Ghosh, Aditya K

Conventional cigarette smoking remains a leading preventable cause of morbidity and mortality despite declining prevalence, yet evidence-based treatments remain underused. This narrative review examines guideline-supported therapies and emerging approaches, including digital tools, neuromodulation, and harm-reduction strategies. Standard care typically combines FDA-approved pharmacotherapy with behavioral counseling. Digital interventions can extend access and support adherence, particularly when integrated with pharmacotherapy and follow-up. Repetitive transcranial magnetic stimulation (rTMS) can be considered as an adjunctive option for patients who do not respond to pharmacotherapy and is FDA-approved. For patients unable to quit, structured harm-reduction strategies may help reduce risk while supporting progression toward eventual abstinence. These approaches should be used alongside, not in place of, guideline-recommended pharmacotherapy and behavioral counseling, which remain the gold standard for care. This review outlines a pragmatic, primary care–oriented model that integrates stepped-care with harm-reduction strategies.

Prostate cancer is the second most common cancer in U.S. men, with higher incidence and mortality among African Americans and those with genetic or familial risk. Despite guidelines promoting early detection, prostate-specific antigen (PSA) screening in primary care remains inconsistent. We assessed PSA screening patterns and the association between risk factors and testing. A retrospective analysis was conducted on men aged ≥40 seen at primary care clinics from 2020 to 2022. Risk scores were created based on the number of prostate cancer risk factors. Univariate and multivariate analyses assessed associations between the risk scores, PSA screening, and cancer diagnosis. Of 176,326 patients, 31.4% underwent PSA testing, rising to 78.1% with a risk score of 4. The predictive model was significant (χ 2 = 19,527.021, df = 11, p < .001). PSA testing odds were higher with Medicaid or commercial insurance (vs. Medicare) and lower for self-pay patients. Former and never smokers were more likely to be tested than current smokers. Age, African American race, and family history increased the odds of receiving PSA testing. Prostate cancer diagnosis reached 25% at a risk score of 5, with significant predictors including older age, African American race, family history, and mention of “prostate” in clinical notes. PSA screening remains underused in primary care, even among high-risk patients. More risk factors were linked to higher testing rates, but African American and low-income groups were under-tested. Provider education and decision-support tools may improve guideline adherence and equity.

Background: Acute heart failure affects ~9% of patients with hematological malignancies. This study aimed to evaluate the impact of acute heart failure on in-hospital mortality among patients with hematological malignancies and to identify independent predictors of mortality in this population. Methods: The National Inpatient Sample (2016–2021) was queried for adults (⩾18 years of age) with hematological malignancies and those who experienced in-hospital mortality. Among these, we identified patients who were hospitalized with a diagnosis of acute heart failure. Univariate analysis and multivariate regression were employed to analyze the mortality risk. A p ⩽ 0.05 was considered significant. Results: Among 40,246 patients with hematological malignancies who died in the hospital, the univariate analysis showed a higher in-hospital mortality in the acute heart failure cohort compared to the non-acute heart failure group (8.08% versus 4.52%, p < 0.001). However, after adjusting for sociodemographic factors and comorbidities, acute heart failure was associated with a lower risk of in-hospital mortality (OR 0.87, 95% CI 0.84–0.9, p < 0.001). Predictors of mortality in the acute heart failure cohort were age >60 years, hematopoietic stem cell transplant, severe sepsis, arrhythmias, infective endocarditis, bleeding from any source, acute respiratory failure, hepatic dysfunction, metabolic encephalopathy, and invasive ventilation (all p < 0.01). On subgroup analysis, acute myeloid leukemia, chronic myeloid leukemia, chronic lymphocytic leukemia, and multiple myeloma had a higher in-hospital mortality in the acute heart failure cohort compared to the non-acute heart failure group ( p < 0.001). Conclusion: Acute heart failure in patients with hematological malignancies was associated with poor outcomes in the presence of severe sepsis, organ dysfunction, and the need for mechanical ventilation. Close monitoring and a multidisciplinary team approach are recommended to optimize the treatment plan for this population.

