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Background: Acute kidney injury (AKI), a severe complication of nephrotic syndrome (NS) is being more prevalent in recent times. Objectives were: 1) Determine incidence, etiology, short term outcome of AKI in children hospitalised with NS. 2) Compare above variables in steroid sensitive nephrotic syndrome (SSNS) versus steroid resistant nephrotic syndrome (SRNS). Methods: Prospective observational study over 18 months including all consecutive nephrotics hospitalized with AKI. AKI defined according to KDIGO criteria with baseline creatinine taken as lowest value in last 6 months/ nadir during stay. Secondary NS were excluded. Demographics, clinical features, labs, hospital course, treatment and follow up at 3 months were recorded. SSNS and SRNS were compared. Results: The incidence of AKI in hospitalised nephrotics (30/304) was 9.8%, 30 patients (16 boys) with mean age 4.08 years (± 4.04 SD). Common etiologies of AKI were infection (60%), nephrotoxic drugs, hypovolemia, and thrombosis in decreasing order. Nephrotics developing AKI had a longer hospital stay versus those without AKI (p

Background/Aims: Both generic and disease specific prognostic scoring systems have been employed in areas of critical care. The score of Acute Physiology and Chronic Health Evaluation (APACHE) II is a generic point score which provides general assessment of illness and severity. In order to determine the mortality of critically ill malaria patients, this study aims to find the ideal time point for the APACHE II score. Materials and Methods: This longitudinal study was carried out after getting necessary ethics committee approval. Score of APACHE II on days 0, 2nd and 7th were evaluated and appropriate statistical tests were applied. Results: Out of 120 patients, 54 patients were of P. vivax, P. falciparum - 60 and six mixed infection patients. Mean APACHE II score was maximum on day 0 followed by day 2 and 7 in decreasing order. The APACHE II score was statistically greater on all days in patients who didn’t survive. The Receiver Operating Characteristic (ROC) curve when plotted showed score of APACHE II on day 2 - cut-off ≥14 to be the most valid in mortality prediction with a sensitivity of 64.28% and specificity of 87.80% as most of the results were on the left from the diagonal line and had greatest area under the curve. Conclusion: The prognostic score APACHE II was discovered to be helpful in patients with severe falciparum/vivax malaria who required intensive care treatment since the second day's sequential score significantly differentiates between survivors and non-survivors. The optimum cut-off for identifying individuals at high risk of mortality is 14, and the Day-2 APACHE II score is an ideal biomarker for predicting the outcomes of ICU patients. Recommendation: Malaria is a major cause of tropical sepsis in India leading to significant amount of mortality. Sequential APACHE II scoring instead of single time APACHE II score calculated on admission could have a role in evaluation of effectiveness of treatment, trend in recovery or dysfunction and prediction of mortality.

Background: COVID-19 infection is known for multi-organ involvement of which Kidney injury predominates. AKI is associated with raised mortality in intensive care setting worldwide. Due to scarcity of data of renal involvement in pediatric COVID-19 population, we aimed to study its incidence in pediatric population requiring admission for COVID 19. Methods: This was a single centred observational study where all the indoored COVID-19 infected children were looked for any form of renal involvement. We divided the study population into subgroups of those having any underlying renal ailment and the other without any underlying illness. Results: 342 patients with COVID-19 infection were enrolled. Renal involvement was seen in 38 (11%) subjects. Of them 31 subjects developed AKI. Maximum number of population had severe/ stage III AKI (as per KDIGO criteria). Among the AKI subgroup (N=31), 41.9% (n= 13) required acute RRT of which 6 subjects were successfully discharged. 20/31 (64.5%) subjects of AKI subgroup were discharged with complete renal recovery and 11/31 (35.4%) had expired. Among the 7 subjects who did not develop AKI, all were discharged successfully. Conclusions: AKI occurred in significant proportion of study population with SARS-Co-V2 infection. AKI subgroup reports higher mortality rate which is proportional to the stage of AKI.

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CT colonography for colorectal cancer screening has been proved to be effective and cost-saving. CT colonography uses minimally invasive evaluation of colorectum and has better patient acceptance, which appears to be a promising screening modality to improve low colorectal cancer screening rate. This study investigated the utilization patterns of CT colonography and factors associated with its use among U.S. adult population. This retrospective cross-sectional study analyzed the National Health Interview Survey 2015 and 2018. U.S. adults ages 45 or older without a history of colorectal cancer were included. Survey design-adjusted Wald F tests were used to compare the utilization of CT colonography during the study period. Multivariable logistic regression was used to identify the predictors of CT colonography among individual socioeconomic and health-related characteristics. The study sample included 34,768 individuals representing 129,430,319 U.S. adult population ages 45 or older. The overall utilization of CT colonography increased from 0.79% in 2015 to 1.33% in 2018 (P < 0.001). 54.5% study participants reported being up-to-date on recommended colorectal cancer screening; of those, 1.8% used CT colonography. Compared with individuals ages 65+, those ages 45–49 years were 2.08 times (OR, 2.08, 95% confidence interval, 1.01–4.35) more likely to use CT colonography. Socioeconomically disadvantaged characteristics (e.g., racial/ethnic minority, low income, publicly funded insurance) were associated with a greater likelihood of CT colonography. This study demonstrated an increasing trend in utilization of CT colonography for colorectal cancer screening in U.S. adults. Younger individuals, racial/ethnic minorities, or those with lower income appear to have a higher CT colonography utilization.Prevention Relevance:Although computed tomographic (CT) colonography has been proved to be cost-effective and have better patient acceptance, its overall utilization for colorectal cancer (CRC) screening is low (

AKI in the setting of immune checkpoint inhibitors. Need for kidney biopsy for diagnosis of immune checkpoint inhibitors. Importance of pathology in diagnosis of immune checkpoint inhibitor–induced AKI.

Objectives: Quantifying cerebral microbleeds (CMBs) in cerebral amyloid angiopathy (CAA) is important, however manual counting of CMBs on brain MRI is laborious. This work aims to develop a novel automatic deep learning segmentation algorithm for fast and accurate quantification of CMBs on brain MRIs. Method: We used (a) internal dataset (susceptibility-weighted imaging [SWI] clinical scans from 83 patients with CAA) with heterogeneous protocols on 1.5T and 3T scanners and manual CMB segmentation by 2 readers, and (b) public dataset (57 SWI scans from 30 patients with Alzheimer’s and CMB locations). The data was split into training, validation, and testing subsets (internal: 50/20/13; Public: 38/9/10). Preprocessing included N3 bias field correction, brain extraction, and up-sampling to a fixed in-plane resolution (0.2mm). Model used multi-channel 2D input (Fig1.b) and mimicked manual CMB segmentation. We trained base-model initially using the public dataset and then applied transfer learning using the internal dataset to segment CMBs in clinical scans. We evaluated model’s performance by sensitivity (S), precision (P), number of false positives per scan (FPC) and F1-score (F1). Results: On 10 public test scans, base model performed well (S 0.81, P 0.74, FPC 0.60, F1 0.77) but had high FPC for 13 internal test scans (S 1.00, P 0.15, FPC 4.31, F1 0.26). After transfer learning, the precision, FPC and F1-score were improved for internal scans (S 0.80, P 0.80, FPC 0.15, F1 0.80). Conclusion: Refined deep-learning based CMB counting algorithms could quantify CMBs for heterogeneous clinical MRI dataset with good sensitivity, precision, and false positivity. This method may accelerate further CAA clinical diagnosis and research.

