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.

Non-Small Cell Lung Cancer Presenting as Anterior Nasal Mass and Epistaxis.

Lung malignancy presentation with an uncommon metastatic site is a diagnostic challenge and often associated with poor prognosis. Nasal cavity is a rare metastatic site for any type of lung cancer. We report an unusual case of poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis presenting as a right vestibular nasal mass with epistaxis. A 76-year-old male patient with chronic obstructive pulmonary disease and 80 pack-year smoking history presented with spontaneous epistaxis. He reported a new rapidly growing right-sided nasal vestibular mass first noticed 2 weeks prior. Physical examination showed fleshy mass with crusting in right nasal vestibule along with a left nasal domus mass. Imaging revealed an ovoid mass in the right anterior nostril and a large mass in the right upper lobe of the lung (RULL) along with thoracic vertebral sclerotic metastasis and large left frontal lobe hemorrhagic lesion with severe vasogenic edema. Positron emission tomography scan showed large right upper lobe mass and suspected to be the primary malignancy along with widespread metastasis. Biopsy of the nasal lesion revealed poorly differentiated non-small cell carcinoma with squamous and glandular features. The diagnosis of very poorly differentiated adenosquamous carcinoma of the lung with widespread metastasis was made. In conclusion, unusual metastatic sites with unknown primary lesions require a thorough diagnostic workup involving biopsy and extensive imaging. Lung cancer with unusual metastatic sites is inherently aggressive and associated with poor prognosis. Multidisciplinary treatment modalities should be employed keeping in view the functional status and comorbidities of the patient.

"Tear Drops in the Duodenum": Uncommon Cause of Iron Deficiency Anemia in Adults.

A 64-year-old man presented to the internal medicine resident clinic with fatigue and abdominal pain of six-month duration. He did not have diarrhea, hematemesis, melena, or hematochezia. Physical examination was unremarkable. Laboratory findings were consistent with iron deficiency anemia. Upper and lower gastrointestinal (GI) endoscopies revealed normal findings. Duodenal biopsy showed trophozoites (tear-drop-shaped) morphologically consistent with Giardia duodenalis. He was prescribed metronidazole and iron replacement therapy, with a resultant improvement in symptoms as well as lab values at the four-month follow-up visit.

Rheumatoid Vasculitis: Is It Always a Late Manifestation of Rheumatoid Arthritis?

Rheumatoid vasculitis (RV) is an infrequent complication of longstanding severe rheumatoid arthritis (RA). The active vasculitis associated with rheumatoid disease occurs in about 1%-5% of the patient population. RV is a manifestation of "extra-articular" rheumatoid arthritis and involves the small- and medium-sized arteries in the body. Newer RA treatments, including biologic therapies, offer a broader array of potential therapeutic options, although no controlled trials exist to guide treatment. In general, following tissue confirmation of the diagnosis, the severity of organ involvement and disease manifestations can guide treatment decisions. We want to alert clinicians of this unique yet severe complication of RA which has high morbidity and mortality. We describe a thought-provoking case of a 44-year-old male with past medical history (PMH) of hypertension who presented with over three-month history of lower extremity (LE) swelling, discoloration, and ulceration. Arthralgias with constitutional symptoms (fatigue, weight loss), large pericardial effusion, was found to have leukocytoclastic vasculitis along with rheumatoid factor (RF) >650, and anti-cyclic citrullinated peptide (anti-CCP) antibodies >300, low C4 and normal C3. Pericardial fluid appeared serous, exudative, showed histiocytes, multinucleated giant cells and necrotic debris consistent with rheumatoid effusion. Skin, right shin, punch biopsy showed epidermal necrosis from underlying occlusive vasculopathy. Skin, left lower back, punch biopsy showed focal leukocytoclastic vasculitis. The patient was started on high dose steroids with marked improvement in the symptoms, Rituximab was planned awaiting QuantiFERON to be negative. Pan-CT angiography of the whole body was negative for any vascular changes ruling out polyarteritis nodosa (PAN).

Relationship Between Thyroid Hormone Levels and Mean Platelet Count and Volume: Quantitative Assessment.

Background The hormones of the hypophysis-thyroid axis (HTA), thyroid stimulating hormone (TSH), and thyroid hormones, L-thyroxine (T4) and 3, 3', 5-L-triiodothyronine (T3), modulate the metabolism, differentiation, and proliferation of almost every cell in the body. Several studies have examined the effect of HTA hormones on platelet count and mean platelet volume (MPV), but have reported inconsistent results. Our aim was to examine the association between HTA hormones and platelet count and MPV in a large cohort of the adult population of the United States. Methods  We used the continuous National Health and Nutritional Examination Survey (NHANES) which made available data on HTA hormones (1999-2000, 2001-2002, 2007-2008, 2009-2010, and 2011-2012) to examine the association between HTA hormones and platelet count and MPV. Analyses were performed with adjustments for the complex survey sampling methods of NHANES data. Unadjusted and adjusted generalized linear regressions were performed to examine the relationship between HTA hormones and platelet count and MPV. Regression models were adjusted for age, sex, race, alcohol use, smoking status, serum c-reactive protein, red blood cell folate, diabetes mellitus, glomerular filtration rate, body mass index, and hypertension. Results Of the 10,619 individuals eligible for inclusion in the analyses, 5,267 (49.6%) were females and 2,132 (20.08%) were African Americans. The mean ± standard deviation of platelet count was 256.4 ± 67.1 109/L, MPV 8.04 ± 0.92 fL, serum T4 7.92 ± 1.68 mg/dL, and serum T3 114.08 ± 24.6 ng/dL. In unadjusted analyses, an increase in the serum levels of T4 or T3 was associated with a significant increase in the platelet count and MPV (all p-values < 0.05). In contrast, an increase in serum TSH level was associated with a significant decrease in the platelet count (p-value = 0.05) but had no effect on MPV. After adjustment for potential confounders, serum T4 levels were significantly associated with platelet count but not with MPV. Individuals in the lowest quartile of T4 had 18.73 x 109/L lower platelet count than individuals in the upper-most quartile (p-value = 0.03). Serum TSH and serum T3 levels had no effect on platelet count or MPV after adjusting for potential confounding variables. Conclusions We report that only serum T4 levels, and not TSH or T3 levels, are independently associated with platelet count and there is no independent association between HTA hormones and MPV. Our findings suggest a possible role of serum T4 on thrombopoiesis or on platelet lifespan.