Got Sugar? Pharmacist Intervention to Improve A1c

AIM: Within 6 months, we aim to decrease by 10% the number of our diabetic patients with an A1c \u3e8 through Clinical Pharmacist referrals.https://jdc.jefferson.edu/patientsafetyposters/1033/thumbnail.jp

Case Report: Cytarabine-Induced Pericarditis and Pericardial Effusion

Introduction: Cytarabine (cytosine arabinoside, Ara-C) is an antimetabolite analogue of cytidine that is used as a chemotherapeutic agent for the treatment of acute myelogenous leukemia and lymphocytic leukemias1 . The most common side effects of this therapy include myelosuppression, pancytopenia, hepatotoxicity, gastrointestinal ulceration with bleeding, and pulmonary infiltrates2. Cardio-pulmonary complications of cytarabine therapy are uncommon, but include supraventricular and ventricular arrhythmias, sinus bradycardia, and recurrent heart failure2, 3. Occasionally, patients may develop pericarditis leading to pericardial tamponade, which can be fatal. We report a case of cytarabine-induced pericarditis and pericardial effusion to increase awareness about this serious side effect of cytarabine and review the current literature. Case Presentation: A 44-year-old male with hypertension, obstructive sleep apnea, stage 3 chronic kidney disease, and recent admissions for symptomatic anemia of unknown etiology presented to the hospital after his outpatient lab work revealed a leukocytosis of 75,000 cells/µl, thrombocytopenia of 117,000 platelets/ µl, and anemia with hemoglobin of 6.4 g/dl. An inpatient bone marrow biopsy revealed acute myeloid leukemia. A baseline transthoracic echocardiogram was obtained in preparation for inpatient chemotherapy, and demonstrated mild global left ventricular dysfunction with ejection fraction of 40%. The cardiomyopathy was attributed to his underlying hypertension or sleep apnea, and not coronary artery disease based on a normal coronary computed tomography (CT) angiogram. The patient was started on induction therapy with high-dose cytarabine therapy at 3g/m2 every twelve hours without an anthracycline agent such as doxorubicin

Abdomen Actin’ Up: A Unique Presentation of Disseminated Abdominal Actinomycosis

INTRODUCTION Abdominal actinomycosis is a chronic, indolent disease characterized by nonspecific symptoms such as fatigue, weight loss, fever, and abdominal pain. Actinomyces is a genus of fastidious, gram-positive, non-acid-fast, branching filamentous bacilli characterized by sulfur granules that is normally found in oral flora and inhabits the gastrointestinal (GI) tract. Actinomyces infections are relatively rare, however when present, they have the ability to invade multiple organs and disseminate throughout multiple body cavities. Factors that increase the risk of developing actinomycosis include poor oral hygiene, alcoholism, and preexisting dental disease. Intrauterine devices (IUDs) also increase the risk of developing pelvic actinomycosis. Over the past 10-20 years, actinomycosis is being diagnosed with increasing frequency and should be considered in the differential for patients presenting with indolent abdominal symptoms along with risk factors. KEY POINTS While still rare, the incidence of abdominal actinomycosis is increasing. Abdominal actinomycosis presents with a chronic, indolent course of nonspecific symptoms similar to other, more common conditions and, should be considered in patients with indolent abdominal symptoms and risk factors including poor dental hygiene, dental disease, and alcoholism. The diagnosis is based on abscess fluid culture growing Actinomyces. Treatment of actinomycosis is generally with a long course of IV Penicillin G later transitioned to oral Amoxicillin

Fatal Rituximab-Induced Nonspecific Interstitial Pneumonia: Case Report and Review of the Literature

Introduction: Rituximab is a chimeric anti-CD20 monoclonal antibody that is used to treat some hematological malignancies such as B-cell lymphomas, and various autoimmune diseases including immune thrombocytopenic purpura, systemic lupus erythematous, rheumatoid arthritis, and autoimmune hemolytic anemia. The most common side effects include fever, chills, and rigors. Respiratory complications such as cough, bronchospasm, sinusitis, and rhinitis have also been reported in 30% of patients in clinical trials.1 Rituximab-induced lung injury is a very rare but potentially fatal complication. We report a case of fatal single agent rituximab-induced nonspecific interstitial pneumonia to increase awareness about this serious side effect and review the current literature. Case Presentation: This case involves a 72-year-old female with stage IV marginal-zone lymphoma (diffuse nodal and splenic involvement) who required therapy due to transfusiondependent anemia and was initiated on single-agent rituximab (four weekly doses at a dose of 375 mg/m2). She tolerated the first two infusions well, but started to feel short of breath after her third infusion. By the time she arrived to the infusion center for her fourth dose, she was short of breath at rest and was found to be hypoxic to 68% on room air. Of note, the patient had COPD with a 30 pack-year smoking history, quit three years ago, but had no previous oxygen requirement. She was admitted to the hospital where she was started on broad-spectrum antibiotics and placed on five liters of oxygen delivered via nasal cannula. A chest CT scan with contrast showed extensive bilateral ground-glass opacities with interlobular septal thickening (Figure 1a). On the second day of admission, the patient became hypoxic to 70% on six liters of supplemental oxygen, but did not tolerate bilevel positive airway pressure so she was transferred to the medical intensive care unit. Methylprednisolone 125 mg every six hours was started intravenously for possible rituximab-induced lung reaction in the intensive care unit. A repeat CT scan of the chest two weeks later revealed improvement in the bilateral airspace opacitie

Diagnostic Yield of Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) in Lung Cancer Staging, Subtyping and Diagnosis of Unexplained Mediastinal Lymphadenopathy

INTRODUCTION Lung cancer (LC) is the most commonly diagnosed cancer worldwide and the most frequent cause of cancer death in both men and women in the US (more deaths than the next three most common cancers combined)1 Clinical staging of LC is an integral part of patient care because it directs therapy and has prognostic value Patients are routinely investigated with a conventional workup (medical history, PE, lab tests, bronchoscopy), CT and integrated whole-body PET-CT, followed by mediastinal tissue staging for enlarged or PET-positive intrathoracic nodes2 Mediastinal tissue staging has been classically performed by mediastinoscopy, but they can also be sampled under real-time ultrasound control from the airways (endobronchial ultra-sound guided fine needle aspiration [EBUS-FNA]). Current lung cancer staging guidelines acknowledge endosonography as a minimally invasive alternative to surgical staging to detect nodal disease,3,4 reducing the need for surgical staging in up to two thirds of patients5,6 The purpose of this study was to evaluate the diagnostic yield of EBUS-FNA for accurate lung cancer staging, subtyping and assessment of mediastinal lymphadenopath