Pembrolizumab-Associated Stevens-Johnson Syndrome in a Patient With Metastatic Non-small Cell Lung Cancer: A Case Report.

Pembrolizumab is a monoclonal antibody that binds to the programmed cell death-1 (PD-1) receptor and is approved for the treatment of several malignancies. We present a rare case of Stevens-Johnson syndrome (SJS) occurring in a 75-year-old female 14 days after receiving the first dose of pembrolizumab therapy to treat stage IV non-small cell carcinoma of the lungs with metastasis to the brain. Although pruritus and papular, erythematous rashes are documented after its use, severe reactions such as SJS and toxic epidermal necrolysis (TEN) are rarely seen in clinical practice. In addition to supportive care, the patient also received intravenous immunoglobulin (IVIG) and corticosteroid therapy and responded well to the therapy. Nearly complete re-epithelialization was achieved four weeks after the start of skin lesions. This case highlights a rare phenomenon of SJS- and TEN-associated adverse reactions following treatment with pembrolizumab.

ECG Interpretation Proficiency of Healthcare Professionals.

ECG interpretation is essential in modern medicine, yet achieving and maintaining competency can be challenging for healthcare professionals. Quantifying proficiency gaps can inform educational interventions for addressing these challenges. Medical professionals from diverse disciplines and training levels interpreted 30 12-lead ECGs with common urgent and nonurgent findings. Average accuracy (percentage of correctly identified findings), interpretation time per ECG, and self-reported confidence (rated on a scale of 0 [not confident], 1 [somewhat confident], or 2 [confident]) were evaluated. Among the 1206 participants, there were 72 (6%) primary care physicians (PCPs), 146 (12%) cardiology fellows-in-training (FITs), 353 (29%) resident physicians, 182 (15%) medical students, 84 (7%) advanced practice providers (APPs), 120 (10%) nurses, and 249 (21%) allied health professionals (AHPs). Overall, participants achieved an average overall accuracy of 56.4% ± 17.2%, interpretation time of 142 ± 67 seconds, and confidence of 0.83 ± 0.53. Cardiology FITs demonstrated superior performance across all metrics. PCPs had a higher accuracy compared to nurses and APPs (58.1% vs 46.8% and 50.6%; P < 0.01), but a lower accuracy than resident physicians (58.1% vs 59.7%; P < 0.01). AHPs outperformed nurses and APPs in every metric and showed comparable performance to resident physicians and PCPs. Our findings highlight significant gaps in the ECG interpretation proficiency among healthcare professionals.

Nitrofurantoin-Associated Acute Granulomatous Interstitial Nephritis.

We report the case of a 71-year-old female who was incidentally found to have nonoliguric acute kidney injury on a routine workup for new-onset visual hallucination. Further history revealed inadvertent usage of nitrofurantoin for 3 months for an anticipated urological procedure. Renal biopsy demonstrated acute granulomatous interstitial nephritis. The renal function significantly improved following discontinuation of nitrofurantoin and corticosteroid administration. We highlight a rare association of nitrofurantoin with acute granulomatous interstitial nephritis through this case report.

Tobacco smoking-associated risk for tuberculosis: a case-control study.

Tobacco smoking as a risk factor for tuberculosis (TB) is often ignored. This study was carried out to study tobacco smoking-associated risk for tuberculosis. Ninety-five patients with TB, admitted in the Himalayan Institute Hospital, Dehradun, India and 190 controls were randomly selected and questioned regarding their smoking status and type, quantity and duration of tobacco used. Pulmonary tuberculosis (PTB) was present in 57.8%, extra-pulmonary tuberculosis (EPTB) in 26.3% and disseminated TB in 15.7% cases. The odds ratios (ORs) for association of smoking tobacco (cigarette and beedi [a thin, Indian cigarette made of flaked tobacco wrapped in a rectangular piece of dried Diospyros melanoxylon leaf] collectively), cigarette and beedi with TB were 3.53 (P < 0.0001), 1.65 (P = 0.337) and 4.49 (P < 0.0001) respectively. The ORs for PTB, EPTB and disseminated TB among smokers were 3.44 (P = 0.0001), 3.56 (P = 0.0067) and 2.51 (P = 0.145) respectively. The OR for sputum positivity for acid fast bacilli (AFB) among smokers was 4.65 (P = 0.0001). The ORs for a positive association with TB increased with duration of smoking (P < 0.0001) and number of cigarettes/beedis smoked (P < 0.0001). Univariate analysis showed a significant association between TB and other confounding risk factors viz., previous TB contact (OR 6.93, P = 0.0001), previous TB infection (OR 38.27, P < 0.0001) and malnutrition (OR 3.77, P = 0.0032). In multivariate analysis using a logistic regression model, factors independently associated with TB were smoking (OR 3.05, P = 0.000), previous TB contact (OR 6.52, P = 0.001), previous TB infection (OR 37.72, P = 0.001) and malnutrition (OR 3.73, P = 0.009). Therefore, smoking has a strong association with PTB and EPTB but not with disseminated TB. Significant association exists between beedi smoking and TB but not between cigarette smoking and TB. The risk for TB depends upon dose, duration and type of tobacco smoked.