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What Will it Take to Cure Cancer? Historical Context and Future Directions in Cancer Medicine
No full textLaurie Sands, MD Memorial Lecture:
What Will it Take to Cure Cancer? Historical Context and Future Directions in Cancer Medicine. Christopher Lieu, MD, Co-Director, GI Medical Oncology, Associate Director for Clinical Research, University of Colorado
Objectives: Where have we been? Chemotherapy Where are we now? Targeted and Immunotherapy Where are we going? How do we get better
Babesiosis unmasked in chronic lymphocytic leukemia: A case report
No full textChronic lymphocytic leukemia (CLL)-related autoimmune cytopenias are common. Herein, we present the case of a patient with bicytopenia (anemia and thrombocytopenia), weakly positive direct Coombs test, and increased hemolytic markers. Cytopenias were initially presumed to be autoimmune and related to CLL. He was started on prednisone but to no effect. This prompted re-evaluation of peripheral blood smear which showed intra-erythrocytic inclusions. Considering the patient’s recent extensive hiking in tick-endemic areas and current residence in New York State, polymerase chain reaction for Babesia was performed, yielding a positive result. Treatment with atovaquone and azithromycin for 6 weeks resulted in a significant improvement in both cytopenias and hemolytic markers
Updates and Current Knowledge on the Common Forms of Gastroenteritis: A Review
No full textAcute gastroenteritis is a major cause of diarrheal illnesses throughout the United States. The purpose of this article is to review the current knowledge in diagnostic and therapeutic aspects. A comprehensive literature review was conducted using PubMed and Google Scholar, focusing on articles published within the last ten years. There are multiple etiologies of gastroenteritis that affect the general population. Out of the many causes, norovirus continues to be a leading cause of acute diarrheal illness worldwide. Rotavirus was also a common form of diarrhea worldwide, but the development of routine vaccination has largely reduced its incidence. Bacterial gastroenteritis continues to be a significant burden on healthcare facilities worldwide. Supportive care remains the cornerstone of treatment, while using antibiotics remains crucial in severe bacterial forms of gastroenteritis. Acute gastroenteritis remains a significant global health concern requiring a multifaceted approach for effective management. Enhanced diagnostic techniques, vaccine development, and robust public health measures are essential in controlling the spread of gastroenteritis
Shared Decision-Making in Food Protein-Induced Enterocolitis Syndrome
No full textFood protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy presenting with profuse vomiting, lethargy, and potential progression to severe dehydration and hypotension. Delayed-onset bloody diarrhea may also be a feature, though generally in neonates. FPIES can be misdiagnosed due to nonspecific symptoms and the fact that there is no laboratory test specific for the disease. There is currently very limited understanding of the FPIES pathophysiology. Clinical management relies mostly on case series, case reports, uncontrolled observational studies, and expert opinion rather than controlled studies and a plethora of mechanistic research. As a result, there are multiple areas in FPIES where care is preference-sensitive and dependent on patient values and preferences, given the lack of high-quality trials that clearly indicate a single best course of action. While in some vain this may signify major knowledge gaps and unmet needs in research and patient care, in another sense, this represents an opportunity to evolve patient care in a way that may be more tailored toward individual patient or family values and preferences through shared decision-making as the research continues to evolve. There has been increased recognition that the burden of FPIES on patients and families is substantial, and there is opportunity to take advantage of particular care options to help mitigate this burden. This rostrum wishes to discuss areas where current FPIES care can be evolved to incorporate a more contextualized, preference-sensitive approach, involving shared decision-making, to provide the optimal management to each individual patient
Green Endoscopy: A Review of Global Perspectives on Environmental Sustainability of Gastrointestinal Endoscopy
No full textEndoscopic procedures are the cornerstone of intervention in gastroenterology-from evaluating common illnesses to non-surgically managing complex diseases. Expectedly, these procedures are linked to greenhouse gas (GHG) emissions globally and contribute significantly to the global climate change crisis. Professional gastroenterology societies globally raise awareness of this evolving crisis and suggest specific measures to appropriately measure the burden contributed by endoscopy units and mitigate the environmental impact of this common clinical practice. To the unsuspecting eye, the solution to this crisis is relatively simple: decrease the utilization of endoscopic procedures. However, the dependence of modern medicine on these procedures, both diagnostically and therapeutically, makes it significantly more challenging to reduce their utilization. Instead, a structured approach to systematically consider the specific indications for each procedure, minimize waste generation, promote recycling of waste products, and limit the number of repeat endoscopies until clinically necessary may be more pragmatic to reduce GHG emissions globally. In this narrative review, we discuss the perspectives of global gastroenterology societies on sustainable or green endoscopy and summarize their recommendations to aid the day-to-day gastroenterologist in making their contribution to environmental sustainability while providing optimal care to their patients
Trends in hypertensive heart disease-related mortality among older adults in the USA: a retrospective analysis from CDC WONDER between 1999 and 2020
No full textBackground: While hypertensive heart disease (HHD) has been widely studied, this study uniquely examines the impact of the COVID-19 pandemic on HHD mortality trends, which has not been thoroughly explored in the current literature. The pandemic\u27s effects on healthcare access, economic instability, and social isolation present new challenges and opportunities for understanding HHD mortality among the elderly.
