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Background This study investigates the relationship between coronavirus disease 2019 (COVID-19) infection and acute pancreatitis. We present large registry data assessing the association between acute pancreatitis and mortality in patients with COVID-19 post-infection. Methods The researchers identified adult patients aged 18-90 years with COVID-19 infections in the TriNetX (COVID-19 research network) database between January 20, 2020, and June 1, 2021. The researchers identified n=1,039,688 cases divided into two cohorts: those with post-acute pancreatitis (n= 1,173) and those without post-acute pancreatitis (n=1,038,515) post COVID-19 infection having follow-up within a two-week period. The researchers then conducted a 1:1 propensity score match to account for differences in the cohorts and created two well-matched cohorts (n=1,173/1,173). Results Patients that developed acute pancreatitis had higher mortality (12.4% vs 3.7%, p<0.001), stroke (3.6% vs 1.7%, p=0.005), higher inpatient admissions (28.2% vs 10.6%, p<0.001), and higher rates of ICU admission (9.5% vs 3.2%, p<0.001). Conclusion In a large multinational federated database, we observed higher mortality, stroke, higher inpatient admissions, and higher rates of ICU admissions among patients with COVID-19 with pancreatitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Annie et al.)

Introduction Dioxins, polychlorinated biphenyls (PCBs), and 2,3,7,8-Tetrachlorodibenzodioxin (TCDDs) are persistent organic pollutants widely distributed in the food chain. For over 50 years, the Monsanto plant in Nitro, West Virginia, created dioxin waste while producing herbicides, Agent Orange (during the Vietnam War), and different forms of rubber. Recent and past literature has established a link between the Monsanto plant and increased cancer cases within the region. Soft tissue sarcoma is one of the few specific cancers that has been linked to dioxin exposure. This pilot study examined whether sarcoma cases were clustered or randomly distributed within Kanawha County, West Virginia over the years 2000 to 2013. We hypothesize that sarcoma cancer cases will be spatially clustered. Methods This study assessed the spatial distribution of cancer patients with addresses within the Nitro, West Virginia, and study area. The Charleston Area Medical Center shared soft tissue sarcoma (n = 97) cases from 2000 to 2013. An unweighted K function with confidence intervals (99 Monte Carlo permutations) and 10 distance at 2800 meters each band analyzed the distribution of cases. Results The results suggest that sarcoma cases are slightly clustered within the study area. The region also has a high concentration of chemical and industrial sites. The eighth distance band exhibited the greatest difference (11384), between the expected versus the observed K function. Conclusion The unweighted K function shows non-random clustering. Future studies could investigate possible associations to industrial, chemical, or other possible point source contamination within the study area., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Annie et al.)

Background Aortic stenosis is classified as stenosis that can be caused by a congenital disability in infants and children but is more commonly produced by a degenerative process of calcification and scarring of the valve in the later decades of life. High systemic pressure and hemodynamic disturbances characteristic of this area of the cardiovascular system makes the aortic valve susceptible to plaque and cholesterol buildup over time, similarly to atherosclerosis, contributing to the pathology of aortic stenosis. Thus, this study aims to assess the short and long-term clinical outcomes of risk factor reduction, post transcatheter aortic valve replacement (post-TAVR), and results of tested medication outcomes. Methods Data were obtained from Charleston Area Medical Center, which is a tertiary care 800-bed community teaching facility and was examined using STATA 11.4 (StataCorp LLC, College Station, Texas, USA), a Cox proportional hazards model to test for clinical significance. This study examined the medications aspirin, clopidogrel, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. Additional medications analyzed included statin, anticoagulant, aspirin with clopidogrel, and beta-blocker with ACE inhibitor and statin following the procedure of transcatheter aortic valve replacement (TAVR) and the overall risk of a hazard event of mortality. Results Results suggest that clopidogrel by itself had the lower rate of mortality at one year with hazards of 0.6906, a p-value of 0.221 and a 95% confidence interval of 0.3677 - 1.259; and at three years with hazards of 0.4845, a p-value of 0.027 and a 95% confidence interval of 0.2552 - 0.9201. Statins had the second-lowest rate at one year with hazards of 0.7299 and a p-value 0.215 and a 95% confidence interval of 0.4438 - 1.200; and at three years with hazard of 0.8529 and a p-value of 0.530 and a 95% confidence interval of 0.5192 - 1.401. Both of these medications had a consistent lower hazard and/or risk of death compared to other standard medication regiments. Within our center's data, clopidogrel had the best clinical outcome.  Conclusions This study showed that therapy with aspirin and clopidogrel alone did not demonstrate a significant increase in mortality versus alternative anticoagulation therapy in patients post aortic valve replacement. Clopidogrel and statin usage post-aortic valve revascularization may have a trend towards a reduction in mortality., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Herron et al.)

