Kumar, Rohit

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Lung Cancer Screening provide criteria for selecting individuals for screening and offer recommendations for evaluating and managing lung nodules detected during initial and subsequent annual screening. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Lung Cancer Screening.

The NCCN Guidelines for Lung Cancer Screening recommend criteria for selecting individuals for screening and provide recommendations for evaluation and follow-up of lung nodules found during initial and subsequent screening. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Lung Cancer Screening.

Crystal-storing histiocytosis (CSH) is an uncommon condition in which histiocytes accumulate a crystalline matter within their cytoplasm. Generally, those crystals are composed of either monoclonal or polyclonal immunoglobulin chains, which have a strong association with an underlying lymphoproliferative or plasma cell disorder (LP-PCD). Rarely, CSH has been reported as local or generalized manifestation of a variety of benign disorders. These cases are associated with crystals composed of nonimmunoglobulin substances. We are reporting an exceptional case of a local colonic CSH with Charcot–Leyden crystals. This patient underwent a screening colonoscopy that detected some polyps. The biopsy reported tubular adenomas, with a markedly dense, transmural inflammatory infiltrates, which were predominantly composed of eosinophils and crystal-storing histiocytes containing Charcot–Leyden crystals. The patient had a negative workup for LP-PCD and autoimmune conditions, including a normal skeletal survey and bone marrow aspirate/biopsy. The only positive laboratory workup was an elevated absolute eosinophil count and a positive IgG anti-Strongyloides antibody. Giving those findings, this parasitic infection is the most likely etiology of the CSH in our patient. Although there was an initial negative evaluation for LP-PCD, close monitoring of patients with either immunoglobulin or nonimmunoglobulin CSH is recommended.

INTRODUCTION Hemophilia A and B are rare X-linked disorders that result in bleeding due to reduced activity of coagulation factor VIII and IX, respectively. With the availability of better medical care and prophylactic treatment modalities, the life expectancy of patients with hemophilia is approaching that of the general population. Patients with hemophilia were initially thought to be protected from cardiovascular disease (CVD) due to hypocoagulable state but this aging population is now known to be at risk for CVD. The primary objective of this study was to determine the incidence of CVD and associated mortality in hospitalized male patients with hemophilia. METHOD: We reviewed National Inpatient Sample (NIS) database from 01/2012 to 09/2015 for admissions due to CVD, defined as acute myocardial infraction (AMI) or ischemic cerebrovascular accident (CVA), as a primary diagnosis using International Classification of Diseases, 9th Revision, and Clinical Modification (ICD-9-CM) codes 410.XX for AMI and 433.XX-437.1 for CVA in males age ≥18 years. Hospitalizations with associated diagnosis of hemophilia A or B were identified using ICD-9CM codes 286.0 or 286.1, respectively. We calculated age-, race- and comorbidities- standardized incidence rate of CVD in hospitalizations with or without associated hemophilia using multivariate logistic regression analysis. Baseline clinical characteristics was also compared between the 2 groups in the overall NIS population. Pearson's Chi-square test and t-test was used to compare categorical and continuous variables, respectively. A propensity score match (PSM) analysis was performed to determine the effect of hemophilia on mortality rate in hospitalizations due to CVD. A trend analysis was done to determine the variation in incidence of CVD over the study period. A p-value ≤0.05 was considered significant. RESULTS: Approximately 50 million (weighted) hospitalizations during the study period were analyzed. A total of 20,845 (0.04%) hospitalizations had associated diagnosis of hemophilia. The baseline clinical characteristics of the overall population is described in table 1. The standardized incidence rate of CVD was significantly lower in hemophilia group 2.9% vs 5.5% (AMI 1.1% vs 2.8% and CVA 1.8% vs 2.7%) compared to non-hemophilia group (p<0.001 for all comparisons). The annual incidence of CVD did not change over the study period in the hemophilia group (trend p=0.906). On PSM analysis, the mortality rate in the CVD associated hospitalizations was not different between the hemophilia and non-hemophilia group, 3.3% vs 4% respectively (OR 0.81 95%CI 0.20-3.3, p=0.772). CONCLUSION: We present a large-scale analysis of CVD incidence and outcomes in hospitalized hemophilia (A or B) patients. Although, CVD and its risk factors are statistically less common in patients with hemophilia compared to general hospitalized population, the incidence is still clinically comparable. Moreover, the CVD associated mortality rate is similar. As patients with hemophilia are at higher risk of CVD treatment related adverse effects, further studies on optimal cardio- prevention and treatment strategies are warranted. Disclosures No relevant conflicts of interest to declare.

Aim: Platelet function is intricately linked to the pathophysiology of critical Illness, and some studies have shown that antiplatelet therapy (APT) may decrease mortality and incidence of acute respiratory distress syndrome (ARDS) in these patients. Our objective was to understand the efficacy of APT by conducting a meta-analysis. Materials and Methods: We conducted a meta-analysis using PubMed, Central, Embase, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar. Studies were included if they investigated critically ill patients receiving antiplatelet therapy and mentioned the outcomes being studied (mortality, duration of hospitalization, ARDS, and need for mechanical ventilation). Results: We found that there was a significant reduction in all-cause mortality in patients on APT compared to control (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.70–0.97). Both the incidence of acute lung injury/ARDS (OR: 0.67; 95% CI: 0.57–0.78) and need for mechanical ventilation (OR: 0.74; 95% CI: 0.60–0.91) were lower in the antiplatelet group. No significant difference in duration of hospitalization was observed between the two groups (standardized mean difference: −0.02; 95% CI: −0.11–0.07). Conclusion: Our meta-analysis suggests that critically ill patients who are on APT have an improved survival, decreased incidence of ARDS, and decreased need for mechanical ventilation.