Disseminated Intravascular Coagulation in Acute Promyelocytic Leukemia Patients: A Retrospective Analysis of Outcomes and Healthcare Burden in US Hospitals

Objective: Acute promyelocytic leukemia (APL) is associated with an elevated risk of developing disseminated intravascular coagulation (DIC). The purpose of this study was to assess the outcomes of hospitalizations related to DIC in APL and their impact on healthcare. Materials and Methods: This study entailed a cross-sectional and retrospective analysis of the US National Inpatient Sample database. We identified adults with APL and categorized them into groups of patients with and without DIC. Our focus areas included in-hospital mortality, length of stay, charges, and complications associated with DIC. Unadjusted odds ratios/coefficients were computed in univariate analysis, followed by adjusted odds ratios (aOR)/coefficients from multivariate analysis that accounted for confounding factors. Results: Our analysis revealed that APL patients with DIC had a substantially higher aOR for mortality (aOR: 6.68, 95% confidence interval [CI]: 4.76-9.37, p<0.001) and a prolonged length of stay (coefficient: 10.28 days, 95% CI: 8.48-12.09, p<0.001) accompanied by notably elevated total hospital charges (coefficient: $215,512 [95% CI: 177,368-253,656], p<0.001), thereby emphasizing the reality of extended medical care and economic burden. The presence of DIC was associated with increased odds of sepsis, vasopressor support, pneumonia, acute respiratory failure, intubation/mechanical ventilation, and acute kidney injury, reflecting heightened vulnerability to these complications. Patients with DIC demonstrated significantly higher odds ratios for major bleeding, intracranial hemorrhage, gastrointestinal bleeding, red blood cell transfusion, platelet transfusion, fresh frozen plasma transfusion, and cryoprecipitate transfusion, highlighting the pronounced hematological risks posed by DIC. Conclusion: This study has revealed the significant associations between DIC in APL and various outcomes, underscoring the clinical and economic implications of these conditions. The hematological risks further increase patients' vulnerability to bleeding events and the need for transfusions.

Castleman disease- demographics, associations, and outcomes: an analysis of adult 791 cases.

BACKGROUND: Castleman disease (CD), also known as angiofollicular lymph node hyperplasia or large lymph node hyperplasia, is a rare medical condition. Despite its rarity, it exhibits diverse clinical presentations and outcomes, which pose challenges for comprehensive understanding and management. This study aims to shed light on the demographics, associations, and outcomes of CD by conducting a retrospective analysis. METHODS: The National Inpatient Sample (US) was used to identify patients with the diagnosis of Castleman disease using ICD-10 diagnosis code D47.Z2, during the years 2016-2019. Data was collected on demographics, associated diagnoses, treatments and outcomes. Data analysis was performed using STATA Version 17, College Station, TX: Stata Corp LLC. RESULTS: Our study identified 791 hospitalizations involving adult CD patients. The mean age of these patients was 52.4 years, with a male predominance (56.1%). Whites comprised the largest racial group affected (50.1%). Most patients were covered by Medicare (39.6%). The majority received treatment in urban teaching hospitals (84.0%) and large-bed size facilities (62.5%). In-hospital mortality was low at 2.8%, with an average length of stay of 7.5 days and average total charges of $109,308. Common associations included acute kidney injury (27.0%), congestive heart failure (17.1%), sepsis (16.4%), and acute respiratory failure (12.6%). Hematological and lymphatic associations featured anemia (47.5%), thrombocytopenia (12.2%), and other conditions. Red blood cell transfusions were administered to 11.1% of patients. CONCLUSION: This study contributes valuable insights into CD, a rare and clinically heterogeneous disease. It underscores the importance of recognizing its associations and complications. Additionally, it highlights the need for further research and improved diagnostic and treatment guidelines to address the complexity of this condition.

Cytokine Release Syndrome in Patients Treated With Chimeric Antigen Receptor T-cell Therapy: A Retrospective Study Analyzing Risks, Outcomes, and Healthcare Burden.

