No abstract

No abstract

Objective: To investigate the association between using febuxostat and cardiovascular events. Methods: Systematic search of randomized controlled trials was performed using PubMed/MEDLINE, Cochrane review, and EMBASE databases through April 17, 2019. Meta-analysis was performed using random effect model and estimates were reported as risk difference (RD) with 95% CIs. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The main outcomes of interest were cardiovascular mortality and all-cause mortality. Results: A total of 15 randomized controlled trials (16,070 participants) were included. The mean AE SD age was 58.1AE11.7 years. At the median follow-up of 6.4 months, use of febuxostat was not associated with statistically significant risk of cardiovascular mortality (RD, 0.12%; 95% CI,-0.25% to 0.49%; I 2 ¼48%; low certainty evidence), all-cause mortality (RD, 0.20%; 95% CI,-0.28% to 0.68%; I 2 ¼60%; very low certainty evidence), major adverse cardiovascular events (RD, 0.40%; 95% CI,-0.34% to 1.13%; I 2 ¼26%; low certainty evidence), myocardial infarction (RD,-0.06%; 95% CI,-0.29% to 0.17%; I 2 ¼0%; moderate certainty evidence), stroke (RD, 0.10%; 95% CI,-0.15% to 0.35%; I 2 ¼0%; moderate certainty evidence), or new-onset hypertension (RD, 1.58%; 95% CI,-0.63% to 3.78%; I 2 ¼58%; very low certainty evidence). These findings were consistent in patients with existing cardiovascular disease. Conclusion: This meta-analysis suggested that use of febuxostat was not associated with higher risk of mortality or adverse cardiovascular outcomes in patients with gout and hyperuricemia. The results were limited by low to moderate certainty of evidence.

No abstract

No abstract

Metastasis of extra-intestinal carcinoma to the gastrointestinal tract (GIT) is a rare event, most commonly occurring with malignant melanoma. Anti-PD-1 (programmed death-1) immunotherapeutic agents are immune checkpoint inhibitors with proven benefit across multiple cancer types, including squamous cell carcinoma of the head and neck (SCCHN). Here we describe a case of small bowel perforation attributed to a primary SCCHN metastasizing to the GIT in the setting of treatment with PD-1 inhibitors.

Neurofibromatosis type 1 (NF-1) is known to be associated with increased risk of malignancy by at least fourfold. Malignant lymphomas are rare in adults with NF-1. Hereby, we present a 75-year-old male with NF-1 complaining of weakness, nausea, and vomiting associated with abdominal pain. Three months prior to presentation, he had suffered a motor vehicle accident (MVA) resulting in multiple rib fractures that was seen in chest X-ray. For the following three months, he had intermittent chest pain, but it was attributed to the recent rib fracture. During this admission, the severity of chest pain worsened and the associated vomiting inclined further investigation; including CT imaging and bone biopsy, it was revealed to be a rare case of diffuse B cell lymphoma in a patient with NF-1. However, we believe the recent MVA caused an anchoring bias in making a prompt diagnosis. In addition, the appearance of the neurofibroma, resulted in suboptimal physical examination, and hence, there was a delay in reaching the diagnosis. We will discuss here the presentation of this case, to highlight the rare association and to increase awareness of when encountering a challenging diagnosis.

No abstract