Purpose Colorectal cancer (CRC) is the fifth most common cancer in India, however, there is a paucity of systematically collected data related to its molecular epidemiology, specifically related to tumour microsatellite instability (MSI) and Lynch syndrome prevalence. Methods We prospectively recruited 207 unrelated patients who were diagnosed with CRC from whom primary tumour biopsy along with a matched blood sample was obtained. A sequential genetic testing approach for Lynch syndrome detection in colorectal cancer patients in accordance with the UK’s National Institute of Health and Care Excellence’s guideline (DG27) was utilised. Briefly, DNA from tumour biopsies were tested for MSI status followed BRAF V600E testing in samples which showed MSI-high result. Germline testing for the mismatch repair genes was carried in patients who had MSI-high and BRAF V600E negative tumours. Seventeen patients recanted their consent to participate in the study and therefore, results from 190 out of 207 patients is presented here. Results Mean age at cancer diagnosis across the cohort was 52.3 years with male to female ratio of 2:1 and 57.3% of the patients had tumours in the descending colon or rectum. MSI-high status was observed in 79 patients (42.6%) and, was inversely associated with age (OR = 0.95, 95% CI = 0.92–0.97, p = BRAF V600E negative mutation status (96%) and of these, 48 were diagnosed with Lynch syndrome (63%; MLH1 = 38, MSH2 = 4, MSH6 = 4, PMS2 = 1, EPCAM = 1). The variants c.154del and c.306G > T in the MLH1 gene were most commonly observed across Lynch syndrome patients in our cohort. Conclusions This is the first systematic evaluation of the molecular epidemiology of CRC in India. We observe a high proportion of patients with young onset CRC coupled with high prevalence of MSI-high status and Lynch syndrome. The study provides a unique opportunity to explore development of novel Lynch syndrome detection and cancer prevention pathway in Indian healthcare settings.

PURPOSE To describe the socioeconomic profile, awareness level and reasons for the delay in accessing timely eye care for cataract surgery in patients of lens-induced glaucoma (LIG). METHODS This cross-sectional observational study included all patients with LIG who presented to a tertiary eye care centre in central rural India between March 2019 to February 2020. Data were collected through a questionnaire. RESULTS Out of the 731 patients included in the study, the majority were females (69.36%). The mean age of the patients at presentation was 62.66 ± 10.37 years. Only a few participants, 193 (26.40%) were aware of LIG. Lower socioeconomic profile, older age, female gender and illiteracy were found to be strongly associated with awareness about LIG (p

To further define the epilepsy phenotype in a cohort of children with 15q13.3 microdeletion syndrome.We retrospectively reviewed the phenotypic spectrum of all children aged18 years with epilepsy and 15q13.3 microdeletion syndrome.Thirteen children were included, 69% were female. The median age of children in the cohort was 12 years (age range: 3 years-15 years). Median age at seizure onset was 4 years. Eleven children (85%) had intellectual disability. Nine of 13 children (69%) had a history of typical absence seizures with median age of onset at 5 years (2 had absence status epilepticus). Thirty-one percent (4/13) had focal with impaired awareness non-motor onset seizures. ILAE recognized absence epilepsy syndromes were diagnosed in 6/13 (46%). The remainder were classified as having genetic generalized epilepsies with overlap clinical features, combined or focal epilepsies. Electroencephalogram in the cohort showed generalized (85%) and focal epileptiform discharges (62%) and posterior dominant rhythm slowing (33%). One child had electrical status epilepticus of sleep. Neuroimaging was performed in 5 children (38%) and revealed abnormal findings in 3. Seizures were drug resistant in a third of the cohort. Valproate resulted in seizure freedom in 5 (42%). Oxcarbazepine caused clinical worsening in one child with combined seizure types. Two children tried cannabidiol and one tried the ketogenic diet; neither was effective.The epilepsy phenotype in children with 15q13.3 microdeletion syndrome is defined by childhood onset absence seizures, and may have atypical features such as, early onset absences, persistence into adolescence, status epilepticus, intellectual disability and treatment resistance. Focal seizures and focal EEG findings may be observed and should be treated cautiously, given the possibility of combined seizure types. Valproate appeared effective, although other treatments must be explored further.

To evaluate the central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) changes on spectral domain optical coherence tomography (SD-OCT) after cataract surgery with intraocular lens (IOL) implantation in a pediatric population.This was a longitudinal, prospective, interventional study which included 90 pediatric patients who underwent cataract extraction with IOL implantation. Serial SD-OCT scans were done at postoperative day 1, 1-month, and 3-month follow-up. CMT and SFCT were measured at each visit.A statistically significant increase in CMT was noted at 1 month (from 199.3 μm to 210.04 μm) post surgery, which declined over a 3-month period (202.70 μm, P = 0.0001). In case of SFCT, a constant increase was observed for over 3 months of follow-up (baseline: 296.52 μm; 1 month: 309.04 μm; and 3 months: 319.03 μm, P = 0.0001). The traumatic cataract group showed more pronounced changes in CMT and SFCT than the non-traumatic cataract group. No significant difference was observed regarding these parameters between those who underwent primary posterior capsulotomy (PPC) versus those who did not. None of the patients in the study group developed cystoid macular edema. These posterior segment-related anatomical changes did not affect the final visual outcomes.Cataract surgery induces potential inflammatory changes in the macula and choroid in pediatric patients. Such changes are more pronounced in trauma-related cases; however, they are not significant enough to affect the visual outcomes. Similarly, the additional surgical step of PPC does not induce significant anatomical or functional changes.

