History Of Tobacco Use Research Articles

Social support for cancer patients and alcohol and tobacco use: an integrative review

Objective: to assess the knowledge about social support and mental health of people diagnosed with cancer, smokers, and alcohol users, and the implications of these behaviors for cancer treatment. Methods: integrative review using the following databases: CINAHL, Embase, LILACS, PsycINFO, MEDLINE, SCOPUS, and Web of Science, without restriction of period and language. The data was analyzed descriptively. Results: 3,010 documents were identified, 14 studies were eligible. The different types of social support received by people with cancer and a history of alcohol and tobacco use stand out: emotional (n=5), informational (n=4), family and material (n=2 each), religious, sexual-affective partner, tangible, affective, positive social interaction, instrumental and social companionship (n=1 each). Conclusion: targeted social support that is sensitive to the particularities of the history of substance use can significantly improve the way people cope with the disease and treatment. Contributions to practice: providing integrated social support for this population is essential for thinking about quality of life throughout treatment and recovery.

Accelerated hazard prediction based on age time-scale for women diagnosed with breast cancer using a deep learning method

Breast cancer is the most common cancer in women. Previous studies have investigated estimating and predicting the proportional hazard rates and survival in breast cancer. This study deals with predicting accelerated hazards (AH) rate based on age categories in breast cancer patients using deep learning methods. The AH has a time-dependent structure whose rate changes according to time and variable effects. We have collected data related to 1225 female patients with breast cancer at the Mandarin University of Medical Sciences. The patients' demographic and clinical characteristics including family history, age, history of tobacco use, hysterectomy, first menstruation age, gravida, number of breastfeeding, disease grade, marital status, and survival status have been recorded. Initially, we dealt with predicting three age groups of patients: ≤ 40, 41–60, and ≥ 61 years. Then, the prediction of accelerated risk value based on age categories for each breast cancer patient through deep learning and the importance of variables using LightGBM is discussed. Improving clinical management and treatment of breast cancer requires advanced methods such as time-dependent AH calculation. When the behavioral effect is assumed as a time scale change between hazard functions, the AH model is more appropriate for randomized clinical trials. The study results demonstrate the proper performance of the proposed model for predicting AH by age categories based on breast cancer patients' demographic and clinical characteristics.

The association between the mental health disorders, substance abuse, and tobacco use with head & neck cancer stage at diagnosis.

Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system. This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use. The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.

Incidence, patient characteristics, and treatment patterns of U.S. active-duty service members diagnosed with COVID-19-associated VTE in the outpatient setting

Abstract Background Venous Thromboembolism (VTE) is a well-established complication of acute coronavirus disease 2019 (COVID-19) infection. We sought to clarify the incidence, patient characteristics, and treatment patterns of VTE within United States active-duty service members (ADSM) diagnosed with COVID-19 infection in the outpatient setting. Methods Our team conducted a multicenter retrospective review of the outpatient healthcare records for all U.S. ADSM diagnosed COVID-19-associated VTE between January 1, 2020, and April 30, 2022. The data was obtained from the COVID-19 surveillance case list maintained by the Armed Services Health Surveillance Division (ASHSD) of the U.S. Defense Health Agency (DHA). The Defense Medical Surveillance System (a database containing inpatient and outpatient electronic medical records for active-duty service members) was used to capture all appropriate medical encounters using ICD-10 coding for venous thromboembolic events within 365 days of COVID-19 diagnosis. Chart review for data adjudication was performed by the physician investigator team. Results Among 365,788 ADSM who were diagnosed with COVID-19 in the outpatient setting, a total of 159 patients were identified as having COVID-19-associated VTE. The overall incidence rate of VTE was 43.47 per 100,000 people within 365 days of diagnosis (90-day incidence rate of 32.5/100,000). The median time from COVID-19 diagnosis to VTE was 23 days (IQR 13-87). Of 159 patients, 33 (20.7%) were diagnosed with DVT, 143 (90%) with PE, and 20 (12.5%) with both PE and DVT. The median age was 30 years old (IQR 23-38). The majority of patients were male (85%). 49% were white. The most common medical comorbidity was obesity (33%), 11% had a history of active tobacco use, and 9.4% of patients had a prior VTE diagnosis. Only 34% of patients were vaccinated for COVID-19 prior to their diagnosis (35 Pfizer–BioNTech, 13 Moderna, and 4 other). 148 (93%) of patients were treated with a direct oral anticoagulant, 10 (6.2%) were treated with low molecular weight heparin, and 1 (0.8%) was treated with a vitamin K antagonist. 96 (60.3%) required hospitalization with 4 (2.5%) requiring subsequent thrombectomy. None experienced major bleeding events. Only 2 (1.3%) of the patients died within 22 days from VTE diagnosis. The remaining 98.7% were alive at 875 days (SD 230) of follow-up. Conclusion The incidence of venous thromboembolism in active-duty military patients with COVID-19 was rare, affecting mostly unvaccinated, minority men in their 30s with risk factors such as obesity, prior VTE, and prior tobacco use. Of the women with VTE, 54% were non-white minorities. While VTE diagnosis was associated with a low mortality rate, the majority of patients required hospitalization.