Objective: Multicancer Detection (MCD) tests, such as the GRAIL Galleri, offer a novel approach to cancer screening by detecting cancer-specific methylation patterns in cell-free DNA through a single blood sample. This study evaluated an 18-month implementation of MCD testing in a tertiary ambulatory internal medicine clinic. Patients and Methods: Between June 2022 and November 2023, 2244 asymptomatic (without symptoms attributed to cancer) patients underwent MCD testing. The study focused on operational workflows, patient and physician education, and diagnostic follow-up of positive results. Standardized materials, including electronic health record (EHR) workflows, FAQs, and diagnostic pathways, were developed to facilitate implementation. Challenges included managing false positives, patient anxiety, costs, and ethical considerations. Results: Of the 2244 patients tested, 17 (0.76%) had positive results, and 15 underwent further diagnostic evaluation. Cancer was confirmed in 11 (73.3%) patients, including cases of breast, colon, esophageal, lymphoma, ovarian, and pancreatic cancers. Four patients had no identifiable malignancy despite comprehensive work-up. Conclusions: MCD testing is feasible in routine clinical workflows, with 73% of positive cases yielding cancer diagnoses. While promising, further research is required to assess long-term outcomes, cost-effectiveness, and optimal implementation strategies of cancer interception in broader healthcare settings.

A 67-year-old male with positive signals for neuroendocrine and head/neck cancer on a commercially available multicancer detection test underwent an extensive negative diagnostic workup at a local hospital. Referred to our medical center for advanced imaging and endoscopic procedures ultimately led to the diagnosis of an early-stage seminoma with eventual orchiectomy. This case highlights challenges in evaluating positive multicancer detection results, emphasizing the need for a broader understanding of how to interpret these testing results to fully evaluate complex cases, as well as the need for protocolized follow-up approaches to a positive multicancer detection test.

Objective Persistent post-COVID symptoms are estimated to occur in up to 10% of patients who have had COVID-19. These lingering symptoms may persist for weeks to months after resolution of the acute illness. This study aimed to add insight into our understanding of certain post-acute conditions and clinical findings. The primary purpose was to determine the persistent post COVID impairments prevalence and characteristics by collecting post COVID illness data utilizing Patient-Reported Outcomes Measurement Information System (PROMIS ® ). The resulting measures were used to assess surveyed patients physical, mental, and social health status. Methods A cross-sectional study and 6-months Mayo Clinic COVID recovered registry data were used to evaluate continuing symptoms severity among the 817 positive tested patients surveyed between March and September 2020. The resulting PROMIS ® data set was used to analyze patients post 30 days health status. The e-mailed questionnaires focused on fatigue, sleep, ability to participate in social roles, physical function, and pain. Results The large sample size (n = 817) represented post hospitalized and other managed outpatients. Persistent post COVID impairments prevalence and characteristics were determined to be demographically young (44 years), white (87%), and female (61%). Dysfunction as measured by the PROMIS ® scales in patients recovered from acute COVID-19 was reported as significant in the following domains: ability to participate in social roles (43.2%), pain (17.8%), and fatigue (16.2%). Conclusion Patient response on the PROMIS ® scales was similar to that seen in multiple other studies which used patient reported symptoms. As a result of this experience, we recommend utilizing standardized scales such as the PROMIS ® to obtain comparable data across the patients’ clinical course and define the disease trajectory. This would further allow for effective comparison of data across studies to better define the disease process, risk factors, and assess the impact of future treatments.

Insulin regulates many cellular processes, but the full impact of insulin deficiency on cellular functions remains to be defined. Applying a mass spectrometry–based nontargeted metabolomics approach, we report here alterations of 330 plasma metabolites representing 33 metabolic pathways during an 8-h insulin deprivation in type 1 diabetic individuals. These pathways included those known to be affected by insulin such as glucose, amino acid and lipid metabolism, Krebs cycle, and immune responses and those hitherto unknown to be altered including prostaglandin, arachidonic acid, leukotrienes, neurotransmitters, nucleotides, and anti-inflammatory responses. A significant concordance of metabolome and skeletal muscle transcriptome–based pathways supports an assumption that plasma metabolites are chemical fingerprints of cellular events. Although insulin treatment normalized plasma glucose and many other metabolites, there were 71 metabolites and 24 pathways that differed between nondiabetes and insulin-treated type 1 diabetes. Confirmation of many known pathways altered by insulin using a single blood test offers confidence in the current approach. Future research needs to be focused on newly discovered pathways affected by insulin deficiency and systemic insulin treatment to determine whether they contribute to the high morbidity and mortality in T1D despite insulin treatment.