Background Primary pancreatic lymphoma (PPL) is a rare neoplasm. Being able to distinguish it from other pancreatic malignancies such as pancreatic ductal adenocarcinoma (PDAC) is important for appropriate management. Unlike PDAC, PPL is highly sensitive to chemotherapy and usually does not require surgery. Therefore, being able to identify PPL preoperatively will not only direct physicians towards the correct avenue of treatment, it will also avoid unnecessary surgical intervention. Aim To evaluate the typical and atypical multi-phasic computed tomography (CT) imaging features of PPL. Methods A retrospective review was conducted of the clinical, radiological, and pathological records of all subjects with pathologically proven PPL who presented to our institutions between January 2000 and December 2020. Institutional review board approval was obtained for this investigation. The collected data were analyzed for subject demographics, clinical presentation, laboratory values, CT imaging features, and the treatment received. Presence of all CT imaging findings including size, site, morphology and imaging characteristics of PPL such as the presence or absence of nodal, vascular and ductal involvement in these subjects were recorded. Only those subjects who had a pre-treatment multiphasic CT of the abdomen were included in the study. Results Twenty-nine cases of PPL were diagnosed between January 2000 and December 2020 (mean age 66 years; 13 males/16 females). All twenty-nine subjects were symptomatic but only 4 of the 29 subjects (14%) had B symptoms. Obstructive jaundice occurred in 24% of subjects. Elevated lactate dehydrogenase was seen in 81% of cases, whereas elevated cancer antigen 19-9 levels were present in only 10% of cases for which levels were recorded. The vast majority (90%) of tumors involved the pancreatic head and uncinate process. Mean tumor size was 7.8 cm (range, 4.0-13.8 cm). PPL presented homogenous hypoenhancement on CT in 72% of cases. Small volume peripancreatic lymphadenopathy was seen in 28% of subjects. Tumors demonstrated encasement of superior mesenteric vessels in 69% of cases but vascular stenosis or occlusion only manifested in 5 out of the twenty-nine individuals (17%). Mild pancreatic duct dilatation was also infrequent and seen in only 17% of cases, whereas common bile duct (CBD) dilation was seen in 41% of subjects. Necrosis occurred in 10% of cases. Size did not impact the prevalence of pancreatic and CBD dilation, necrosis, or mesenteric root infiltration (P = 0.525, P = 0.294, P = 0.543, and P = 0.097, respectively). Pancreatic atrophy was not present in any of the subjects. Conclusion PPL is an uncommon diagnosis best made preoperatively to avoid unnecessary surgery and ensure adequate treatment. In addition to the typical CT findings of PPL, such as homogeneous hypoenhancement, absence of vascular stenosis and occlusion despite encasement, and peripancreatic lymphadenopathy, this study highlighted many less typical findings, including small volume necrosis and pancreatic and bile duct dilation.

To identify risk-factors for developing endophthalmitis following open globe injury (OGI) in children.Retrospective, single-center, case-control study of children aged18 years who sustained OGI.Our cohort of 93 eyes consisted of 30 cases (Group A- endophthalmitis) and 63 controls (Group B- no endophthalmitis). Twenty-four eyes (80%) diagnosed with endophthalmitis presented after 24 hours of injury. The presence of central corneal zone-1 injuries (Odd ratio [OR]: 6.64, p= 0.001) and vitreous in wound (OR: 3.53) were associated with the risk of developing endophthalmitis. (p=0.05) Additionally the presence of iris prolapse (OR: 4.76) and posterior capsular rupture (PCR) (OR: 5.80) increased the risk of developing endophthalmitis.(p0.05) . Streptococci was isolated in 15 eyes, Pseudomonas in 3 eyes, and Candida in 1 eye. The visual outcomes at three months were significantly worse in Group A (LogMAR 1.77±1.06) compared to Group B (LogMAR 0.65±0.68)(p0.05).Central corneal involvement, vitreous/ iris incarceration and PCR were important risk factors for development of PTE in children.

Extra time of sitting in front of a digital device is required for e-learning by children during Corona virus (COVID-19) pandemic which can lead to many ocular problems including digital eye strain (DES). In view of increased incidence of DES in children, multiple studies had been conducted in central India to assess the eye strain in children due to excessive online classes as a research project named "Digital eye strain among kids (DESK) study." This study DESK-3 aimed to report series of cases of acute acquired comitant esotropia (AACE) in children attending online classes during COVID-19 pandemic. Children aged 6-18 years with recent onset of esotropia of1-month duration without any similar history in past presented in month of July-August 2020 at a tertiary children eye care hospital were evaluated. Data collection included age and gender of child, presence or absence of diplopia, visual acuity, duration of smartphone use, duration of online classes, angle of deviation for near and distance and cycloplegic refraction. Total eight children of AACE were included in the study. The mean age of children was 12.5 ± 4.2 years. All eight were males. The mean duration of smartphone use was 4.6 + 0.7 hours per day. All children were attending online classes4 hours per day on smartphone of average size 5.5 inches. Five children were emmetropic, one myopic, one pseudomyopic and one hyperopic. The angle of deviation for near and distance were 48.1 ± 16.4 PD and 49.3 ± 15.9 PD respectively with normal ocular motility. Seven children complained of horizontal diplopia in all gazes. Neurological examination and CT scan of brain and orbit was normal in all patients. Two months before the lockdown only one case was identified as compared to eight during the lockdown. Prolonged near work during smart phone use for e-learning might lead to the development of AACE in children.

Purpose: To subjectively evaluate the degree of visual fatigue in children attending online classes during the coronavirus 2019 (COVID-19) pandemic and objectively evaluate accommodation and vergence dysfunction in these children. Methods: Children aged between 10 and 17 years with recent onset of asthenopia symptoms were included. Symptoms were evaluated using the Convergence Insufficiency Symptom Survey (CISS) questionnaire. A CISS score of 16 or greater was considered symptomatic. Binocular vergence and accommodation parameters were objectively evaluated. For ease of comparison, children were divided into two groups: children using digital devices for less than 4 hours/day and children using digital devices for 4 hours/day or more. Results: A total of 46 children with a mean age of 14.47 ± 1.95 years were evaluated. The mean duration of online classes during the COVID-19 pandemic was 3.08 ± 1.68 hours/day, which is higher than before the COVID-19 pandemic (0.58 ± 0.71 hours/day, P < .00001). The mean CISS scores were 21.73 ± 12.81 for children using digital devices less than 4 hours/day and 30.34 ± 13.0 for children using digital devices for 4 hours/day or more ( P = .019). Mean near exophoria ( P = .03), negative fusional vergence ( P = .02), negative relative accommodation ( P = .057), and accommodation amplitude ( P = .002) were different between the two groups. The Spearman correlation between the symptomatic CISS score and the duration of online classes showed a linear association (coefficient r s = 0.39; P = .007). In the multivariate analysis, only the duration of online classes longer than 4 hours was a significant risk factor ( P = .07) for the symptomatic CISS score. Conclusions: Online classes longer than 4 hours were more detrimental to abnormal binocular vergence and accommodation parameters than online classes shorter than 4 hours. [ J Pediatr Ophthalmol Strabismus . 2021;58(4):224–231.]

