Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response parameters in women undergoing their first ICSI-ET cycle.
The prevalence and incidence of diabetes mellitus (DM) are increasing worldwide. We aim to assess mortality and socio-economic outcomes among patients hospitalized for stroke and diabetes in the US and evaluate their recent trends. We examined: in-hospital mortality, length of stay (LoS), and overall hospital charges in diabetic patients over 18 years old who were hospitalized with a stroke from 2005 to 2014, included in the National Inpatient Sample. In those patients, the mean (SD) age slightly decreased from 70 (13) years to 69 (13) years (p-trend < 0.001). Interestingly, although incident cases of stroke amongst DM patients increased from 17.4 to 20.0 /100,000 US adults (p-trend < 0.001), age-adjusted mortality for those with hemorrhagic strokes decreased from 24.3% to 19.6%, and also decreased from 3.23% to 2.48% for those with ischemic strokes (p-trend < 0.01 for both), but remained unchanged in TIAs patients. As expected, the average total charges per hospital stay almost doubled over the ten-year period, increasing from 15 970 to 31 018 USD/stay (adjusted for inflation). Nonetheless, median (IQR) LoS slightly decreased from 4 (2–6) to 3 (2–6) days (p-trend < 0.001). In total, our data show that, from 2005 to 2014, the incidence of stroke among the diabetes patient population are gradually increasing, in-hospital mortality is steadily decreasing, along with average LoS. Admission costs were up almost twofold during the same period.
INTRODUCTION: Hepatic sinusoidal obstructive syndrome (SOS) occurs when sinusoidal endothelial cells are damaged leading to occlusion of hepatic venules. Causes include hematopoietic stem cell transplantation, chemotherapy, toxins, and radiation. Here, we report the case of a man with blinatumomab induced SOS. CASE DESCRIPTION/METHODS: A 39-year-old male with a recent history of drug induced liver injury presented with relapsed t (9;22) negative ALL and was started on blinatumomab therapy. On clinical examination, the patient was jaundiced with a distended abdomen. Prior to starting blinatumomab the patient’s aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin were 162 U/l, 71 U/L, and 12.3 mg/dL respectively. These levels rose over the next several weeks (ALT, 100 U/L; AST, 364 U/L; total bilirubin, 28.4 mg/dL). Abdominal CT showed large volume ascites, gastric varices, and hepatomegaly with numerous hypodense lesions (Figure 1). Transjugular liver biopsy (Figure 2) revealed SOS as well as cholestatic liver disease, consistent with sepsis. The patient’s condition progressed despite treatment with defibrotide, and he died of multiple organ failure 1 month after starting blinatumomab. DISCUSSION: Hepatic SOS occurs when hepatic terminal venules and sinusoids become obstructed. SOS is commonly seen in the setting of hematopoietic stem cell transplantation, but also occurs after chemotherapeutic agents, radiation therapy, liver tumor embolization and transplantation. The incidence of SOS varies widely between studies. Pre-existing liver disease, patients age, and prior radiation therapy are known risk factors. Clinical features of SOS include RUQ pain, jaundice, and ascites as well as elevated ALT, AST, and bilirubin. In severe disease, PT and platelet counts may also be abnormal. SOS is a clinical diagnosis, and imaging studies, such as an abdominal US, are frequently done during initial evaluation. Liver biopsy is not commonly used for diagnosis, but will show dilated and congested liver sinusoids with RBCs. Although SOS has been previously reported in the setting of chemotherapy, blinatumomab induced SOS is rare. Moreover, even though hepatotoxicity in the setting of blinatumomab has been documented, the mechanism of liver injury remains unknown. Further studies can explore whether SOS could relate directly to the method of liver injury in the setting of blinatumomab.
