wound with radius and ulna fractures with chronic osteomyelitis managed by limb salvage. The patient had a history of IVDA and a neglected forearm wound with fractures in both the radius and ulna, along with chronic osteomyelitis. The approach taken to manage this complex injury involved limb salvage. The case emphasizes the treatment challenges associated with patients who had IVDA and neglected their wounds. Thorough evaluation combining clinical and radiological assessments, followed by appropriate surgical planning and intervention, played a crucial role in restoring the functional status of the limb. Neglected open fracture wounds in the forearm are uncommon and have limited documentation in the existing literature. The described patient’s chronic history of IVDA and the disregarded open forearm osteomyelitis exemplify the severe consequences that can arise from injectable drug abuse in the upper extremity. In such cases, limb preservation and optimization of functional outcomes become paramount. To the best of our knowledge, this is one among the few reported cases of this nature, highlighting the significance of sharing such experiences to enhance medical understanding and inform future treatment approaches.

Association and Significance of Allostatic Load with Outcomes of Patients with Chronic Myeloid Leukemia (CML)

Introduction: Chronic psychosocial stress has been linked to cancer development and progression. Allostatic load (AL) has been proposed as a novel approach to measure the biological consequence of cumulative stress seeking to explain health disparities. As a multidimensional framework, AL delineates functioning across several physiologic networks including neuroendocrine, cardiovascular, metabolic, and inflammatory systems. Emerging evidence highlights the association between AL and cancer risk, yet little is known about its relevance in hematologic malignancies and its impact on treatment outcomes. Aim: To assess the influence of AL on the outcomes of CML patients (pts). Methods: We performed a retrospective analysis of a cohort of CML pts assessing sociodemographic, clinical, laboratory, and molecular data from 2003 to 2023. The AL was obtained from 23 biomarkers (peripheral pulse, systolic & diastolic blood pressure, hemoglobin, red & white blood cells, platelets, Na, K, Cl, CO2, Ca, urea, creatinine, glucose, total protein, albumin, AST, ALT, ALk, total bilirubin, body mass index, and estimated glomerular filtration rate). We calculated an AL index by summing the number of biomarkers that were out of normal range and categorizing the AL score as low (˂3) or high (≥3). The outcomes of interest were molecular response (MMR, MR 4, MR 4.5) and survival endpoints (freedom-free [FFS], event-free [EFS], transformation-free [TFS], and overall [OS]). Results: We included 132 CML pts; median age at diagnosis was 62 years (IQR, 46-72.5 years). Most pts were women (61.4%), more likely to identify as white (69.2%), then black (23.3%), and had multiple comorbidities (Median, Charlson Comorbidity Index 4, IQR 2-6). Reported healthy behaviors included regular exercise (76.8%), never smoking (64.8%), and not having history of substance abuse (85.4%). The mean AL index was 5.11 with 84.8% of pts allocated to high AL score (15.2% low). High AL was correlated with black race (OR= 3.527, CI 0.77-16.17), men (OR=1.73, CI 0.66-4.51), alcohol consumption (OR=0.55, CI 0.18-1.64), tobacco use (OR=0.48, CI 0.17-1.32), and substance abuse (OR=0.33, CI 0.093-1.17). AL was also associated with Social Determinants of Health, including living in metropolitan areas (OR=0.37, CI 0.10-1.318) or alone (OR=1.67, CI .46-6.23), and employment (OR=0.4, CI 0.1-1.3). Notably, pts with high AL presented a statistically significant lower probability of MMR (HR= 0.56, CI 0.31-0.98), and worse FFS (HR=2.76, CI 1.17-6.50). There was also a for pts with high AL not achieving MR4 (OR= 0.44, CI 0.17-1.15) or MR4.5 (OR=0.48, CI 0.18-1.28), having TKI failure (OR= 2.39, CI 0.90-6.34), transformation to accelerated or blast phase (OR=3.13, CI 0.39-25.06), and worse EFS (HR 1.15, CI 0.59-2.26) (illustrated in the figure). Conclusion: Pts with CML who have a high AL index showed an association with unfavorable treatment outcomes and deep molecular responses. AL, as a measurement of chronic stress, shows a potential ability to elucidate racial and socioeconomic disparities and predict molecular and clinical responses. Assessing AL through multiple time points could uncover help identify modifiable risk factors that could potential help improve outcomes.

