Prevalence of hospitalized women at high-risk for developing lung cancer.

BACKGROUND: Lung cancer screening with low-dose computer tomography (CT) has been shown to reduce the lung cancer mortality in high-risk individuals by 20%. Despite the proven mortality benefit, the utilization of lung cancer screening among high-risk populations remains low. OBJECTIVE: This study explores the prevalence of high-risk population for developing lung cancer among hospitalized women and evaluates the screening behavior toward other common cancers during a hospital stay. METHODS: This is a cross-sectional study in which 248 cancer-free hospitalized women aged 50-75 years who reported current or prior smoking were enrolled during hospital admission at an academic center. A bedside survey was conducted to collect socio-demographic, cancer screening behavior, and medical comorbidities for the study patients. Unpaired t-test and Chi-square tests were used to compare characteristics and common cancer screening behavior by lung cancer risk stratification. RESULTS: Forty-three percent of the hospitalized women were at intermediate to high-risk for developing lung cancer risk. Intermediate to high-risk women were more likely to be older, Caucasian, retired, or with a disability, and had higher comorbidity burden as compared to the low-risk group. Women at low and intermediate to high risk were equally non-adherent with breast (35% vs 31%, p = 0.59) and colorectal (32% vs 24%, p = 0.20) cancers screening guidelines. Only 38% of women from the intermediate to the high-risk group had a CT chest within the last year. CONCLUSION: The study's findings suggest that almost half of the hospitalized women who report current or past smoking are at high-risk for developing lung cancer.

Osmotic Demyelination After Rapid Correction of Hyperosmolar Hyperglycemia.

Osmotic demyelination syndrome (ODS) is seen due to an overt rise in serum osmolality, most often during rapid correction of chronic hyponatremia. We present the case of a 52-year-old patient who presented with polydipsia, polyuria, and elevated blood glucose with rapid correction of glucose levels under five hours and developed dysarthria, left-sided neglect, and unresponsiveness to light touch and pain in the left extremities on the second day of hospitalization. MRI revealed restricted diffusion in the central pons, extending into extrapontine areas suggestive of ODS. Our case highlights the importance of cautious correction of serum hyperglycemia and monitoring serum sodium levels in patients with a hyperosmolar hyperglycemic state (HHS).

Hospitalized Women's Willingness to Pay for Inpatient Screening Colonoscopy.

Background: Despite the proven mortality benefit of screening colonoscopy, ∼27% of hospitalized women are nonadherent with colorectal cancer (CRC) screening guidelines. Colonoscopy is the most frequently used test for CRC screening in the United States. Although CRC is the second most common cause of cancer death in the United States, CRC screening has not been part of usual hospital care. Objective: This study explores how hospitalized women perceive value of inpatient screening colonoscopy by evaluating the mean amount of money that hospitalized women are willing to contribute toward the cost of a screening colonoscopy during a hospital stay. Methods: A cross-sectional bedside survey consisting of a contingent valuation questionnaire was used to assess the contribution these women considered to be justified for the convenience of an inpatient screening colonoscopy. The probit regression model was used for the analysis of contingent valuation data to predict mean willingness to pay toward inpatient screening colonoscopy. Results: Of the 312 enrolled patients, 48% were willing to pay a mean of $171.56 (95% confidence interval [CI] $37.59-$305.54, p = 0.012) in advance toward the cost of an inpatient screening colonoscopy. After adjustment of possible sociodemographic and clinical covariates that could impact willingness to contribute, hospitalized women were willing to pay a mean of $178.41 (95% CI $40.67-$316.16, p = 0.011). Conclusions: The findings of this study suggest that hospitalized women value the prospect of screening colonoscopy during hospitalization. Offering screening colonoscopy to nonadherent hospitalized women, especially those who are at high risk for developing CRC, may improve adherence among hospitalized women.This study is registered at www.clinicaltrials.gov (NCT04162925).

Hereditary Angioedema Presenting as Isolated Jejunal Swelling.

Hereditary Angioedema (HAE) is a rare disorder caused by C1 esterase inhibitor deficiency or dysfunction. Patients with HAE usually present without urticaria or pruritis affecting the skin, upper airway, or the gastrointestinal tract. They can also present with involvement of unusual sites making the diagnosis challenging and leading to unnecessary testing and complications. Prompt diagnosis and treatment is crucial to prevent mortality and morbidity associated with acute flare. Here we present, what is believed to be second case of isolated involvement of the jejunum from an attack of HAE.

Effect of inpatient breast cancer education and risk assessment on mammography utilization among hospitalized women post discharge.

OBJECTIVE: To evaluate prevalence of nonadherence to breast cancer screening guidelines after bedside educational intervention and informed individualized risk assessment score during an inpatient stay. METHODS: A prospective intervention study was conducted among 507 cancer-free (except skin cancer) women aged 50-75 years hospitalized to a general medicine service. Study intervention included one-on-one bedside education via handout and videos about breast cancer screening and informed individualized risk assessment using the Gail risk model to predict 5-year risk for breast cancer development. Study outcomes were measured using posthospitalization follow-up survey to determine if intervention resulted in improved adherence to breast cancer screening. Chi-square and unpaired t-tests were utilized to compare population characteristics. RESULTS: The mean age for the study population was 60.5 years (SD = 6.9), the mean 5-year Gail risk score was 1.77 (SD = 1), and 36% of women were African American. One hundred sixty nine (33%) hospitalized women were nonadherent to breast cancer screening recommendations. Only 15% of the nonadherent women were reachable for follow-up survey, and 42% of these women self-reported adherence to screening mammography after a mean follow-up period of 27 months. CONCLUSION: This study provides evidence that most women who are nonadherent to breast cancer screening remain nonadherent after hospital discharge despite educational interventions. Our study intervention was only partially successful in enhancing breast cancer screening among hospitalized women who were overdue and at high risk. Further studies need to evaluate strategies to overcome the barriers and improve adherence whenever patients encounter health care system regardless of clinical locale.

