Recent Weight Loss Research Articles

High-grade diffuse large B cell non-Hodgkin lymphoma involving the mucosal hemorrhoid tissue: A case report

Non-Hodgkin's lymphomas are a diverse group of immune system cancers that can affect any organ in the body. Few reports describe the development of malignant lymphoma in internal or external hemorrhoids. We present the case of a 67-year-old female with a long-standing history of non-bleeding, prolapsing hemorrhoids, and recent significant weight loss. Following an excisional hemorrhoidectomy, pathological analysis revealed high-grade diffuse large B-cell non-Hodgkin lymphoma (DLBCL) involving the mucosal hemorrhoid tissue. The case underscores the importance of considering malignancy in atypical presentations of common conditions. Treatment for anal canal lymphomas remains uncertain, with medical management generally preferred over surgery. Accurate diagnosis requires histopathologic examination due to the overlap of clinical features with other pathologies.

Eosinophilic gastroenteritis, a rare case report and literature review

Abstract Introduction/Objective Eosinophilic gastroenteritis (EGE) is a rare inflammatory condition affecting the gastrointestinal tract, initially described by Kaijser et al. in 1937. It manifests as eosinophil-rich infiltration throughout the GI tract, often accompanied by peripheral eosinophilia. EGE is categorized under eosinophilic gastrointestinal disorders (EGIDs), alongside eosinophilic esophagitis (EOE) and eosinophilic colitis (EC). Symptoms vary based on the affected GI segment. This report aims to present a case of extensive EGE in a young male patient and review of similar cases to enhance clinical and histopathologic understanding. Methods/Case Report A 29-year-old male presented with abdominal pain, nausea, vomiting, and recent weight loss. He had a history of similar abdominal symptoms for a few years. Previous extensive investigations were inconclusive. Current imaging revealed soft tissue nodules, mild splenomegaly, and biliary dilation. Laboratory tests showed no significant abnormalities. Endoscopy revealed a gastric antral ulcer with marked eosinophilic infiltration on microscopy. Results (if a Case Study enter NA) NA Conclusion Eosinophilic gastroenteritis is an uncommon disease that presents with variable non-specific symptoms which require a high level of suspicion for diagnosis. EGE diagnosis requires excluding other causes of eosinophil accumulation. There is no clear distinction between the upper normal and abnormally increased eosinophils in GIT biopsies. Peripheral eosinophilia is common, along with other abnormal laboratory findings. Diagnosis relies on histopathology due to nonspecific symptoms. Clinicians and pathologists face challenges in diagnosing EGE, emphasizing the importance of considering it in the differential diagnoses. Efforts to establish diagnostic criteria for EGE are limited, despite its long-known existence. The condition’s vague symptoms necessitate a high level of clinical suspicion, with diagnosis primarily based on histopathologic features.

8288 Navigating Diagnostic Challenges of Amiodarone Induced Thyrotoxicosis in a Psychiatrically Complex Patient within a Community Hospital Setting

Abstract Disclosure: M.S. Shah: None. K.P. Sanu: None. S. Humayon: None. R. Chawla: None. N.K. Bains: None. This case delves into the intricate diagnostic and therapeutic journey of a 64-year-old male who presented to a community hospital with psychosis. Medical history was pertinent for ventricular arrhythmias treated with amiodarone 400 mg once daily, bipolar disorder with medication non-compliance and heart failure with reduced ejection fraction status post automatic implantable cardioverter-defibrillator placement. Collaboration with the patient's family revealed a history of repeated hospitalizations for similar presentations as well as recent weight loss. The challenge lay in distinguishing between manic episodes and other potential underlying medical causes. The patient's recent weight loss and amiodarone use prompted a thyroid panel, revealing a TSH of 0.01 mlU/L (n = 0.27 to 4.20 mIU/L), free T4 of >7.77ng/dL (n = 0.93 to 1.70 ng/dL), and free T3 of >7.51ng/dL (n = 2.00 to 4.40 pg/mL). Inadequate facilities for a radioactive iodine uptake (RAIU) scan and thyroid doppler ultrasound heightened the diagnostic challenge, making the history and physical exam pivotal in steering the course of this patient's care. The Burch-Wartofsky score was found to be elevated at 30 due to delirium and abdominal pain reported in the emergency department. Amiodarone use for over two years with no prior history of thyroid dysfunction, along with the absence of a goiter or thyroid antibodies suggestive of Graves disease heightened the suspicion for amiodarone-induced thyrotoxicosis type 2 (AIT type 2). Due to the lack of RAIU scan and thyroid ultrasound to better differentiate between AIT type 1 and type 2, the patient was treated with methimazole and prednisone along with an antipsychotic medication regimen. The discontinuation of antipsychotic medications became necessary due to QTc prolongation and subsequent defibrillator discharge. The patient's further improvement without psychiatric medications highlighted the success of the tailored treatment strategy, emphasizing the importance of accurate diagnosis in patients with psychiatric comorbidities. The patient’s relatively rapid clinical response also aids in differentiating AIT type 1 from type 2. This case brings awareness to the importance of a comprehensive history and physical exam, particularly in the setting of a community hospital with limited diagnostic resources. Despite the inability to obtain history directly from the patient and having diagnostic constraints, the judicious use of available resources and clinical acumen led to the diagnosis of Amiodarone-induced thyrotoxicosis type 2. Clinicians should keep a broad differential to avoid confirmation bias in treating psychiatric patients with a complex medical history. This case serves as a testament to the importance of a holistic approach to patient care and the need for ongoing advancements in diagnostic capabilities within community healthcare settings. Presentation: 6/2/2024

