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Evolving Paradigms in Acute Myeloid Leukemia: Personalized Approaches to Therapy Across Age and Risk Groups
No full textAcute myeloid leukemia (AML) is an aggressive hematologic malignancy characterized by the clonal proliferation of myeloid precursors and rapid progression. Historically consisting of intensive chemotherapy, AML management has evolved significantly due to advances in molecular diagnostics and risk stratification. This review discusses current therapeutic paradigms in AML, emphasizing the growing role of personalized medicine across age and risk groups. For younger, fit patients, intensive regimens such as the 7 + 3 protocol remain the standard, often enhanced by targeted agents like FMS-like tyrosine kinase 3 (FLT3) and IDH inhibitors. Older or unfit individuals benefit from low-intensity treatments such as hypomethylating agents combined with venetoclax, now considered a frontline standard of care. The use of liposomal chemotherapy (CPX-351), measurable residual disease (MRD) monitoring, and maintenance therapy further refine post-remission strategies. Emerging therapies, including menin inhibitors, antibody-drug conjugates, and immunotherapies like CAR-T cells and vaccines, offer additional options, especially in relapsed/refractory settings. This comprehensive review outlines the current landscape and future directions in AML therapy, emphasizing the transition toward individualized, mutation-driven treatment strategies
Predictive Factors for Acute Kidney Injury After Primary Bariatric Surgery in Patients With or Without Preoperative Chronic Kidney Disease and Postoperative Complications: An Analysis of MBSAQIP Database
No full textIntroduction: Patients who underwent bariatric surgery are at risk of dehydration and postoperative acute kidney injury (AKI). This study aimed to investigate the predictive factors of AKI after sleeve gastrectomy and gastric bypass, considering preoperative chronic kidney disease and postoperative complications as predisposing factors for AKI.
Methods: The MBSAQIP database was analyzed to assess patients who had AKI after gastric bypass or sleeve gastrectomy between 2015 and 2020. Patients were categorized based on postoperative AKI. Multivariate logistic regression was used to identify independent predictive factors of AKI in all the patients who underwent laparoscopic primary bariatric surgery. The analysis was repeated in patients without postoperative major complications, with subgroups with or without preoperative chronic kidney disease.
Results: Patients were divided into AKI (N = 1376) and non-AKI (N = 1,137,775) groups. The AKI group consists of a significantly older, more male, and black race, compared to the non-AKI group. The factors most predictive of AKI in all the patients consist of readmission within 30 days (OR = 10.10), ICU admission (OR = 7.90), septic shock (OR = 6.72), preoperative chronic kidney disease (OR = 5.95), myocardial infarction (OR = 3.9), cardiac arrest (OR = 3.5), using hypertension medication (OR = 3.3), previous organ transplant (OR = 3.2) and reintubation (OR = 3.08).
