Disparities in the Occurrence of Long-Term Effects of Bone Marrow Suppression after Treatment in Adolescent Young Adult Breast Cancer Survivors.

BACKGROUND: Many adolescent and young adult (AYA) patients with breast cancer (BC) receive adjuvant therapy as initial treatment, with long-term bone marrow suppression as a potential complication, but no studies have evaluated the impact of race/ethnicity on the development of bone marrow suppression in AYA BC survivors. PATIENTS AND METHODS: Female patients ages 15-39 years diagnosed with BC (2006-2018) and surviving ≥ 2 years were identified from the California Cancer Registry and linked to statewide hospitalization data. We estimated the cumulative incidence of developing late effects of bone marrow suppression, such as leukopenia, anemia, thrombocytopenia, bleeding, and infection/sepsis, during hospital discharge diagnoses present ≥ 2 years after diagnosis. We examined the impact of sociodemographic and clinical factors on late effects using multivariate Cox proportional hazards regression. RESULTS: Of 11,293 patients, 42.8% were non-Hispanic (nH) White, 28.8% Hispanic, 19.5% nH Asian/Pacific Islander, and 7.5% nH Black. In multivariable analyses, nH Blacks had the highest risk (versus nH Whites) of anemia [hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.47-2.02], leukopenia (HR 1.56, CI 1.14-2.13), thrombocytopenia (HR 1.46, CI 1.08-1.99), major infection/sepsis (HR 1.64, CI 1.4-1.92), and bleeding (HR 1.89, CI 1.39-2.58). Hispanics had a higher risk of developing anemia (HR 1.17, CI 1.04-1.32), bleeding (HR 1.4, CI 1.12-1.76), and major infections/sepsis (HR 1.36, CI 1.21-1.52). Asian/Pacific Islanders had only a higher risk of developing bleeding (HR 1.33, CI 1.03-1.72). Patients from a low neighborhood socioeconomic status had a 20% higher risk of infection/sepsis (HR 1.21, CI 1.1-1.34), but there were no associations for the other late effects. CONCLUSIONS: We identified that AYAs of nH Black, Hispanic, and Asian/Pacific Islander race/ethnicity are at an increased risk of several late effects after adjuvant therapy compared with nH White patients. From these data, providers can implement early/frequent screening of hematologic late effects in these high-risk survivors.

A Cross-Sectional Study of Antibiotic Prescribing for Childhood Upper Respiratory Tract Infections in Irish General Practice

Introduction This study aimed to analyse antibiotic prescribing in cases of upper respiratory tract infection (URTI) in children under 6 years attending Irish daytime and out-of-hours General Practice (GP) services. There have been large scale changes in entitlements for free GP care for this group in recent years. Methods A cross-sectional study of children under 6 years with URTI presentations was performed, over a two-week period for three years from 2015 to 2017. Factors associated with antibiotic prescription and preferred antibiotic compliance were examined using multivariate logistic regression. Results 1,007 Under-6 patients presented with an URTI in our sample over the study period. Following introduction of free GP care, patients were 50% less likely to receive an antibiotic prescription. Overall antibiotic prescribing fell from 70% to 50% in daytime services and from 72% to 60% in the out-of-hours setting. Patients presenting to out-of-hours services were more likely to receive an antibiotic (OR: 1.42) and less likely to receive a deferred antibiotic (OR: 0.53). One quarter to one third of all prescriptions were for deferred antibiotics. Year-on-year trends showed a 13% decrease in prescriptions and 13% increase in preferred antibiotic use. Conclusion The introduction of free GP care led to significant reductions in antibiotic prescribing, which may be due to changes in health seeking behaviour by parents or other reasons. Antibiotic prescribing was more commonplace in the out-of-hours setting, and rates remains high by international standards. This study underlines the importance of ongoing work around GP antimicrobial stewardship, particularly in the out-of-hours setting.

Cardiac infection and sepsis in 3 intravenous bath salts drug users.

The street drug "bath salts" are psychoactive mixtures of cathinone derivatives. We report 3 cases of disseminated Staphylococcus aureus infection with cardiac involvement (2 endocarditis and 1 pericarditis), secondary to intravenous bath salts use.

