The COVID-19 pandemic has altered the typical annual pattern of influenza. We aim to assess its impact on influenza outcomes, especially on mortality, cardiovascular, and non-cardiovascular complications. This study utilized discharge records from the National Inpatient Sample (NIS) for 2019 and 2022. We analyzed the data of hospitalized influenza patients (20 years and younger) using descriptive statistics and logistic regression models. 29,270 influenza hospitalizations were identified in the pre-pandemic year and 29,860 in the post-mitigation year. The median age was 6 years (IQR: 2–12) in the post-mitigation year vs. 4 years (IQR: 1–9) in the pre-pandemic year, P < 0.001. Mortality and major cardiovascular complications, including myocarditis and tachyarrhythmias, showed no differences. Respiratory failure was more common in post-mitigation (21.4
Conservative management with tranexamic acid (TXA) is known in difficult-to-access pseudoaneurysms, including those of the pulmonary artery, and its broad efficacy is seen in hemorrhagic pathologies such as subarachnoid hemorrhage. We present the case of a 90-year-old woman with paroxysmal atrial fibrillation on apixaban, remote cholecystectomy, and multiple comorbidities (including hypothyroidism, interstitial lung disease, and asthma) who was admitted for right upper quadrant pain, nausea, and laboratory evidence of cholestasis (total bilirubin 3.0 mg/dL, aspartate aminotransferase 250 U/L). Computed tomography was suggestive of choledocholithiasis, and gastroenterology recommended briefly holding apixaban before endoscopic retrograde cholangiopancreatography (ERCP). On hospital day 3, ERCP was abandoned because of an upper esophageal sphincter narrowing and Zenker's diverticulum. Interventional radiology then performed a percutaneous transhepatic cholangiography with a 22-gauge Chiba needle, but nondilated intrahepatic ducts prevented drain placement. Ultimately, a laparoscopic-assisted ERCP achieved successful common bile duct stone extraction. Postprocedurally, the patient's hemoglobin declined from 13.6 to 9.4 g/dL (without transfusions), and abdominal imaging identified a 1.8-cm intrahepatic pseudoaneurysm plus a 4.1-cm peripancreatic hematoma. Diagnostic angiography demonstrated delayed pseudoaneurysm filling without a definable feeding artery suitable for embolization. Given the small lesion and occult arterial source, we administered oral TXA 1,000 mg three times daily to promote thrombosis. Within 48 hours, hemoglobin stabilized around 8.8 g/dL, and repeat CT revealed spontaneous pseudoaneurysm thrombosis. The patient was discharged uneventfully with stable hemoglobin and had no pseudoaneurysm reaccumulation at short-term follow-up. Should TXA have failed, we had discussed a potential percutaneous thrombin injection, which has shown success for endovascularly inaccessible hepatic pseudoaneurysms. This case underscores the risk of iatrogenic bleeding in patients on direct oral anticoagulants who require multiple biliary interventions and highlights how a short course of TXA can be a practical alternative when standard embolization is not feasible.
Colon cancer is the third leading cause of cancer death in the United States and disproportionately affects Black individuals. Screening guidelines were recently lowered to begin at age 45, but it remains unclear whether widely accessed online health sources such as YouTube reflect these updates and represent high-risk racial/ethnic groups. This cross-sectional study analyzed the top 50 English-language YouTube videos (< 12 min) on “colon cancer screening” accessed in August 2024. Three reviewers assessed video quality using DISCERN and the Patient Education Materials Assessment Tool (PEMAT). Accuracy was rated on a 5-point Likert scale against the 2024 American Cancer Society and 2021 U.S. Preventive Services Task Force guidelines. Race/ethnicity of individuals in videos was subjectively categorized. The top 25 (T25) most-viewed videos were compared with the bottom 25 (B25) using Student t-tests and Fisher’s exact test. Compared with B25 videos, T25 were more understandable (Mean PEMAT: 69.0 vs. 71.5, p < 0.04) and actionable (Mean PEMAT: 52.5 vs. 58.5, p = 0.23) but less comprehensive in discussing risks and benefits of treatment. Both groups demonstrated high guideline concordance (ACS and USPSTF Likert > 4). Representation of Black and Hispanic individuals remained limited and did not differ significantly by popularity. The most popular YouTube videos on colon cancer screening are guideline-concordant, understandable, and actionable, but lack comprehensiveness on screening options, and sufficient representation of high-risk racial/ethnic groups. More comprehensive and targeted educational outreach efforts are needed to promote colon cancer screening, especially in high-risk racial/ethnic groups.