Conclusion: Various factors have been identified as independent predictors of AKI in patients who have undergone bariatric surgery. Recognizing these risk factors enables surgeons and clinicians to categorize patients more effectively and prioritize attention toward those at high risk, thus aiding in the prevention of AKI and its associated consequences
Necrobiosis Lipoidica Arising in a Port Wine Stain Treated With Topical Ruxolitinib
No full textWe present a unique case of necrobiosis lipoidica (NL) arising within a port-wine stain (PWS), which, to our knowledge, has not been previously reported. NL is a rare granulomatous disorder often associated with diabetes mellitus, characterized by chronic inflammation and microvascular dysfunction. PWS, a congenital vascular malformation, results from defective endothelial differentiation and capillary malformation. The coexistence of these conditions suggests a potential link in their pathophysiological mechanisms, including inflammation, endothelial dysfunction, and shared signaling pathways such as mitogen-activated protein kinase (MAPK), phosphoinositide 3-kinase (PI3K), and tumor necrosis factor (TNF)-alpha. Our patient\u27s NL lesions demonstrated improvement with topical ruxolitinib, a Janus kinase (JAK) inhibitor, after failing conventional therapies, including clobetasol, tacrolimus, and pulsed dye laser. To our knowledge, this is the first reported case of NL successfully treated with topical ruxolitinib monotherapy. This case highlights the emerging role of JAK inhibitors in managing granulomatous disorders and raises intriguing questions about the shared pathophysiologic mechanisms between inflammatory and vascular processes. Further investigation into cytokine dysregulation, immune responses, and targeted therapies for these overlapping pathologies could inform more effective treatment strategies and improve patient outcomes
Early Versus Late Weight-Bearing After Ankle Fracture Surgery: A Comparative Review
No full textEarly weight-bearing (EWB) and late weight-bearing (LWB) protocols are the two primary regimens implemented for patients following ankle fracture surgery, yet their outcomes remain variable. This review aimed to assess these protocols, including their limitations and implications, to support more tailored postoperative management and ultimately improve patient recovery. EWB demonstrated superior short-term outcomes compared to LWB, including higher functional assessment scores, improved range of motion, and earlier return to work times. However, patients in this group revealed lower protocol adherence and higher wound-related issues in select patients, including complication and reoperation rates. As a result, LWB is more often favored by surgeons for elderly, diabetic, or morbidly obese patients despite lower early functional outcome scores. Overall, the literature remains inconclusive, highlighting the need for personalized rehabilitation plans and further research to refine risk stratification and optimize recovery across diverse patient populations
Oral Tranexamic Acid for Lichen Planus Pigmentosus Inversus: A Case Report of Therapeutic Success
No full textLichen planus pigmentosus (LPP) is an uncommon variant of lichen planus typically found in middle-aged patients of color with dark brown or gray patches on sun-exposed areas such as the face, trunk, and upper extremities.1 A rarer variant is lichen planus pigmentosus inversus (LPPI), which, in contrast to LPP, more commonly affects Caucasians and has a predilection for intertriginous regions like the axillae, groin, abdominal folds, and antecubital and popliteal areas.2 Few case reports describe effective treatments for LPP, and even fewer on LPPI. Topical tretinoin and tacrolimus 0.1% ointment are the most commonly used treatments; however, responses vary.3 To our knowledge, this is the first report to demonstrate the detailed use and favorable effects of oral tranexamic acid (TXA) in improving hyperpigmentation in a patient with LPPI
Mechanism that Links Perceived Racism and Discrimination and Youth Cannabis Use, A Structural Equation Modeling Approach
Get PDFBackground and objectives: Exposure to discrimination stands as a prevalent social stressor and social determinant of health. This study sought to examine mechanisms linking perceived racism and discrimination (PRD) with youth cannabis use.
Methods: Data were drawn from the 2021 Adolescent Behaviors and Experiences Survey (n = 7,705). Latent variables were constructed to assess stress and mental health, sleep disorder and lack of physical activity, lack of family and peer support, and financial adversity. Separate mediation analyses were conducted to examine the pathways from PRD to current (past 30-day), and frequent (≥20 days in the past 30-day) cannabis use, adjusted by sociodemographic factors.
Results: Adolescents with PRD (vs. no PRD) reported a higher prevalence of current use (16.2 % vs. 10.9 %, p \u3c 0.0001) and frequent use (4.6 % vs. 2.7 %, p = 0.008). Stress and mental health mediated the pathways from PRD to current (βindirect effect [SE] = 0.02 [0.01], p = 0.02) and frequent cannabis use (βindirect effect [SE] = 0.03 [0.01], p \u3c 0.001). Financial adversity was associated with current (β [SE] = 0.15 [0.06], p = 0.01) and frequent cannabis use (β [SE] = 0.26 [0.08], p = 0.002). Sleep disorder and physical activity did not significantly mediate the relationship between PRD and current or frequent cannabis use. Lack of family and peer support showed no association with cannabis use.
