The Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) risk stratification model, developed to predict ≥10

Background: Recent advancements in multiple myeloma (MM) diagnosis and treatment significantly improved patients' survival and quality of life. Severe Renal Impairment (RI) remains a significant challenge in newly diagnosed MM (NDMM), complicating treatment and affecting outcomes. Prior studies reported improved overall renal recovery in the era of novel therapies. However, there is a lack of evidence documenting the outcomes of patients presenting with severe RI. We present an updated analysis of the characteristics and outcomes of patients with NDMM presenting with severe RI in an ethnically diverse, low socio-economic population. Methods: A single-center retrospective review of patients with NDMM presenting to Montefiore Medical Center (Bronx, New York) was conducted from 2011-2023. Severe RI was defined as an estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m². MM risk was assessed using the mSMART 3.0 tool. Results: Out of 284 patients with NDMM, 58 (20%) patients presented with severe RI. Black patients (p = 0.018) and older adults (64 years vs 60 years, p value 0.032) were more likely to present with severe RI. Severe RI at diagnosis correlated with high-risk myeloma (p = 0.002), high R-ISS stage (p < 0.001), and a lower likelihood of receiving stem cell transplants (p < 0.001). Among those with severe RI, 23/58 required dialysis of which 6/23 were taken off dialysis at last follow-up after renal recovery. Median eGFR at diagnosis, 6 months and 1 year after diagnosis was 11, 23 and 23.5 ml/min/1.73 m2, respectively. 14 out of 58 patients (39%) achieved renal recovery to eGFR > 30 one year post-diagnosis, with no significant difference in race, sex, or ethnicity. The most common first-line treatment for patients with severe RI was CyBorD (62%). The median time from diagnosis to first treatment (including plasma exchange) was 10 days. By the last follow-up, 35/58 patients (60%) had a stem cell transplant, with a median time from diagnosis to transplant of 275 days. The median overall survival (OS) for patients with severe RI at diagnosis was 49 months, while it was not reached for those without severe RI (p < 0.001). Early death (≤ 2 months after diagnosis) occurred in 2 patients, both with severe RI. Among patients with severe RI, multivariate Cox regression survival analysis showed that achieving free light chain (FLC) below 500 mg/L (HR 0.212, p < 0.001) and receiving a stem cell transplant (HR 0.209, p 0.002) improved outcome. Conclusions: Despite improvements in the life expectancy of patients with MM, severe renal failure remains a challenge, particularly among minorities. Socioeconomic factors need to be explored as a contributor to outcomes in patients with severe RI. Achieving FLC clearance and undergoing stem cell transplant may play a role in survival in patients with NDMM and severe RI.

Cancer patients are more vulnerable to COVID-19 compared to the general population, but it remains unclear which types of cancer have the highest risk of COVID-19-related mortality. This study examines mortality rates for those with hematological malignancies (Hem) versus solid tumors (Tumor). PubMed and Embase were systematically searched for relevant articles using Nested Knowledge software (Nested Knowledge, St Paul, MN). Articles were eligible for inclusion if they reported mortality for Hem or Tumor patients with COVID-19. Articles were excluded if they were not published in English, non-clinical studies, had insufficient population/outcomes reporting, or were irrelevant. Baseline characteristics collected included age, sex, and comorbidities. Primary outcomes were all-cause and COVID-19-related in-hospital mortality. Secondary outcomes included rates of invasive mechanical ventilation (IMV) and intensive care unit (ICU) admission. Effect sizes from each study were computed as logarithmically transformed odds ratios (ORs) with random-effects, Mantel-Haenszel weighting. The between-study variance component of random-effects models was computed using restricted effects maximum likelihood estimation, and 95% confidence intervals (CIs) around pooled effect sizes were calculated using Hartung-Knapp adjustments. In total, 12,057 patients were included in the analysis, with 2,714 (22.5%) patients in the Hem group and 9,343 (77.5%) patients in the Tumor group. The overall unadjusted odds of all-cause mortality were 1.64 times higher in the Hem group compared to the Tumor group (95% CI: 1.30-2.09). This finding was consistent with multivariable models presented in moderate- and high-quality cohort studies, suggestive of a causal effect of cancer type on in-hospital mortality. Additionally, the Hem group had increased odds of COVID-19-related mortality compared to the Tumor group (OR = 1.86 [95% CI: 1.38-2.49]). There was no significant difference in odds of IMV or ICU admission between cancer groups (OR = 1.13 [95% CI: 0.64-2.00] and OR = 1.59 [95% CI: 0.95-2.66], respectively). Cancer is a serious comorbidity associated with severe outcomes in COVID-19 patients, with especially alarming mortality rates in patients with hematological malignancies, which are typically higher compared to patients with solid tumors. A meta-analysis of individual patient data is needed to better assess the impact of specific cancer types on patient outcomes and to identify optimal treatment strategies.