Role of postmortem toxicology in drowning investigations

AbstractDrowning is the third most common cause of unintentional injury death worldwide. In forensic medicine, drowning refers to an event in which the victim dies due to liquid penetrating into the airways or due to submersion in a liquid. Medico‐legal examination of bodies found in water is a challenging task. Establishing proper cause and manner of death requires the joint efforts of the police, medical examiner, and representatives of postmortem toxicology. Information of the circumstances, the victim's individual characteristics and medical background, together with postmortem findings is required. The presence of alcohol and drugs revealed by postmortem toxicology can give insight into the decedent's medical history, drug abuse history, and possible impairment at the time of death. There is ample epidemiological research indicating that alcohol is the most important single contributing factor for fatal drowning, while hypno‐sedative medicines and illicit drugs, especially amphetamines, also appear to pose a risk. Evidence shows that alcohol can be produced postmortem in a submerged body by microbial contamination and fermentation, and this phenomenon is even more significant the higher the water temperature and the longer the submersion time. The reliability of the blood alcohol concentration obtained can be verified in many ways, for example by comparing the ratios of blood, vitreous and urine alcohol concentrations with reference values, or by testing for non‐oxidative ethanol metabolites, the presence of which suggests antemortem alcohol ingestion. Compared to alcohol postmortem changes, very little is known about the long‐term stability of drugs in bodies found in water.This article is categorized under: Toxicology > Analytical Toxicology > Post‐Mortem

1833. Infectious Diseases in Patients Experiencing Homelessness in Detroit, MI Over a Three-Year Period (2020-2023)

Abstract Background The homeless population has many health challenges. In Detroit there are estimated 8000 people experiencing homelessness, 62% with a disabling condition, and an estimated readmission rate 4x greater than non homeless (Homeless Action Network Detroit). Coordinating care presents unique challenges. It is imperative to examine infections over the long term to identify areas for care improvement, education, infection prevention and better access. We show an infection profile in patients experiencing homelessness from admissions over 3 years at a large hospital in Detroit. This will bring to light the needs of this population and foster delivery of equitable care to the classically underserved. Methods This is a retrospective cohort study done over a 3 year period from 2020-2023 in homeless patients hospitalized at a 850 bed urban hospital. In total we were able to identify 200 patients, and 31 patients had information collected from the EMR. Results Patients were mostly Black (83%) males (77%). 48% had primary care providers. 87% had history of substance abuse (35% endorsing IV). Of the 31 patients, all had an infection during the study period. 16% with diagnosis of HIV, and 42% had Hep C. Most common infections were as follows: soft tissue (51.6%), pneumonia (29%), urinary tract (16%). Most common organism in culture was Staph aureus (42%; 46% MRSA), Strep (13%) and E coli (13%). Of gram negatives, 20% were ESBL and 20% AmpC. 35% had a surgical procedure while inpatient. The most common antibiotics were vancomycin (35%) and cephalosporins (32%). Treatment duration was usually 7-10 days (29%). 61.3% completed treatment, 16% had recurrent infection, and 9.6% lost to follow up. 55% received ID consult, but only 9.6% followed up in clinic. 19.3% saw a street medicine organization. Readmission was low (9.6%), although 19.3% had an ER visit post discharge. Conclusion This preliminary study establishes a profile of infections in those experiencing homelessness in Detroit. This data will help educate providers, allow equitable and targeted care to be delivered, and lead to intervention options that improve access to care. In the future we plan to create useful tools such as an antibiogram specific to this population that can help community health organizations impact care delivered at initial contact. Disclosures Marcus Zervos, MD, Contrafect: Advisor/Consultant|GSK: Grant/Research Support|Johnson and Johnson: Grant/Research Support|Pfizer: Grant/Research Support

Rates and risk factors for persistent opioid use after cardiothoracic surgery: A cohort study