Background Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a promising immunotherapy for various malignancies. However, its use is associated with challenges, including cytokine release syndrome (CRS), a potentially severe complication. This retrospective study aims to analyze the risks, outcomes, and healthcare burden of CRS in patients undergoing CAR-T therapy. Method Data from the 2020 National Inpatient Sample (NIS) were utilized, comprising 415 CAR-T-related hospitalizations. They were categorized into those with CRS (n = 68) and those without CRS (n = 347). Baseline characteristics, including age, gender, race, income, insurance status, and comorbidities, were compared. Outcomes of interest included in-hospital mortality, length of stay (LOS), total hospital charges, and access to complications, associations, and interventions. Statistical analyses, including multivariable models, were employed to assess associations. Results Hospitalizations with CRS did not exhibit significant differences in age, gender, race, income, or insurance status compared to those without CRS. The multivariable analysis showed no statistically significant difference in mortality (adjusted odds ratio (aOR) = 2.48, 95% confidence interval (CI): 0.71 to 8.69, p = 0.151), LOS (coefficient = -2.1 days, 95% CI: -5.43 to 1.21, p = 0.207), or total hospital charges (coefficient = $207,456, 95% CI: $6119 to $421,031, p = 0.057) between the two groups. The CRS group had a higher incidence of fever (aOR = 1.91, 95% CI: 1.15 to 3.17, p = 0.014), acute respiratory failure (aOR = 2.10, 95% CI: 1.01 to 4.40, p= 0.049), and the need for intubation/mechanical ventilation (aOR = 2.59, 95% CI: 1.14 to 5.88, p = 0.024). Hemophagocytic lymphohistiocytosis (HLH) was significantly associated with CRS (aOR = 6.72, 95% CI: 2.03 to 22.18, p = 0.002). Conclusion While the development of CRS in CAR-T-treated patients did not significantly increase mortality, LOS, or total hospital charges, it was associated with specific risks and outcomes, including fever, respiratory failure, and HLH. This study emphasizes the importance of vigilance in recognizing and managing CRS in CAR-T therapy to optimize patient outcomes. The findings contribute valuable insights to guide clinical decision-making in the context of CAR-T therapy.

Inter radicular bone dimensions in primary stability of immediate molar implants - A cone beam computed tomography retrospective analysis.

PURPOSE: The purpose of the study was to analyze the dimensions of socket morphology, interradicular bone dimensions, root length and morphology, buccal cortical bone thickness and gap defect between the implant bone in mandibular molars with cone beam computed tomography (CBCT) for immediate molar implant (IMI) placement. MATERIALS AND METHODS: Sample sizes of 300 mandibular 1st and 2nd molars were each selected from the CBCT scans by inclusion and exclusion criteria. CBCT measurements were performed for socket size morphology, mesiodistal width, and buccolingual cancellous bone width at the crest at the apex. Width of the buccal cortical plate at the crest and interradicular bone (IRB) at the apex, 3 mm cervical to the apex and 6 mm cervical to the apex. Vertical parameters from the crest to furcation (L1), length from furcation to the apex (L2) and mesiodistal root morphology were measured to analyze the root configuration. RESULTS: All the parameters were analyzed for descriptive statistics for the mean and standard deviation. The majority were of Type B and C socket morphology with peri-implant bone defects of 2-2.5 mm, and the interradicular bone septum (IRB) was moderate for both first molar (1 M) and second molar (2 M) sites, but 2 M was shown to have less IRB than 1 M. Adequate buccal cortical bone thickness of 1.1 mm to 1.4 mm and buccolingual cancellous bone width were measured for both the 1 M and 2 M sites. CONCLUSION: The morphology of the molar extraction socket determines the adequate stability for IMI. In mandibular molar teeth, where interradicular bone is incompetent in providing good primary stability, in addition to interradicular bone, clinicians should look for support from the apical bone and interdental septal bone for attaining primary stability of IMI.

Recurrent neutropenia and chronic diarrhea following thymectomy: the good, the bad, and the ugly.

Good syndrome (GS) is a rare paraneoplastic syndrome seen before or after diagnosis of thymoma, and its treatment, and is characterized by hypogammaglobulinemia. Rarely, pure white cell aplasia (PWCA) can also be seen which can present as recurrent neutropenia. We describe a 64-year-old man with recurrent sinus infections and previous thymectomy for stage 1 type B2 thymoma presenting with chronic diarrhea and recurrent neutropenia necessitating serial hospitalizations despite repeated antimicrobial treatment. Immunoglobulin levels, including IgM, IgA, IgD, and IgE were undetectable. Flow cytometry also showed absent B cells. Patient was initiated on immunoglobulin replacement therapy with consequent significant clinical improvement. Despite thymectomy, patients can develop thymoma-associated paraneoplastic syndromes, including GS.