12265 Isolated Adrenocorticotropic Hormone Deficiency In The Setting Of Anti-PD1 Immunotherapy

Abstract Disclosure: J. Poncelet: None. Q. Wang: None. A.J. Montero: Advisory Board Member; Self; AstraZeneca, Gilead. Other; Self; Medical Advisor for Paragon Infusion Services. L. Tranchito: None. Isolated Adrenocorticotropic Hormone Deficiency in the Setting of Anti-PD1 Immunotherapy Introduction: Immune checkpoint inhibitors have been associated with endocrine immune-related adverse events, such as secondary adrenal insufficiency with isolated ACTH deficiency in rare instances. Case Presentations: We present two different cases of isolated ACTH deficiency (IAD) while on anti-PD1 therapy with pembrolizumab. Patient A is a 66-year-old woman with history of tobacco use, hypertension, and COPD diagnosed with stage IV lung adenocarcinoma. After completing 15 cycles of pembrolizumab, she reported symptoms of fatigue, weakness, lightheadedness, and was subsequently admitted to the hospital for symptomatic hyponatremia. Lab workup revealed a morning cortisol level of 0.6 ug/dL (n2.5-20 ug/dL) and ACTH <1.5 pg/mL (n7.2-63.3 pg/mL), both of which had previously been normal. Her TSH was mildly elevated with a normal free T4. Her FSH, LH, prolactin, and IGF levels were normal as was MRI of the pituitary. She therefore was diagnosed with IAD and started physiologic steroid replacement therapy with hydrocortisone with subsequent symptomatic improvement and normalization of her serum sodium. Patient B is a 60-year-old woman with a history of osteoporosis, aortic stenosis, and stage II triple negative breast cancer treated with neoadjuvant chemotherapy and pembrolizumab. Two months after starting immunotherapy, she presented to her oncology office with symptoms of fatigue, poor appetite, body aches, and dizziness. Her labs revealed mild hyponatremia, cortisol of 0.9 ug/dL (n2.5-20 ug/dL) and ACTH <1.5 pg/mL (n7.2-63.3 pg/mL). TSH, LH, FSH, and prolactin levels were normal. She started physiologic steroid replacement therapy with hydrocortisone for IAD, which led to improvement in her symptoms. Both patients continue pembrolizumab. Conclusions: Immune-related adverse events affecting endocrine pathways have been reported with immune checkpoint inhibitors. There is no method to predict which patients may be affected, and no guidelines exist on when or how often to monitor hormone levels in these patients. Importantly, patients can continue immune checkpoint inhibitors despite IAD if controlled by hormone replacement, though ACTH recovery should not be expected[1]. Recognition of symptoms can prompt earlier evaluation for secondary adrenal insufficiency and provide greater benefit to patients. 1.Schneider BJ, Naidoo J, Santomasso BD, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update [published correction appears in J Clin Oncol. 2022 Jan 20;40(3):315]. J Clin Oncol. 2021;39(36):4073-4126. doi:10.1200/JCO.21.01440 Presentation: 6/1/2024

