A rare case of Levofloxacin-related Iliopsoas and Achilles tendon rupture

Achilles tendon rupture is a well-documented adverse effect of Fluoroquinolones; however, herein we present a case of complete iliopsoas and Achilles, and partial semimembranosus tendon rupture secondary to Levofloxacin.

In-hospital outcomes of CAR T-cell therapy in United States in 2018: A nationwide analysis

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Background: CAR T-cell therapy is a type of adoptive cell transfer (ACT). In 2017 CAR T-cell therapy was approved by the Food and Drug Administration (FDA) for management of diffuse large B-cell lymphoma refractory to at least two prior lines of therapy (DLBCL) including primary mediastinal large B-cell lymphoma (PMBCL), and B cell precursor acute lymphoblastic leukemia (ALL) up to 25 years of age that is refractory or in second or later relapse. Since its inception, several patients underwent CAR T-cell therapy but data on real world outcome is limited. In this study we aim to evaluate the in-hospital outcomes of CAR T-cell therapy in the United States in 2018. Methods: This is a cross-sectional study using National Inpatient Sample 2018 database. Discharges with the ICD-10-PCS code for CAR T-cell therapy and ICD-10-CM code of ALL, DLBCL or PMBCL were included in the study. We analyzed their in-hospital outcomes (Total discharges, length of stay in days, hospitalization cost, and mortality - number of deaths). We applied the cost to charge ratio to hospitalization charges to estimate the mean hospitalization cost. The weighted sample represents national estimates. Results: We identified 785 discharges with CAR T cell therapy and diagnosis of ALL, DLBCL or PMBCL. 155 (19.75 %) were ALL, 620 (78.98%) DLBCL, and 10 (1.27%) PMBCL. Mean length of stay for the study cohort was 23.26 days. Specifically, for ALL mean LOS was 33.67 days, DLBCL 20.76 days, and PMBCL 17 days. Mean hospitalization cost for the study cohort was $285,989, specifically for ALL it was $342,228, DLBCL $274,102, PMBCL $179,431. There were a total of 60 (7.6%) deaths in the study cohort. Diagnosis specific mortality was 20 (12.9%) in ALL, 40 (6.4%) in DLBCL and none in PMBCL. Conclusions: Majority of discharges who underwent CAR T-cell therapy were DLBCL followed by ALL and PMBCL. CAR-T Cell hospitalizations have high costs and long length of stays. Mean length of stay was highest in ALL discharges, least in PMBCL. Mean hospitalization cost was higher in DLBCL discharges compared to ALL and was least in PMBCL discharges. The in-hospital mortality with the CAR-T cell therapy appears to be higher than reported in clinical trials, especially for ALL. [Table: see text]

Immune-related adverse events in melanoma: A nationwide analysis 2016

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Background: Melanoma is an aggressive skin cancer. Immunotherapy is currently used as a first-line treatment for unresectable metastatic disease. Combination immunotherapy has been shown to improve overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) compared to single-agent immunotherapy. However, immunotherapy related adverse events (irAE's) are being increasingly seen. This study analyses the incidence of irAE's and the variation in the length of stay, and mortality. Methods: This is a retrospective cohort analysis of the 2016 NIS database. We identified hospitalizations with either primary or secondary diagnosis of Melanoma. Logistic regression of irAE's such as pneumonitis, colitis, hypophysitis, adrenal insufficiency, encephalitis, myocarditis was performed. We evaluated the association between irAE's and various parameters. Results: We identified 13170 hospitalizations with primary or secondary diagnosis of melanoma. Univariate logistic regression showed pneumonitis (OR: 1.39; p value: < 0.01), hypophysitis (OR: 20.61; p value < 001), adrenal insufficiency (OR: 10.36, p value = < 0.01), colitis (OR 23.94, p value < 001), myocarditis (OR: 1; p value was n/a), encephalitis (OR 1.71; p value was 0.5). Univariate logistic regression for LOS showed colitis (OR 1.23; p value: 0.01), adrenal insufficiency (OR 0.20; p value: 0.748), hypophysitis (OR -2.50; p value: 0), myocarditis no admissions, encephalitis (OR -2.15; p value 0.01). Univariate logistic regression for mortality showed pneumonitis (OR 6.07; p value: < 0.01), colitis (OR 0.86 p value: 0.721), adrenal insufficiency (OR 1; p value: 0.996). Conclusions: The above results suggest that the incidence of colitis is the highest among irAE’s in melanoma patients likely due to immunotherapy. Hypophysitis is the next most common side effect, it’s followed by adrenal insufficiency which can be life-threatening. A high index of suspicion and anticipation of the above complications can lead to their timely detection and treatment.