Results: Age-adjusted mortality rates (AAMRs) increased overall between 1999 and 2020, from 36.7 to 133.9 per 100,000 people, according to analysis. The data on AAMRs indicated a consistent rise from 1999 to 2017, with a notable uptick from 2017 to 2020. An investigation based on gender revealed that older men had a consistently higher AAMR than older women. The biggest AAMRs were found among the non-Hispanic (NH) Black or African-American population, according to variations in AAMR based on race and ethnicity. Geographic differences between states revealed that compared to Nebraska, Oregon, North Dakota, Maine, and Minnesota, the District of Columbia, Oklahoma, Nevada, Vermont, and Mississippi had substantially higher AAMRs. The West, Northeast, and Midwest were in second place with a continuously higher AAMR, followed by the South. Furthermore, compared to non-metropolitan areas, metropolitan areas had a higher AAMR.
Conclusion: The importance of including demographic and geographic factors in public health planning and interventions is highlighted by these findings, which provide insightful information on mortality trends associated with HHD in the elderly
Evaluation of 14-3-3eta protein as a diagnostic biomarker in the initial assessment of inflammatory arthritis
No full textObjective: Serum 14-3-3eta are novel biomarkers of rheumatoid arthritis (RA). It is not clear whether 14-3-3eta may be present in other forms of inflammatory arthritis (IA). We evaluated the presence of 14-3-3eta as a diagnostic biomarker in the evaluation IA.
Methods: A retrospective cohort study of adult patients who were evaluated for IA by a rheumatologist with a result for the lab test of 14-3-3eta was conducted.
Results: Of 280 included patients, 30% were diagnosed with RA, 11% with psoriatic arthritis (PsA), and 59% with another condition. Twenty-four (9%) patients had positive results for 14-3-3eta. Fifty-two percent of positive patients were diagnosed with RA, with 48% having another diagnosis including axial spondyloarthritis, gout, Sjögren\u27s, undifferentiated IA, diabetic cheiroarthropathy, prostate cancer with bone metastasis, osteoarthritis, unspecified arthralgia. No patients with PsA had a positive value. RA patients had a higher value for 14-3-3eta compared to non-RA (5.44 [1.56~9.31] vs. 0.69 [0.40~0.98] ng/mL, p=0.03, square brackets are 95% confidence interval values). The mean value for the 14-3-3eta in seropositive RA trended higher than seronegative (8.0 [2.3~13.7] vs. 1.4 [0.4~2.4] ng/mL, p=0.06). In the RA cohort, elevated 14-3-3eta was associated with elevated erythrocyte sedimentation rate (odd ratio=6.62 [1.24~47.09], p\u3c 0.04), but not other variables.
Conclusion: 14-3-3eta may aid as a diagnostic biomarker of RA. However, it is not specific for RA, especially at low positive levels, and may be positive in other forms of IA. Ideal cutoff values need to be established for RA and non-RA conditions. It was not found in PsA
Massive Hemoptysis: Unveiling the Unforeseen: A Problem Bigger Than Then Primary Problem
No full textMassive Hemoptysis: Unveiling the Unforeseen: A Problem Bigger Than Then Primary Problem. Hanan Malik, MD; Yishan Dong, Pulmonary Fellow; Shahzeib Syed, Pulmonary Fellow
Objectives: Evaluation and basic management of hemoptysis Acknowledging rare complication of ablation procedure, and its management
Atrial Fibrillation: Ablation Procedure Complications. Abrar Shah, MD, Electrophysiology Cardiology
Objectives: Understanding common and uncommon AF ablation complication Management and Treatment of AF ablation complicatio
Impact of frailty on outcomes and biliary drainage strategies in acute cholangitis: A retrospective cohort analysis
No full textBackground: Acute cholangitis (AC) is a potentially fatal infection of the biliary tract characterized by varying degrees of severity, with endoscopic retrograde cholangiopancreatography (ERCP) serving as the primary drainage modality. Though frailty is linked to poor outcomes in general, its implications for AC patients remain unexplored.
Methods: Using the National Inpatient Sample Database 2017-2020, we identified adult AC hospitalizations, which were further stratified based on frailty. A multivariate regression model was used for analysis.
Results: We included 32,310 AC patients, out of whom 11,230 (34.76 %) were frail. Frail patients had elevated AC severity as well as in-hospital mortality (adjusted odds ratio [aOR] 6.89; P \u3c 0.01). Additionally, frail patients were found to have significantly higher odds of complications including septic shock (aOR 15.87), acute renal failure (aOR 5.67), acute respiratory failure (aOR 11.11) and need for mechanical ventilation (aOR 13.80). From a procedural viewpoint, frail patients had higher odds of undergoing percutaneous biliary drainage (PBD) but lower odds of undergoing early ERCP (ERCP within 24 h of admission). When compared to non-frail counterparts, frail patients were more likely to undergo PBD as opposed to early ERCP (aOR 1.46; P = 0.01).
Conclusion: Frailty independently predicts poor AC outcomes and has a notable impact on the choice of biliary drainage procedure. Recognizing frailty instead of age alone as a determinant of AC outcomes can aid clinicians in risk stratification and guide tailored interventions in this population
Controversies in the Indications for Surgery
No full textIt has been said “good surgeons know how to operate, better ones when to operate, and the best, when not to operate.” In addressing the treatment of craniosynostosis, this adage holds for both neurosurgeons and plastic surgeons. The nature and mechanisms of neurologic dysfunction in nonsyndromic craniosynostosis are subjects of great debate. Even in cases where there is a clear indication to operate, nuances of surgical management such as optimization of timing and technique are vigorously debated.
This chapter discusses the controversies in management of craniosynostosis, including the role of genetics and bony compression on neurologic outcome, the advisability, timing, and type of surgery, and the optimization of perioperative supports