9388 Unusual Case Of Ectopic Adrenocorticotropic Hormone Syndrome Secondary To Non-small Cell Lung Cancer

Abstract Disclosure: A. TakallooBakhtiari: None. G.L. Nunlee-Bland: None. V. Ganta: None. A. Zenebe: None. H. Abdalla: None. A. Elobeid: None. W.A. Odonkor: None. Introduction: Ectopic adrenocorticotropic hormone syndrome (EAS) is a rare condition due to adrenocorticotropic hormone (ACTH) release from non-pituitary tumors. It increases the mortality of affected patients thus finding and removal of the ACTH-producing source allows for curing or reduction of symptoms and serum cortisol levels. The most common cause of EAS is lung cancer. Cushing syndrome (CS) due to EAS is an uncommon paraneoplastic phenomenon in non-small cell lung cancer. Clinical case: The patient is an 80-year-old man with a past medical history of hypertension, dementia, stroke, schizophrenia, and recently diagnosed lung adenocarcinoma. He presented with a few weeks history of dysuria and generalized fatigue. There was no family history for any endocrine disorders. He has a 40 pack-year history of tobacco use. He denied alcohol or illicit drug use. Upon initial evaluation, VS: BP 155/95 mmHg, HR 82 beats/min, Ht 77 inches, Wt 125 lb with a BMI 14.7 Kg/m2. He had no typical symptoms of CS. A physical exam showed a cachectic man with no other remarkable findings. Laboratory tests on admission showed severe hypokalemia of 1.8 mEq/L (3.5-5 mEq/L) with hypochloremic metabolic alkalosis. (bicarbonate 45 mEq/L (22-28 mEq/L) and chloride 79 mEq/L (96-106 mEq/L)). Patient was normoglycemic with HbA1c of 5.0%. Random morning cortisol was 55 μg/dL (13-24 μg/dL). Supine renin and aldosterone levels were 0.45 ng/ml/h (0.25-5.8 ng/ml/h) and 1.0 ng/dL (3-16 ng/dL), respectively, excluding hyperaldosteronism. Beside urinary tract infection, other biochemical workup revealed elevated 24-h urinary free cortisol level 5233 mcg/24h (4.0-50.0 mcg/24h) with creatinine 0.7 g/24h (0.5-2.15 g/24h). Failure to suppress cortisol with low dose dexamethasone suppression test (LDDST) was evident: morning cortisol >60.0 g/dL , with concurrent serum dexamethasone 299 ng/dL (180-550 ng/dL). Plasma ACTH level was elevated 327 pg/ml (6-50 pg/ml), favoring ACTH-dependent CS. A magnetic resonance imaging (MRI) of the sella and computed tomography (CT) of the abdomen did not show pituitary or adrenal masses. Therefore, a diagnosis of ectopic CS due to lung cancer was established. Pathology of the lung mass showed tumor cells were negative for synaptophysin, chromogranin, and CD52. The immunohistochemically findings support primary adenocarcinoma of the lung. Patient refused surgical or medical treatment and was discharged to a hospice facility. Conclusion: The clinical presentation of EAS ranges from the abrupt onset of the signs and symptoms of severe hypercortisolism, including hypertension, hypokalaemia, metabolic alkalosis as in our patient to the gradual and slow onset of the classical signs and symptoms of CS. Though EAS with adenocarcinoma of the lung is rare, it is important to consider it within the differential diagnosis of any adenocarcinoma of the lung presenting with the relevant symptoms. Presentation: 6/3/2024

9183 Pituitary Metastasis Of Lung Adenocarcinoma Presenting As Anterior Pituitary Dysfunction

Abstract Disclosure: O. faour: None. M. Kinaan: None. S.K. Suryanarayanan: None. Introduction: The pituitary should not be overlooked as a site for metastasis and can be the first presentation of neoplastic disease in some patients. Most common presenting symptoms: headache, ophthalmoplegia, visual field defect and Arginine Vasopressin Deficiency (AVP-D). We present a case of pituitary metastasis of lung adenocarcinoma presenting as anterior Pituitary dysfunction that also showed partial AVP-D unmasked after starting steroids. Case Description: A 63-year-old male with history of tobacco use, COPD, and hypertension presented with syncope. He reported a 30lbs weight loss within prior 2 months, low energy, increased thirst, and polyuria. Physical exam was significant for cachexia, normal visual field on confrontation, and vital signs of BP 100/61, HR 83, and Weighing 180 lbs. Since he had syncope, Cortisol checked was undetectable and Free T4 was low, He was started on hydrocortisone and levothyroxine. CTA chest revealed a right hilar mass measuring 2.7 x 3 cm. Endobronchial biopsy was consistent with lung adenocarcinoma. MRI of pituitary gland revealed solid hypointense lesion with glandular thickening and diffuse heterogeneity involving most of the pituitary gland measuring up to 16 mm. No cavernous sinus invasion. Pituitary infundibulum showed diffuse thickening and enhancement of the pituitary stalk throughout with Intact posterior pituitary bright spot. Labs showed low LH, cortisol, ACTH, GH, TSH, and ADH. Initially, the patient was able to maintain a euvolemic status through increased water intake; however, he was later found to have partial central AVP-D when steroids were introduced. He responded to the use of Desmopressin, developed hyponatremia after 3 doses. He was started on a combination of carboplatin/pemetrexed/pembrolizumab but had no response and was transferred to palliative care/hospice and passed away within 7months after diagnosis.Discussion:Pituitary metastasis is rare and most commonly occurs in lung and breast cancers. Unfortunately, they are associated with poor prognosis. MRI findings of loss of posterior pituitary bright spot, thickening of the stalk, and dumbbell shape can be helpful in distinguishing between primary pituitary tumors and metastases. PET-FDG scan has limited value. Pituitary metastasis commonly presents with posterior pituitary dysfunction due to direct blood supply. Unmasking or worsening of AVP-D can happen with steroid replacement in patients requiring initiation or intensification of Desmopressin therapy. Treatment involves combination of surgery, radiation therapy, and systemic treatment for the primary cancer which can improve symptoms only but does not improve mortality. Presentation: 6/1/2024