Current perspectives of 3d printing in dental applications / Perspectivas Atuais Da Impressão 3D Em Aplicações Odontológicas

Objective: To evaluate the applications of 3d printing /additive manufacturing (AM) in dental education & clinical dentistry and elaborate various 3d printing technologies, its benefits, limitations and future scope. Methods: Research papers on the application of 3d printing in dentistry were searched in Scopus and Pubmed and studied using bibliometric analysis. This review briefly describes various types of 3d printing technologies with their accuracy, use of different materials for 3d printing and their respective dental applications. It also discusses various steps used to create 3D printed dental model using this technology. Furthermore, the application of this technology in dental education and various clinical procedures are discussed. Results: 3d printing is an innovative technology making a paradigm shift towards treatment customization. It helps in customized production of dental implants, surgical guides, anatomic models etc. using computer-aided design (CAD) data. This technology coupled with state-of-the-art imaging techniques and CAD software has enabled, especially oral surgeons to precisely plan and execute complex surgeries with relative ease, high accuracy and lesser time. 3d printing is also being utilized in other disciplines of dentistry to prepare aligners, crown and bridge, endodontic guides, periodontal surgery guides, surgical models for treatment planning and patient education. Alongside its possibilities have also been explored in preclinical skills in operative, endodontics etc (AU)

Objetivo: Avaliar as aplicações da impressão 3D/manufatura aditiva (AM) na educação odontológica e odontologia clínica, e elaborar várias tecnologias de impressão 3D, seus benefícios, limitações e escopo futuro. Métodos: Artigos de pesquisa sobre a aplicação da impressão 3D em odontologia foram pesquisados no Scopus e no Pubmed e estudados por meio de análise bibliométrica. Esta revisão descreve resumidamente vários tipos de tecnologias de impressão 3D a partir da sua precisão, uso de diferentes materiais para impressão 3D e suas respectivas aplicações odontológicas. Ele também discute várias etapas usadas para criar um modelo dentário 3D impresso usando essa tecnologia. Além disso, a aplicação desta tecnologia na educação odontológica e vários procedimentos clínicos são discutidos. Resultados:a impressão 3D é uma tecnologia inovadora que está mudando o paradigma em direção à personalização do tratamento. Ele ajuda na produção personalizada de implantes dentários, guias cirúrgicos, modelos anatômicos etc. usando dados de design auxiliado por computador (CAD). Essa tecnologia, combinada com técnicas de imagem de última geração e software CAD, permitiu, especialmente aos cirurgiões orais, planejar e executar cirurgias complexas com relativa facilidade, alta precisão e menor tempo. A impressão 3D também está sendo utilizada em outras disciplinas da odontologia para preparar alinhadores, coroas e pontes, guias endodônticos, guias de cirurgia periodontal, modelos cirúrgicos para planejamento de tratamento e educação do paciente. Ao lado de suas possibilidades também foram exploradas em habilidades pré-clínicas em cirurgia, endodontia etc (AU)

Extensive Myiasis infestation associated with Oral Squamous Cell Carcinoma: Report of two cases.

Myiasis is the condition of infestation of the body by fly larvae (maggots). The deposited eggs develop into larvae, which penetrate deep structures causing adjacent tissue destruction. It is an uncommon clinical condition, being more frequent in tropical countries and hot climate regions, and associated with poor hygiene, suppurative oral lesions, alcoholism and senility. The diagnosis of Myiasis is basically made by the presence of larvae. The reported cases of oral Myiasis associated with oral cancer in the literature are few. This paper reports two cases of oral and maxillofacial Myiasis involving larvae in patients with squamous cell carcinoma in adult males. The condition was managed by manual removal of the larvae, one by one, with the help of forceps and subsequent management through proper health care.

Demographic and clinical profile of oral lichen planus: A retrospective study.

INTRODUCTION: Oral lichen planus (OLP) is a relatively common inflammatory mucocutaneous disorder that frequently involves the oral mucosa. The clinical presentation of OLP ranges from mild painless white keratotic lesions to painful erosions and ulcerations. An important complication of OLP is the development of oral squamous cell carcinoma, which led the World Health Organization (WHO) to classify OLP as a potentially malignant disorder. The demographic and clinical characteristics of OLP have been well-described in several relatively large series from developed countries, whereas such series from developing countries are rare. OBJECTIVE: The objective of this retrospective study was to investigate the epidemiological and clinical characteristics of 128 OLP patients in rural population of India. MATERIALS AND METHODS: In this study, the diagnostic criteria proposed by van der Meij et al. in 2003 based on the WHO definition of OLP were used to identify cases. RESULTS: In 128 patients, M:F ratio was 1.61:1. The buccal mucosa was the most common site (88.20%). White lichen was seen in 83.59% and red lichen in 16.40% cases. Reticular type of OLP was the most common form (83.5%) followed by erosive (15.6%) and atrophic OLP (0.78%). The incidence of systemic diseases included hypertension (11%), diabetes mellitus (2.4%), and hypothyroidism (0.78%). Histopathologically epithelial dysplasia was present in 4 cases. CONCLUSION: Most of the characteristics are consistent with previous studies with differences in few. Lichen planus is a chronic disease where treatment is directed to control of symptoms. Long-term follow-up is essential to monitor for symptomatic flare ups and possible malignant transformation.