Citations

Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital anomaly affecting around 0.4–0.8% of the population, but limited mortality data exist. We characterized trends and disparities in AAOCA-related mortality in the United States from 1999 to 2023. We queried the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research multiple-cause-of-death database for AAOCA-related deaths among all age groups. Age-adjusted mortality rates (AAMR) per 1,000,000 population with 95% confidence interval, stratified by year, sex, race, regions, and urbanization status, were abstracted. Annual percent changes were computed by Joinpoint regression. From 1999 to 2023, there were 6665 AAOCA-related deaths. Overall AAMR fell insignificantly from 1.1 in 1999 to 0.9 by 2001, rose to 1.1 in 2008, declined significantly to 0.5 by 2020, and then increased to 0.8 by 2023. Male AAMRs exceeded females (1999: 1.3 vs 0.9; 2023: 1.2 vs 0.4). Racially, from 1999–2020 to 2021–2023, non-Hispanic (NH) Blacks exhibited the highest AAMR (1.8 vs 1.5), trailed by NH Whites (0.8 vs 0.6) and Hispanics (0.5 vs 0.6). Regionally, AAMRs from 1999 to 2020 were 0.9 in the Northeast, Midwest, and South, and 0.8 in the West. Moreover, both urban and rural AAMRs were 0.9. Among age groups, <44 years mortality declined, with the steepest drop in 15–44 years, while mortality for >45 years plateaued. Although AAOCA mortality declined overall, especially in children and young adults, it remains high among men, NH Blacks, and Midwest residents. Its recent rebound underscores the need for early detection, risk stratification, and surveillance for timely interventions.

Antiretroviral therapy has transformed treatment of HIV infection from a fatal disease into a chronic condition, yet opportunistic infections remain prevalent in patients with declining CD4 cell counts, requiring a pattern-based radiologic approach and vigilant clinical assessment to differentiate infections, malignancies, and immune reconstitution inflammatory syndrome.

An understanding of regions of endemicity and the spectrum of organ system involvement can improve recognition of the imaging features of coccidioidomycosis, which can overlap with those of other diseases.

PURPOSE Initial reports indicate that access to contemporary therapies currently used in North America for the treatment of multiple myeloma (MM) varies internationally. No studies have quantitatively reported the extent of disparities in the access to MM therapies worldwide, with a goal to investigate access to MM therapies and barriers globally. METHODS From June 18 to July 15, 2023, an electronic survey was distributed to 176 oncologists treating MM outside the United States. MM drugs were categorized by accessibility, with the cutoff for adequate access set at 60% of respondents affirming easy/moderate access. RESULTS Ninety-five (54%) respondents from 33 countries completed the survey. Fifty-one percent of the respondents were from university-based academic programs, and 17% of the responders treated only plasma cell disorders. Most respondents had adequate access to noncellular MM therapies, except for isatuximab, ixazomib, selinexor, and elotuzumab. Among the cellular therapies, 17% had access to Chimeric Antigen Receptor T-cell therapy, whereas 23% had access to approved T-cell engagers (TCEs). Financial stress on patients and health care systems has emerged as a primary barrier to global inaccessibility of treatment drugs. CONCLUSION Global access to novel MM therapies remains challenging, and we have identified barriers and suggested strategies to bridge this gap.