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Loncastuximab Tesirine in the Treatment of Relapsed or Refractory Diffuse Large B-Cell Lymphoma
Get PDFCurrently, a significant percentage of patients with DLBCL are refractory or relapse after a first line of immunochemotherapy. Second relapses after autologous stem cell transplantation or chimeric antigen receptor T-cell therapies present few treatment options and do not yield good results. New molecules have entered the immunotherapy arsenal. Loncastuximab tesirine comprises a humanized anti-CD19 monoclonal conjugated antibody, which consists of an anti-CD19 antibody and cytotoxic alkylating agent, SG3199. Several studies have proven its efficacy in the treatment of refractory cases of DLBCL with a good safety profile, with the main adverse effects being neutropenia, thrombopenia, and liver enzyme involvement. In this review, we explain the mechanism of action of this molecule, the clinical data that have led to its acceptance by the FDA, and the new therapeutic options that are proposed in association with this drug
COVID-19 National Football League (NFL) Injury Analysis: Follow-Up Study
Get PDFBackground:
In 2020, COVID-19 spread across the world and brought normal daily life to a halt, causing the shutdown of nearly everything in order to prevent its spread. The National Football League (NFL) similarly experienced shutdowns and the resulting effects, leaving athletes unable to train in some of the most advanced facilities with many of the best trainers in the world. A previous study, titled COVID-19 Return to Sport: NFL Injury Prevalence Analysis, determined that there was increased injury prevalence during the 2020 season, likely due to decreased physiological adaptations within athletes’ bodies as a result of facility shutdowns. Understanding injury epidemiology is vital to the prevention of injuries and the development of return-to-play protocols.
Objective:
The objective of this study is to perform a follow-up study to COVID-19 Return to Sport: NFL Injury Prevalence Analysis in order to examine the longitudinal effects of the COVID-19 pandemic on injury epidemiology. This study examines if there was a recovery to baseline levels of injuries or if there are still lingering effects from the COVID-19 pandemic–induced spike in injuries.
Methods:
To determine if there was change in the number of injuries for each season, injury tallies collected from the 17-week-long 2018, 2019, and 2020 NFL regular seasons were compared with those from the 18-week-long 2021 and 2022 NFL regular seasons. A Kruskall-Wallis test with post hoc Dunn analysis was conducted to compare the rate of injuries per team per week between each of the 2018, 2019, 2020, 2021, and 2022 regular seasons.
Results:
The Kruskall-Wallis test revealed an H statistic of 32.61 (P\u3c.001) for the comparison of the injury rates across the 5 seasons. The post hoc Dunn analysis showed that 2020 had a statistically significant difference when compared with each of the 2018 (P\u3c.001), 2019 (P=.04), 2021 (P=.02), and 2022 (P=.048) seasons. The 2019 season showed no statistical significance when compared with the 2021 (P=.23) and 2022 (P=.13) seasons.
Conclusions:
The results of this follow-up study, combined with the previous study, show that extended training interruptions stemming from COVID-19 in 2020 induced detraining and led to increased injuries. Additionally, the results of this study show that retraining can occur, resulting in the development of injury protective factors, as injury rates returned to baseline levels after 2020. This is the first large-scale and long-term opportunity to demonstrate the effects of these principles and how they are important to understanding injury epidemiology
Comparing Intubation Rates in Patients Receiving Parenteral Olanzapine With and Without a Parenteral Benzodiazepine in the Emergency Department
No full textStudy objective: United States prescribing information recommends against coadministration of injectable olanzapine with injectable benzodiazepines due to a risk of cardiorespiratory depression, whereas European prescribing information recommends the 2 drugs not be administered within 60 minutes of each other. In contrast, a recently published American College of Emergency Physicians clinical policy recommends injectable olanzapine and benzodiazepines be coadministered for treating severe agitation. We sought to compare injectable olanzapine with and without injectable benzodiazepines for evidence of cardiorespiratory depression.
Methods: We performed a retrospective study of patients in an urban emergency department from January 2017 through November 2019 who received parenteral olanzapine with or without parenteral benzodiazepines. We included patients receiving 2 total medication doses, either olanzapine+benzodiazepine or 2 doses of olanzapine, coadministered within 60 minutes. The primary outcome was tracheal intubation in the emergency department. Secondary outcomes included hypotension (systolic blood pressure less than 90 mmHg) and hypoxemia (SpO2 less than 90%).
Results: We identified 693 patients (median [alcohol]=210 mg/dL, median age=37 years [IQR 29 to 49]). In total, 549 received 2 doses of olanzapine, and 144 patients received olanzapine and a benzodiazepine. We found no difference in intubation rates between the olanzapine-only group (21/549, 3.8%) and the olanzapine+benzodiazepine group (5/144, 3.5%; difference=0.3%, 95% confidence interval -3.0% to 3.7%). Rates of hypoxemia (2% olanzapine-only and 3% olanzapine+benzodiazepine) and hypotension (9% both groups) also were not different between groups.
Conclusion: We found no difference in cardiorespiratory depression between patients receiving only olanzapine versus olanzapine plus a benzodiazepine
Bigeminy with Prolonged QT Interval as an Ominous Sign for Impending Torsades de Pointes: A Case Report
Get PDFIntroduction: Ventricular ectopic beats and corrected QT interval (QTc) prolongation are both relatively common entities that are typically benign. It is difficult to predict subsequent dysrhythmias from either electrocardiogram (ECG) feature. The combination of both features may better predict the risk of torsades de pointes. We highlight a case of torsades preceded by a bizarre bigeminal rhythm with QTc prolongation likely caused by memantine use and hypokalemia.
