Many cardiopulmonary complications occur after aneurysmal subarachnoid hemorrhage. This is due to sympathetic nervous system activation which results in release of norepinephrine from myocardial sympathetic nerves. Cardiac troponin I is a marker for diagnosis of cardiac injury. Elevated levels of troponin in these patients are associated with worse clinical outcomes. PubMed was searched for literature using regular and Medical Subject Heading (MeSH) keywords for data collection. Papers published in English language involving human subjects within the last 20 years focusing on cardiac troponin elevation following subarachnoid hemorrhage were included. Systemic complications that occur after subarachnoid hemorrhage worsen the clinical outcome of patients and have negative effects on the mortality and morbidity of these patients. Cardiac troponin I elevation is significantly associated with the severity of the stroke, poor neurological status, longer ICU stay, and death. Cardiac troponin I should be measured in patients presented with acute stroke. Hemodynamic monitoring and appropriate supportive care can improve clinical outcomes.

Digital communication has revolutionized the way children interact and maintain social relations. However, not every tween (8-12 years) or teen (13-18 years) is able to take full advantage of digital media and may cross personal and social boundaries causing distress, mostly to their own friends at school and beyond. This results in adverse health effects for both the cyberbullying perpetrator and the victim. Articles reviewed on elementary school children and adolescents, collected from two different databases, showed that the number of elementary school kids using smartphones has more than doubled in the past few years. Given this rise, the risk of cyberbullying has also increased. Not all elementary school kids have the required media literacy to understand that their friends have equal rights in the virtual world as they do in the schoolyard. Regardless, they still carry a smartphone with data, use computers, and other electronic media to bully, embarrass, exclude, or humiliate others, often through social networking sites. Moving from tweens to teens seems to worsen the cyberbully behavior and choices, with middle school kids facing the highest cyberbullying incidents followed by high school kids and then the elementary school kids. The anonymity of cyberspace and the perceived lack of consequences seems to embolden the cyberbully. Identifying the mindset of a cyberbully and those at high risk of becoming a cyberbully can help target intervention efforts where they are needed the most and prevent cyberbullying.

Ischemic stroke remains a major cause of mortality and morbidity in patients with atrial fibrillation. The use of appropriate anticoagulants reduces the risk of ischemic stroke in these patients. The current literature review is aimed to analyze the follow-up efficacy and safety of direct factor Xa inhibitors versus warfarin in the prevention of primary and secondary ischemic stroke, risk of major and minor bleedings, and food and drug interaction in patients with atrial fibrillation (AF). We selected PubMed as our database and we found 83,611 articles using the regular keyword 'atrial fibrillation'. We found 2,224 articles using the regular keywords 'direct factor Xa inhibitors' and 'atrial fibrillation'. Finally, we obtained 326 studies using MeSH keywords: atrial fibrillation, direct factor Xa inhibitors, and warfarin. Ultimately, 46 articles were selected after applying the inclusion/exclusion criteria. All studies were randomized controlled trials (RCT) or clinical trials. Analysis of all studies showed that direct factor Xa inhibitors are superior to warfarin in the prevention of ischemic stroke in patients with non-valvular AF, with a lower rate of major and minor bleeding events and lower foods and drug interaction. Unlike warfarin, direct factor Xa inhibitors do not need frequent blood monitoring and dose adjustment. We found that warfarin and other vitamin K inhibitors may promote the calcification of heart valves and coronary arteries. There is some evidence that direct factor Xa inhibitors may slightly reverse these calcifications in coronary arteries and heart valves.

Introduction:Waldenstorm's macroglobulinemia (WM) is a type of indolent B cell lymphoma characterized by immunoglobulin M monoclonal gammopathy and bone marrow infiltration by lymphoplasmacytic cells. Being an uncommon hematologic malignancy, studies on epidemiology of this disease are limited. Median survival is 5-11 years and depends on disease progression, treatment complication and transformation to high-grade lymphoma. In the nationally representative database, we aimed to find out the trends and outcomes of hospitalizations primarily due to WM. Methods:We used National Inpatient Sample (NIS) for the years 2007-2017 by Healthcare Cost and Utilization Project. We extracted a study cohort of adult hospitalizations due to WM using International Classification of Diseases (9th/10th editions) Clinical Modification diagnosis codes. Our primary and secondary objectives were to estimate the trends of hospitalization and outcomes as well as identify predictors of poor outcomes. Poor outcomes were defined as in-hospital mortality and discharge to facility. We utilized Cochran Armitage trend test and multivariable survey regression modeling to analyze trends and predictors of poor outcomes using SAS software, version 9.4 (SAS Institute, North Carolina, USA). Results:We studied a total of 7,379 patients who were hospitalized with WM during 2007-2017. Overall from 2007 to 2017 the burden of hospitalizations has decreased from 804 to 645 . The cohort consisted of elderly patients with a median age of 69-years (IQR:61-78), 60.2% were males, 78% Caucasians, and 10.5% African American. Mean length of stay was 7-days which remained stable over the period. A decline in the proportion of WM patients being discharged to facility (20.1% in 2007 to 13.9% in 2017; pTrend<0.001) and in-hospital mortality (4.7% in 2007 to 2.3% in 2017; pTrend<0.001) was observed. Furthermore, in multivariable logistic regression analysis, rural hospitals (OR 4.3; 95%CI 1.5-12.4; p<0.001), lower median household income (OR 4.1; 95%CI 1.4-12.2; p<0.05) and concurrent conditions like septicemia (OR 10.7; 95%CI 4.2-26.7; p<0.001), and pulmonary circulatory disease (OR 3.6; 95%CI 1.4-9.1; p< 0.001) were associated with higher odds of in-hospital mortality. Conclusion:In this nationally representative study, we observed that the hospitalizations due to WM had mildly declined and outcomes were improved during the study period which might be an indication of improvements in treatment modalities. WM in benign state is rarely a grave prognosis and does not require frequent hospitalization but mortality is usually due to other comorbidities and hyperviscosity. We were able to identify several risk predictors that were associated with poor outcomes which require further studies to better risk stratification and develop preventive measures. Disclosures No relevant conflicts of interest to declare.

Atrial fibrillation has become the most commonly seen cardiac arrhythmia in clinical practice affecting almost 5.6 million Americans with that number expected to rise in the near future. The current literature review is aimed to assess the efficacy of catheter ablation in the treatment of patients with atrial fibrillation when compared to standard medical therapy. A PubMed search for studies of "Atrial Fibrillation" found 83,251 articles. Following the application of inclusion/exclusion criteria, we identified 44 articles of relevance that compared catheter ablation and medical therapy in the treatment of atrial fibrillation. These 44 articles included 20 Observational studies, eight randomized clinical trials, three clinical trials, five cohort studies, and eight review articles. Our review determined that catheter ablation was associated with a much lower rate of reoccurrence of atrial fibrillation when compared to medical therapy, as well as decreased cardiovascular outpatient visits and thromboembolic complications. The effect of quality on life when compared to medical treatment, however, was found to be inconclusive.