Introduction:Polysubstance abuse (PSA) is a significant problem affecting our society. In addition to negatively affecting the health and well-being of substance users, alcohol and/or drug abuse is also associated with heavy injury burden. The goal of this study was to determine if elevated serum alcohol (EtOH) levels on initial trauma evaluation correlate with the simultaneous presence of other substances of abuse (SOAs). We hypothesized that PSA would be more common among patients who present with EtOH levels in excess of the legal blood alcohol content (BAC) (≥0.10%).Methods:An audit of trauma registry records from January 2009 to June 2015 was performed. Abstracted data included patient demographics, BAC measurements, all available formal determinations of urine/serum “drug screening,” Glasgow Coma Scale (GCS) assessments, injury mechanism/severity, and 30-day mortality. Stratification of BAC was based on the 0.10% cutoff. Parametric and nonparametric statistical testing was performed, as appropriate, with significance set at α = 0.05.Results:We analyzed 1550 patients (71% males, mean age: 38.7 years) who had both EtOH and SOA screening. Median GCS was 15 (interquartile range [IQR]: 14–15). Median ISS was 9 (IQR: 5–17). Overall 30-day mortality was 4.25%, with no difference between elevated (≥0.10) and normal (<0.10) EtOH groups. For the overall study sample, the median BAC was 0.10% (IQR: 0–0.13). There were 1265 (81.6%) patients with BAC <0.10% and 285 (18.4%) patients with BAC ≥0.10%. The two groups were similar in terms of mechanism of injury (both, ∼95% blunt). Patients with BAC ≥0.10% on initial trauma evaluation were significantly more likely to have the findings consistent with PSA (e.g., EtOH + additional substance) than patients with BAC <0.10% (377/1265 [29.8%] vs. 141/285 [49.5%], respectively, P < 0.001). Among polysubstance users, BAC ≥0.10% was significantly associated with cocaine, marijuana, and opioid use.Conclusions:This study confirms that a significant proportion of trauma patients with admission BAC ≥0.10% present with the evidence of additional substance use. Cocaine and opioids were most strongly associated with acute alcohol intoxication. Our findings support the need for further research in this important area of public health concern. In addition, specific efforts should focus on primary identification, remediation of withdrawal symptoms, prevention of drug-drug interactions, and early PSA intervention.
Objectives: Data regarding the longitudinal relationship of global longitudinal strain (GLS) and echocardiographic parameters are lacking in peripartum cardiomyopathy (PPCM). We evaluated GLS and its correlation with change (∆) in left ventricular ejection fraction (LVEF). Methods: We retrospectively identified women age ≥16 years hospitalized at Montefiore Medical Center in Bronx, NY from 1999-2015 with International Statistical Classification of Diseases and Related Health Problems, 9th revision codes for PPCM or an occurrence of unexplained heart failure during or up to 5 months postpartum. N = 195 charts were reviewed for inclusion/exclusion criteria, n = 53 patients met criteria for PPCM, and of those, n = 13 had a baseline and follow-up echocardiogram suitable for GLS analysis.Results: Of those eligible for strain analysis, the mean age was 30 ± 6 years, 46.2% identified as Black and 38.5% as Hispanic/Latina. Baseline LVEF was 30 (25, 35)%, GLS was −13.2 (−14, −7.6)%. At a mean follow-up time of 1.2 ± 0.7 years, 11/13 had persistently mild −15.6 (−16.3, −12.7)%, and 2/13 severely abnormal GLS −7.05
Introduction: Stroke remains a major complication patients may face following Transcatheter Aortic Valve Replacement (TAVR). It has been hypothesized that turbulent flow across persistent paravalvular leak (PVL) may lead to low level hemolysis, a state known to heighten serum thrombotic potential and increase stroke risk. We hypothesized that the presence of paravalvular leak would lead to elevations in serum mean platelet volume (MPV), a marker of platelet activation and aggregation, and thus would heighten stroke risk after TAVR. Methods/Results: We retrospectively reviewed the charts of 322 patients who underwent TAVR at Montefiore Medical Center from January 2015 to January 2019. Stroke was seen in 24 patients (7%) following TAVR and was associated with higher overall mortality (p=<0.001). PVL was recorded in scaling severity of “none”, “trace”, “mild”, “moderate”, and “severe”. “Significant PVL”, defined as the presence of “mild” or greater PVL on initial post-op transthoracic echocardiogram, was found in 72 patients (22.4%). No associations were seen between the presence of significant PVL and stroke after TAVR. Serum MPV values after TAVR were not associated with the presence of significant PVL, nor with an increase in the observed rate of stroke or death on follow-up. Conclusions: Stroke after TAVR is significantly associated with increased mortality. In our dataset, the presence of significant PVL was not associated with increased rate of stroke or elevated serum MPV levels post-TAVR. Moderate and severe PVL are known to generate the greatest amount of hemolysis and were rare in our dataset (combined 1.5%), likely contributing to the lack of significant findings.
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