7698 A case of Pheochromocytoma in a patient with severe aortic stenosis

Abstract Disclosure: C. Lane: None. L.E. Aguirre: None. J. Azocar-Villalobos: None. R.I. Dorin: None. Background: Pheochromocytomas are rare neuroendocrine tumors derived from chromaffin tissue of the adrenal medulla and can secrete catecholamines. Pre-operative management of pheochromocytoma involves initiation of a- followed by b-adrenergic receptor blockade. In critical aortic stenosis (AS), adrenergic blockade may be complicated by decreased cardiac output and hypotension owing to dependence of venous return on maintenance of high afterload (1). We report a case of critical AS and incidentally discovered pheochromocytoma and describe our management strategy, which involved prioritization of aortic valve repair prior to adrenal surgery and multidisciplinary approach to initiation and titration of a- and b-adrenergic blockade prior to cardiac catheterization and transcutaneous aortic valve replacement (TAVR) procedures. Clinical Case: A 75-year-old Caucasian male with past medical history of obstructive sleep apnea, tobacco use, and cocaine use disorder was admitted with progressive dyspnea, decreased exercise tolerance, and involuntary weight loss of 18 kg over 3 months, and community acquired pneumonia. On admission, he was found to have critical aortic stenosis (valve area of 0.59 cm2, mean gradient 83 mmHg) and new HFrEF (EF 40-45%). CT chest demonstrated incidental right adrenal mass (5.6 x 5.0 x 4.7 cm) with central necrosis, HU units >10, and evidence of internal hemorrhage. Subsequent laboratory and functional imaging studies confirmed diagnosis of pheochromocytoma. Pre-procedural a-adrenergic blockade with doxazosin followed by beta-blockade was managed by a multidisciplinary team with ICU admission for monitoring and uncomplicated completion of cardiac catheterization and TAVR. Conclusions: Pre-procedural diagnosis of pheochromocytoma, multidisciplinary management, and intensive care setting for monitoring hemodynamic response to initiation and titration of a and b-adrenergic blockade appeared to be key factors in achieving uncomplicated completion of cardiac interventions prior to surgical resection of pheochromocytoma and critical AS. Successful TAVR was associated with marked improvement in hemodynamic status. Maintenance of b-adrenergic blockade to reduce myocardial contractility was critical to preservation of the prosthetic aortic valve and in preparation for planned robotic resection of the pheochromocytoma.

Declining Trends in Septic Revision Following Total Knee Arthroplasty From 2010 to 2019: A National Cohort Analysis

Periprosthetic joint infections (PJI) following total knee arthroplasty (TKA) are associated with high patient morbidity, mortality, and healthcare costs. Methods to reduce the burden of PJI have been shown to be efficacious on a small scale. On a national scale, it is unknown whether these methods have reduced PJI rates. A retrospective trend analysis was conducted using a national database. The incidence of 2-year septic revision was observed for the entire cohort and patients who had high-risk co-morbidities from 2010 to 2019. A multivariable logistic regression was performed to compare the odds ratios of 2-year septic revision rates from 2011 to 2019 to the reference year of 2010. Linear regression was used to compare the change throughout this period in the overall and high-risk sub-analysis groups. Among the 860,185 patients, 5,589 underwent septic revision within 2 years. The 2-year septic revision rate decreased from 0.75% in 2010 to 0.69% in 2019 (compounded annual growth rate [CAGR] = -0.94%, P = 0.049). Multivariable logistic regressions demonstrated that the odds of septic revision in 2019 were significantly lower than those in 2010 (OR [odds ratio]: 0.83, 95% CI [confidence interval]: [0.70 to 0.96], P = 0.017). In high-risk patients, the septic revision rate decreased from 1.04 to 0.80% (CAGR = -2.80%, P = 0.004), specifically in those who had a history of psychoses, Medicaid insurance, anemia, heart failure, obesity, liver disease, tobacco use, and drug abuse (P < 0.05 for all). This study demonstrates a national reduction in the 2-year septic revision rate in all TKA patients, including patients considered at high risk for PJI. This suggests current preventative methods may be efficacious on a national scale in TKA. Further research is needed to identify more modalities to reduce the national incidence of this morbid and costly complication.

Accessibility of neurotization in deep inferior epigastric perforator flap reconstruction: inequities and implications for pre-authorization.

Breast anesthesia and hypoesthesia occur commonly after mastectomy and negatively impact quality of life. Neurotization during deep inferior epigastric perforator (DIEP) breast reconstruction offers enhanced sensory recovery. However, access to neurotization for DIEP reconstruction patients has not been evaluated. This retrospective study included patients who underwent DIEP breast reconstruction between January 2021 and July 2022 at a tertiary-care, academic institution. Demographics, outcomes, insurance type, and Area Deprivation Index (ADI)were compared using two-sample t-test or Chi-square analysis. Of the 124 patients who met criteria, 41% had neurotization of their DIEP flaps. There was no difference in history of tobacco use (29% vs 33%), diabetes (14% vs 9.6%), operative time (9.43 hr vs 9.73 hr), length of hospital stay (3 d vs 3 d), hospital readmission (9.8% vs 6.8%), or reoperation (12% vs 12%) between to patients with and without neurotization. However, access to neurotization differed significantly by patient health insurance type. Patients who received neurotization had a lower median ADI percentile of 40.0 indicating higher socioeconomic advantage compared to patients who did not receive neurotization at 59.0 (p=0.01). Access to neurotization differed significantly by patient health insurance and by ADI percentile. Expanding insurance coverage to cover neurotization is needed to increase equitable access and enhance quality of life for patients who come from disadvantaged communities. Our institution's process for pre-authorization is outlined to enhance likelihood of insurance approval for neurotization.