Approach to pancytopenia: Diagnostic algorithm for clinical hematologists.

Pancytopenia is a relatively common phenomenon encountered in clinical practice. The evaluation of a patient with pancytopenia requires a comprehensive approach and identifying the underlying cause can be challenging given the wide range of etiologies including drugs, autoimmune conditions, malignancies, infections, hemophagocytosis, and inheritable conditions. Recent advances in molecular hematology which include genomic profiling and next-generation sequencing have helped gain major insights into various hematological conditions and can guide diagnosing specific diseases in a shorter time at lower costs. However the approach to manage patients with pancytopenia in the current era of genomics is not well defined in the literature and is widely variable in practice. Herein, we conducted a systematic review to help devise an algorithm and management approach for pancytopenia, which serves as a general consultative approach.

Pharmacological interventions for stress ulcer prophylaxis in critically ill patients: a mixed treatment comparison network meta-analysis and a recursive cumulative meta-analysis.

BACKGROUND: Proton pump inhibitors (PPI), histamine-2 receptor antagonists (H2RA), sucralfate and antacids are the commonly administered agents for stress ulcer prophylaxis (SUP) in critically ill patients. The authors of this paper have conducted a network meta-analysis to compare the efficacy of these agents in SUP. METHODS: Electronic databases were searched for randomized controlled trials, cohort studies and conference abstracts for studies comparing a SUP agent in critically ill patients to another active SUP agent or placebo. Overt, occult and clinically significant upper gastro-intestinal (UGI) bleeding, all-cause mortality, pneumonia, gastric colonization and ICU length of stay were considered as the outcome measures. A random effects model was used to generate pooled estimates. RESULTS: A total of 53 studies (4258 participants) were included. The pooled estimates were in favor of PPI and sucralfate for the overt UGI bleeding. PPI and H2RA bolus were associated with increased risk of gastric colonization and pneumonia. CONCLUSIONS: SUP in critically ill patients was not associated with any benefit with regard to clinically significant bleeding episodes. However, PPI and sucralfate significantly reduces overt UGI bleeding. On the contrary, PPI and H2RA bolus are associated with an increased risk of gastric colonization and pneumonia.

Predictors of recurrent hospital admissions among prostate cancer survivors.

Cancer survivors often have poor outcomes compared to their peers without cancer. Mortality from prostate cancer has been steadily decreasing, and these cancer survivors have other comorbidities that progress over time. Current study explores the type of admissions and associated risk factors with recurrent hospitalizations among prostate cancer survivors. A retrospective review of medical records was performed at a single academic institution for male patients aged 40 years and older who were diagnosed with prostate cancer more than 2 years prior to the study's observation period from January 2008 to December 2010. Unpaired t test and Chi-square tests were used to compare patients' characteristics, and logistic regression models were used to assess risk factors association with recurrent admissions. In total, 245 prostate cancer survivors were stratified by single versus recurrent hospital admission. The characteristics of the study population were similar to the exception of mean Gleason score that was lower, while cardiovascular admissions and clinical comorbidities were higher in the recurrent group. In the multivariable regression analyses where sociodemographic, primary prostate cancer treatment-related sequelae and clinical comorbid conditions were simultaneously analyzed, congestive heart failure (OR 3.90, 95% CI 1.25-12.2) and history of metastasis (OR 8.10, 95% CI 1.10-60.1) were associated with recurrent hospital admissions. Prostate cancer survivors experience a greater number of recurrent admissions, and therefore, understanding the nature of these admissions and associated medical comorbidities may help us in developing screening or preventive strategies to reduce the readmissions for this group of cancer survivors.

Medical hospitalizations in prostate cancer survivors.

The objectives of the study were to explore the context and reasons for medical hospitalizations among prostate cancer survivors and to study their relationship with obesity and the type of prostate cancer treatment. A retrospective review of medical records was performed at an academic institution for male patients aged 40 years and older who were diagnosed and/or treated for prostate cancer 2 years prior to the study's observation period from January 2008 to December 2010. Unpaired t test, ANOVA, and Chi-square tests were used to compare patients' characteristics, admission types, and medical comorbidities by body mass index (BMI) and prostate cancer treatment. Mean age for the study population was 76 years (SD = 9.2). Two hundred and forty-five prostate cancer survivors were stratified into two groups: non-obese (BMI < 30 kg/m(2)) and obese (BMI ≥ 30 kg/m(2)). The study population's characteristics analyzed by BMI were similar including Gleason score, presence of metastatic disease and genitourinary-related side effects. Only 13 % of admissions were for complaints related to their genitourinary system. Neither the specific treatment that the patients had received for their prostate cancer, nor obesity was associated with the reasons for their medical admission. Survivorship after having a diagnosis of prostate cancer is often lengthy, and these men are at risk of being hospitalized, as they get older. From this inquiry, it has become clear that neither body mass index nor prior therapy is associated with specific admission characteristics, and only a minority of such admissions was directly related to prostate cancer or the genitourinary tract.

Vanishing bile duct syndrome in a HIV patient on HAART therapy.

Vanishing bile duct syndrome refers to a group of disorders characterised by progressive destruction of the intrahepatic bile ducts resulting in cholestasis. It is a final common pathway for many disorders. The diagnoses is mainly made by histological findings. To consider a diagnosis there should be loss of interlobular bile ducts in more than fifty per cent of small portal tracts provided that the specimen contains at least 10 portal tracts. Here the authors present a case of vanishing bile duct syndrome which developed after initiation of highly active antiretroviral treatment therapy.