This randomized, single-treatment, 2-sequence study evaluated the food effect on oral bioavailability of desidustat. Healthy adult male and female subjects were enrolled and randomly assigned to receive desidustat 50 mg orally in a fasting state in one period and a fed state in the other period. A standardized high-fat, high-calorie breakfast was served to assess the food effect. The pharmacokinetic results showed that the time to maximum blood concentration of desidustat was delayed significantly (P .0001) in the fed state compared to the fasting state. The ingestion of food decreased the maximum blood concentration (C

Purpose: To determine the surgical outcomes of bleb needling and the risk factors of failure of needling after failed filtration surgeries in patients with pediatric glaucoma. Methods: The medical records of patients who underwent needling with 5-fluorouracil following filtering surgeries (trabeculectomy, combined trabeculectomy, and trabeculotomy) between January 2012 and December 2016 were retrospectively reviewed. At the 1-year follow-up visit, complete success and qualified success were defined as an intraocular pressure (IOP) of less than 18 mm Hg with and without antiglaucoma medication, respectively. Results: Forty-five eyes that underwent needling and fulfilled the study criteria were included in the analysis. The mean age at needling was 9.6 years. The mean time interval between filtration surgery and the first needling procedure was 57.3 days. Thirty-eight of 45 eyes (84.4%) had undergone needling within 3 months after the primary surgery. Cumulative success was achieved in 35 eyes (77.7%) after needling (complete success in 22 eyes and qualified success in 13 eyes). Mean follow-up after needling was 18.9 months. The mean IOP before and after needling was 31.7 ± 9.45 and 16.6 ± 5.68 mm Hg, respectively ( P < .00001). Steroid-induced glaucoma ( P = .01), high IOP prior to the first filtration surgery ( P = .01), and an inability to achieve low IOP (< 9 mm Hg, P = .04) immediately after needling were significant risk factors associated with failure. Conclusions: Bleb needling is an efficient method for lowering IOP after a failed trabeculectomy or combined trabeculectomy and trabeculotomy in the pediatric population. [ J Pediatr Ophthalmol Strabismus . 2021;58(2):118–125.]

Single electron transistor (SET) has several advantages over CMOS such as it is highly scalable and has ultra-low power consumption. It has emerged as a promising technology to be used as a building blocks for next generation integrated circuit design. In this paper, prospective and efficient implementation of high speed, low power and extremely compact digital multipliers using SET is proposed for the first time. For effective analysis and comparison, three different 8-bit signed multipliers such as Baugh Wooley, Booth and Array multiplier have been designed and their simulation results are validated using the Cadence Virtuoso ADE tool. Performance comparison in terms of power and delay between SET and 16 nm CMOS is evaluated. From the simulation results, it is observed that multipliers based on SET outperforms its CMOS counterpart in all aspects. Considering above mentioned multipliers, SET based Booth multiplier design is having lowest power consumption of 1.41 µW and propagation delay of 6.09 ps as compared to 7.53 µW and 454.94 ps respectively for CMOS counterpart below.

Technological tools can redesign traditional approaches to radiology education, for example, with simulation cases and via computer-generated feedback. In this study, we investigated the use of an AI-powered, Bayesian inference-based clinical decision support (CDS) software to provide automated "real-time" feedback to trainees during interpretation of clinical and simulation brain MRI examinations. Radiology trainees participated in sessions in which they interpreted 3 brain MRIs: two cases from a routine clinical worklist (one without and one with CDS) and a teaching file-based simulation case with CDS. The CDS software required trainees to input imaging features and differential diagnoses, after which inferred diagnoses were displayed, and the case was reviewed with an attending neuroradiologist. An observer timed each case, including time spent on education, and trainees completed a survey rating their confidence in their findings and the educational value of the case. Ten trainees reviewed 75 brain MRI examinations during 25 reading sessions. Trainees had slightly lower confidence in their findings and diagnosis and rated the educational value slightly higher for simulation cases with CDS compared to clinical cases without CDS (p 0.05). There were no significant differences in ratings of clinical cases with or without CDS. No differences in overall timing were found among the reading scenarios. Simulation cases with "CDS-provided feedback" may improve the educational value of interpreting imaging studies at a workstation without adding additional time. Further investigation will help drive innovation in trainee education, which may be particularly relevant in this era of increasing remote work and asynchronous attending review.

Objectives In recent years immunotherapy has escalated to frontline treatment options for metastatic non-small cell lung cancer. Cardiovascular toxicity from chemotherapeutic agents is well described in this patient population with common underlying risk factors like smoking. We explored cardiovascular toxicity form the addition of immune checkpoint inhibitors to traditional chemotherapy. Materials and Methods This is a retrospective study from SEER-Medicare datasets which represents 34 % of the US population. This study included patients age ≥ 65 years-old with newly diagnosed metastatic non-small cell lung cancer between the years 2013 and 2015. Patients were divided into 2 cohorts, one who received traditional chemotherapy only (control arm) and the others who received immune checkpoint inhibitors in addition to traditional chemotherapy (study arm). The primary endpoint was the hazards of new cardiovascular toxicity in the study versus the control arm. Results We identified 6405 patients who met our study criteria. Of these, 5730 patients received chemotherapy only while 675 patients received chemotherapy and immune checkpoint inhibitors. Results showed that the hazard ratio for all cardiovascular toxicity was 0.81 (95 % CI:0.72−0.91, p = 0.0003) in patients who received immune checkpoint inhibitors with chemotherapy. Among the subgroups, hazards ratio for acute coronary syndrome was 0.82 (95 % CI: 0.64–1.05, p = 0.10), hazards ratio for heart failure was 0.74 (95 % CI: 0.62−0.88, p = 0.0007), hazards ratio for cardiac arrhythmia was 0.72 (95 % CI: 0.63−0.82, p Conclusions Results from this study are reassuring that adding immune checkpoint inhibitors to chemotherapy is safe and does not result in increased cardiovascular toxicity but instead showed lower hazards.

