Online medical crowdfunding in the United States: a cross-sectional analysis of gendered cancer campaign outcomes

This cross-sectional analysis examined online US crowdfunding campaigns from 2010–2018. Campaigns including prostate, breast, bladder, kidney, cervical, uterine, ovarian, testicular, oral, and thyroid cancers were included. Multivariable modeling was utilized to examine predictive factors for successful campaigns. A total of 1830 online cancer campaigns were included in the final analysis. Breast cancer was estimated to be the most frequent online campaign type (n = 3682), followed by cervical (n = 492), kidney (n = 475), ovarian (n = 460), and prostate cancers (n = 382). Breast cancer campaigns generated the most total funding ($15.3 million). In adjusted models, breast cancers generated significantly more donations per campaign than any other cancer. There was no difference in the average amount of funds raised per campaign by most cancer types, except for thyroid (19.4% less than breast, p < 0.001). Friend-authored campaigns generated more funding than self- and family-authored. Male cancers are under-represented, and breast cancer campaigns are disproportionately over-represented in online medical crowdfunding and generate more donations than many other cancers. Gendered differences in cancer crowdfunding are likely multifactorial and may be influenced by social networks and public health campaigns

Cushioning the blow: role of perirenal fat in renal trauma injury severity

ObjectivesTo explore the association between perirenal fat thickness (PFT) and renal trauma grade. We hypothesise this association is related to a shock-absorbing effect of adiposity around the kidney.Patients and methodsWe identified all patients with renal trauma who arrived at the emergency department of a single trauma centre between 2014 and 2020. Radiology images were reviewed to measure the PFT around the uninjured kidney due to disrupted PFT around the traumatised kidney. Patients with no available images or penetrating trauma mechanism were excluded. Logistic regression was used to assess the relation between PFT and high-grade renal trauma (HGRT; defined as American Association for the Surgery of Trauma Renal Grade IV-V), adjusting for age, sex, and Injury Severity Scale (ISS).ResultsA total of 150 patients with renal trauma were included. The median (interquartile range) age was 38.5 (26-52) years and 106 (70.7%) were males. The PFT ranged between 2.1 and 50.1 mm, and 31 (20.7%) had HGRT. Interestingly, PFT only mildly correlated with body mass index (BMI; Pearson correlation coefficient 0.42, P &lt; 0.001). Those with HGRT had significantly lower PFT compared to those without HGRT (median 9.5 vs 11.9 mm, P = 0.047). In the multivariable analysis adjusting for age, sex, and ISS, increasing PFT was associated with decreased odds (odds ratio 0.91, 95% confidence interval 0.84-0.98; P = 0.015) of HGRT.ConclusionIncreasing PFT is associated with lower risk of HGRT following blunt injury. These results support a protective cushion role of adiposity in renal trauma. Notably, PFT was not strongly correlated with BMI, underscoring limitations of BMI in measuring adiposity

Impact of the COVID-19 pandemic on emergency department visits for genitourinary trauma.

IntroductionThe mean number of emergency department visits for all-cause traumas has declined significantly during the COVID-19 pandemic. We aim to identify how a global pandemic and social distancing could affect the trends and pattern of genitourinary traumas.MethodsWe queried the National Electronic Injury Surveillance System to obtain consumer product-related genitourinary injuries leading to emergency department visits. Using three key events in 2020, we divided the study period to three intervals: January 20, when the first COVID-19 case was confirmed in the United States; March 13, when a national state of emergency was declared; April 20, when Texas became the first state to start a phased reopening of economy. We compared the injury characteristics in 2020 to their identical intervals in 2019.ResultsDaily emergency department visits dropped significantly during the national lockdown (mean 131.5 vs. 78; Δ-40.7%; p &lt; 0.01). The genitourinary injuries decreased significantly in children ≤ 17&nbsp;years (p &lt; 0.01), males (p &lt; 0.001), and White population (p &lt; 0.01). However, it did not change significantly in adults 18-64&nbsp;years (p = 0.92), old adults ≥ 65&nbsp;years (p = 0.37), females (p = 0.60), Black population (p = 0.90), other/unknown races (p = 0.93), and for injuries sustained at home (p = 0.75) and public (p = 0.11) locations. During the lockdown period, injuries associated with toilets/toilet seats (- 320, - 74.6%), day wear (- 266, - 77.7%), beds/bedframes (- 209, - 64.2%) decreased while injuries associated with knickknacks/statues/vases (+ 154, n/a), sofas/couches/divans (+ 130, 2,684%), and razors/shavers (+ 99, n/a) increased.ConclusionsThe COVID-19 lockdown had a significant impact on genitourinary traumas. The contributing factors could be investigated further to prevent such injuries during deconfinement periods

Adverse reactions of PDE5 inhibitors: An analysis of the World Health Organization pharmacovigilance database.

BackgroundDespite their efficacy and general safety, rare but devastating adverse drug reactions have been associated with phosphodiesterase type 5 inhibitors.ObjectivesTo determine the safety profile of oral phosphodiesterase type 5 inhibitors with a particular focus on priapism and malignant melanoma.Materials and methodsIn this case-non-case study, we queried the individual case safety reports for phosphodiesterase type 5 inhibitors within the World Health Organization global database of individual case safety reports (VigiBase) between 1983 and 2021. We included all individual case safety reports for sildenafil, tadalafil, vardenafil, and avanafil in men. For comparison, we also extracted the safety data from the Food and Drug Administration trials for these drugs. We assessed the safety profile of phosphodiesterase type 5 inhibitors by disproportionality analysis by measuring reporting odds ratio for their most commonly reported adverse drug reactions, once for all phosphodiesterase type 5 inhibitor reports and once for reports of oral phosphodiesterase type 5 inhibitor use in adult men (≥18 years old) with sexual dysfunction.ResultsA total of 94,713 individual case safety reports for phosphodiesterase type 5 inhibitors were extracted. A total of 31,827 individual case safety reports were identified relating to adult men taking oral sildenafil, tadalafil, vardenafil, or avanafil for sexual dysfunction. The most common adverse drug reactions included poor drug efficacy (42.5%), headache (10.4%&nbsp;vs. 8.5%-27.6% [Food and Drug Administration]), abnormal vision (8.4%&nbsp;vs. ≤4.6% [Food and Drug Administration]), flushing (5.2%&nbsp;vs. 5.1%-16.5% [Food and Drug Administration]), and dyspepsia (4.2%&nbsp;vs. 3.4%-11.1% [Food and Drug Administration]). Priapism showed significant signals for sildenafil (reporting odds ratio&nbsp;=&nbsp;13.81, 95% confidence interval: 11.75-16.24), tadalafil (reporting odds ratio&nbsp;=&nbsp;14.54, 95% confidence interval: 11.56-18.06), and vardenafil (reporting odds ratio&nbsp;=&nbsp;14.12, 95% confidence interval: 8.36-22.35). Comparing with other medications in VigiBase, sildenafil (reporting odds ratio&nbsp;=&nbsp;8.73, 95% confidence interval: 7.63-9.99) and tadalafil (reporting odds ratio&nbsp;=&nbsp;4.25, 95% confidence interval: 3.19-5.55) had significantly higher reporting odds ratios for malignant melanoma.ConclusionPhosphodiesterase type 5 inhibitors show significant signals correlating with priapism among a large international cohort. Further clinical study is needed to elucidate whether this is from proper or inappropriate use or other confounding conditions, as analysis of pharmacovigilance data does not allow for quantifying the clinical risk. Also, there appears to be a relationship between phosphodiesterase type 5 inhibitor use and malignant melanoma, which warrants additional study to better understand causation