Case Report: An 84-year-old female presented to the emergency department with a fall. A syncope workup revealed an ECG demonstrating bigeminy with a prolonged QTc interval. Several minutes after obtaining the ECG, the patient went into torsades. She had multiple subsequent cardiac arrests during the rest of her hospital stay. This case report details the importance of recognizing ventricular bigeminy in the context of QTc prolongation as a harbinger of torsades.
Conclusion: While premature ventricular contractions including bigeminy may be a benign finding, when accompanied by prolonged QTc intervals, they warrant immediate investigation and treatment of potential underlying pathology to prevent torsades and subsequent cardiac arrest
Endoscopist Experience With Pediatric Recurrent and Intentional Foreign Body Ingestion (RIFBI): Management Considerations and Future Directions
No full textObjectives and study: Accidental foreign body ingestion (FBI) is a common pediatric referral concern. In contrast, recurrent and intentional FBI (RIFBI) is infrequent and associated with greater endoscopic and surgical intervention in adults. Although pediatric guidelines exist for FBI, the risk and therapeutic implications of RIFBI are not addressed. An anonymous international survey on pediatric gastroenterologist experience with RIFBI was distributed.
Methods: A 33-item REDCap© survey was distributed via email to pediatric gastroenterologists identified through mailing and email lists obtained from pediatric gastroenterology professional organizations.
Results: During 9-12/2021 we accrued 202 completed surveys. Respondents were from 27 countries and across the career span. Eighty percent reported experience with RIFBI; 74% reported seeing ≤ 3 patients with RIFBI within the past 24 months and 4% reported seeing ≥ 6. Of those who treated RIFBI, 38% reported an average number of annual ingestions per patient was ≥5. Frequent morbidity but not mortality was reported. Half reported adherence to FBI guidelines. Later-career endoscopists treated RIFBI more aggressively than accidental ingestion. Ninety-six percent noted that patients with RIFBI had psychiatric comorbidities. Providers at academic medical centers reported referring to behavioral health more than those in other settings.
Conclusion: Most gastroenterologists surveyed reported encountering RFBI several times a year and in patients with psychiatric comorbidities. Greater likelihood of adverse outcomes associated with endoscopy was reported. Most reported referral to behavioral health and few had RIFBI management protocols. A broader spectrum of psychologic comorbidities in the pediatric population with RIFBI, notably depression and autism spectrum disorder, were reported
Sacroiliac Dysfunction and Minimally Invasive Sacroiliac Joint Fusion
No full textThe sacroiliac joint (SIJ) is the largest diarthrodial joint in the human body and accounts for approximately 20% of all low back pain, which is commonly seen in patients with lumbosacral fusions. Despite this, SIJ dysfunction often poses a challenging diagnosis depending on clinical evaluation, imaging, and image-guided joint injection. SIJ fusion is an effective and safe method of treatment, with minimally invasive approaches fitting well within the armamentarium of interventional radiologists treating chronic pain and other musculoskeletal conditions. Contemporary technical approaches and clinical considerations are discussed
Evidence-Based Clinical Practice Guideline for the Pharmacologic Management of Acute Dental Pain in Adolescents, Adults, and Older Adults: A Report From the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania
Get PDFBackground. A panel convened by the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania conducted systematic reviews and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after simple and surgical tooth extraction(s) and for the temporary management (ie, definitive dental treatment not immediately available) of toothache associated with pulp and periapical diseases in adolescents, adults, and older adults.
Types of Studies Reviewed. The panel conducted 4 systematic reviews to determine the effect of opioid and nonopioid analgesics, local anesthetics, corticosteroids, and topical anesthetics on acute dental pain. The panel used the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations, Assessment, Development and Evaluation Evidence-to-Decision Framework to formulate recommendations.
Results. The panel formulated recommendations and good practice statements using the best available evidence. There is a beneficial net balance favoring the use of nonopioid medications compared with opioid medications. In particular, nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen likely provide superior pain relief with a more favorable safety profile than opioids.
Conclusions and Practical Implications. Nonopioid medications are first-line therapy for managing acute dental pain after tooth extraction(s) and the temporary management of toothache. The use of opioids should be reserved for clinical situations when the first-line therapy is insufficient to reduce pain or there is contraindication of nonsteroidal anti-inflammatory drugs. Clinicians should avoid the routine use of just-in-case prescribing of opioids and should exert extreme caution when prescribing opioids to adolescents and young adults
Textbook and Board Exam Prep Resource Trends in Academic Health Sciences Libraries Serving College of Osteopathic Medicine Programs
No full textObjective: This study collected and analyzed data on the required and recommended textbooks and board exam prep resources in academic health sciences libraries that serve accredited colleges of osteopathic medicine (COM) programs in the United States.
Methods: The study consisted of locating, compiling, and analyzing data on the required and recommended texts and board exam prep resources through the COM libraries’ public-facing websites.
Results: The investigators compiled the required or recommended texts and the board exam prep resources used within the COM curricula from 38 COM libraries.
Conclusion: The study results provide information for medical school administrators, especially within the academic affairs department and library directors, to help identify trends across U.S. osteopathic medical schools to justify the need for additional resources and services. These results can assist medical and library leadership in COM schools in planning for their future academic health sciences libraries and COM programs. Finally, the findings could assist programs in library and information sciences in redesigning their curriculum and students who seek future careers in academic health sciences libraries