AimsTo describe the clinical features, visual acuity and causes of ocular morbidity in children (0–18 years) with microphthalmos, anophthalmos, and coloboma (MAC) from North India.MethodsA retrospective study conducted between October 2017 and September 2018 in three tertiary eye institutes, part of the Bodhya Eye Consortium with consensus led common pro formas. Children with complete clinical data and without syndromic/systemic involvement were included. The clinical phenotype was divided into isolated ocular coloboma (CB), coloboma with microcornea (CBMC), colobomatous microphthalmos (CBMO), non-colobomatous microphthalmos (MO) and anophthalmos (AO).ResultsA total of 532 children with MAC were examined. Seventeen records were excluded due to incomplete data (0.2%). 515 children (845 eyes) were included: 54.4% males and 45.6% females. MAC was unilateral in 36% and bilateral in 64%. CB, CBMC, CBMO, MO and AO were seen in 26.4%, 31%, 22%, 8% and 12.5% of eyes, respectively. Nystagmus was found in 40%, strabismus in 23%, cataract in 18.7% and retinal detachment in 15%. Best-corrected visual acuity (BCVA) of ConclusionThe MAC group of disorders cause significant ocular morbidity. The presence of microcornea or microphthalmos with coloboma predicts worse BCVA. The variation of the MAC phenotype with the district of origin of the patient raises questions of aetiology and is subject to further studies.

Summary Background Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness. Methods In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing. Findings Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57–76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53–2·21), male sex (1·63, 1·07–2·48), smoking status (former smoker vs never smoked: 1·60, 1·03–2·47), number of comorbidities (two vs none: 4·50, 1·33–15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11–7·18), active cancer (progressing vs remission: 5·20, 2·77–9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79–4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07–0·84) or the US-Midwest (0·50, 0·28–0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality. Interpretation Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments. Funding American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.

Although first line therapies for essential tremor have been identified from small clinical trials, responses are variable. We conducted a survey of tremor management in a large sample of ET cases.The Movement Disorders Clinical Case Registry within a US Veterans Health Administration medical center was used to identify 1468 patients with ET.Of 1468 charts reviewed, 1074 (73.19%) met criteria for ET with characterization of temporal course and treatment; 291/1074 subjects (27.1%) did not receive any treatment. Almost half (500/1074; 46.6%) of the patients received monotherapy, 196/1074 (18.2%) two, 66/1074 (6.1%) three, and 21/1074 (2.0%) four or more medications. Of all prescriptions, primidone was the most used (546/1172; 46.6%), followed by propranolol (419; 35.8%), topiramate (122; 10.4%) and gabapentin (35; 3.0%). Medication response was available for a total of 1030 prescriptions, of which 138 (13.4%) were discontinued due to side effects; 180 (17.5%) prescriptions were ineffective. Furthermore, 52/1074 patients (4.8%) were treated with botulinum toxin injections and 41/1074 (3.8%) underwent deep brain stimulation surgery.Our data suggest that more widespread recognition of limitations underlying conventional approaches, as well as increased referrals for nonpharmacological therapies, may be necessary to achieve improved outcomes in ET populations.

As a rare immune-mediated adverse reaction to immune checkpoint inhibitor (ICI) therapy, immune checkpoint inhibitor associated renal-limited thrombotic microangiopathy (ICI-rTMA) is a biopsy-proven kidney-limited TMA without the classical triad of systemic TMA. With the expanding use of ICIs, reports of ICI-rTMA are limited yet emerging. ICI-rTMA currently has a poor renal prognosis and a lack of treatment strategy. Furthermore, ICI re-challenge poses a difficult clinical dilemma wherein renal function must be maintained without risking the higher mortality associated with ICI withdrawal. This review summarizes six reported cases of ICI-rTMA and discusses the current literature on ICI-rTMA regarding its potential mechanisms of pathogenesis, the vital role of kidney biopsy in diagnosis, treatment options, and the dilemma surrounding ICI re-challenge.

Relevant uncertainties on theoretical atomic data are vital to determine the accuracy of plasma diagnostics in a number of areas including in particular the astrophysical study. We present a new calculation of the uncertainties on the present theoretical ion-impact charge exchange atomic data and X-ray spectra based on a set of comparisons with the existing laboratory data obtained in historical merged-beam, cold-target recoil-ion momentum spectroscopy, and electron beam ion traps experiments. The average systematic uncertainties are found to be 35-88% on the total cross sections, and 57-75% on the characteristic line ratios. The model deviation increases as the collision energy decreases. The errors on total cross sections further induce a significant uncertainty to the calculation of ionization balance for low temperature collisional plasmas. Substantial improvements of the atomic database and dedicated laboratory measurements are needed to get the current models ready for the X-ray spectra from the next X-ray spectroscopic mission., accepted for publication in Sensors, plasma diagnostics special issue

Purpose: To find the accuracy of Scheimpflug imaging for the evaluation of posterior lens capsule and to assess the incidence of pre-existing posterior capsular tear (PCT) in pediatric traumatic cataracts. Methods: It was a prospective, non-randomized, and interventional study. Scheimpflug imaging was done preoperatively to detect pre-existing PCT in pediatric traumatic cataracts after blunt trauma. All patients underwent cataract extraction with intraocular lens implantation. Intraoperatively, the posterior capsule status was noted and compared with the preoperative Scheimpflug images. Results: Forty-seven eyes of 47 children having traumatic cataracts following closed-globe injury were included. There were 32 males and 15 females with a mean age of 10.91 ± 2.75 years. The mean duration of performing the Scheimpflug imaging from injury was 41.7 ± 7.78 days. Preoperative Scheimpflug imaging showed intact posterior lens capsule in 36 eyes and PCT in 11 eyes. Intraoperative, 37 eyes had an intact posterior lens capsule and 10 eyes had PCT. The Scheimpflug imaging did not detect the PCT in three eyes (false-negative), and in four eyes, PCT was detected falsely on Scheimpflug imaging (false-positive). The sensitivity and specificity of the Scheimpflug imaging were 70 and 89.18%, respectively. The accuracy of the technique was 85.11%. Conclusion: Scheimpflug imaging is a useful modality for the detection of PCT preoperatively in cases with doubtful posterior lens capsule integrity.

BackgroundViral infections are pervasive and leading causes of myocarditis. Immune-suppression after chemotherapy increases opportunistic infections, but the incidence of virus-induced myocarditis is unknown.ObjectiveAn unbiased, blinded screening for RNA viruses was performed after chemotherapy with correlation to cardiac function.MethodsHigh-throughput sequencing of RNA isolated from blood samples was analyzed following chemotherapy for hematological malignancies (N = 28) and compared with left ventricular ejection fraction (LVEF).ResultsOn initial rigorous analysis, low levels of influenza orthomyxovirus and avian paramyxovirus sequences were detectable, but without significant correlation to LVEF (r = 0.208). A secondary broad data mining analysis for virus sequences, without filtering human sequences, detected significant correlations for paramyxovirus with LVEF after chemotherapy (r = 0.592, P < 0.0096). Correlations were similar for LVEF pre- and post- chemotherapy for orthomyxovirus (R = 0.483, P < 0.0421). Retrovirus detection also correlated with LVEF post (r = 0.453, p < 0.0591), but not pre-chemotherapy, but is suspect due to potential host contamination. Detectable phage and anellovirus had no correlation. Combined sequence reads (all viruses) demonstrated significant correlation (r = 0.621, P < 0.0078). Reduced LVEF was not associated with chemotherapy (P = NS).ConclusionsThis is the first report of RNA virus screening in circulating blood and association with changes in cardiac function among patients post chemotherapy, using unbiased, blinded, high-throughput sequencing. Influenza orthomyxovirus, avian paramyxovirus and retrovirus sequences were detectable in patients with reduced LVEF. Further analysis for RNA virus infections in patients with cardiomyopathy after chemotherapy is warranted.