The strengthening mechanism of resin cements on porcelain surfaces.

All-ceramic crowns bonded with resin cements have increased performance, and two theories have been proposed. Marquis (1992) suggested that the resin modified defects by crack healing, while Nathanson (1993) proposed that resin polymerization shrinkage strengthened porcelains. Both theories imply a sensitivity of strengthening to defect size. The hypothesis tested was that resin strength enhancement is independent of defect severity. We ground 200 porcelain discs to remove imperfections and indented 120 to create a large defect. Discs were tested dry, wet, and after being coated with 75-100 microm of resin cement in bi-axial flexure. Disc strength with and without indentations was increased significantly when coated with 2 resin cements. Both cements significantly increased the strength independent of defect population, and the hypothesis was accepted. It is proposed that the combination of surface pre-treatment and cement moved the fracture origin from the porcelain/cement interface to the cement surface, consistent with resin strength enhancement independent of defect severity.

An analysis of strokes in a rural hospital.

A four-year retrospective analysis of strokes in a rural hospital was undertaken for comparison with other areas as well as to understand the impact of the DRG system on the rural hospital. Risk factors, studies, treatment, disposition as well as resource considerations were all evaluated.

Unusual manifestations of peripartal cardiac disease.

Because peripartal cardiac disease occurs infrequently, its manifestations may be unfamiliar to most physicians. We report two unusual cases of postpartum cardiac disease: one patient presented with cerebral and peripheral arterial embolization, and the second patient developed late eclamptic seizures with subsequent myocardial infarction. Both patients recovered. Nonobstetric physicians should be aware of these pregnancy-associated medical complications to allow prompt diagnosis and aggressive therapy.

Immunoblastic lymphadenopathy and asbestosis.

Immunoblastic lymphadenopathy was diagnosed in a 71-year-old white man who had weakness, with weight loss, fever, cough, and generalized lymphadenopathy. The patient had a long occupational history of shipyard work. Diagnosis of asbestosis was made clinically by chest x-ray, and ferruginous bodies were found in the lung at autopsy. Recent reports have suggested a possible association between asbestos exposure and lymphoproliferative neoplasms. Chronic antigenic stimulation by asbestos could predispose one to the immunoproliferative disorder seen in this patient or be responsible for it. The possible significance of this relationship, previously unreported, is discussed for future consideration.

Tracheobronchitis due to Corynebacterium pseudodiphtheriticum.

We have presented a case of tracheobronchitis due to C pseudodiphtheriticum in a patient with COPD who was treated with prednisone and apparently was not otherwise immunocompromised. Chronic lung disease seems to predispose to infection with C pseudodiphtheriticum; it can also occur in the immunocompetent host. This organism, when isolated in pure culture, should not be dismissed as a contaminant, but must be considered a possible etiologic agent. Sensitivity of diphtheroids to antibiotics is extremely variable. We believe vancomycin should be used in respiratory tract infections caused by diphtheroids, including C pseudodiphtheriticum, until the results of in vitro antibiotic susceptibility tests are available.

Endothelial and epithelial sources of endothelin-1 in sheep bronchi.

Airway smooth muscle tone and growth is regulated by endothelin-1 (ET-1), but the sources of ET-1 in the airway wall have not been clearly defined. We therefore wished to estimate the relative contributions of the epithelium and endothelium to ET-1 production in the bronchi (mean ID 1.7-4.9 mm) of mature normal sheep. Morphometric assessment of bronchial cross-sections revealed a number of epithelial cells three times greater than endothelial cells by direct cell count. In contrast, the overall cell surface density was five to six times greater, and the airway smooth muscle-centered cell surface density was three to four times greater for endothelial cells than for epithelial cells. The expression of preproendothelin-1 mRNA was detected in cultured aortic endothelial cells (as a substitute for bronchial endothelial cells) but not in cultured bronchial epithelial cells, and the former secreted seven times more immunoreactive ET-1 than the latter. These findings show that topographically the endothelium is better positioned for the regulation of ovine bronchial smooth muscle than the epithelium. Furthermore, the findings suggest greater constitutive ET-1 secretion by cultured endothelium than by epithelium.