Enfortumab-vedotin use for urothelial carcinoma in two patients on hemodialysis.

Enfortumab vedotin (EV) is a novel treatment option for patients with advanced/metastatic urothelial carcinoma who have progressed after chemotherapy and immunotherapy. Two patients at two different New England tertiary cancer care centers were treated with EV while concurrently receiving hemodialysis (HD), where a complete response to EV in both patients was noted. The use of EV in patients requiring HD is extrapolated from the available pharmacokinetic and pharmacodynamic literature on monoclonal antibodies in patients requiring HD. There is a paucity of data for the use of antibody-drug conjugates like EV in patients needing dialysis.

Immunotherapy in Biliary Tract Cancers: Where Are We?

PURPOSE OF REVIEW: Biliary tract cancers (BTCs) are a heterogenous group of cancers arising from the biliary tract. The hallmark of these cancers is the advanced stage of presentation and a paucity of durable treatment options. Despite the advances in targeted therapy and immunotherapy in solid tumors, systemic cytotoxic chemotherapy has remained the mainstay for cholangiocarcinomas. RECENT FINDINGS: With advances in the understanding of the tumor microenvironment, genetic features, and inflammatory milieu, have led to the identification of tumor-infiltrating immune cells as indicators of prognosis and response to treatment in BTC. Through an improved comprehension of immunology, immuno-oncology is becoming another pillar of treatment along with traditional radiation, surgery, cytotoxic chemotherapy, and targeted therapies. This article reviews the evidence for immunotherapy use in cholangiocarcinoma, which still being in infancy, and offers promising new novel options for the management of biliary tract cancers.

Neuro-Chikungunya: Acute Transverse Myelopathy Associated with Chikungunya Virus Infection.

Chikungunya is an arboviral infection caused by Chikungunya virus, an RNA virus from Togaviridae family.1 The disease manifests as fever, rash and characteristically, with arthralgia.1 Chikungunya is strongly believed to have neurotropism but has not been well studied like other neurotropic arboviruses.2 Encephalitis appears to represent the most common clinical manifestation6 and occurs either simultaneously or within few days of onset of systemic symptoms, during the period of viremia. A delay of more than two weeks has been reported with other complications like myelitis, Guillian Barre syndrome and optic neuritis. This case describes the clinical, serological, neuroimaging and CSF findings of Chikungunya induced acute transverse myelitis in a 13 years old male patient who responded to steroid treatment. It is a relatively unknown and very rare complication of Chikungunya virus infection during outbreak of Chikungunya infection in September 2016.

Paradigm shift in transfusion practices during early COVID-19 pandemic: A single center retrospective study.

BACKGROUND: The advent of coronavirus disease 2019 (COVID-19) unveiled the worst national blood crisis that the United States had witnessed in over a decade. With the pandemic influencing the different stages of the acquisition of blood products outside the hospital setting, we aimed to explore the possible barriers contributing to the shortage of blood products within the medical community. AIM: To assess the adherence to restrictive blood transfusion practices for patients in the COVID era and pre-COVID era. METHODS: We conducted a retrospective cross-sectional study on hospitalized patients distinguishing the pattern of blood transfusion during the COVID and pre-COVID era in a community hospital. Data was tabulated to include the number of red blood cell (RBC) transfusions and if transfusions met restrictive blood transfusion criteria as per institutional guidelines. Chi-square was applied to test the statistical association between qualitative variables. Unpaired t test and Mann Whitney U test were applied respectively to test the mean difference of quantitative variables. RESULTS: A total of 208 patients were included in the study, of which 108 were during COVID era and 100 were during pre-COVID era. The leading reason for admission in both the COVID era and pre-COVID era transfused patients was shortness of breath (53.7% and 36% P = 0.001), followed by gastrointestinal bleeding (25.9% and 21% P = 0.001). There was a higher percentage of RBC transfusions in the intensive care unit in the COVID-era group than in the pre-COVID era group (38.9% vs 22%, P = 0.008). The restrictive transfusion criteria were met in 62% vs 79% in the COVID and pre-COVID eras, respectively (P = 0.008). CONCLUSION: The COVID-era group received RBC transfusions with less stringent adherence to restrictive blood transfusion practices in comparison to pre-COVID era group.

Machine learning natural language processing for identifying venous thromboembolism: systematic review and meta-analysis.

ABSTRACT: Venous thromboembolism (VTE) is a leading cause of preventable in-hospital mortality. Monitoring VTE cases is limited by the challenges of manual medical record review and diagnosis code interpretation. Natural language processing (NLP) can automate the process. Rule-based NLP methods are effective but time consuming. Machine learning (ML)-NLP methods present a promising solution. We conducted a systematic review and meta-analysis of studies published before May 2023 that use ML-NLP to identify VTE diagnoses in the electronic health records. Four reviewers screened all manuscripts, excluding studies that only used a rule-based method. A meta-analysis evaluated the pooled performance of each study's best performing model that evaluated for pulmonary embolism and/or deep vein thrombosis. Pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with confidence interval (CI) were calculated by DerSimonian and Laird method using a random-effects model. Study quality was assessed using an adapted TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) tool. Thirteen studies were included in the systematic review and 8 had data available for meta-analysis. Pooled sensitivity was 0.931 (95% CI, 0.881-0.962), specificity 0.984 (95% CI, 0.967-0.992), PPV 0.910 (95% CI, 0.865-0.941) and NPV 0.985 (95% CI, 0.977-0.990). All studies met at least 13 of the 21 NLP-modified TRIPOD items, demonstrating fair quality. The highest performing models used vectorization rather than bag-of-words and deep-learning techniques such as convolutional neural networks. There was significant heterogeneity in the studies, and only 4 validated their model on an external data set. Further standardization of ML studies can help progress this novel technology toward real-world implementation.

An interesting case report of acute renal failure due to wasp bite.

Wasp bite usually presents with local complications. It may very unusually present with acute renal failure (ARF) and multiple organ dysfunctions. We present an interesting case of a 24-year-old female with multiple wasp bites all over the body leading to ARF, hepatic dysfunction, and rhabdomyolysis. Intensive hemodialysis and other conservative measures led to complete recovery. Proper management and early intervention is necessary for recovery from even drastic complication and is beneficial in terms of improvement of overall morbidity and mortality.