BACKGROUND:Postpartum hemorrhage remains a leading cause of severe maternal morbidity and mortality. The association between mild thrombocytopenia and postpartum blood loss or red blood cell transfusion has not been well studied. OBJECTIVE:To evaluate whether mild thrombocytopenia at admission to labor and delivery is associated with increased rates of postpartum hemorrhage and packed red blood cell transfusion. STUDY DESIGN:The authors performed a retrospective cohort study of pregnancies delivered within a large health maintenance organization from 2008 to 2020. Maternal characteristics and outcomes of those with mild thrombocytopenia were compared to those with typical platelet levels before delivery. The primary outcome was the rate of red blood cell transfusion. Secondary outcomes included quantity of red blood cell transfusion, postpartum hemorrhage, additional procedures performed, and use of uterotonic medications. Statistical analysis was done using χ2 or Mann-Whitney U test. A multivariable logistic regression was also performed. RESULTS:Data from a total of 305,794 pregnancies were included in this study. Mild thrombocytopenia was associated with a small but statistically significant increase in postpartum red blood cell transfusion compared with typical platelet levels (1.2% vs 0.9%, P < .0001). Mild thrombocytopenia was also associated with a higher rate of 2 or more red blood cell transfusions (0.33% vs 0.19%), postpartum hemorrhage (2.4% vs 2.0%), use of uterotonics, and additional procedures performed (all P values < .05). These outcomes all remained statistically significant after adjusting for confounding variables. CONCLUSIONS:Mild thrombocytopenia prior to delivery is associated with a small increased chance of red blood cell transfusion, postpartum hemorrhage, uterotonic use, and the need for additional procedures postpartum.
5098 Background: PSMA imaging can identify recurrent prostate cancer after definitive surgery/radiation prior to detection on computed tomography (CT) or bone scan. Radiation to PSMA+ findings is common but lacks clear data demonstrating long term benefit. PSMA+ biochemically recurrent prostate cancer (PSMA+ BCR) is often defined and treated as metastatic castration sensitive prostate cancer (mCSPC), yet PSMA imaging alone as an eligibility criteria was never studied in the mCSPC trials. PSA+ BCR requires better understanding to define at-risk patients (pts). Methods: NCT05588128 enrolls pts after definitive and possibly salvage therapies. Pts are required to be 1 year removed from definitive therapy with a PSA>0.5 ng/ml, testosterone>100 ng/dL, and negative CT/bone scans. Lymph nodes (LNs) up to 1.5 cm and prior therapies are permitted. At enrollment pts have a baseline PSMA, which is repeated every 6 months (mos) if positive. If negative PSMA is done annually. CT and bone scan are also repeated annually. Pts are allowed to have radiation therapy or systemic therapies for ≤6 mos and remain on-study. Up to 350 pts will be enrolled and followed for up to 5 years. Results: Over 120 pts have enrolled since 3/2023 and 86 pts are evaluable after the 6-month PSMA scan/follow-up. The pts have a median age of 71 years, PSA=3.05, PSA doubling time=11.1 mos (29% less than 6 mos). In an overlapping descriptive analysis 10 pts were PSMA- and 17 pts had only local disease. For PSMA+ LNs, 17 pts had 1 LN, 9 pts had 2-3 LNs+, 5 pts had 4 LNs+, and 18 pts had 5+ LNs. 7 pts had bone findings, but negative bone scan. 4 pts had PSMA+ serosal nodules. 4 pts had radiation to solitary LNs. 1 pt elected androgen deprivation and 1 pt had salvage radiation. 4 pts enrolled on a clinical study at the NCI without androgen deprivation. At 6 mos PSMA scan only 1 pt had metastatic disease (bone scan findings). No pts had LNs beyond eligibility size criteria. No pts had new visceral findings. Conclusions: These preliminary data from an ongoing study suggest PSMA+ BCR is an indolent disease process and pts are at limited risk for clinically relevant progression within 6 mos. This study continues to accrue at the NCI and will seek to better define high risk PSMA+ BCR. These preliminary data may better inform the risk/benefits of aggressive treatment of PSMA+ BCR and clinical studies in PSMA+ BCR. Clinical trial information: NCT05588128 .
