Analyzing multiple risk factors in patients with sarcomas A case-control study

CONTEXT: Sarcomas are a rare group of malignancies. Very little is known about their risk factors. AIMS: The aim was to evaluate different risk factors in patients with sarcomas and to determine the median age at diagnosis, differences in race, gender, histological grades and staging in sarcoma patients. SETTINGS AND DESIGN: A retrospective case-control study was conducted in a tertiary care hospital in the USA. This included patients diagnosed with sarcomas from year 2000 to 2010. MATERIALS AND METHODS: Data were extracted with the help of electronic medical records using International Classification of Diseases, Ninth revision codes. Healthy, matched controls were randomly selected from the same tertiary care hospital database. STATISTICAL ANALYSIS: Univariate comparisons between cases and controls were done using a two-group independent t-test for age and using Chi-square tests for the categorical variables. In order to identify possible independent predictors of sarcomas, a multiple logistic regression model was constructed using sarcoma status as the dependent variable and using, initially, all variables with a univariate P \u3c 0.2 as independent variables. Variables were reduced in a manual stepwise manner to arrive at a final model. Statistical significance was set at P \u3c 0.05. All analyses were performed using SAS 9.4 (SAS Institute Inc., Cary, NC, USA). RESULTS: A total of 425 sarcoma patients and 429 age, sex and race matched healthy controls were analyzed in this study. We found that a history of smoking and alcoholism was significantly associated with sarcomas. We also found that the history of cancer in first-degree relatives had a significant relationship. In addition, patients with sarcomas are more likely to have a history of another malignancy when compared with controls. CONCLUSIONS: Smoking and alcohol are potential risk factors for sarcomas. In addition, a history of cancer in the first-degree relative is also a potential risk factor. Patients with sarcomas are likely to have a history of another malignancy when compared with controls

Lenalidomide maintenance therapy after autologous peripheral blood stem cell transplant (pbsct) in multiple myeloma patients: Factors that impact treatment.

Background: Lenalidomide maintenance after an Autologous PBSCT is an important part of therapy offered in the management of patients with Multiple myeloma.We set out to perform a study to assess the clinical application of Lenalidomide maintenance in the post-transplant setting.We assessed all factors cited by physicians as a reason to offer, not offer, or discontinue maintenancetherapy. Patient factors were also studied in regards to reasons for starting, continuing, or discontinuing Lenalidomidemaintenance therapy post-transplant. Methods: This study was IRB approved by the Henry Ford Cancer Institute. A retrospective chart review of 128 consecutive patients who received Autologous PBSCT at our institution was conducted between the time periods of March 2010 to December 2016. Results: In patients that were eligible and offered Lenalidomide maintenance afterAutologous PBSCT, 70% (70/99) received maintenance therapy (see Table 1). The trend to offer Lenalidomide maintenancetherapy in patients post PBSCT increased from45% to nearly 80% by 2016 (see Table 2). By June of 2015, 45 patients had started maintenance, of which 42% completed 2 years of maintenance by June of 2017. There were 14% (10/70) of patients who received maintenance therapy until progression, while 20% (14/70) continue to be on maintenance without significant side effects. Neutropenia or thrombocytopenia accounted for 20% (14/70) of patients discontinuing maintenance therapy. In our patient population, there were no reports of secondary malignancies. Twenty two percent (29/128) of patients declined maintenancetherapy. Of these 29 patients 65% (19/29), did not have a specified reason documented for declining therapy in their charts. In maintenance eligible patients, 22% (29/128) were not offered maintenance therapy. Of these patients, 24% (7/29) had no documented reason, another 24% were not offered maintenance due to stringent complete response (sCR), and 20% (6/29) due to progressive disease (PD). Conclusion: We set out to study real world application of Lenalidomide maintenance post autologousPBSCT based on both patient and physician factors. Physician preference for not offering maintenance therapy appeared to be based on achievement of sCR or in the setting of PD. This preference was mainly documented until 2013. After 2013, the trend to offer Lenalidomide maintenance therapy in patients increased from45% to nearly 80% by 2016, suggesting increasing influence of emerging data on Lenalidomide maintenance therapy post autologous PBSCT. We also noted that neutropenia and thrombocytopenia were important factors for discontinuation of maintenance therapy, similar to the 20% incidence of most commonly reported grade 3 and 4 adverse events with IFM 2005-02 and CALGB 100104 study. Figure 1. Overall survival in lymphoma patients with stem cell transplantation from 2012 to 2016, stratified by GFR cutoff of 90 mL/min

Effect of follow-up appointments and admission unit on readmissions in patient with cancer on chemotherapy: A tertiary center experience.