Introduction: Chemotherapy for hematologic malignancies can cause severe cardiomyopathy. Chemotherapeutic agents also induce immune suppression increasing the risk of opportunistic infections. Hypothesis: We have hypothesized that immunosuppression after chemotherapy increases opportunistic viral infections, myocarditis and cardiomyopathy. Methods: Viral gene sequences were identified using an unbiased high-throughput sequencing approach of patient blood samples following chemotherapy treatment for hematological malignancies (N = 28). Detected viral sequences were correlated with cardiac ejection fraction (LVEF) measured before and after treatment. Results: In a blinded analysis undertaken by two investigators viral sequences were identified in blood samples from patients after chemotherapy. Low levels of Influenza A, orthomyxovirus and Avian Paramyxovirus sequences were detected but identified individual virus sequences did not have a significant correlation to reduced LVEF post chemotherapy (r = 0.177-0.293). Detected sequences for all RNA viruses combined did indicate some correlation with LVEF, r = 0.621, suggesting potential for nonspecific RNA virus detection ( p < 0.0078). In a secondary broad screen, data mining was performed including all detectable viral sequences without the filtering of human related sequences. In this broad analysis a significant correlation was detected for Paramyxovirus with reduced cardiac LVEF (r = 0.592 post, compared to r = 0.464 prior to chemotherapy; P < .0096). For detected Orthomyxovirus sequences correlations were similar for LVEF pre- and post- chemotherapy (R = 0.483, P < 0.0451). Retroviruses reads were increased but suspect due to human genome retrovirus sequences (R= 0.512; P < 0.0351). No correlation was seen for Anellovirus, a DNA virus. Reduced LVEF did not correlate with chemotherapy (p = NS). Conclusions: This is the first report of screening for RNA viruses in the circulating blood of patients post chemotherapy using a high-throughput sequencing approach. Influenza Orthomyxovirus and Avian Paramyxovirus sequences were detectable in patients with reduced LVEF after chemotherapy. Further analysis for RNA virus infections in cardiomyopathy after chemotherapy is warranted.

Purpose: To compare the safety, feasibility, and outcomes of clear corneal cataract surgery with or without sutures in children (2 to 8 years old) with congenital or developmental cataracts. Methods: One hundred seventy consecutive eligible eyes with pediatric cataracts were randomized into treatment groups depending on closure of clear corneal incisions: suture group and sutureless hydroclosure group (sutureless group). Patients were evaluated on days 1, 7, 30, and 90 postoperatively, with an emphasis on wound leakage from incisions and complications. Results: Wound leakage from any corneal incisions was not observed in both groups. Shallow anterior chamber on the first postoperative day was observed in 2 and 3 eyes in the suture and sutureless groups, respectively ( P = .48). Hypotony was not observed in any patients. Intraocular pressure measurements were comparable on follow-up visits ( P > .05). Mean cylindrical error was significantly greater ( P = .03) in the suture group than the sutureless group (1.01 and 0.74 diopters, respectively) after 1 month. One patient developed endophthalmitis after suture removal in the suture group. Conclusions: Sutureless hydroclosure of incisions is not inferior compared to suturing in pediatric cataracts. This avoids suture-related complications while reducing the astigmatic error and is thus potentially less amblyogenic. However, sutures must be used whenever the incision architecture is compromised. [ J Pediatr Ophthalmol Strabismus . 2021;58(4):246–253.]

Scleroderma, "en coup de sabre" is a rare disorder, characterized by linear depressed scarring at frontoparietal area of the face, seldom associated with ophthalmological findings. Extraocular muscle involvement and paralytic strabismus are rarely associated with linear scleroderma. Here we are reporting a case of unilateral linear scleroderma in an 8-year-old child, with features of strabismus fixus secondary to fibrosed medial rectus (MR) muscle, enophthalmos and en coup de saber (sword-like scar) on the eyebrow. MRI orbit was suggestive of the bulky MR and the inferior rectus muscle. MR recession along with partial loop myopexy resulted in cosmetically acceptable ocular alignment in this case. Histopathology of the portion of muscle and intermuscular septum showed diffuse fibrosis of the muscle. Linear scleroderma may be the causative etiology of strabismus fixus in our case, never reported before in literature.

Background Immune checkpoint inhibitors (ICIs) are a novel class of anticancer agents that have demonstrated clinical response for both solid and hematological malignancies. ICIs are associated with development of immune-related adverse events including cardiotoxicity. We estimated the incidence of newly diagnosed cardiovascular disease in patients treated with ICIs at a large, tertiary care center. Methods All patients with a cancer diagnosis who received any ICI treatment in the University of Florida’s Integrated Data Repository from 2011 to 2017 were included. Cardiovascular disease was defined as a new ICD diagnosis code for cardiomyopathy, heart failure, arrhythmia, heart block, pericardial disease, or myocarditis after initiation of ICI treatment. Results Of 102,701 patients with a diagnosis of malignancy, 424 patients received at least one ICI. Sixty-two (14.6%) patients were diagnosed with at least one new cardiovascular disease after initiation of ICI therapy. Of the 374 patients receiving one ICI, 21 (5.6%) developed heart failure. Of the 49 patients who received two ICIs sequentially, three (6.1%) developed heart failure and/or cardiomyopathy. Incident cardiovascular disease was diagnosed at a median of 63 days after initial ICI exposure. One patient developed myocarditis 28 days after receiving nivolumab. Mortality in ICI treated patients with a concomitant diagnosis of incident cardiovascular disease was higher compared to those who did not (66.1% vs. 41.4%, odds ratio = 2.77, 1.55–4.95, p = 0.0006). Conclusions This study suggests a high incidence of newly diagnosed cardiovascular disease after the initiation of ICI therapy in a real-world clinical setting.

