Thrombotic microangiopathy (TMA) is a rare disorder characterized by microvascular injury and occlusion resulting in tissue ischemia and dysfunction. TMA occurs in a variety of settings including cocaine use. Although cocaine is widely used in the United States, cocaine-associated TMA is only rarely reported. Therefore, other factors may predispose cocaine users to the development of TMA. Emerging evidence indicates that cocaine activates complements. Therefore, complement activation may contribute to the development of cocaine-induced TMA. Here, we report a cocaine user who presented with renal failure. Renal biopsy demonstrated TMA. Laboratory tests revealed reduced serum complement C3 and normal complement C4 levels indicative of alternative complement activation. We postulate that complement activation is involved in the pathogenesis of cocaine-induced TMA.
e18640 Background: Limited English proficiency (LEP) has been shown to exacerbate health inequities in the US due to difficulties navigating a complex health system and assimilating complicated information regarding diagnosis, and treatment. Advances in multiple myeloma (MM) care have improved clinical outcomes but added complexity to diagnosis and treatment. However, there is limited data on whether LEP impacts health inequities in MM care. We sought to assess the impact of primary language on MM care and outcomes at our safety net hospital, serving a culturally and linguistically diverse population where patients have equal access to novel agents and autologous stem cell transplant (SCT). Methods: We retrospectively studied 213 patients with newly diagnosed MM between January 1st, 2000, and December 31st, 2021. Data were extracted from electronic medical records. Patients were classified as LEP or EP based on self-reported language at the time of diagnosis. Patients were subsequently propensity matched based on age, sex, type of insurance, Charlson comorbidity index, creatinine, LDH, year of MM diagnosis, ISS stage, presence of high-risk cytogenetics, and receipt of SCT. Type of insurance was used as a surrogate for socioeconomic status. Kaplan Meier estimate and log rank tests were used to assess overall (OS) and progression free survival (PFS). Results: Of 213 patients, 75 (35.2%) had LEP, 135 (63.4%) were black, 49 (23.0%) were white, 22 (10.3%) patients were of another race, and 7 (3.3%) did not self-identify. Mean age was 63.6 (SD ± 11.4), and 114 (53.5%) patients were male. Median follow-up of the entire cohort was 56.9 months. At baseline, there were no statistically significant differences in the covariates above between LEP and EP patients except for increased incidence of diabetes mellitus in EP patients (84.0% vs. 89.1%, p 0.02). More LEP patients were inpatients at the time of diagnosis compared to EP patients (36.0% [27/ 75] versus 23.9% [33/138]). Median number of hospitalizations and ED visits in the first 6 months of diagnosis were 4 and 3 versus 1 and 2 in LEP versus EP patients, respectively. There were no differences in adjusted PFS or OS between propensity matched LEP and EP patients. Conclusions: In our cohort, there were no significant differences in demographics, clinical parameters, socioeconomic status, or transplant utilization between LEP and EP patients, which allowed us to assess the association of primary language with any observed health inequities. In a setting where all patients have access to novel treatments, SCT, patient navigators, interpreters, and social workers, there were no differences in PFS or OS. However, language barriers may explain health inequities related to later diagnosis and increased healthcare utilization. LEP patients with MM may benefit from additional language-concordant resources to improve disparities.
1571 Background: African Americans have higher incidence of cancer and lower survival rates compared to other ethnicities. We studied the 5-year relative survival between black and white races for the most common cancers in the United States. Methods: Data was obtained from the SEER database, the largest population-based cancer database including 28% of US population. Data containing 5-year relative survival from the patients who were diagnosed from 1973 to 2010. We included data for cancers of colorectal, lung, prostate, breast and melanoma, the most common cancers in the United States. Results: For colorectal cancer average 5-year relative survival from 1973 to 2010 is 59.9% for whites and 51.5% for blacks. Same results for lung cancer are 14.6% for whites and 12.2% for blacks, for breast cancer is 84.5% for whites and 71.6% for blacks, for prostate cancer is 86.9% for whites and 80.5% for blacks, and for melanoma is 87.9% for whites and 66.4% for blacks. The average black to white 5-year relative survival ratio is 0.86, 0.84, 0.85, 0.92, and 0.76 for cancers of colorectal, lung, breast, prostate, and melanoma, respectively. This ratio has decreased from 0.89 to 0.86 and from 0.87 to 0.81 for colorectal and lung cancer, respectively and for cancers of breast, prostate and melanoma it has increased from 0.85 to 0.87, from 0.88 to 0.89, and from 0.73 to 0.80 respectively. Conclusions: Our analysis shows that for colorectal and lung cancer the survival rate difference between blacks and whites has increased over 4 decades but for cancers of breast, prostate and melanoma this ratio has decreased. Better understating of the factors contributing to racial differences in cancer survival has potential applicability in policymaking for a better and equal health care delivery.
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