Cardiovascular disease remains a major contributor to morbidity and mortality in the US and elsewhere, and stroke is a leading cause of disability worldwide. Despite recent success in diminishing stroke incidence in the general US population, in parallel there is now a concerning propensity for strokes to happen at younger ages. Specifically, the incidence of stroke for US adults 20–44 years of age increased from 17 per 100,000 US adults in 1993 to 28 per 100,000 in 2015. Occurrence of strokes in young adults is particularly problematic as these patients are often affected by physical disability, depression, cognitive impairment and loss of productivity, all of which have vast personal, social and economic implications. These concerning trends among young adults are likely due to increasing trends in the prevalence of modifiable risk factors amongst this population including hypertension, hyperlipidemia, obesity and diabetes, highlighting the importance of early detection and aggressive prevention strategies in the general population at early ages. In parallel and compounding to the issue, troublesome trends are evident regarding increasing rates of substance abuse among young adults. Higher rates of strokes have been noted particularly among young African Americans, indicating the need for tailored prevention and social efforts targeting this and other vulnerable groups, including the primordial prevention of risk factors in the first place, reducing stroke rates in the presence of prevalent risk factors such as hypertension, and improving outcomes through enhanced healthcare access. In this narrative review we aim to emphasize the importance of stroke in young adults as a growing public health issue and increase awareness among clinicians and the public health sector. For this purpose, we summarize the available data on stroke in young adults and discuss the underlying epidemiology, etiology, risk factors, prognosis and opportunities for timely prevention of stroke specifically at young ages. Furthermore, this review highlights the gaps in knowledge and proposes future directions moving forward.

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Huda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Huda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Introduction: Social determinants of health (SDOH) are contextual factors and shared experiences that impact an individual’s life and health. Unfavorable SDOH are recognized as a major source of excess cardiovascular disease (CVD) risk; however, prior studies have focused on restricted sets of SDOH domains. We aimed to assess the burden of multiple unfavorable SDOH at the population level, and the association between increasing cumulative burden of unfavorable SDOH features and atherosclerotic CVD (ASCVD) prevalence. Methods: Using a nationally-representative sample of 164,696 adults from the National Health Interview Survey (2013-17) we identified 39 parameters (classified as favorable or unfavorable) from the Healthy People 2020SDOH domains: Economic stability, Education, Food access, Neighborhood conditions, Social context, Health systems. An aggregate score of these features ranging 0-36 was then divided into quartiles-- the most unfavorable scores in the highest quartile. ASCVD was ascertained via self-report. Results: 15,758 individuals (8%), representing ~19.6 million Americans, had ASCVD and were more likely to experience economic instability, adverse neighborhood and social cohesion, psychologic distress, food scarcity, and significant cost and non-cost-related healthcare barriers than those without ASCVD. The age adjusted mean (SD) SDOH risk score among ASCVD vs non-ASCVD participants was 12.5 (0.13) vs 0.9 (0.03) respectively. We observed a graded increase in ASCVD prevalence with higher SDOH quartiles (Figure). In multivariate analyses, adults with highest SDOH scores had 2-fold higher odds of having ASCVD compared to those with lowest scores (Figure). Conclusions: In the US, aggregate SDOH risk significantly discriminate risk of prevalent ASCVD among US adults. Standardized SDOH risk scores have the potential to inform risk stratification models at the individual level for addressing avoidable social inequities in health status.

Introduction: Obesity has been established as a major risk factor for a number of non-communicable diseases and over the year's multiple strategies have been directed at addressing this issue including minimally invasive procedures like laparoscopic sleeve Gastrectomy, specifically with an end goal of weight reduction for the morbidly obese. This procedure has become the preferred choice for both patients and physicians over the past few years. Laparoscopic sleeve Gastrectomy was introduced at our center recently; we have carried out a retrospective review of charts to evaluate this procedure short-term outcome at our center in our local population. Methods: A retrospective Cohort study, based on a record review for the treatment outcome of laparoscopic sleeve gastrectomy, was carried out at the department of surgery, Aga khan University Hospital, Karachi over a three-year period since its inception and analyzed in June 2015 using SPSS version 20. Results: A total of 17 patients fulfilled the inclusion criteria, out of which 12 were females (70.6%). The mean age of study participants was 41.53 years. Only one patient had undergone liposuction previously for weight loss. The most common comorbidities observed were diabetes mellitus (23.6%), hypertension (23.6%) and polycystic ovarian syndrome (17.7%). A statistically significant mean reduction in excess body weight of 28.9±14.90 Kg, CI 21.27-36.59 was observed along with reduction in BMI at 1 year with a mean difference of 11.1±5.38 Kg/m 2 , CI 21.27-36.60. Results were further analyzed for reduction in percentage excess body weight which showed a mean reduction of 43.6% for the study participants. Co-morbidity improvement was seen as reduction in systolic blood pressures in 9 patients (52%) though these were not found to be significant. Conclusion: Laparoscopic Sleeve Gastrectomy shows great potential for the Indian sub-continent population, especially for patients requiring rapid weight loss for better health outcomes, although long term follow up and out comes will determine the effectiveness of the procedure over extended periods and its role as a first line intervention for obesity.

Lambl's excrescences were first described in 1856 by a Bohemian physician, Vilém Dušan Lambl, and since then have gained widespread attention and controversy within the medical literature. Despite numerous case reports and observational studies, consensus on the significance and management of Lambl's excrescences remains sparse. We describe the case of a 48-year-old male who presented with recurrent embolic strokes. No underlying paroxysmal arrhythmia or inter-atrial shunt was identified, and the only pathological finding was a 1-mm aortic valve strand. We managed this patient successfully using a novel oral anticoagulant.