Increased vaccination rates and better understanding of influenza virus infection and clinical presentation have improved the disease’s overall prognosis. However, influenza can cause life-threatening complications such as cardiac tamponade, which has only been documented in case reports. We searched PubMed/Medline and SCOPUS and EMBASE through December 2021 and identified 25 case reports on echocardiographically confirmed cardiac tamponade in our review of influenza-associated cardiac tamponade. Demographics, clinical presentation, investigations, management, and outcomes were analyzed using descriptive statistics. Among 25 cases reports [19 adults (47.6 ±15.12) and 6 pediatric (10.1 ± 4.5)], 15 (60%) were females and 10 (40%) were male patients. From flu infection to the occurrence of cardiac tamponade, the average duration was 7±8.5 days. Fever (64%), weakness (40%), dyspnea (24%), cough (32%), and chest pain (32%) were the most prevalent symptoms. Hypertension, diabetes, and renal failure were most commonly encountered comorbidities. Sinus tachycardia (11 cases, 44%) and ST-segment elevation (7 cases, 28%) were the most common ECG findings. Fourteen cases (56%) reported complications, the most common being hypotension (24%), cardiac arrest (16%), and acute kidney injury (8%). Mechanical circulatory/respiratory support was required for 14 cases (56%), the most common being intubation (9 cases, 64%). Outcomes included recovery in 88% and death in 3 cases. With improving vaccination rates, pericardial tamponade remains an infrequently encountered complication following influenza virus infection. The complicated cases appear within the first week of diagnosis, of which nearly half suffer from concurrent complications including cardiac arrest or acute kidney injury. Majority of patients recovered with timely diagnoses and therapeutic interventions.

has a fixed treatment duration, making it an appealing alternative to continuous therapies.Part 2 of LOTIS-5 commenced in January 2022; recruitment is ongoing.

Authors: Arjola Agolli, MD, MBA, Angela Ishak, MD, Mahima Viswanathan MD, Edzel Lorraine Co, DMD, MD, Jeevan Shivakumar, MD, Olsi Agolli, MD Context: Breast cancer is a rising concern and the world’s most prevalent cancer. It affected 2.3 million people, with 685,000 related deaths in 2020. Epstein-Barr virus (EBV) has been hypothesized to increase the risk of breast cancer by activating the HER2/HER3 signaling cascades, creating a state of prolonged immune stimulation, or stimulating the pro-inflammatory cytokines and aromatase activity. Almost 90-95% of the world population is infected with EBV but its association with breast cancer has not been clearly elucidated. Objective: To better understand the association between the EBV infection and the risk of breast cancer. Study Design and Analysis: A systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Studies published in English language from 2012 through May 2022, worldwide were included. Out of 688 articles identified, only 24 studies were eligible to include in the review. Databases: PubMed, ScienceDirect, Cochrane, EBSCOhost, JSTOR, and Scopus Population studied: Adult population worldwide Intervention/Instrument: N/A Outcome Measures: Percentage of adult women diagnosed with breast cancer and prior infected with EBV. Results: A total of 24 case-control studies including 1.989 women with breast cancer and 1.034 control cases were analyzed. EBV infection was detected among 27.9 % of women with breast cancer cases versus 8.02% found in normal and benign breast tissue controls. EBV infection was mainly associated with invasive breast cancer (68.1%). The presence of EBV infection was detected using PCR and, was found to be highest among women with breast cancer in Sudan (64.1%) and lowest among women with breast cancer in Mexico (4.6%). Conclusions: EBV infection might be related to an increase in breast cancer risk among women worldwide and geographical distribution variances are observed. Additional studies are required to better understand Epstein Barr’s viral oncogenic effects on the pathogenesis of breast cancer and to improve prevention and treatment protocols for breast cancer.