Efficacy of Brodalumab in Patients with Psoriasis and Risk Factors for Treatment Failure: A Review of Post Hoc Analyses.

Factors such as obesity, alcohol consumption, and tobacco use are associated with both increased psoriasis severity and inadequate response to systemic and biologic therapies. Obesity is linked to chronic inflammation, which can contribute to psoriasis pathogenesis. Fixed-dose therapies may have reduced efficacy in patients with a higher body mass index, while weight-based dosing can increase the burden of drug-specific side effects. Alcohol and nicotine from tobacco have also been shown to stimulate keratinocyte and immune cell proliferation and production of proinflammatory cytokines. While these risk factors are prevalent among patients with moderate-to-severe psoriasis, their influence on treatment outcomes may be overlooked when evaluating therapeutic options. Brodalumab is a fully human interleukin-17 receptorA antagonist approved for the treatment of moderate-to-severe psoriasis. In this review, we describe the lifestyle-related risk factors associated with decreased response to treatment. We further summarize the post hoc analyses of brodalumab in participant subgroups with moderate-to-severe psoriasis and a history of prior biologic failure, obesity, and alcohol or tobacco use from two phase 3 clinical trials (AMAGINE-2 and AMAGINE-3; ClinicalTrials.gov identifiers: NCT01708603 and NCT01708629, respectively). Our review of clinical trial and real-world data suggests that brodalumab is an efficacious and safe treatment option for patients with lifestyle factors that increase the likelihood of treatment failure, allowing them to achieve skin clearance and improve quality of life.

Management Of A Completely Edentulous Hemimandibulectomy Patient With Maxillary Twin Occlusion And Mandibular Hollow Denture Prosthesis- A Case Report

The occurrence of Squamous Cell Carcinoma is high in patients with a history of long term tobacco use. Extensive lesions of the oral cavity may lead to resection of mandible, which can compromise the patient’s functions and esthetics to varying degrees, due to its complex attachments and prominent position in the facial architecture. Prosthodontic rehabilitation of a completely edentulous hemimandibulectomy patient is even more challenging due to a number of compromising factors. Revamping certain basic principles of Prosthodontics maybe necessary for successful rehabilitation of these patients. The ultimate aim of the Prosthodontist is to improve the quality of life of these patients, which will not only have a positive physical impact but also enhance the overall mental well being of these patients. This case report presents such a complex scenario of prosthodontic rehabilitation of a completely edentulous hemimandibulectomy patient. Due to the mandibular deviation towards the resected side, incorporation of a maxillary twin occlusion on the unresected side was required to attain a favourable post operative maxillomandibular relation. Due to the extension of the mandibular denture into the defect area in the mandibular region, considerable increase in weight of the mandibular denture was expected, which would have compounded the already existing compromised retention and stability owing to the decreased mandibular denture bearing area. Hence a hollow mandibular denture was planned to reduce the weight of mandibular dentures. Considerable improvement in esthetics and function were noticed and the patient is comfortable and well tolerated with the present prosthesis

Emerging Epidemic: Non-Smoker Lung Cancer in India\'s Urban Centres

Abstract: Recent research has revealed a concerning trend in the incidence of lung cancer among non-smokers in India, particularly within urban centers. Contrary to the traditional association of lung cancer with smoking, a significant proportion of cases in India are now emerging in individuals with no history of tobacco use. This phenomenon is primarily attributed to severe air pollution, which has become a critical public health issue in many Indian cities. Rapid industrialization and urbanization have led to increased exposure to airborne pollutants, including fine particulate matter (PM2.5), nitrogen dioxide (NO2), and other carcinogens, which are now recognized as significant risk factors for lung cancer. Genetic predispositions further exacerbate this risk, with studies indicating that certain populations are more susceptible to developing lung cancer due to genetic mutations influenced by environmental exposures. These mutations and biomarkers, such as EGFR and ALK gene rearrangements, have been increasingly identified in Indian non-smoker lung cancer patients, providing critical insights into the disease's etiology and potential targeted therapies. India currently ranks fourth globally in lung cancer prevalence, with urban areas experiencing the highest growth rates. Projections suggest that the incidence of lung cancer will continue to rise, potentially reaching alarming levels by 2025. This emerging epidemic highlights the urgent need for comprehensive public health strategies to address air pollution and its associated health risks. Efforts must be directed towards reducing pollution levels through stringent regulatory measures, promoting cleaner technologies, and enhancing public awareness about the health impacts of air pollution. Additionally, implementing widespread screening programs and advancing research on genetic and environmental interactions can aid in early detection and personalized treatment approaches for affected individuals. In conclusion, the rising incidence of lung cancer among non-smokers in urban India signifies a shifting landscape in the disease's epidemiology. Addressing this public health challenge requires an integrated approach that combines environmental, genetic, and healthcare interventions to mitigate the growing burden of lung cancer in non-smoking populations.