Views of nutrition needs in patients with systemic sclerosis.

Systemic sclerosis is a debilitating inflammatory condition synonymous with gastrointestinal symptoms which have the potential to impact dietary intake and nutritional status. This study aimed to describe symptoms experienced by patients with systemic sclerosis that may impact on dietary intake and assess nutrition education preferences in this cohort. A 24-item online qualitative and quantitative survey distributed via REDCap® was conducted in adult patients (aged ⩾18 years) living with systemic sclerosis and attending outpatient services at a single healthcare setting from January to March 2022. Data were collected on demographics, symptoms that may impact dietary intake, nutrition priorities and preferred nutrition education models. Data are mean ± standard deviation or number (%). Of 322 eligible patients, 156 (48%) participated (63 ± 12 years, 86% female, body mass index 27 ± 7 kg/m2). Most patients experienced gastrointestinal conditions (n = 123/155; 79%), which occurred daily in 26% (n = 40/155) of patients. A third of patients (n = 48/156; 31%) reported diet manipulation for symptom management. Recent weight loss was common (n = 36/154; 23% of patients). Less than a third of patients had seen a dietitian (n = 45; 29%), while 69% of patients (n = 107) desired dietetic consultancy. The preferred methods of consultation were written resources and face-to-face, respectively, and systemic sclerosis symptom management (n = 100; 64%) and losing weight (n = 53; 34%) were the most desired education topics reported. Gastrointestinal conditions are common and occur frequently in patients with systemic sclerosis. Patients want to engage with dietetics services to better manage symptoms via face-to-face consultations and written resources. These results will inform future dietetic service delivery.

Knowledge and Attitudes Toward Pressure Ulcer Prevention Evidence-based Guidelines among Nursing Students at Jazan University, Saudi Arabia.

Pressure ulcers (PUs) are a common global problem. They affect health-care costs and patient health because of increased morbidity and mortality rates. Critically ill patients are more prone to acquiring PUs than other patients. As the prevalence of PUs is high in Saudi Arabia, more attention is required for PU prevention. Nurses' knowledge and attitudes toward PU prevention are crucial. This study aimed to assess the knowledge and attitudes of nursing students regarding PU prevention evidence-based guidelines. This descriptive, cross-sectional study was conducted among nursing students at Jazan University. Data were collected using an electronic questionnaire. Data were entered, coded, and analyzed using the SPSS version 23. A total of 378 participants were included. The mean age was 22.4 ± 3.4 years, and the mean knowledge score was 7.6 ± 2.64 (range = 0-16). Of the participants, 365 (96.6%) and 13 (3.4%) were considered to have poor and good knowledge about PUs, respectively. Only 72 (19%) correctly identified a lack of oxygen as the cause of PUs; other participants answered malnutrition and moisture. Conversely, 200 (52.9%) participants indicated that recent weight loss below patients' ideal weight increases the risk for PUs. Concerning knowledge about preventive measures, 64 (16.9%) participants correctly answered that a backward sitting position, with both legs resting on a footrest, can reduce the amount of pressure. Meanwhile, 169 (44.7%) participants correctly selected thick air cushion as a means to reduce the magnitude of pressure when patients are sliding down on a chair. Some participants answered that PUs can be reduced if patients are mobilized. Seventy-two (19%) participants indicated that patients laying on a visco-elastic foam mattress should be repositioned every 2 h to reduce the duration of pressure. Age, year of education, training experience, and department were not significantly associated with knowledge about PUs (P = 0.333, P = 0.370, P = 0.700, and P = 0.810, respectively). The general knowledge and attitudes toward PUs of the nursing students at Jazan University were poor. Nevertheless, they had an average knowledge level regarding PU prevention. Age and training experience were not significantly associated with knowledge about PUs.