Background Peripheral vascular disease (PVD) patients are commonly transfused with red blood cells (RBC) due to their inability to compensate for anemia and blood loss. Anemias, as well as allogeneic transfusions, have been demonstrated as independent risk factors for increased mortality and morbidity following cardiovascular procedures. The relationships between anemia, transfusion, and adverse outcomes in PVD patients remain unascertained and understudied. Methods A retrospective cohort study was conducted to determine mortality at 30-day, one-year, and three-year markers among 330 randomly selected PVD patients. The clinical features of patients receiving transfusions were examined, and the mortality rates were compared between patients who received an RBC transfusion and those who did not. Cox regression analysis was employed to identify independent variables predicting mortality. Results Transfusions were found to have increased mortality rates over non-transfused patients at 30 days (6.1% vs. 1.8%, p = 0.05), one year (21.8% vs 12.1%, p = 0.02), and three years (41.2% vs. 23.0%, p = 0.001). Using a multivariate regression model, it was determined that the transfusion itself was not a significant cause of this decrease in survival, while the propensity to transfuse was a predictor for both short (30 days, 36.73 [1.85-728.06], p = 0.04) and long-term mortality (one year (8.83 [2.62-29.77], p < 0.001; three years (7.07 [1.46-8.07], p <0.01). Anti-coagulation therapy using intravenous (IV) heparin and the chronic comorbidities of coronary artery disease and diabetes mellitus were also robust independent predictors of decreased survival. Conclusion This study was able to find an association between RBC transfusion and reduction in short-term (three months) and long-term (three years) survival. Those requiring IV heparin during the hospital stay were at an increased risk of requiring blood transfusion, and patients receiving IV heparin were also found to have a significant increase in mortality rates., Competing Interests: The authors have declared that no competing interests exist.

Introduction Drug abuse and overdoses are on the rise in West Virginia. Multiple socioeconomic and prescription-prescribing practices influenced this shift. The shifting burden of intravenous drug use to more rural areas has created unique challenges for patient access (medical attention, addiction education, rehabilitation), as well as created an avalanche of additional costs for hospital networks. Methods We analyzed sepsis cases from 2006 to 2015 to investigate whether different types of drug use have increased the odds of developing sepsis as compared to other forms of drug use. To investigate this aspect, the authors examined this relationship by using a logistical regression and a time series analysis of the total cases of drug use and infections. Results The initial analysis investigated the association between drug use and the number of sepsis cases at Charleston Area Medical Center from 2006 to 2015 using a time series analysis. Results suggest that there are similar relationships between sepsis and sedative usage (p=0.016) and sepsis by mixed/other drug (p= 0.020) use. For logistic regression (n=2284), the infection models of sepsis/skin, endocarditis/skin infection, and osteomyelitis/skin infection showed several exposures significantly increased the risk of different infections. A drug user with a positive urine test for opiates is 80.8 percent more likely to develop sepsis as compared to skin infections (p=0.001). The use of sedatives also significantly increased the odds of developing sepsis by 83.2 percent (p=0.002). Conclusion Sepsis left untreated will result in a high mortality rate. As illicit drug use increases, sepsis cases will increase. Further research is needed to understand the continued relationship between drug use and the incidence of sepsis. Based on the current evidence, sepsis appears to be slightly affected by drug use and seems to be influenced by sedatives and opiates but only at a marginal level., Competing Interests: The authors have declared that no competing interests exist.

Introduction The effect of insurance coverage on the health of at-risk populations is poorly understood in the Appalachian region of the United States. The goal of this study is to examine how different types of insurance coverage (Private Insurance, Medicare under 65, Medicare 65 or over, Medicaid and Self Pay) may influence cancer survival over time. This study analyzes colon, bladder, as well as combines anal, rectal, and esophageal cancers. Methods We systematically analyzed all West Virginia Cancer Registry patients between the years of 2000 and 2013 who was diagnosed with colon, bladder, anal, rectal, and esophageal cancers. Separate analysis examined colon (n = 927), bladder (n = 269), and combined anal, rectum, and esophageal cancers (n = 398). Cox proportional hazards models investigated the effect of insurance types on survival while controlling for age, sex, tobacco use, alcohol use, and cancer stage. Results Overall, tobacco use marginally significantly decreased colon cancer survival. Tobacco use had a suggestive relationship at hazards ratio at 1.150, 95% confidence interval: 0.9990-1.235, p = 0.052. The type of payer group did not alter survival. Older individuals tend to have a lower survival rate compared to those that are younger at the time of diagnosis. Also, late-stage cancer faced lower survival compared to those with early-stage cancer. Other results within stage groups corresponded to existing literature. Conclusion For the three differing cancer groupings, there was no significant survival difference for patients by insurance type. The effect of tobacco usage on colon cancer survival merits further research. The study design could be improved by considering more risk factors such as patient comorbidities that might affect patient care and survival., Competing Interests: The authors have declared that no competing interests exist.

In the United States and Canada, pine forest ecosystems are being dramatically affected by an unprecedented pine beetle infestation attributed to climate change. Both decreased frequency of extremely cold days and warmer winter temperature averages have led to an enphytotic devastating millions of acres of pine forest. The associated ecosystem disruption has the potential to cause significant health impacts from a range of exposures, including increased runoff and water turbidity, forest fires, and loss of ecosystem services. We review direct and indirect health impacts and possible prevention strategies. The pine beetle infestation highlights the need for public health to adopt an ecological, systems-oriented view to anticipate the full range of potential health impacts from climate change and facilitate effective planned adaptation.