Single centre real world data on disease profile and outcome of 700 patients with penile cancer treated with curative intent at an Indian cancer centre.

121 Background: Globocan 2022 reported that there are close to 10000 newly diagnosed penile cancer (PeCa) patients annually in India, which contributes to around 27% of the world’s burden of this disease. With the rarity of this male genitourinary cancer globally and absence of level I evidence on most aspects of the disease, real world data from a single Centre assumes importance and this retrospective study highlights the clinico-demographic profile, oncological outcome and surgical complications in patients treated with a curative intent. Methods: We retrospectively reviewed our prospectively maintained institutional database for patients with PeCa treated with curative intent from 2013 to 2021. Data was collected for demographic variables, clinico-pathological characteristics, post-operative complications and oncological outcomes. Descriptive data were expressed as mean / median / proportions. The Kaplan Meier method was used to calculate the cancer specific survival (CSS) of the patients, stratified by pN status. Results: From 2013 to 2021, 700 patients were treated for PeCa at our centre with curative intent, with a median age of 54 years (IQR 44-62) and a mean BMI of 24.1 kg/m2. Around 40% of the patients had history of tobacco use. The clinico-pathological features and Clavian Dindo complication rates are summarized in the table. With a median follow-up of 42 months, the CSS for cN0 patients under observation for their groins was 97.3%.CSS for patients with pN0, pN1, pN2 and pN3 was 90.6%, 79.4%, 71.4% and 55%. Amongst pN3, 24.3% received adjuvant chemo alone, 23.7% received adjuvant RT/CTRT alone while 33.7% received both adjuvant chemo and RT.CSS of pelvic nodal pN3 patients was 35% compared to 71% of inguinal perinodal extension pN3. Conclusions: Our series, one of the largest reported from a single centre, highlights the real world oncological outcome of PeCa patients. We reemphasize the importance of addressing inguinal nodes early and adequately and the worser outcome of pN3 due to pelvic node involvement compared to pN3 due to extra nodal extension of inguinal nodes. [Table: see text]

Comprehensive survival analysis of oral squamous cell carcinoma patients undergoing initial radical surgery

ObjectiveThis study was designed to evaluate the five-year overall survival (OS) rate and postoperative survival time of patients diagnosed with oral squamous cell carcinoma (OSCC), as well as examine the clinical and pathological factors influencing survival outcomes in OSCC patients.MethodsData were collected from OSCC patients who underwent their first radical surgical intervention in the Department of Maxillofacial Surgery at the First Affiliated Hospital of Chongqing Medical University between April 2014 and December 2016. Follow-up was conducted until March 2022.ResultsThe study included a total of 162 patients. The observed 5-year OS rate was 59.3%. Approximately 45.7% of OSCC patients experienced postoperative recurrence or metastasis, with a 5-year overall disease-free survival rate of 49.4%. There was no significant difference in the impact of sex, age, smoking, alcohol consumption, primary tumour location, depth of invasion or primary tumour size on the 5-year survival rate (p > 0.05). Univariate analysis revealed that clinical stage (Hazard Ratio = 2.239, p = 0.004), perineural invasion (PNI) (Hazard Ratio = 1.712, p = 0.03), lymph node metastasis (pN) (Hazard Ratio = 2.119, p = 0.002), pathological differentiation (Hazard Ratio = 2.715, p < 0.001), and recurrence or metastasis (Hazard Ratio = 10.02, p < 0.001) were significant factors influencing survival. Multivariate analysis further indicated that pathological differentiation (Hazard Ratio = 2.291, p = 0.001), PNI (Hazard Ratio = 1.765, p = 0.031) and recurrence or metastasis (Hazard Ratio = 9.256, p < 0.001) were independent risk factors of survival. Intriguingly, 11 OSCC patients were diagnosed with oesophageal squamous cell carcinoma (ESCC) within 1-4 years following surgery.ConclusionThe survival prognosis of OSCC patients is significantly associated with clinical stage, PNI, lymph node metastasis, pathological differentiation, and recurrence or metastasis. Pathological differentiation, PNI and recurrence or metastasis are independent risk factors affecting survival. Routine clinical screening for ESCC may be recommended for OSCC patients with a history of alcohol consumption and tobacco use.

