Cannabis smoking is common among adolescents and young adults. Diffuse alveolar hemorrhage (DAH) is a rare and life-threatening complication of cannabis abuse. DAH is characterized by bleeding into alveoli secondary to the disruption of the alveolar-capillary basement membrane as a result of an injury at the level of alveolar microcirculation. The differential diagnosis of DAH includes systemic vasculitis, bland pulmonary hemorrhage, and alveolar damage. The impact of cannabis on the respiratory function includes mucus hypersecretion, inflammatory edema, and increased alveolar permeability. Moreover, in vitro coagulation studies on rats showed that two major cannabinoids, cannabinol and THC, have antithrombotic activity. We present two cases of cannabis use resulting in acute lung injury and diffuse alveolar hemorrhage.

BACKGROUND: There are no prospective studies comparing hospitalization and post-hospitalization outcomes between teaching internal medicine services and nonteaching hospitalists, and no prospective studies comparing these outcomes between locum and employed hospitalists. OBJECTIVE: To compare the length of stay, hospital costs readmission rate, and mortality rate in patients treated by teaching internal medicine services vs. hospitalists and among patients treated by locum vs. employed hospitalists. DESIGN: Prospective cohort study. Propensity score was used to obtain weighted estimates. SETTING: Referral center. PATIENTS: All patients 18 years and older admitted to internal medicine services. INTERVENTION: Treatment by teaching internal medicine services vs. hospitalists. Treatment by locum hospitalists vs. employed hospitalists. MAIN MEASURES: Primary outcome was adjusted length of stay and secondary outcomes included hospital cost, inpatient mortality, 30-day all-cause readmission, and 30-day mortality. KEY RESULTS: A total of 1273 patients were admitted in the study period. The mean patient age was 61 ± 19 years, and the sample was 52% females. Teaching internal medicine physicians admitted 526 patients and non-teaching hospitalists admitted 747 patients. Being seen exclusively by teaching internal medicine physicians comports with a shorter adjusted hospital stay by 0.6 days (95% CI − 1.07 to − 0.22, P = .003) compared to non-teaching hospitalists. Adjusted length of stay was 1 day shorter in patients seen exclusively by locums compared to patients seen exclusively by employed services (95% CI − 1.6 to − 0.43, P < .001) with an adjusted average hospital cost saving of 1339 dollars (95% CI − 2037 to − 642, P < .001). There was no statistically significant difference in other outcomes. CONCLUSIONS: Teaching internal medicine services care was associated with a shorter stay but not with increased costs, readmission, or mortality compared to nonteaching services. In contrary to the "expected," patients treated by locums had shorter stays and decreased hospital costs but no increase in readmissions or mortality.

Background: There is a lack of studies comparing hospitalization and post-hospitalization outcomes between internal medicine (IM) hospitalists and family medicine (FM) hospitalists.  Objective: To compare the length of stay (LOS), hospital cost, and 30-day all-cause readmission rate among patients treated by IM hospitalists and FM hospitalists.   Design and Setting: Prospective cohort study in a referral center. Propensity score matching was used to balance baseline characteristics between comparative arms. Participants: 747 patients 18 years and older who were admitted to hospitalist services. Intervention: Treatment by IM hospitalists and FM hospitalists. Main Measures:  LOS, hospital cost, and 30-day all-cause readmission. Treatment arms were compared by two methods. We compared patients who were seen by FM exclusively with those treated exclusively by IM services. Covariate adjusted differences in outcomes were estimated by multivariable regression. For a secondary set of analyses, exposure to FM and IM was converted to a continuous independent variable. Key Results: Forty, 333, and 374 patients were seen by FM, IM, and a combination of both services, respectively. Using average treatment on the treated as the estimand, FM care provided a shorter weight-adjusted LOS by 0.5 days (CI: -0.92- -0.04, P =0.026) compared to IM, but no difference in hospital cost (-126, CI: -906-653, P=.74).  There was no difference in adjusted hazard for 30-day readmission between FM and IM (HR: 2, CI: 0.67-6.2, P =0.062). Propensity weight-adjusted multiple regression models of the complete cohort (n=747) did not show any difference in any outcomes with increased exposure to FM care.  Conclusions: Understanding variation in practices and outcomes between different hospitalist models opens opportunities to improve care and decrease the length of stay.

IgA vasculitis is a small vessel vasculitis that usually presents acutely and resolves with supportive care. However, it can cause serious complications. The etiology of IgA vasculitis and the pathophysiology of atraumatic avascular necrosis of the hip remain largely unknown. Adult IgA vasculitis can rarely become complicated by avascular necrosis. We report a case of a 43-year-old male with no significant past medical history who presented with bilateral avascular necrosis of the hips in the setting of acute IgA vasculitis.