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The primary aim of this study was to evaluate epidemiological characteristics and prevalence of lung disease among e-cigarettes users in the United States. A population-based, cross-sectional survey was performed using the National Health and Nutrition Examination Survey (NHANES) of 2015–2018. Adults using e-cigarettes (SMQ900), traditional smoking (SMQ020: > 100 cigarettes in lifetime or SMQ040: current cigarettes use), and dual smoking (e-cigarettes and traditional smoking) were identified and compared in their sociodemographic characteristics and prevalence of lung diseases (Asthma: MCQ010 and COPD: MCQ160O). We used the chi square test (categorical variables) and Mann–Whitney test and unpaired-student t test (continuous variables). p-value <0.05 was used as a reference. We excluded respondents <18 years and missing data on demographics and outcomes. Out of 178,157 respondents, 7745 (4.35%), 48,570 (27.26%), and 23,444 (13.16%) were e-cigarette smokers, traditional smokers, and dual smokers, respectively. Overall prevalence of asthma was 15.16% and COPD was 4.26%. E-cigarette smokers were younger in comparison to traditional smokers (median: 25 years vs 62 years; p < 0.0001). In females (49.34% vs 37.97%), Mexican (19.82% vs 13.35%), annual household income above $100,000 (23.97% vs 15.56%), prevalence of e-cigarette smoking was higher in comparison to traditional smoking (p < 0.0001). The prevalence of COPD was higher among dual smokers in comparison to e-cigarette and traditional smoking (10.14% vs 0.25% vs 8.11%; p < 0.0001). Prevalence of asthma was higher among dual and e-cigarette smokers in comparison with traditional smokers and non-smokers (22.44% vs 21.10% vs 14.46% vs 13.30%; p < 0.0001). Median age (Q1–Q3) was lower at which asthma (7 years (4–12) vs 25 years (8–50)) was diagnosed first among e-cigarettes smokers in comparison with traditional smokers. In a mixed effect multivariable logistic regression analysis, we found higher odds of asthma among e-cigarette users in comparison with non-smokers (Odds ratio (OR): 1.47; 95% Confidence Interval (CI): 1.21–1.78; p = 0.0001). Chronic Obstructive Pulmonary Disease (COPD) respondents were also associated with 11.28 higher odds of e-cigarette utilization (Oddsratio (OR): 11.28; 95% Confidence Interval (CI): 5.59–22.72; p < 0.0001). We conclude the higher prevalence of e-cigarette users is seen among the younger population, female, Mexican race, and annual income above $100,000 in comparison to traditional smokers. Chronic Obstructive Pulmonary Disease (COPD) and asthma were both more prevalent in dual smokers. As asthma was more prevalent and diagnosed at an early age in e-cigarette smokers, more prospective studies are needed to understand the effects of e-cigarette among the population at risk to mitigate the sudden rise in utilization and to create awareness.

Objective: Primary objective of this study is to find prevalence of metabolic syndrome (MetS) in patients with acute ischemic stroke (AIS) amongst non-valvular atrial fibrillation (NVAF). Secondary aim of this study is to identify the independent components of MetS (obesity, diabetes, hypertension, high TG, low HDL), those predict AIS and compare with CHA 2 DS 2 VASc score (CHF, HTN, age>75, DM, history of stroke/TIA/thromboembolism, history of vascular disease, sex: female) amongst NVAF. Methods: A cross-sectional study was performed to identify cohort of adult hospitalization with secondary diagnosis of NVAF from Nationwide Inpatient Sample of 2008-2017. From patients with NVAF, primary hospitalization for AIS and secondary diagnosis of MetS, its components, and components of CHA 2 DS 2 VASc score were identified using ICD 9 & 10 codes. Weighed analysis using multivariable survey logistic regression was performed to evaluate the predictive potential of MetS and its components as well as to compare them with CHA2DS2VASc for AIS. Results: Amongst 33,462,134 hospitalizations with NVAF, 2.9% were due to AIS. Amongst AIS hospitalizations prevalence of MetS was 0.16% (vs 0.20%) [obesity (8.4 vs 13.7%), DM (31.6 vs 34.1%), HTN (84.3 vs 75.9%), high TG (0.4 vs 0.2%), low HDL (0.02 vs 0.02%)] in comparison to non-AIS. (p<0.001) In regression analysis, patients with MetS [aOR 1.16 (95%CI 1.04-1.30)] and its component DM [1.3 (1.3-1.4)], HTN [2.2 (2.1-2.3)], high TG [1.8 (1.7-2.0)], low HDL [1.02 (0.7-1.4) weak significant] had higher risk of AIS. Amongst CHA 2 DS 2 VASc components besides HTN and DM, history of stroke/TIA, history of vasc. disease, female and age 65-74 and >75 had higher odds of AIS (Table 1) . Conclusion: MetS and its components high TG and low HDL independently predict a high risk of AIS. Future study would evaluate whether adding of high TG and low HDL in CHA 2 DS 2 VASc score and starting anticoagulants amongst patients MetS may mitigate the risk of AIS.

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Duodenal adenocarcinoma (DA), gastrointestinal stromal tumor (GIST), and pancreatic neuroendocrine tumor (PNET) are a set of rare gastrointestinal (GI) cancers characterized by nonspecific symptoms such as anemia, weight loss, and abdominal pain. We report an interesting case of DA, GIST, and PNET in a 79-year-old African American male who presented to the emergency department with syncope. The patient was tachycardic and found to have severe anemia. Further computed tomography (CT) of the abdomen and pelvis with contrast revealed a mass within the duodenal bulb along with a pancreatic cystic lesion. The patient underwent gastroduodenectomy and distal pancreatectomy with incidental findings of GIST in the posterior gastric wall. The patient after surgical removal of all tumors no longer experienced abdominal pain and had hematocrit and hemoglobin (H&H) level of 9.1/31.7 postoperation day (POD) 14. The case unfolds a rare presentation of three neoplasms that were moderate to well-differentiated with no metastases. It highlights the importance of assessment of rare GI neoplasms concurrently with colorectal cancer when geriatric patients present with nonspecific GI symptoms.