A Peculiar Case of Disseminated Melioidosis with Atypical Features Likely Linked to Bong/Water Pipe Use

Abstract Melioidosis, caused by Burkholderia pseudomallei, is a challenging infectious disease with global implications, primarily affecting Southeast Asia. We present the case of a 24-year-old male with a curious history of tobacco use, presenting with fevers, weight loss, and genitourinary symptoms. Diagnostic challenges arose as symptoms mimicked other diseases. Disseminated melioidosis was confirmed via Gram staining and positron emission tomography scan findings, emphasizing the disease’s diverse clinical manifestations. Treatment with ceftazidime and cotrimoxazole led to prompt recovery. Notably, the patient’s tobacco use linked to contaminated water highlights a unique transmission route. This case underscores the need for heightened awareness and preventive measures in endemic regions.

Frailty scores impact the outcomes of urgent carotid interventions in acute stroke patients: A comprehensive analysis of risk and prognosis

BackgroundCarotid artery disease is an important cause of ischemic strokes. Patient selection for urgent carotid interventions (ie, urgent carotid endarterectomy [uCEA] and urgent carotid artery stenting [uCAS]) performed within 2 weeks of an event during the index hospitalization is based primarily on a patient’s overall health and risk profile. Identifying high-risk patients remains a challenge. Frailty, a decrease in function related to aging, has emerged as an important factor in the treatment of the elderly population. This study aimed to design a quantitative risk score based on frailty for patients undergoing uCEA and uCAS after an acute stroke. MethodsA total of 307 acute stroke patients treated with uCEA or uCAS were identified from a prospectively maintained database. Frailty scores were calculated using the Hospital Frailty Risk Index based on International Classificiation of Diseases, 10th edition, codes. Stroke-specific risk categories were created based on the incidence of stroke, death, and myocardial infarction (MI) associated with frailty scores. Primary end points included 30-day stroke, death, and MI, and the secondary end point was discharge modified Rankin scale (mRS). Statistical analyses were performed using SAS software. ResultsThe average age was 65.9 years; hypertension, a history of tobacco use, and hyperlipidemia were the most common comorbidities. The median Hospital Frailty Risk Score was 27; the majority of patients in this study were in the intermediate and high risk frailty groups (50.5% and 41.7%, respectively). uCAS patients had a higher median presenting National Institutes of Health Stroke Scale (NIHSS) (8 vs 2; P < .001) and shorter median time to intervention compared with uCEA patients (1 day vs 3 days; P ≤ .001). The 30-day composite stroke, death, and MI rate was 8.1%, with higher rates observed in patients with frailty scores of >30 (11.7%) and uCAS (12.2%). Hemorrhagic conversion and death were more common in uCAS patients. Functional independence (mRS 0-2) was observed in uCEA patients after minor stroke and in uCAS patients after minor or moderate stroke. Patients with high-risk frailty score (>30) presenting with a moderate stroke were more likely to be functionally dependent (mRS > 2) on discharge (67 vs 41.3%; P < .001). ConclusionsFrailty is a valuable prognosticative tool for clinical outcomes in patients undergoing urgent carotid interventions after an acute stroke. Higher frailty scores were associated with increased stroke, death, and MI rates. Frailty also influenced functional dependence at discharge, particularly in patients with moderate stroke. These findings highlight the importance of considering frailty in the decision-making process for carotid interventions. Further research is needed to validate these findings and explore interventions to mitigate the impact of frailty on outcomes.

Prior nonarthroplasty shoulder surgery and modifiable risk factors negatively affect patient outcomes after shoulder arthroplasty