BackgroundThis study’s aim was to estimate potential risk factors for persistent opioid use after cardiothoracic surgery. MethodsThis study included participants in the McGill University Health Centre clinical trial (2014 to 2016). Provincial medical services, prescription claims, and medical charts data were linked. Persistent opioid use was defined as an initial peri-operative opioid dispensation followed by an opioid dispensation between 91 and 180 days postdischarge. Multivariable Cox Proportional Hazards models were used to assess factors associated with persistent opioid use. ResultsA cohort of 815 patients (mean age: 68.9 [standard deviation = 8.9]) was assembled, of which 8.2% became persistent opioid users. Factors such as higher Charlson Comorbidity Index (adjusted hazard ratio: 3.4, 95% confidence interval: 1.1–10.6), history of diabetes (adjusted hazard ratio: 2.1, 95% confidence interval: 1.3–3.4), substance and alcohol abuse (adjusted hazard ratio: 16.3, 95% confidence interval: 5.3–49.5), and radiotherapy (adjusted hazard ratio: 2.4, 95% confidence interval: 1.5–4.1) were associated with a higher hazard of persistent opioid use. Previous opioid use (adjusted hazard ratio: 1.7, 95% CI: 1.0–2.8), daily peri-operative opioid dose (adjusted hazard ratio: 2.3, 95% confidence interval: 1.5–3.7), having an opioid dispensation 30 days pre-admission (adjusted hazard ratio: 1.7, 95% confidence interval: 1.0–2.8), and pre-admission analgesic use (adjusted hazard ratio: 1.7, 95% confidence interval: 1.0–2.8), were also associated with an increased hazard of persistent use. Being prescribed multimodal analgesia at discharge (adjusted hazard ratio: 0.54, 95% confidence interval: 0.32–0.92) was associated with a 46% decreased hazard of developing persistent opioid use. ConclusionMultiple patient- and medication-related characteristics were associated with an increased hazard of persistent opioid use.

Prevalence and Factors Influencing Severity of Post-Menopausal Symptoms among women of Rural Odisha: An Explorative study

Background: Menopause simply means that the stoppage of menstruation. It also refers to the changes a women goes through around this period. In present date also the word menopause require many unturned stones to be turned on. Objectives: The main aim of this study is to investigate the current prevalence of severity of menopausal symptoms among women along with to explore the factors which may influence the severity of those symptoms. Methods and materials: the current paper adopted an exploratory descriptive design to study among 200 women between the age of 45-55yr in 3 villages namely Shayampur, Bharatpur and Rental Colony of rural Odisha. The data collected by using the self structured sociodemographic proforma and Standardized menopause rating scale for exploring the factors influencing the severity of symptoms. Result: The study resulted that almost all the women present with postmenopausal symptoms where as severe symptoms are seen among 17-18% of women. The factors which influence most for the severity of symptom are age, parity and with history of substance abuse. Conclusion: hence it can be concluded that advance age of achieving menopause, multiparity and use of substance makes the postmenopausal women suffer more with severity of menopausal symptoms.

Abstract 16826: A Rare Case of an Emergent Third Valve in Valve Intervention

Introduction: Bioprosthetic valves are prone to structural degeneration due to an average lifetime of 10-15 years. Valve in Valve (VIV) TAVR has become an alternative to the high-risk surgical patients as the growing number of successful bioprosthetic valve placements and the deteriorations over time. Emergent VIV intervention effectiveness with prior multiple artificial valves is less studied. Hypothesis: We report a case of a 54-year-old male presenting with obstructive shock with history of substance abuse and bicuspid aortic valve status post bioprosthetic aortic valve with aortic root repair at age of 15(1983), aortic stenosis requiring repeat surgical bioprosthetic Aortic Valve Replacement (SAVR) (25 mm) at age 42(2011). Recalcitrant cardiogenic shock despite vasopressor. Emergent Heart catheterization showed mild coronary artery disease (CAD) and severe cardiomyopathy, Left Ventricle ejection Fraction 15-20%. Aortic valve Gradient was 80 mmHg. Transesophageal Echocardiography (TEE) ruled out endocarditis. Impella CP and Swan-Ganz catheter were placed for hemodynamic support and monitoring. Methods: The Heart Team approach was followed. Patient was at high risk of mortality and operative complications with redo sternotomy. He subsequently underwent valve in valve TAVR with self-expanding 26 mm valve. Prior surgical valve did not require fracturing post implantation. Results: Post Trans Aortic Valve Replacement (TAVR) the mean gradient on echocardiogram decreased to 10 mmHg and LVEF recovered to 55-60%. The patient was successfully weaned off Vaso-pressors and eventually discharged home. Conclusion: Most common cause of transcatheter bioprosthetic valve failure is stenosis from calcification and thrombosis. VIV TAVR in recent studies has proven to be safe with favorable outcomes. Our patient had already undergone two surgical valve interventions, presented with critical bioprosthetic valve stenosis requiring salvage TAVR for cardiogenic shock. After the Heart team approach, TAVR was opted as a more favorable option for the patient. Although, the life of a bioprosthetic valve results in multiple interventions but overall valve in Valve technique has been proven to provide expected results in emergent high-risk patients.

