Unusual presentation of JAK2-negative polycythemia

Polycythemia vera is a relatively rare disease occurring in 0.02–2.8 per million population. Globally, about 95% of PV is dueto JAK2V617F mutation in the chromosome 9p. The remaining 5% were found to have a wide range of mutations includingJAK2 exon12 mutation and calreticulin (CALR) mutation. In India, the incidence of JAK2-negative polycythemia is relativelyhigh, reaching up to 18%. Polycythemia usually presents as symptoms secondary to hyperviscosity or as symptoms secondary toincreased histamine release by the cells. Herein, we describe a 46-year-old Indian male presented with a headache and found to bein hypertensive urgency, which was later found to be secondary to JAK2-negative polycythemia

Thoracic Ewing\u27s Sarcoma: A Case Report

Ewing\u27s sarcoma family of tumors (ESFTs) contains multiple tumors with similar histological and immunohistochemical features. ESFTs are small, round cell, highly malignant tumors that arise from the neuroectoderm of bone and extraskeletal soft tissue. Ewing\u27s sarcoma is the second most common primary malignant bone cancer in children and adolescents, with the second decade of life being the most common age of diagnosis. In this article, we present a case of a young male who presented to the emergency department complaining of shortness of breath and cough and was later diagnosed with Ewing\u27s sarcoma of the chest wall, which is also called Askin\u27s tumor, and it is an extremely rare disease with only 17 cases reported in the literature

Lung Cancer in Tennessee

Introduction Lung cancer is the most common cause of cancer-related death in the United States (US). Tobacco smoking is a well-recognized cause of lung cancer. About 2% of the United States (US) population lives in Tennessee (TN). Nearly 21 % of TN adults are current smokers as per 2019 data, compared to 14% across the US. The percentage of smokers has historically been high in TN and its surroundings. This can be attributed to the area\u27s socio-economic and cultural characteristics, along with large areas of tobacco farming in the region. This increases the risk of lung cancer in the TN population. Surveillance Epidemiology and End Results Program (SEER) is a collection of cancer registries across the US, covering about 35% of the US population (TN cancer registry is not a part of SEER). Our study compares lung cancer incidence and characteristics in the TN cancer registry with the SEER 18 registry. Materials and Methods Data were collected from the TN cancer registry and SEER separately for lung and bronchial cancer. Data was analyzed for different histological subtypes, age groups, gender, stage at diagnosis, and rural/urban residence. Stata and Microsoft Excel were used in data analysis. A Chi-square test was used to calculate the statistical significance. Results From 2008 to 2017, 58644 cases of lung cancer were reported in the Tennessee cancer registry. During the same period, 519112 cases were reported in the SEER registry. The most frequent histological subtype of lung cancer in TN and SEER was adenocarcinoma (frequency of 17,503 Vs. 182346), followed by squamous cell carcinoma and small cell carcinoma. Most cancers in TN and SEER were diagnosed at stage of distant metastasis (46% vs. 52% ), followed by regional metastasis, localized, and in situ (Image1). The frequency of lung cancer diagnosis was high among those older than 65 in TN and SEER (64% vs. 69%). Males had a higher incidence of lung cancer in both registries. Most lung cancers were reported in the urban area in both registries. Chronic obstructive pulmonary disease was the most commonly reported secondary diagnosis (3,099), followed by pleural effusion in the TN database; the comparable data were not available in SEER. Relative survival at 12 months and five years for lung cancer in TN were 46.6 % and 19.5 % (Vs. 46.4% and 19.9% in SEER) Discussion and Conclusion If both registries were perfect, then lung and bronchial cancer incidence will be 9241 and 6048 per million in ten years in TN and SEER, respectively. But after careful analysis, we conclude that such analysis will be erroneous. The proportion of different histological types, stage at diagnosis, age groups, and gender were in the same order in both groups. Although chi-square test values are significant for all the variables, we infer no conclusion considering the data\u27s inherent bias. Further in-depth analysis of the data is required

Trends in Inhaler Prescriptions and Associated Cost in the United States From 2014 to 2018: An Analysis From the Medicare Part D Database

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) and asthma constitute the majority of the pulmonary disease burden in the United States. Various kinds of inhalers are used for treating both these conditions, and Medicare is the biggest payer for them. We analyze the trend in prescriptions and associated expenses of various inhaler prescriptions from 2014 to 2018 using the Medicare part D database. METHODS: Medicare part D data is analyzed for the years 2014-2018. Inhalers are grouped based on their drug class. The number of beneficiaries and the associated expenses for each inhaler and the groups were calculated separately and analyzed using statistical software. RESULTS AND CONCLUSION: Some 85 million beneficiaries received inhalers through Medicare part D over the four years. Medicare spent 50.5 billion US dollars on these prescriptions, which showed an increase of 130% users and 128% expenditure over the four years. Medicare\u27s expense for inhaler prescriptions is growing and is expected to increase even more in the near future