Background: Readmissions are a huge burden on patients and organizations, especially in light of the newly emerging bundled payment systems. Many interventions have been proposed to reduce readmissions, including admitting patients to a cancer-specific unit (CSU) and scheduling follow-up appointments after discharge. Methods: We conducted a retrospective cohort study to identify the effect of admission unit and follow-up appointments on readmissions within 30 days among cancer patients receiving outpatient chemotherapy. We included unplanned admissions between July and October 2016 at Henry Ford Hospital. Results: There were 232 inpatient admissions. Of those, 73 (31%) were readmitted. The number of admissions to the CSU was 100 (43%) compared to 132 admissions (57%) to other general practice units (GPUs). Mean length of stay was 5.8 (1-29) days and 3.8 (1-30) days, respectively. Most common malignancies were hematological (27% and 22%) and gastrointestinal (26% and 19%). The most common reasons for admissions were infections (29% and 28%) and pain management (19% and 12%). Of patients who were admitted to the CSU, 24 (24%) were readmitted compared to 49 (37%) for other GPUs, OR 0.53 (95% CI:0.3-0.95, p = 0.033). Readmission rates were also calculated based on the type of appointment scheduled within 30 days of discharge (Primary care (PCP) and oncology, PCP only, Oncology only and neither). Odds ratios of readmission were calculated for the last three categories in comparison to having both appointments. Of admissions that had both appointments, 15 (23%) had a readmission within 30 days. Of admissions that had oncology only appointments, 39 (33%) had a readmission; OR 1.6 (95% CI: 0.8 to 3.3, p = 0.15). Of admissions that had a PCP only appointment, 6 (42%) had a readmission; OR 2.5 (95% CI: 0.7 to 8.3, p = 0.13) and of admissions that had neither appointments, 12 (57%) had a readmission; OR 4.4 (95% CI 1.6 to 12.6, p = 0.0049). Conclusions: Care for cancer patients is challenging as they carry a high risk of readmission, admitting cancer patients to cancer-specific units significantly reduces that risk. Having no follow-up appointments carries a high risk of readmission

Warfarin Dosing and Time Required to Reach Therapeutic International Normalized Ratio in Patients with Hypercoagulable Conditions

OBJECTIVE: The purpose of this study was to analyze the difference in duration of anticoagulation and dose of warfarin required to reach a therapeutic international normalized ratio [(INR) of 2 to 3] in patients with hypercoagulable conditions as compared to controls. To our knowledge, this study is the first in the literature to delineate such a difference. MATERIALS AND METHODS: A retrospective chart review was performed in a tertiary care hospital. The total study population was 622. Cases (n=125) were patients with a diagnosis of a hypercoagulable syndrome who developed venous thromboembolism. Controls (n=497) were patients with a diagnosis of venous thromboembolism in the absence of a hypercoagulable syndrome and were matched for age, sex, and race. RESULTS: The total dose of warfarin required to reach therapeutic INR in cases was higher (50.7±17.6 mg) as compared to controls (41.2±17.7 mg). The total number of days required to reach therapeutic INR in cases was 8.9±3.5 days as compared to controls (6.8±2.9 days). Both of these differences were statistically significant (p\u3c0.001). CONCLUSION: Patients with hypercoagulable conditions require approximately 10 mg of additional total warfarin dose and also require, on average, 2 extra days to reach therapeutic INR as compared to controls

VZV encephalitis following successful treatment of CMV infection in a patient with kidney transplant

A 73-year-old woman with a history of deceased donor kidney transplantation and a recent cytomegalovirus (CMV) infection, presented to the emergency department with an altered mental status. She was found to have varicella zoster virus VZV encephalitis based on cerebrospinal fluid analysis and was treated successfully with intravenous valaciclovir with an improvement in her mental status. A review of the literature shows very few case reports on patients with kidney transplantation developing VZV encephalitis. A few case reports and studies report an association between CMV and VZV infection. In these patients, CMV infection can cause a marked decline in immunity and this predisposes them to other infections. Such associations have also been reported between other types of virus infections from the Herpesviridae family. The risk of disseminated VZV infection increases in the presence of CMV infection