Abstract 18072: Multiple Sclerosis and Covid-19-Related Myocarditis: A Brain and Heart Affectation

Introduction: Myocarditis (MC) and multiple sclerosis (MS) are inflammatory affectations of the myocardium and the central nervous system, respectively. It has been suggested that MS and MC share similar immunological dysfunctions. MS and MC also have associations with viral infection, and SARS-CoV-2 specifically has been associated with MC, indicating that a viral infection may induce or enhance a dysfunctional immune response favored by individuals' genetic susceptibility. Hypothesis: We hypothesized that patients with preexisting MS may be more susceptible to COVID-19-related MC. Methods: A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD codes, a cohort of patients admitted for COVID-19 as the primary diagnosis (index event) was identified. The cohort then was divided into two groups based on the presence of MS upon admission. The records of both groups were compared by demographics and a panel of 16 comorbidities. Pearson's chi-square and t-test were used to compare the group's characteristics when appropriate. A Kaplan-Meier analysis was then used to compare the probability of the outcome (MC) 90 days following the index event. A p-value of <0.05 was considered significant. Results: We found a total of 2,782,278 patients admitted for COVID-19, with 24,515 (0.88%) having a history of MS. Patients with MS were younger (mean age 58 vs. 60, p<0.0001), predominantly female (73%), and had more comorbidities (Elixhauser Comorbidity Index 8.8 vs. 6.3, p<0.0001). A history of hypertension, heart failure, obesity, cerebrovascular accident, drug abuse, smoking, asthma, cancer, diabetes, MC, and MI were significantly more prevalent in the MS group. No differences in rheumatoid arthritis, CKD, and HIV were identified. COVID-19 patients with pre-existing MS were significantly at higher risk of MC, 90 days after admission (Log-Rank p=0.04). Conclusions: Despite its striking analogies to MS, the precise mechanism by which SARS-CoV-2 induces MC is unknown. Our findings highlight the likelihood that SARS-CoV-2 can induce myocardial inflammation in patients with a dysfunctional immune response. Moreover, MS patients were more exposed to established cardiovascular disease risk factors.

Prevalence and pattern of maxillofacial injuries associated with domestic violence: A retrospective study at a major trauma center.

This study aimed to analyze the frequency and pattern of maxillofacial injuries associated with domestic violence. Medical records of victims of domestic violence between May 2016 and May 2023 were scrutinized retrospectively. The following data were analyzed: gender and age, history of previous abuse, hospital admission, pregnancy, type of facial injuries, anatomical location of injuries, side of injuries, concomitant injuries, mechanism of impact, treatment modality, and history of drug and alcohol abuse. Seventy-eight patients were included, comprising of 75 (96.2%) women and 3 (3.8%) men. Domestic violence was an etiology of 2.7% of all maxillofacial injuries. The mean age was 27.06 ± 5.5 years. 33.3% of cases had a history of previous domestic violence. The assailant was drug addicted in 47.4% of cases. The attacker was the current partner of the victim in 79.5% of the victims. Soft tissue injuries were found in 96.1% of cases. Maxillofacial fracture was observed in 52.6% of victims among which zygoma was the most common (16.7%) followed by the nose and mandible (15.4%). Isolated fracture was observed in 85.3% of patients and 71.8% of the injuries were observed on the left. Concomitant injuries were present in 51.3% of patients with arms/hands being the most frequent (48.7%). Punch (67.9%) constituted the majority of the mechanism of impact. Based on the statistical analysis, punches resulted in significantly higher soft tissue contusion (p = .046), and injuries that required no intervention were significantly higher in punched victims (p = .002). Maxillofacial soft tissue injuries with or without isolated fracture on the left side of the zygoma, mandibular angle, or nose in association with arms/hands injuries in young adult women could be clues of domestic violence. Appropriate care such as preventive programs for drug or alcohol abuse should be implemented to reduce domestic violence, thereby reducing these injuries.

