RESUMO
BACKGROUND: We examined whether hospital resources mediated the association between race/ethnicity and postoperative VTE, in a national cohort. METHODS: National Inpatient Sample data were restricted to major abdominal surgeries (1993-2020) performed for malignancies. Hospital resource index was as a summary measure of hospital size, teaching status, and private payor proportions. The composite VTE outcome included postoperative deep vein thrombosis and pulmonary embolism. Adjusted logistic regression with 4-way decomposition described joint and mediating effects. RESULTS: Among 1,169,862 surgeries, unadjusted VTE rate was 1.0 â% (14,789). VTE risk was 28 â% higher for Black/African Americans (adjusted Odds Ratio â= â1.28, 95 â% CI: 1.21, 1.37) relative to White/Caucasians. VTE risk was lower among Black individuals as hospital resource index increased (excess risk â= â-0.005, p â< â0.001), with an effect size of likely minimal clinical impact. CONCLUSION: Cohorts that are more vulnerable to postoperative VTE did not meaningfully benefit from improving hospital resources. It is likely that lifestyle modifying behaviors, environmental factors, and comorbidity management are more influential in reducing risks.
RESUMO
Drug-induced liver injury (DILI) presents a significant challenge in clinical practice, particularly with the rising popularity of herbal and dietary supplements (HDS) in the United States. Tongkat Ali (Eurycoma longifolia Jack), a Southeast Asian herb, has garnered attention for its purported health benefits, including enhancing testosterone levels. Here, we present a case of a 47-year-old male with acute liver injury following Tongkat Ali use, the first reported case of its kind in the literature. The patient exhibited worsening scleral icterus, elevated liver enzymes, and jaundice shortly after initiating Tongkat Ali supplementation, prompting hospitalization and subsequent clinical improvement upon discontinuation of the supplement. Differential diagnosis and exclusion of other etiologies were essential in establishing the causal link between Tongkat Ali consumption and liver damage, underscoring the difficulty in diagnosing HDS-induced liver injury. The rise in DILI cases parallels the expanding use of nutraceuticals, necessitating vigilance among healthcare professionals. While mechanisms of herbal-induced liver injury remain unclear, genetic predisposition and metabolic factors may be implicated. This case emphasizes the importance of heightened awareness among healthcare providers regarding the potential hepatotoxic effects of herbal supplements, particularly in individuals consuming multiple agents. Further research into the safety profile and mechanisms of Tongkat Ali-induced liver injury is warranted to inform clinical management and promote safer supplement use.
RESUMO
Body composition is increasingly recognized as an important factor in cancer outcomes. Use of computed tomography (CT) in cancer care provides the opportunity to accurately quantify whole-body lean and adipose tissues from images at the third lumbar spine. We sought to substantiate the use of routinely captured, single-slice chest CT images at the thoracic level for evaluation of skeletal muscle, residual lean tissue, and adiposity among pediatric solid tumor patients. We performed a retrospective analysis among children who underwent treatment for a solid tumor at Columbia University Irving Medical Center. Skeletal muscle (SM), residual lean tissue (RLT), and adipose tissue cross-sectional areas (cm2 ) were analyzed at diagnosis and at first follow-up for disease evaluation (6-14 weeks). Imaging analysis was performed utilizing slice-O-matic image analysis software. Of the 57 patients identified, 39 had chest CT imaging that included intervertebral level T12-L1, and 22 also had concurrent imaging at L3. Correlation coefficients between body composition variables at T12-L1 and L3 were strong (r = 0.93-0.98). Paired t-test showed a significant decrease in SM (-4.2 ± 8.12, p = 0.003) and RLT (-10.7 ± 28.5, p = 0.025) as well as a trend toward a significant increase in visceral adipose tissue (3.10 ± 9.65, p = 0.052). Univariable analysis demonstrated a significant association between increasing age and increased SM loss (ß = -0.496 with SE = 0.194, p = 0.011), and a lack of association between body mass index and body composition changes. We provide the first line of evidence that single-slice images from routinely obtained chest CT scans provide a simple, readily available mechanism for assessing body composition in pediatric solid tumor patients. Adverse body composition changes were observed, particularly among adolescents and young adults. Precis: Changes in body composition can be detected via routine CT images in pediatric patients undergoing treatment for solid tumors.