The astrophysical journal 913(2), 140 (2021). doi:10.3847/1538-4357/abf737, We investigated experimentally and theoretically dielectronic recombination (DR) populating doubly excited configurations $3l3l^{\prime} $ (LMM) in Fe xvii, the strongest channel for soft X-ray line formation in this ubiquitous species. We used two different electron beam ion traps and two complementary measurement schemes for preparing the Fe xvii samples and evaluating their purity, observing negligible contamination effects. This allowed us to diagnose the electron density in both EBITs. We compared our experimental resonant energies and strengths with those of previous independent work at a storage ring as well as those of configuration interaction, multiconfiguration Dirac���Fock calculations, and many-body perturbation theory. This last approach showed outstanding predictive power in the comparison with the combined independent experimental results. From these we also inferred DR rate coefficients, unveiling discrepancies from those compiled in the OPEN-ADAS and AtomDB databases., Published by Univ., Chicago, Ill. [u.a.]

Introduction: Prognostic scoring system in Intensive Care Unit (ICU) can be generic, which can be applied to any critical illness for which patients are admitted in critical wards or can be disease specific. Malaria Severity Score (MSS) is a disease specific prognostic scoring system. Aim: To study the role of MSS in patients having malaria who were critically ill having multi organ dysfunction and to correlate the score with risk of mortality. Materials and Methods: This longitudinal study was conducted at the Department of General Medicine, SBKSMI & RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. Adult patients (>18 years) with falciparum as well as vivax malaria, who had positive peripheral smear malaria and were admitted in ICU/Casualty (Emergency) ward, were taken in the study. The score was calculated on day of admission, day 2 and day 7. The score was analysed between two groups: survivors and non-survivors. Appropriate statistical tests were applied (z-test for two population proportion and Chi-square test for categorical values). The p-value

Candidemia is the most frequent invasive fungal infection in hospitalized patients. This report describes the case of a nine month old baby on whom three colostomy were performed due to intestinal obstruction. After third colostomy, patient presented with fecal peritonitis. Peripheral blood lm examination revealed yeast form of candida. Subsequently candida species was isolated on blood culture and subculture on cornmeal agar and biochemical tests conrmed the presence of Candida albicans. A diagnosis of fungal infection based on the peripheral blood lm has a potential to lead to early diagnosis and prompt treatment of a life threatening infection.

We demonstrate a widely applicable technique to absolutely calibrate the energy scale of x-ray spectra with experimentally well-known and accurately calculable transitions of highly charged ions, allowing us to measure the K-shell Rydberg spectrum of molecular O_{2} with 8 meV uncertainty. We reveal a systematic ∼450 meV shift from previous literature values, and settle an extraordinary discrepancy between astrophysical and laboratory measurements of neutral atomic oxygen, the latter being calibrated against the aforementioned O_{2} literature values. Because of the widespread use of such, now deprecated, references, our method impacts on many branches of x-ray absorption spectroscopy. Moreover, it potentially reduces absolute uncertainties there to below the meV level.

We resonantly excite the $K$ series of O$^{5+}$ and O$^{6+}$ up to principal quantum number $n=11$ with monochromatic x rays, producing $K$-shell holes, and observe their relaxation by soft-x-ray emission. Some photoabsorption resonances of O$^{5+}$ reveal strong two-electron--one-photon (TEOP) transitions. We find that for the $[(1s\,2s)_1\,5p_{3/2}]_{3/2;1/2}$ states, TEOP relaxation is by far stronger than the radiative decay and competes with the usually much faster Auger decay path. This enhanced TEOP decay arises from a strong correlation with the near-degenerate upper states $[(1s\,2p_{3/2})_1\,4s]_{3/2;1/2}$ of a Li-like satellite blend of the He-like $K\alpha$ transition. Even in three-electron systems, TEOP transitions can play a dominant role, and the present results should guide further research on the ubiquitous and abundant many-electron ions where electronic energy degeneracies are far more common and configuration mixing is stronger., Comment: Published in PRA

In recent years immunotherapy has escalated to frontline treatment options for metastatic non-small cell lung cancer. Cardiovascular toxicity from chemotherapeutic agents is well described in this patient population with common underlying risk factors like smoking. We explored cardiovascular toxicity form the addition of immune checkpoint inhibitors to traditional chemotherapy.This is a retrospective study from SEER-Medicare datasets which represents 34 % of the US population. This study included patients age ≥ 65 years-old with newly diagnosed metastatic non-small cell lung cancer between the years 2013 and 2015. Patients were divided into 2 cohorts, one who received traditional chemotherapy only (control arm) and the others who received immune checkpoint inhibitors in addition to traditional chemotherapy (study arm). The primary endpoint was the hazards of new cardiovascular toxicity in the study versus the control arm.We identified 6405 patients who met our study criteria. Of these, 5730 patients received chemotherapy only while 675 patients received chemotherapy and immune checkpoint inhibitors. Results showed that the hazard ratio for all cardiovascular toxicity was 0.81 (95 % CI:0.72-0.91, p = 0.0003) in patients who received immune checkpoint inhibitors with chemotherapy. Among the subgroups, hazards ratio for acute coronary syndrome was 0.82 (95 % CI: 0.64-1.05, p = 0.10), hazards ratio for heart failure was 0.74 (95 % CI: 0.62-0.88, p = 0.0007), hazards ratio for cardiac arrhythmia was 0.72 (95 % CI: 0.63-0.82, p0.0001) and hazards ratio for heart blocks was 0.48 (95 % CI: 0.30-0.76, p0.0001). There was no significant difference in hazards for cardiomyopathy, pericarditis, and myocarditis between the two cohorts. Patients above 75 years, with comorbidities and pre-existing heart disease, were at higher risk.Results from this study are reassuring that adding immune checkpoint inhibitors to chemotherapy is safe and does not result in increased cardiovascular toxicity but instead showed lower hazards.

Extreme-ultraviolet (EUV) spectra of ${\mathrm{Sn}}^{13+}\ensuremath{-}{\mathrm{Sn}}^{15+}$ ions have been measured in an electron-beam ion trap (EBIT). A matrix inversion method is employed to unravel convoluted spectra from a mixture of charge states typically present in an EBIT. The method is benchmarked against the spectral features of resonance transitions in ${\mathrm{Sn}}^{13+}$ and ${\mathrm{Sn}}^{14+}$ ions. Three new EUV lines in ${\mathrm{Sn}}^{14+}$ confirm its previously established level structure. This ion is relevant for EUV nanolithography plasma but no detailed experimental data currently exist. We used the Cowan code for first line identifications and assignments in ${\mathrm{Sn}}^{15+}$. The collisional-radiative modeling capabilities of the Flexible Atomic Code were used to include line intensities in the identification process. Using the 20 lines identified, we have established 17 level energies of the $4{p}^{4}4d$ configuration as well as the fine-structure splitting of the $4{p}^{5}$ ground-state configuration. Moreover, we provide state-of-the-art ab initio level structure calculations of ${\mathrm{Sn}}^{15+}$ using the configuration-interaction many-body perturbation code ambit. We find that the here-dominant emission features from the ${\mathrm{Sn}}^{15+}$ ion lie in the narrow 2% bandwidth around 13.5 nm that is relevant for plasma light sources for state-of-the-art nanolithography.