Abstract 106: CHANTER Syndrome: A Case Report Of A 59 Year Old Man With Positive Outcome

Introduction Cerebellar, Hippocampal, and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER) syndrome was first described in 2019 [1] as a pattern of radiographic findings that are distinct from ischemic, anoxic, or toxic brain injury. Pathophysiology is still uncertain, but some proposed theories include a primary metabolic etiology or a mitochondrial failure of gray matter. Clinically, patients typically present with altered level of consciousness. Radiographically, diffusion weighted imaging shows restriction in the bilateral hippocampi, bilateral cerebelli, and basal nuclei. The cerebral cortex, thalamus, and subcortical white matter are usually spared. Despite the morbid clinical picture on presenation, positive outcomes were reported with early intervention. We describe a case of CHANTER syndrome in a 59 year old man with history of illicit substance abuse. Methods Case report with electronic medical record review. Results 59‐year‐old man with history of illicit substance abuse including cocaine, opioid, and phencyclidine presented to the hospital after being found down at a drug store. Patient did not respond to Naloxone and was eventually intubated due to respiratory compromise. Non‐contrast CT head showed hypoattenuation of the bilateral cerebellar hemispheres with mild effacement of the fourth ventricle. MRI brain showed diffusion signal abnormalities with corresponding T2 FLAIR hyperintensities in the bilateral cerebellar hemispheres, bilateral hippocampi, and bilateral basal ganglia with some involvement of the left occipital lobe suggestive of CHANTER syndrome. As vasogenic edema worsened, hydrocephalus ensued requiring administration of hypertonic saline and eventual external ventricular drain (EVD) insertion in the neurocritical care unit. Despite initial improvement in his level of consciousness after the EVD insertion, his intracranial pressure (ICP) continued to increase and midazolam and ketamine infusion drips were added. A fine balance between lowering the ICP and avoiding respiratory suppresion with sedating infusions was maintained. Consecutive MRI brain images over the course of the following 4 weeks of his stay showed decrease of the abnormal diffusion weighted imaging signal along with improvement in his overall mental status and eventual discharge 12 weeks from his initial presentation. Conclusion This case further strengthens the relationship between CHANTER syndrome and illicit substance use as a likely etiology along with other cases in the literature. Aggressive management in the neurocritical care to control vasogenic edema and avoid ICP elevation is essential to give patients the highest chance of recovery. Clinical improvement At least partial reversal of the radiographic findings of CHANTER syndrome can be attained with treatment, however, unclear if complete reversal is possible.

Abstract 254: Imaging Findings of Stroke Following Treatment of Ruptured Cerebral Aneurysm Increases Risk of Postoperative Delirium

Introduction Delirium is an acute cognitive or perceptual disturbance that is associated with prolonged hospital and ICU length of stay, therefore, extending recovery time. According to a recent study, approximately one in five patients undergoing intracranial procedures are vulnerable to postoperative delirium within the first three days of surgery.1‐4 Retrospective cohort studies found a link between postoperative delirium and intraoperative hypotension, indicating reduced cerebral blood flow.5 ICSS‐ MRI study (International Carotid Stenting Study Magnetic Resonance Imaging Study), indicated that patients with periprocedural hemodynamic depression had decreased cerebral blood flow and increased the risk of new lesions in imaging.6 Ruptured intracerebral aneurysms are associated with higher morbidity and mortality than unruptured ones. This is secondary to delayed postoperative cerebral ischemia and infarction caused by vasospasm.7 Clinical indicators like delirium can play a role in evaluating for delayed cerebral ischemia and infarction leading to timely management of vasospasms.5,8,9 Our study aimed to assess the association between imaging findings of stroke and delirium in patients who underwent treatment for ruptured aneurysms. Methods We reviewed the medical records of 167 patients with ruptured intracranial aneurysms between 2015‐2019. We included all the patients who had a postoperative delirium assessment, neurological assessments, and MRI/CT scans for evaluation of cerebral ischemia. Patients were divided into 2 groups, one group with delirium and the other without delirium. Delirium was assessed by using the ICD9/10 codes and The Intensive Care Delirium Screening Checklist (ICDSC).10 Results A total of 167 patients presented with ruptured aneurysm and the incidence of delirium was 38.3% (64 patients). Patients with delirium had a median age of 57 (50.0‐65.8) compared to a median age of 55 (44.0‐64.0) in patients without delirium. Additional risk factors (delirium vs no delirium) included a history of stroke (17.5%/7.8%), smoking (30.1% vs 40.6%), female gender (63.1% vs 71.9%), preop‐benzodiazepines (26.2% vs 23.4%), intraoperative hypotension (78.6% vs 85.9%), and history of alcohol abuse (9.7% vs 9.4%). None of these factors reached statistical significance between patients with and without Delirium (p‐value >0.05). A new neurological deficit was noted in 17 (26.6%) patients with delirium compared to 12 (11.7%) patients without delirium (p‐value, 0.01). 24/29 (82.8%) patients with new neurological deficits had imaging finding suggesting acute ischemic changes (p‐value, <0.001). 30/64 (49.9%) patients with delirium had imaging findings associated with acute ischemic changes on imaging (p‐value, 0.001). After adjusting for confounders such as age, preop benzodiazepines, history of drug abuse, and history of stroke. Patients with delirium had imaging findings suggestive of acute ischemic changes of stroke ORadj 2.46 (CI 95%, 1.12 – 5.36, p‐value 0.02), while patients with new neurological deficit did not ORadj 1.66 (CI 95%, 0.62 – 4.41, p‐value 0.31). Conclusion Our findings suggest that delirium might be one of the manifestations associated with imaging changes indicating acute silent ischemic strokes. Delirium might be one of the manifestations postoperatively for delayed cerebral ischemia as noted on imaging, this highlights the importance of timely identification and management of patients with delirium.