Background: The prevalence of breast cancer has increased and has currently become one of the most common cancers. Although the majority of the world’s population is infected with Epstein Barr Virus (EBV) during their lives, the severity of symptoms varies and not everyone infected with EBV is diagnosed with cancer. EBV might increase the risk for breast cancer either by activating the HER2/HER3 signaling cascades or by creating a state of prolonged immune stimulation. Materials and Methods: A systematic search of several electronic databases including PubMed, ScienceDirect, Cochrane, EBSCOhost, JSTOR, and Scopus, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. The primary outcome of this review was to assess the prevalence of people with breast cancer that had a prior EBV infection. Results: For this review, 24 case-control studies were accepted. Our analyses included 1.989 breast cancer cases versus 1.034 control cases. EBV was found to be present in 27.9% of breast cancer cases versus 8.02% found in the normal breast tissue of controls. All affected people were women with a mean age was 48.19 years. The most common type of breast cancer found in EBV-infected tissues was invasive breast cancer. Cases were reported sporadically in a wide geographical distribution, and the prevalence varied from 4.6% - 64.1%. Conclusions: A previous EBV infection might be associated with a higher risk for breast malignancy. The most common type is invasive cancer. It mainly affects women and geographical variances are observed. More studies are necessary to elucidate the role of EBV in the mechanisms of breast cancer. Also, it is crucial to improve the prevention and treatment strategies.

Prediabetes and diabetes are important disease processes which have several perioperative implications. About one third of the United States population is considered to have prediabetes. The prevalence in surgical patients is even higher. This is due to the associated micro and macrovascular complications of diabetes that result in the need for subsequent surgical procedures. A careful preoperative evaluation of diabetic patients and patients at risk for prediabetes is essential to reduce perioperative mortality and morbidity. This preoperative evaluation involves an optimization of preoperative comorbidities. It also includes optimization of antidiabetic medication regimens, as the avoidance of unintentional hypoglycemic and hyperglycemic episodes during the perioperative period is crucial. The focus of the perioperative management is to ensure euglycemia and thus improve postoperative outcomes. Therefore, prolonged preoperative fasting should be avoided and close monitoring of blood glucose should be initiated and continued throughout surgery. This can be accomplished with either analysis in blood gas samples, venous phlebotomy or point-of-care testing. Although capillary and arterial whole blood glucose do not meet standard guidelines for glucose testing, they can still be used to guide insulin dosing in the operating room. Intraoperative glycemic control goals may vary slightly in different protocols but overall the guidelines suggest a glucose range in the operating room should be between 140 mg/dL to 180 mg/dL. When hyperglycemia is detected in the operating room, blood glucose management may be initiated with subcutaneous rapid-acting insulin, with intravenous infusion or boluses of regular insulin. Fluid and electrolyte management are other perioperative challenges. Notably diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic state are the two most serious acute metabolic complications of diabetes that must be recognized early and treated.

Hirayama disease is a rare neurological condition also known as monomelic amyotrophy (MMA). It is a type of cervical myelopathy, which involves the anterior horn cells and affects the distal upper extremities. It is self-limited, asymmetrical lower motor weakness of hands and forearms. Young males are more commonly affected. The condition is hypothesized to occur due to an asymmetric compression of the cervical spinal cord by the dural sac, however, the exact mechanism(s) continue to be investigated. We report a case of a 20-year-old male who presented with complaints of right hand and forearm weakness, who was diagnosed with Hirayama disease and treated.