Admissions for posttransplant lymphoproliferative disorder: a 9-year longitudinal analysis of the National (Nationwide) Inpatient Sample.

Background: Posttransplant lymphoproliferative disorder (PTLD), a term that encompasses a wide array of malignancies that occur after transplant, can be one of the most devastating transplant complications. While there have been major advancements in care, especially after the landmark PTLD-1 trial in 2012, there is a paucity of information on hospitalizations for PTLD and the changes in hospitalizations over time. Methods: This retrospective cohort study used the National Inpatient Sample to identify hospitalizations for PTLD that occurred between 2009 and 2018. We extracted data for hospitalizations with a primary or secondary diagnosis of PTLD and examined a range of variables, including age, gender, race, hospital type, hospital location, and disposition status. We also collected data on hospital region, median household income, insurance status, and bed size. Results: There was a statistically significant increase in the number of hospitalizations from 2009 to 2019 and an increasing rate of hospitalizations over the study period. Hypertension, electrolyte imbalances, renal failure, and anemia were among the most common comorbidities. We found an increased mortality rate, but this was not statistically significant. Conclusion: Our study provides insight into the changes in hospitalizations for PTLD over nearly a decade, showing an increase in hospitalizations and reports of comorbidities.

Endoscopic Management of Boerhaave Syndrome: Are Outcomes Better Than Surgery? A Case Report and Review of Literature.

Boerhaave syndrome (BS) is a rare clinical diagnosis associated with a high morbidity and mortality rate. Diagnosis of this condition is usually delayed which can lead to a very poor outcome. The timing of presentation and time to management plays a very important role in the prognosis and selection of the management method. With the advances seen in therapeutic endoscopy, many authors have been exploring the possibility of shifting the focus of management from surgery to interventional endoscopy. We present a case report of a patient presenting with BS that was successfully managed endoscopically. We also reviewed the literature on how surgical management compares to endoscopic management and attempted to establish general recommendations from available literature on management of BS.

Outcomes of cardiac arrest hospitalizations in patients with obesity with versus without prior bariatric surgery status:A nationwide propensity-matched analysis.

Introduction: Prior bariatric surgery (PBS) status in obese patients is thought to curtail the risk of cardiovascular events, but its role in change of outcomes of patients with obesity developing new acute cardiac events such as cardiac arrests (CA) remains largely unknown. Methods: Hospitalizations among adult patients with obesity and CA were identified retrospectively using the National Inpatient Sample (2015 October-2017 December). Propensity-matched analysis (1:1) was performed for sociodemographic/hospital characteristics to identify two cohorts, with (PBS+) or without (PBS-) status. The primary endpoint was in-hospital mortality, and the secondary endpoint was healthcare resource utilization. Results: Both cohorts (n = 1275 each), had patients with comparable age (mean 58 years), with a higher frequency of white (>70 %), females (>60 %), and Medicare enrollees (>40 %). PBS + cohort had lower rates of diabetes (27.8 % vs 36.1 %), hyperlipidemia (33.7 % vs 48.6 %), renal failure (17.3 % vs 22.0 %), chronic pulmonary disease (11.8 % vs 21.2 %) and higher rates of anemias (18.4 % vs 12.2 %), liver disease (5.1 % vs 2.4 %) and alcohol abuse (6.7 % vs 2.4 %) than PBS- cohort (p < 0.05). All-cause mortality (46.3 % vs 45.1 %, p = 0.551) was comparable between the two cohorts. The PBS + cohort was less often transferred routinely (p<0.001) but had a shorter hospital stay (p<0.001) with equivalent hospital charges compared to the PBS- cohort. Conclusions: The PBS status (regardless of chronology) did not increase survival in CA admissions among patients with obesity. Preventive measures are necessary to manage enduring cardiovascular disease risk factors that may limit the advantages of surgery for patients with obesity and aggravate the worse outcomes of future cardiac events.

An Unusual Case of Burning Mouth Syndrome in an Adult Male: A Case Report.

Burning mouth syndrome (BMS) is a rare disorder primarily affecting the oral mucosa and characterized by a chronic burning sensation without specific oral mucosal lesions. This paper presents a case of a 54-year-old adult male patient who complained of chronic burning mouth pain. The clinical diagnosis was made after excluding various differentials, including oral candidiasis, hairy oral leukoplakia, gastroesophageal reflux disease, oral lichen planus, local infective processes, and nutritional deficiencies. Physical examination did not reveal specific signs or lesions related to BMS; however, considering the patient's signs, symptoms, and the exclusion of other possibilities, a possible diagnosis of BMS was considered. The patient was evaluated in an outpatient setting, and management was conducted in this setting to reduce patient costs. This presentation is considered rare, as the disorder predominantly affects postmenopausal females, and most proposed theories behind its pathophysiology revolve around estrogen-mediated modulation of pain receptors. Currently, diagnostic and management criteria for BMS may vary and continue to evolve. The management of this patient focuses on patient education and routine follow-up. This case report presents the management of this particular case, along with a review of other proposed management options.