Opioid use disorder in two samples of the Lebanese population: scale validation and correlation with sleep and mood disorders.

The revised Opioid Risk Tool (ORT-OUD) is a brief, self-report scale designed to provide clinicians with a simple, validated method to screen for the risk of developing an Opioid Use Disorder (OUD) in patients without a prior history of substance abuse. This study aimed to translate and validate the Arabic version of ORT-OUD in the Lebanese population and assess its clinical validity in a sample of patients with OUD. This cross-sectional study in the Lebanese population used several validated scales to assess the risk of OUD, including the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Other tools evaluated chronotype and sleep and mood disturbances. Principal component analysis with Varimax rotation was applied to assess ORT-OUD construct validity. Convergent validity with the Arabic version of ASSIST was evaluated. The ORT-OUD criterion validity was then assessed in a clinical sample of patients with OUD. This study included 581 participants. The prevalence of the OUD risk in the Lebanese population using the ORT-OUD scale and the ASSIST-opioids scale was estimated at 14.5% and 6.54%, respectively. No items of the ORT-OUD were removed; all items converged over a solution of four factors with an eigenvalue > 1, explaining a total of 68.2% of the variance (Cronbach's alpha = 0.648). The correlation coefficients between the ORT-OUD total score and ASSIST subscales were as follows: ASSIST-opioids (r = 0.174; p = < 0.001), ASSIST-sedatives (r = 0.249; p < 0.001), and ASSIST-alcohol (r = 0.161; p = < 0.001). ORT-OUD clinical validation showed a correlation with ASSIST-opioids (r = 0.251; p = 0.093) and ASSIST-sedatives (r = 0.598; p < 0.001). Higher ORT-OUD scores were associated with a family and personal history of alcohol and substance consumption and higher insomnia and anxiety scores. This study is the first to validate the Arabic version of ORT-OUD in the Lebanese population, an essential step towards improving the detection and management of OUD in this population.

30 A Study to Assess Functional and Psychological Outcome After 6 Months of Moderate and Severe Traumatic Brain Injury (TBI)