Introduction: Testicular cancer is the most common solid malignancy in males between the ages of 15 and 35. It is one of the most curable solid tumors with a 5-year survival rate of almost 95%. Testicular cancers are compromised of germ cell tumors (GCTs), which can be divided intoseminomatous and non-seminomatous GCTs (NSGCTs). We present a case of a 44 year old male presenting with scrotal swelling and coffee ground emesis, found to have metastatic non-seminomatous testicular cancer. Case Description/Methods: A 44-year-old man with history of tobacco use presented with a one month history of scrotal swelling and an episode of coffee ground emesis. He also reported fevers, chills, night sweats, and unintentional weight loss. On presentation, he was tachycardiac. Physical exam was notable for a left, hard scrotal mass, tender to palpation; bilateral inguinal lymphadenopathy; and generalized abdominal tenderness. Laboratory testing showed elevated bhuman chorionic gonadotropin and Alpha Fetal Protein levels. An ultrasound of the left scrotum showed a large mixed echogenicity mass. Computed tomography of the chest, abdomen, and pelvis revealed a left scrotal mass, concerning for metastatic disease to the liver and lungs along with mild mediastinal and upper abdominal retroperitoneal adenopathy. Gastroenterology was consulted for hematemesis and recommended an upper endoscopy. An EGD was done that revealed a non-bleeding gastric ulcer with a clean base in the gastric body, Forrest Class III (figure 1,2,3); normal duodenal bulb and second portion of the duodenum. Histopathology from the gastric ulcer showed a poorly differentiated neoplasm. Patient underwent left radical orchiectomy and was diagnosed with metastatic non-seminomatous testicular cancer, stage III C. Discussion: Testicular cancer presents as a painless nodule or swelling of one testicle, but around 10% of patients have clinical manifestation that are due to metastatic disease. Common sites for metastatic disease include the lung, liver, bone, brain, and distant lymph nodes. Gastrointestinal metastasis is rare and occurs in , 5% of patients with NSGCTs and , 1% of patients with SGCTs. Metastasis to the GI tract occurs via direct extension from retroperitoneal/paraaortic lymph nodes and hematogenous spread. Due to their retroperitoneal location, the ileum and jejunum are the most common sites of metastatic disease within the GI tract. Our case represents gastric metastasis of NSGCT of the testis, which is exceedingly rare.
Background: As the prevalence of diabetes is increasing worldwide, our aim is to assess the recent cardiovascular and economic trend in outcomes of patients with stroke and diabetes in the U.S. Methods: Data from the National Inpatient Sample was analyzed between 2005 to 2014. We studied: In-hospital mortality, length of stay (LoS) and overall hospital charges in patients hospitalized for stroke, >18 years of age and known to have diabetes. Results: The prevalence of diabetes gradually increased from 28.2% to 35.5% in all patients hospitalized for stroke (p trend<0.001) between 2005 and 2014. In those patients with diabetes, mean (SD) age slightly decreased from 70 (13) years to 69 (13) years (p trend <0.001). Interestingly, hospitalization for stroke increased from 17.4 to 20.0/100 000 U.S. adults (p trend <0.001). However, in-hospital age-adjusted mortality decreased from 4.64% to 3.73% (p trend <0.001). Age-adjusted mortality of hemorrhagic strokes - which represent only a small proportion of all strokes- decreased from 28.1% to 23.1%, that of ischemic strokes decreased from 3.23% to 2.48% (p trend <0.01 for both) whereas that of TIA was almost stable and lower than 0.2%. As expected, total charges of hospital stay almost doubled as they went up from 15,970 to 31,018 USD/stay (adjusted for inflation). Nevertheless, median (IQR) LoS slightly decreased from 4 (2-6) to 3 (2-6) days (p trend <0.05). Conclusion: Our preliminary data show that the prevalence of diabetes in patients hospitalized for stroke is gradually increasing. Moreover, hospitalization for stroke is also increasing. Nevertheless, in-hospital mortality is on a descending slope, which comes at a price of an almost 2-fold increase in hospital charges from 2005 to 2014. Disclosure A. Tabbalat: None. S.R. Dargham: None. M.B. Elshazly: Stock/Shareholder; Self; Ember Medical. C. Abi Khalil: None.
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