Intravenous unfractionated heparin (UFH) remains one of the most commonly used anticoagulants in the hospital setting. The optimal protocol for initiation and maintenance of UFH has been difficult to determine. Over the past two decades, weight-based nomogram protocols have gained favor. Herein, we present a retrospective study of 377 patients at a single tertiary academic center treated with low intensity (LI) and standard intensity (SI) UFH protocols for therapeutic anticoagulation. UFH levels are measured by anti-Xa assay activity with therapeutic levels of 0.30 to 0.70 IU/mL for SI and 0.25 to 0.35 IU/mL for LI. Patients treated on the LI protocol were more likely to have had a previous history of bleeding and lower baseline hemoglobin. Incidence of new or worsening thrombus while on UFH was comparable between both protocols (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.29-2.98, p=0.899). Patients on LI protocol had higher incidence of bleeding while on UFH (OR 1.21, 95% CI 0.51-2.89, p=0.667). Our study thus suggests that the LI protocol may have comparable efficacy to the SI protocol in treating venous thromboembolism (VTE) and that target anti-Xa levels of 0.25 to 0.35 IU/mL may be more optimal in high-risk patients.

CT colonography for colorectal cancer screening has been proved to be effective and cost-saving. CT colonography uses minimally invasive evaluation of colorectum and has better patient acceptance, which appears to be a promising screening modality to improve low colorectal cancer screening rate. This study investigated the utilization patterns of CT colonography and factors associated with its use among U.S. adult population. This retrospective cross-sectional study analyzed the National Health Interview Survey 2015 and 2018. U.S. adults ages 45 or older without a history of colorectal cancer were included. Survey design-adjusted Wald F tests were used to compare the utilization of CT colonography during the study period. Multivariable logistic regression was used to identify the predictors of CT colonography among individual socioeconomic and health-related characteristics. The study sample included 34,768 individuals representing 129,430,319 U.S. adult population ages 45 or older. The overall utilization of CT colonography increased from 0.79% in 2015 to 1.33% in 2018 (P < 0.001). 54.5% study participants reported being up-to-date on recommended colorectal cancer screening; of those, 1.8% used CT colonography. Compared with individuals ages 65+, those ages 45–49 years were 2.08 times (OR, 2.08, 95% confidence interval, 1.01–4.35) more likely to use CT colonography. Socioeconomically disadvantaged characteristics (e.g., racial/ethnic minority, low income, publicly funded insurance) were associated with a greater likelihood of CT colonography. This study demonstrated an increasing trend in utilization of CT colonography for colorectal cancer screening in U.S. adults. Younger individuals, racial/ethnic minorities, or those with lower income appear to have a higher CT colonography utilization. Prevention Relevance: Although computed tomographic (CT) colonography has been proved to be cost-effective and have better patient acceptance, its overall utilization for colorectal cancer (CRC) screening is low (

PURPOSE: Some elderly patients (≥ 65 years old) with small-cell lung cancer (SCLC) do not receive chemotherapy likely because of fear of toxicity and uncertainty regarding benefits. Thus, we aimed to study real-world trends in utilization of antineoplastics over the years and predictors of utilization, survival, and Medicare expenditure in elderly patients with extensive-stage (ES) SCLC. PATIENTS AND METHODS: Using the linked SEER and Medicare database, we identified elderly patients with newly diagnosed ES-SCLC between 2001 and 2013. The Wald test was used to determine the significance of trends. Cox proportional hazards models were applied for survival analyses. We used SAS, version 9.4 (SAS Institute, Cary, NC). RESULTS: We identified 15,763 patients with newly diagnosed ES-SCLC. Approximately 6,838 patients (43.38%) received antineoplastics, and 8,925 patients (56.61%) received supportive care only. Every year since 2001, the percentage of patients receiving antineoplastics has decreased (45.8% v 36.6% in 2001 and 2013, respectively; Ptrend < .0001). Patients with advanced age ( P < .001), patients from high-poverty areas ( P < .001) or rural areas ( P = .005), patients with Charlson comorbidity index ≥ 3 ( P < .001), and non-Hispanic blacks ( P = .003) and Hispanics ( P = .001) were less likely to receive antineoplastics. Mean Medicare spending per patient decreased over the study period for patients treated with antineoplastics ($45,998 in 2001 and $35,053 in 2013; Ptrend < .001) and for those receiving supportive care only ($34,197 in 2001 and $25,265 in 2013; Ptrend < .001). CONCLUSION: Decreasing utilization of antineoplastics in elderly patients with ES-SCLC since 2001 could be partly secondary to higher comorbidities and physiologic age, leading to poor candidacy. Medicare expenditures decreased likely as a result of value-based treatment initiatives by the Centers for Medicaid and Medicare Services. However, expenditures are likely to increase with use of expensive novel agents.

Background Post-transplant lymphoproliferative disorder (PTLD) is a rare complication following transplant (solid organ or allogeneic) due to the proliferation of lymphoid cells in the immunosuppressed state. The incidence of PTLD follows a bimodal distribution, with high incidence immediately after transplant (early-onset PTLD), followed by a decline and then a high-incidence again five years after transplantation (late-onset PTLD). This study exclusively aims to identify prognostic factors for the subgroup of PTLD, described as very late-onset PTLD, occurring after 10 years of transplant. Methods This study was conducted at the University of Florida, with the requisite study population identified through the cancer registry. Data were collected by individual chart review and analyzed. Survival estimates and univariate and multivariate analyses were performed to measure the effects of each variable on overall survival. Results A total of 33 patients were identified, with a median age at transplant of 42.3 years, while the median age at PTLD diagnosis was 54.7 years. Median time from transplant to PTLD diagnosis was 13.3 years. Kidney (30.3%), liver (27.3%), and heart (24.2%) transplants were the most common allografts associated with very late PTLD development. The most common pathology was diffuse large B-cell lymphoma (DLBCL) in 45.5% of patients. CHOP+/-R (cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (Oncovin), prednisone, rituximab) was the most common chemo regimen used as the initial choice in 36.4% of patients. Median survival was 5.4 years. Univariate analysis showed that age at diagnosis over 65, male gender, bone marrow involvement, past medical history (PMH) of malignancy, immunosuppression regimen at PTLD diagnosis, and initial and final best response to treatment were statistically significant (p