BackgroundTotal shoulder arthroplasty frequently is performed in patients with a history of shoulder surgery. The purpose of this study was to evaluate clinical outcomes after primary shoulder arthroplasty in patients with a history of non-arthroplasty shoulder surgery, and whether certain modifiable risk factors (MRF) were negatively associated with final outcome measures. The secondary purpose was to determine if costs or complications were higher in patients with prior shoulder surgery. MethodsWe conducted a retrospective cohort study of all patients who underwent primary shoulder arthroplasty from January 2015 to December 2019 by one surgeon at one institution. Patients who received hemiarthroplasty were excluded. Univariate analysis was performed to assess the influence of prior shoulder surgery on costs, complications, and patient reported outcome measures (PROMs). Multivariable analysis was performed to determine if MRF negatively affected results, defined as anemia, malnutrition, obesity, uncontrolled diabetes, tobacco use, and opioid use. Results512 patients met inclusion criteria; 139 patients had at least one prior shoulder surgery. Patients with history of prior shoulder surgery were younger (65.2±9.3 years versus 70.7±9.1 years, p<0.001), more likely to be male (52.2% versus 47.8%, p=0.016), more likely to have smoking history (20.1% versus 10.5%, p=0.002), and borderline more likely to use preoperative opioids (47.5% versus 38.9%, p=0.078) while reporting significantly higher pain scores at final follow-up (VAS 1.7±2.4 versus 1.1±1.9, p=0.001) and lower PROMs (p≤0.017 for all). The final ASES score was independently negatively impacted by a history of prior surgery (β =-4.25 (-7.92, -0.56), p=0.024) and other non-modifiable factors including prosthesis type of reverse arthroplasty (β =-6.31, CI -10.02, -2.60, p=0.001), cardiac disease (β =-3.59, CI -7.12, -.0.07, p=0.046), and any complication (β =0.28, CI 0.19, 0.36, p<0.001). The final ASES score was negatively impacted by MRF including opioid use (β =-4.08, CI: -7.32, -0.84, p<0.001) and smoking status (β =-7.59, CI: -12.69, -2.49, p<0.001). Males had slightly higher final ASES scores (β = 3.79, CI 0.46, 7.11, p=0.026). Patients with prior surgery were more likely to have an intraoperative stress fracture [OR 4.6 (1.1, 19.5), p=0.038] and borderline more likely to have neurologic complication [OR 1.7 (1.0, 3.0), p=0.062] or any complication [OR 1.5 (1.0, 2.3), p=0.075]. ConclusionPatients with prior shoulder surgery were younger, more likely to be male, and more likely to have a history of tobacco use and opioid use. These patients experienced worse subjective clinical outcomes and were more likely to experience a complication.

The joint impact of PM2.5 constituents on the risk of cerebrovascular diseases hospitalization: A large community-based cohort study

Air pollution poses significant health risks to urban areas, with limited focus on the chronic association of PM2.5 and its constituents on cerebrovascular diseases (CERs), especially regarding the joint associations. This study explores the individual and joint associations between PM2.5 constituents and CER hospitalization risks through a cohort analysis of 36,271 adults in the Pearl River Delta, South China, from 2015 to 2020. Cox proportional hazards regression and quantile-based g-computation models were used to quantify the individual and joint associations of annual mean concentrations of PM2.5 constituents with hospitalization for CERs. 1151 participants were hospitalized due to CERs during the five-year follow-up period. Joint associations analyses identified that one quartile increase in co-exposure may result in hazard ratios of 1.530 (1.441–1.623), 1.840 (1.710–1.980), and 1.609 (1.491–1.737) for CERs, total, and ischemic stroke hospitalization, respectively. The adverse effect was primarily driven by organic matter and chlorine. Men, those with a history of tobacco or alcohol use or with low residential greenness, were more susceptible to CERs hospitalization following PM2.5 constituents co-exposure. Upcoming strategies should focus on monitoring and regulating PM2.5 constituents, encouraging healthy lifestyles, and enhancing urban greenery.

Use of cigarettes and e-cigarettes, impulsivity and anxiety: Influences on suicidal ideation among youth and young adults in Texas.

Cigarette use and smoking intensity increase risk of suicidal ideation. Less is known about e-cigarette use. Here we examine direct influences of cigarette versus e-cigarette use on suicidal ideation among 16-to-23-year-olds in Texas. Since 2019 the Texas Adolescent Tobacco and Marketing Surveillance study collected data on suicidal ideation every six months covering the previous two-weeks. Youths answering that they had "thoughts that you would be better off dead, or of hurting yourself" on more than two of 14 days were categorized as having suicidal ideation. Generalized linear mixed-effects logistic regressions examined the influence of ever and past 30-day (P30D) use of cigarettes, e-cigarettes, impulsivity and anxiety on suicidal ideation, controlling for gender, race/ethnicity, SES, and grade in school. Interactions between ever and P30D use of both products and a) impulsivity and b) gender were examined. Of the 2,329 participants, 29.1% reported ever and 6.5% reported P30D cigarette use, 48.2% reported ever and 11.6% reported P30D e-cigarette use, and 18.5% reported suicidal ideation. Ever cigarette use among females (aOR=1.83; 95% CI: 1.36-2.46), P30D e-cigarette use (aOR=1.30; 95% CI: 1.00-1.68), and P30D cigarette use (aOR=1.47; 95% CI: 1.06-2.05) were independently associated with higher risk for suicidal ideation, after adjusting for covariates. Impulsivity and anxiety directly increased risk for suicidal ideation regardless of product type used. Hispanic youth had higher risk of suicidal ideation than white youth, while higher levels of SES were protective. Cigarette/e-cigarette use, as well as impulsivity and anxiety, directly increase the risk of suicidal ideation. Clinicians should ask young adults with a history of tobacco use, anxiety or impulsive behavior, about suicidal ideationNicotine prevention and cessation programs might be more effective if they simultaneously target substance use and mental healthCulturally appropriate support is needed for ethnic and racial minority youth and young adults in school, college and at workWhen evaluating and understanding risk, the role of multiple social identities (such as minority status, gender, and SES) is important.