Objective:Assessment of clinical, functional and psychological outcome after 6 months of moderate and severe TBIParticipants and Methods:Sixty consecutive participants aged 18 and above with moderate to severe TBI (GCS score of 3-12 at admission) attending the Outpatient Department of Neurosurgery Specialty, Post Graduate Institute of Medical Education and Research, Chandigarh, India were recruited. The exclusion criteria were any pre-existing major psychiatric disorders, intellectual disability, current or past history of substance abuse, degenerative and/or progressive condition, terminal illness and past history of TBI. Ethical clearance was obtained from Institute Ethics Committee. Written informed consent was obtained from all participants prior to inclusion in the study. Socio-demographic details (age, sex, marital status, family type, place of residence, education and occupation) and clinical details (mode of injury, injury severity, treatment, status on discharge, any previous co morbidities) were obtained from participant and hospital records. Functional outcome was assessed by Glasgow Outcome Scale and Barthel’s Index of Activities of Daily Living. Mini Mental State Examination (MMSE) was used to assess cognitive status. Hospital Anxiety and Depression Scale was used to assess symptoms of anxiety and depression.Results:Out of 60 patients, 40 had moderate head injury and 20 patients had suffered from severe head injury. There were 53 male (88.3%) and 7 (11.7%) female and the mean age was 34 years (SD=14.5). The mean duration of TBI was 11 months (SD=6.5). Fifty percent participants were married and majority was living in joint/extended families. Majorities were residing in rural localities 36 (60%). With regard to education level 11.7% were illiterate, 33% were educated up to 10th standard and 21.7% up to 12th standard. With regard to occupation, 11.7% were unemployed, 6.7% were housewives, 11.7% were students, 8.3% were retired and rest (61.6%) was engaged in varied occupations.The most common mode of injury was road traffic accident (90%). Contusion was the most common CT abnormality noted (37 patients, 61.7%). Regarding treatment, 36 patients (60%) underwent surgical intervention and 24 (40%) were managed conservatively. With regard to surgical intervention, 28 (77.8 %) patients underwent decompressive hemicraniectomy and subsequent cranioplasty and rest 8 (22.2 %) underwent craniotomy and hematoma evacuation. As per Glasgow Outcome Scale, 50 (83%) had low disability and 10 (17%) had moderate to severe disability. The mean Barthel’s Index score was 19.6+1.07 (Range 15-20) which indicated that most of the patients had resumed independence in activities of daily living. Only 25% participants were observed to have cognitive impairment (MMSE). With regard to anxiety and depression 16.7% showed symptoms of anxiety whereas 30% showed symptoms of depression (HADS score &gt;8).Conclusions:After 6 months of TBI, most participants had resumed independence in activities of daily living but cognitive impairment is persistent in 25% and symptoms of depression in 30% participants.

A 15-year review of characteristics and outcomes of patients leaving against medical advice

PurposeDischarging against medical advice can have significant, detrimental effects on burn patient outcomes as well as higher hospital readmission rates and healthcare expenditures. The goal of this study is to identify characteristics of patients who left against medical advice and suggest solutions to mitigate these factors. Data were collected at our American Burn Association verified Burn Unit over a 15-year period. ResultsBetween 2007 and 2022, 37 patients were identified as having left against medical advice from the burn unit. The average patient age was 37 years old with 64.9% being male, and 70.2% were identified as having a substance abuse history. The majority (51.4%) had Medicaid or State health insurance, 29.7% had no insurance, and 18.9% had private insurance. The mechanism of injury was most commonly frostbite (43.2%). The majority sustained < 1% total body surface area injuries. Most (83.7%) had social work and/or case management involved during their admission, and all (100%) had their involvement if the length of admission was greater than one day. Over half (59.5%) returned to the ED within 2 weeks with complications. ConclusionsThis study found that patients discharging against medical advice from the burn unit suffered from smaller injuries, often due to cold related injuries. These patients had comorbid substance abuse or psychiatric histories, and the majority had Medicaid or state health insurance. Recruiting interdisciplinary care members, including social work, psychiatry, and addiction medicine, early may help these patients by encouraging completion of their hospital care and setting up crucial follow-up care.

Variable Selection for Recurrent Events Using Heuristic Approaches: Identifying Informative Variables for Rehospitalization in Schizophrenia Patients

Introduction: Recurrent event data, as a generalization of survival data, are frequently observed in various areas of medical research, including sequential hospitalizations in patients with schizophrenia. As experiencing multiple relapses during schizophrenia can have many implications, such as self-harm or harm to others, loss of education or employment, or other adverse outcomes, identifying and determining the most critical factors related to relapses in this disorder is essential. This study aimed to utilize heuristic approaches for selecting predictor variables in the field of recurrent events with an application to schizophrenia disorder&#x0D; Methods: A two-step algorithm was employed to apply a combination of two variable selection methods, recursive feature elimination (RFE) and genetic algorithm feature selection (GAFS), and four modeling techniques: Gradient boosting (GB), artificial neural network (ANN), random forest (RF), and support vector machine (SVM) to simulated recurrent event datasets.&#x0D; Results: In most simulation scenarios, the results indicated that the combination of RFE and RF applied to the deviance residual (DR) outperforms the other methods. The RFE-RF-DR selected the following predictor variables: Number of children, age, marital status, and history of substance abuse.&#x0D; Conclusion: Our findings revealed that the proposed machine learning-based model is a promising technique for selecting predictor variables associated with a recurrent outcome when analyzing multivariate time-toevent data with recurrent events.