Hospitalization cost and length of stay in pancreatic cancer population: A national inpatient database study

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Background: Pancreatic cancer accounts for 7% of all cancer deaths in the U.S. It contributes to burgeoning health care cost and is associated with poor prognosis. The aim of this study was to describe the disease burden, pattern of resource utilization, hospital cost and outcomes among hospitalized pancreatic cancer patients based on the location of disease. Methods: We conducted a retrospective study utilizing the 2014 national inpatient sample database. Adult records with a primary discharge diagnosis of pancreatic cancer were included. Records with no specification on cancer location were excluded. Regression models (logistic and linear) were used to estimate adjusted odds ratios (OR), mean length of stay (LOS) and hospital charges (HC). Covariates included sociodemographic factors, co-morbidities and therapeutic surgical procedures received during hospitalization. Results: A total of 4,799 discharge records met the inclusion criteria. Overall, 74.3% had cancer in the pancreatic head and 25.6% had cancer in the body and tail. Pancreatic head cancers were more common in whites (73%). Patients with cancer in the body and tail more commonly experienced metastasis than patients with pancreatic head cancer (23.8% versus 20.4% p = 0.02). Compared to pancreatic head cancers, patients with body and tail cancers were more likely to have a pancreatectomy during index hospitalization (OR 45, 95% CI 27.8 - 65.2). Alternatively, cancers of the pancreatic head were more likely to have an endoscopic pancreatic procedure during index hospitalization compared to body and tail (OR 7.39, 95% CI 3.9 -13.9). Pancreatic head cancers were associated with a significantly longer mean hospital LOS (8.1 versus 6.4 days, mean difference 1.66, p < 0.001) and higher mean cost of hospitalization (Mean HC $85,263.40 versus $56,156.60 p < 0.001) compared to cancer in the body and tail. Conclusions: Despite lower rate of metastasis and pancreatectomy, patients hospitalized for pancreatic head cancers have longer hospital LOS and higher healthcare cost burden. Our findings may inform physicians, patients, and policymakers and may help channel resources toward specific patient population to reduce healthcare cost and improve outcomes for individuals and healthcare organizations.

HIV associated cancers

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Background: The incidence or the prevalence of AIDS-defining cancers has reduced drastically (70% or more in the United States) since the introduction of three-drug antiretroviral therapy (ART) in the mid-1990s. However, the data from the inpatient sample is lacking. Methods: This is a retrospective analysis using data from the 2014 National Inpatient Sample database. We identified patients with either primary or secondary diagnosis of human immunodeficiency virus (HIV). Then we identified patients with various cancers including AIDS-defining cancers. Afterward, we ran logistic regression to check the degree of association between the diagnosis of each cancer with the diagnosis of HIV during the identified hospitalizations. We also assessed the prevalence of each of the cancer among the identified HIV patients, as well as the mortality in this cohort. Results: A total of 115955 hospitalizations with a diagnosis of HIV were identified. Among them, there were 6985 hospitalizations with Non-Hodgkin lymphoma, 2230 with rectal and anal cancer, 1170 with Kaposi sarcoma, 870 with head and neck cancer, 865 with skin cancer, 840 with cervical cancer. Logistic regression showed odds ratio (OR) of 1632.857 (95% CI 1168 - 2284, p < 0.01) for Kaposi sarcoma, 9.13 (95% CI 5.7-14.5, p-value < 0.01) for other male cancer, 8.34 (95% CI 7.68-9.06; p-value < 0.01) for Non-Hodgkin's lymphoma, 6.65 (95% CI was 5.5-8, p-value < 0.01) for Hodgkin's lymphoma, 5.04 (95% CI 4.5-5.6 p < 0.01) for rectal and anal cancer, 2.33 (95% CI 1.9-2.8, p < 0.01) for cervical cancer. Mortality was statistically significant with liver cancer, lung cancer, brain cancer, Hodgkin lymphoma, and Kaposi sarcoma. Conclusions: The prevalence of Kaposi sarcoma, Non-Hodgkin lymphoma, and cervical cancer are found to be high among hospitalized patients with HIV most likely because of nonadherence to their HIV medications. Future studies to check their correlation of these cancers with disease control is required. It is interesting to note that the prevalence of rectal and anal cancer, head and neck cancer, and skin cancer is high in this cohort.

Blastic plasmacytoid dendritic cell neoplasm

Blastic plasmacytoid dendritic cell neoplasm is an aggressive neoplasm with a median survival of only a few months despite treatment. An exhaustive immunohistochemical workup is required to differentiate it from myeloid sarcoma and extranodal NK/T cell lymphoma. Treatment is with induction using a regimen utilized for leukemia. Allogeneic hematopoietic stem cell transplantation is recommended for those who achieve remission following induction.

Angioimmunoblastic T-cell lymphoma: a rare subtype of peripheral T-cell lymphoma

Angioimmunoblastic T‐cell lymphoma (AITL) is a rare form of NHL and usually presents in the late stage due to the atypical laboratory findings. Immunohistochemistry of the lymph node in AITL is characterized by positive CD2, CD3, CD4, CD10, CXCL‐13, PD1 often BCL‐6 and CD20 positive. Meshworks of follicular dendritic cells are seen outside follicles with CD21 and CD23 stains. EBV can be often positive as well. Autologous transplantation should be offered in the first remission as poor outcome is reported with anthracycline‐containing regimens.

Central squamous cell carcinoma of the mandible

A rare case of primary central squamous-cell carcinoma of the mandible is reported. Etiology, pathogenesis, clinical features, differential diagnosis and treatment are discussed, and literature on the subject is reviewed.