VZV encephalitis following successful treatment of CMV infection in a patient with kidney transplant

A 73-year-old woman with a history of deceased donor kidney transplantation and a recent cytomegalovirus (CMV) infection, presented to the emergency department with an altered mental status. She was found to have varicella zoster virus VZV encephalitis based on cerebrospinal fluid analysis and was treated successfully with intravenous valaciclovir with an improvement in her mental status. A review of the literature shows very few case reports on patients with kidney transplantation developing VZV encephalitis. A few case reports and studies report an association between CMV and VZV infection. In these patients, CMV infection can cause a marked decline in immunity and this predisposes them to other infections. Such associations have also been reported between other types of virus infections from the Herpesviridae family. The risk of disseminated VZV infection increases in the presence of CMV infection

Analyzing Relationship Between Monoclonal Gammopathy of Undetermined Significance (MGUS) with Different Types of Neuropathy: An Observational Study

To analyze multiple variables, including immunoglobulin subtypes in patients with monoclonal gammopathy of undetermined significance (MGUS) and different types of neuropathy. This was a retrospective, single center study done in a tertiary care hospital in the United States. The data was collected for years 2001-2011. Inclusion criteria were the presence of MGUS and neuropathy. Exclusion criteria were the presence of other factors such as diabetes, vitamin B12 deficiency, alcoholism etc. which can cause neuropathy. Patients with IgM MGUS were compared with patients having Non-IgM MGUS. A total of 281 patients were analyzed in this study. The average age at the time of diagnosis of MGUS and neuropathy was 68 years. The most common type of neuropathy was sensorimotor peripheral neuropathy (46 %). The most common location of neuropathy was the lower extremities (68 %). Among our patients, 52 % had their neuropathy symptoms for 1-5 years before presenting to the clinic. When IgM MGUS was compared with Non-IgM MGUS, a statistically significant difference was found in terms of race (White vs. Others, OR 4.43, 95 % CI 2.13, 9.19, p \u3c 0.001) and survival status (OR 1.98, 95 % CI 1.01, 3.90, p = 0.046). Patients with MGUS are prone to develop different types of neuropathies. Caucasians are more likely to have IgM MGUS as compared to other races. IgM MGUS is generally related to worse outcomes as compared to Non-IgM MGUS. Medical therapies, including gabapentin and pregabalin are effective treatments and the response rate can be as high as 80-90 % with these medications

Stachys annua (L.) L. (BR0000010243978)

Belgium Herbarium image of Meise Botanic Garden

Analyzing Relationship Between Monoclonal Gammopathy of Undetermined Significance (MGUS) with Different Types of Neuropathy: An Observational Study

To analyze multiple variables, including immunoglobulin subtypes in patients with monoclonal gammopathy of undetermined significance (MGUS) and different types of neuropathy. This was a retrospective, single center study done in a tertiary care hospital in the United States. The data was collected for years 2001-2011. Inclusion criteria were the presence of MGUS and neuropathy. Exclusion criteria were the presence of other factors such as diabetes, vitamin B12 deficiency, alcoholism etc. which can cause neuropathy. Patients with IgM MGUS were compared with patients having Non-IgM MGUS. A total of 281 patients were analyzed in this study. The average age at the time of diagnosis of MGUS and neuropathy was 68 years. The most common type of neuropathy was sensorimotor peripheral neuropathy (46 %). The most common location of neuropathy was the lower extremities (68 %). Among our patients, 52 % had their neuropathy symptoms for 1-5 years before presenting to the clinic. When IgM MGUS was compared with Non-IgM MGUS, a statistically significant difference was found in terms of race (White vs. Others, OR 4.43, 95 % CI 2.13, 9.19, p \u3c 0.001) and survival status (OR 1.98, 95 % CI 1.01, 3.90, p = 0.046). Patients with MGUS are prone to develop different types of neuropathies. Caucasians are more likely to have IgM MGUS as compared to other races. IgM MGUS is generally related to worse outcomes as compared to Non-IgM MGUS. Medical therapies, including gabapentin and pregabalin are effective treatments and the response rate can be as high as 80-90 % with these medications