Conclusions: This national study identified important latent factors that are associated with youth cannabis use. Targeted interventions that reduce stress might mitigate the impacts of PRD on adolescent\u27s cannabis use
Seven Questions for a Student\u27s Donor: Evaluation of a Fictional Conversation Lends Insight into Professional Identity Formation in Medical Students
Get PDFReflection exercises have been used within anatomy education to evaluate empathy, humanism, and professionalism. A typical reflection exercise consists of directed prompts to guide the student\u27s reflection as it relates to the experience and/or research question. The aim of this study was to utilize reflections through an open-ended format to enable students to explore their experience participating in donor dissection as they form their professional identity. The Seven Questions exercise was developed to create an imaginary discourse between the medical student and their donor. Students were prompted to provide seven questions they would like to ask their donor, if still living, and provide a 2-3 sentence explanation as to their interest, meaning, and/or purpose of each question. Submissions (n = 418) were evaluated using thematic analysis and four themes were identified: body donation, career development, patient history, and donor gestalt. The theme of body donation included questions specific to the decision to donate one\u27s body for medical education, sharing one\u27s decision with family and electing educational vs. organ donation. The career development theme included questions focused on the donor\u27s previous experience with physicians, hesitation regarding student dissection, and advice for the student dissector. The third theme, patient history, included inquiries related to social history, review of systems, and family history. The final theme of donor gestalt focused on the donor\u27s self-care and legacy. Student responses suggest that dissection and the donor experience organically support students modeling physician behaviors and should be considered as an educational opportunity to aid in developing physician identity
New Onset Diabetes Manifesting as Diabetic Ketoacidosis in a Patient with Chronic Myelogenous Leukemia Treated with Imatinib
Get PDFImatinibis a commonly used antiproliferative agent for treating chronic myelogenous leukemia and gastrointestinal stromal tumors, and it is also thought to be effective in other areas, such as rheumatologic diseases. It has been shown to improve glucose control in diabetic patients by lowering blood sugar, reducing HbA1c levels, and decreasing the need for diabetes medications. However, we present a rare occurrence of severe hyperglycemia and newly elevated HbA1c in a patient on imatinib with no prior history of diabetes. It underscores the need for further research to assess the safety and impact of imatinib on glucose metabolism
Failure to Rescue After Brain Tumor Resection: A National Surgical Quality Improvement Program Analysis (2012-2020)
No full textBackground and objectives: Failure to rescue (FTR) occurs when mortality happens within 30 days after a major postoperative complication. The surgical literature contains varying FTR rates based on various patient characteristics and postoperative complication rates. The impact of frailty on FTR has yet to be described within the context of brain tumor resection (BTR). Our study identified patient characteristics and postoperative complications predictive of FTR in this cohort.
Methods: BTR patients were identified from the American College of Surgeons-National Surgical Quality Improvement Program database (2012-2020) based on craniotomy codes. Frailty was measured using the Risk Analysis Index as has been previously described.
Results: There were 31 667 BTR patients and 2443 (7.71%) developed a major complication, and 387 (15.8%) experienced FTR. The median age of the cohort was 60 years (IQR 49-69). On multivariate analysis, transfer status (odds ratio [OR]: 1.36, 95% CI: 1.01-1.81) and nonelective surgery (OR: 1.60, 95% CI: 1.22-2.10) were independent predictors of FTR. Frail and severely frail patients who underwent BTR had 4.03-fold and 7.90-fold higher odds of FTR. Postoperative complications predictive of FTR were cardiac arrest (OR: 12.75, 95% CI: 8.16-19.92), unplanned reintubation (OR: 2.46, 95% CI: 1.89-3.16), and septic shock (OR: 2.02, 95% CI: 1.37-2.98). The final predictive model demonstrated excellent discriminatory accuracy (c-statistic: 0.81, 95% CI: 0.79-0.83).
Conclusion: Preoperative patient characteristics, including frailty, and the occurrence of certain expected postoperative complications, such as cardiac arrest, are predictive of FTR in BTR patients. Knowledge of baseline frailty could guide preoperative interventions to optimize patients before surgery