Psychiatric disorders and interventions in patients sustaining facial fractures from interpersonal violence

BackgroundThis retrospective study clarified patients´ psychiatric morbidity in IPV-related facial fractures; in particular, their additional psychiatric care. We hypothesized that patients in need of additional support can be identified, allowing overall care processes to be improved.MethodsPatients’ age, sex, anamnestic psychiatric disorders, history of substance abuse, and psychiatric interventions were recorded, as well as the perpetrator, location, time of day, assault mechanism, fracture type, treatment, and associated injuries.ResultsIn all, 807 adult patients were included in the study. Of these, 205 patients (25.4%) had anamnestic psychiatric disorders that were associated independently with female sex (OR 1.95, 95% CI 1.12, 3.41; p = 0.019) or history of substance abuse (OR 5.82, 95% CI 4.01, 8.46; p < 0.001). Patients with anamnestic psychiatric disorder were more likely to be subjected to severe violence, with an increased risk for combination fractures (OR 2.51, 95% CI 1.30, 4.83; p = 0.006). Of all patients, 61 (7.6%) received a psychiatric intervention within the first 12 months. The most common reasons for intervention were anxiety/fear and psychotic symptoms, surfacing within one month in 57% of patients. Anamnestic psychiatric disorders (OR 2.00, 95% CI 1.04, 3.82; p = 0.036), severe mental illnesses (OR 2.45, 95% CI 1.04, 5.77; p = 0.040), and use of an offensive weapon (OR 2.11, 95% CI 1.11, 4.02; p = 0.023) were the strongest independent predictors of psychiatric intervention.ConclusionsOur results emphasize the need for more structured treatment protocols for patients sustaining IPV injury. Special attention is recommended for patients with anamnestic psychiatric disorders, severe mental illnesses, and those assaulted with an offensive weapon.

Forensic-Psychiatric Consultations in General Psychiatry

A subgroup of psychiatric patients are at increased risk of committing interpersonal violence, which may lead to placements in forensic-psychiatric institutions. The majority of patients treated in forensic hospitals have had contact with the general psychiatric care system years before being forensically committed due to an offence. Nevertheless, attempts to establish models related to violence prevention in general psychiatry have remained sparse. In the Canton of Zurich, the forensic psychiatric consultation liaison service provides the general psychiatric clinics with access to forensic psychiatric expertise. In this paper, we describe the consultation service's diagnostic and advisory offers and aim to characterize the patient population seen by the service. We compared the three most common diagnostic groups (schizophrenic, affective and personality disorders) regarding reason for consultation, history of violence and substance abuse. In addition, we analyzed content and kind of the recommendations made. From 2013 to 2021, 188 patients in general psychiatric clinics in Zurich have been examined after informed consent. Most patients had a positive history of violence (72.7%) and substance use (66.1%). Almost half of the patients (48.4%) had been diagnosed with schizophrenia or a related disorder.

Legalization of marijuana or not? Opinions from over 38,000 residents in Taiwan

BackgroundMarijuana is legal in many Western countries and Thailand. In Taiwan, Marijuana remains a category-2 narcotic; however, some legislative candidates recently advocated legalization of medical marijuana. This study surveyed a large sample of Taiwanese to gain a better understanding of the public’s knowledge and attitudes towards legalizing marijuana.MethodsThis cross-sectional mixed-methods study included demographic data and responses to a survey questionnaire, “Knowledge and Attitudes of Legalizing Marijuana” (KALM). The survey included 15 statements about four categories: public health, social impact, medical applications of THC (Δ9-tetrahydrocannabinol), and legal and tax consequences; and two yes/no questions about medical use and legalization of marijuana. Knowledge was scored as disagree = 0, no knowledge = 2, or agree = 4; attitude was scored from 0 = very unimportant to 4 = very important. Responses to an open-ended question asking for additional comments/concerns were analysed with content analysis. The survey was conducted from February 15 to March 1, 2023.ResultsData were analysed from 38,502 respondents, aged 15 to > 56 years. Most were female (67.1%) and parents (76.4%). Scores were higher for respondents who were parents, religious, ≥ 36 years of age, had a high-income status, no history of substance abuse, knowledge of medical marijuana, and did not support legalization of marijuana. Medical personnel had greater knowledge of marijuana, but their attitude indicated they viewed legalization as less important. In the open-ended question, many respondents requested more information about marijuana be provided to the public before considering legalization.ConclusionsTaiwanese respondents considered legalization of marijuana a significant concern, especially as it relates to impacts on public health.