Nationwide Trends in Hospitalizations and Outcomes of Pulmonary Circulation Disorders Among Patients With Cannabis Use Disorder in the United States.

Background and objective The use of cannabis through smoking and vaping has increased significantly over the past decade. However, the prevalence of pulmonary circulation disorder (PCD)-related hospitalizations among cannabis users and their outcomes remain poorly understood. In this study, we used a nationally representative sample to assess the prevalence and trends of hospitalization among cannabis users with PCD. Methods The National Inpatient Sample (NIS) datasets (2007-2014) were used to analyze hospitalizations of patients with cannabis user disorder with PCD (C-PCD arm) versus those without PCD (C-non-PCD arm) to ascertain demographics, comorbidities, and in-hospital outcomes including all-cause mortality and healthcare resource utilization. Results A total of 3,307,310 hospitalizations involving cannabis users were reported, of which 20,328 (0.61%) were related to PCD. We noted a 200% relative increase in hospitalizations in the C-PCD arm (linearly increasing from 0.3% to 0.9% from 2007 to 2014, ptrend<0.001). When compared to the C-non-PCD arm, patients in the C-PCD arm tended to be older (mean age: 47 vs. 34 years), predominantly males (65.6% vs. 62.9%), with significantly higher rates of congestive heart failure (CHF, 28.8%), hypertension (HTN, 22%), chronic obstructive pulmonary disease (COPD, 21.5%), deficiency anemia (19.4%), and valvular heart disease (17.7%). The C-PCD arm had a statistically higher proportion of tobacco and amphetamine abusers (p<0.01) while the C-non-PCD arm had more cocaine and alcohol abusers (p<0.01). Urban teaching hospital admissions were more commonly associated with the PCD arm than the non-PCD arm (65.4% vs. 56.9%). In terms of hospital resource utilization, patients in the C-PCD arm had higher median hospital stay (six vs. three days) and more frequent discharges to a skilled nursing facility or home healthcare than the C-non-PCD group. All-cause mortality during hospitalization was found to be much higher in the C-PCD arm than the C-non-PCD arm (4.1% vs. 0.5%, p<0.001). Multivariable analysis revealed a two-fold higher risk for all-cause mortality with an adjusted odds ratio (OR) of 2.17 (95% CI: 1.99-2.36, p<0.001) with PCD. Conclusion The findings of this nationwide study revealed significantly increased rates of hospitalizations among cannabis users with PCD with two times higher odds of all-cause in-hospital mortality. Further prospective studies are warranted in this subgroup of patients to confirm these findings and facilitate the management of these patients.

Inpatient burden of gastric cancer in the United States.

BACKGROUND: Gastric cancer is associated with significant morbidity and mortality. Over one-half of patients have advanced disease at the time of presentation, leading to a significant burden on the healthcare system. Limited epidemiological data exists on national inpatient hospitalization trends. The aim of this study is to determine the inpatient burden of gastric cancer in the United States. METHODS: We analyzed the Nationwide Inpatient Sample (NIS) database for all subjects with the diagnosis of malignant neoplasm of the stomach (ICD-9 code 151.x) as primary diagnosis during the period from 2001-2011. NIS is the largest all-payer inpatient care database in the U.S. Statistical significance of variation in the number of hospitalizations, patient demographics, and comorbidity measures was determined using Cochran-Armitage trend test. RESULTS: From 2001 to 2011, the number of hospitalizations with the diagnosis of malignant neoplasm of the stomach ranged between 22,430 and 25,371, however, the trend was not significant. Men were always more affected than women with no significant change in overall proportion (P<0.0001). Overall, in-hospital mortality decreased from 11.19% in 2001 to 6.47% in 2011 (P<0.0001). However, average cost of care per hospitalization increased from $21,710 in 2001 to $24,706 in 2011 (adjusted for inflation, P<0.0001). CONCLUSIONS: The total number of hospitalizations remained relatively stable throughout the study period with higher proportion of men affected every year. Although in-hospital mortality in patients with the diagnosis of gastric cancer decreased over the study period, there was a significant rise in the cost of care.

Rectal Cancer in the Eye: A Case Report of Orbital Metastasis.

Orbital metastasis from colorectal cancer is extremely rare. In this case report, we describe a 48-year-old woman who presented with recurrent severe headaches and new onset constipation with no known history of cancer. After vigilant workup, imaging, and biopsies, she was diagnosed with orbital metastasis from a primary rectal carcinoma. She was started on chemotherapy and radiation therapy. Her chemotherapy regimen consisted of FLOX (leucovorin + fluorouracil + oxaliplatin), along with panitumumab, which she tolerated well. She received chemotherapy for seven months before she lost her battle with cancer.