Malnutrition in Head and Neck Free Flap Reconstruction as a Predictor of Adverse Outcomes.

Malnutrition is associated with increased mortality in patients with head and neck (H&N) cancer. Because albumin levels are used as a surrogate for nutritional status, the purpose of this study is to assess whether malnutrition is associated with adverse postoperative outcomes in H&N free flap reconstruction. The 2006-2018 National Surgical Quality Improvement Program Database was queried for patients undergoing flap procedures of the H&N based on Current Procedure Terminology codes. Patients were included if they were operated on by an otolaryngologist or when the primary surgical site was H&N. Nutritional status was categorized as malnourished (preoperative albumin level <3.5 g/dL) or normal (preoperative albumin level ≥3.5 g/dL). Major complications included pulmonary complications, cardiac complications, deep vein thrombosis/pulmonary embolism, and sepsis/septic shock. Minor complications included surgical infection, urinary tract infection, bleeding, and dehiscence. Data were analyzed via univariate chi-square and multivariate regression analyses. Of the patients, 2532 (83.3%) had normal albumin and 506 (16.7%) had hypoalbuminemia. Patients with hypoalbuminemia were more likely to have smoking history (P = 0.008), pulmonary comorbidity (P < 0.001), renal comorbidity (P = 0.018), disseminated cancer (P < 0.001), steroid use (P < 0.001), recent weight loss (P < 0.001), bleeding disorder (P = 0.023), and preoperative transfusion (P < 0.001). After adjustment for preoperative variance, malnourished patients were more likely to experience death (P < 0.001), return to operating room (P < 0.001), free flap failure (P = 0.008), pulmonary complication (P < 0.001), deep vein thrombosis/pulmonary embolism (P = 0.019), wound disruption (P = 0.042), intraoperative transfusion (P < 0.001), minor complication (P < 0.001), major complication (P < 0.001), and extended length of stay (P < 0.001). Of the patients with normal albumin, 2.1% experienced flap failure compared with 6.3% of patients with hypoalbuminemia. It should be noted that malnourished patients were 3.370 times more likely to experience flap failure (95% confidence interval, 1.383-8.212; P = 0.008) and 3.975 times more likely to experience death (95% confidence interval, 1.700-9.626; P = 0.001) than those with normal albumin. Malnutrition is associated with death, flap failure, minor complications, and other major complications following H&N free flap surgery, even after controlling for preoperative variance. Optimizing preoperative nutrition status before free flap procedures may ameliorate morbidity and mortality in H&N patients.

Implementing weight maintenance with existing staff and electronic health record tools in a primary care setting: Baseline results from the MAINTAIN PRIME trial

BackgroundThere is need for interventions that can assist with long-term maintenance of healthy body weight and be sustainably integrated into existing primary care teams. The goal of MAINTAIN PRIME (Promoting Real (World) IMplEmentation) is to evaluate whether a successful electronic health record (EHR)-based weight maintenance intervention can be adapted to a new clinical setting with primary care staff serving as coaches. MethodsEHR tools include tracking tools, standardized surveys, and standardized “SmartPhrases” for coaching. Inclusion criteria were age 18–75 years, voluntary 5% weight loss in the past 2 years with prior BMI ≥ 25 kg/m2, and no bariatric procedures in past 2 years. Participants were randomized 1:1 to tailored online coaching with EHR tracking tools (coaching) or EHR tracking tools alone (tracking). ResultsWe screened 405 individuals between September 2021 and April 2023; 269 participants enrolled (134 coaching; 135 tracking). The most common reason for not enrolling was ineligibility (55%). At baseline, participants were 50.3 (SD 15.02) years old, 66.4% female, and 84% White; 83.7% reported moderate physical activity. Average weight and BMI at baseline were 205.0 (SD 48.9) lbs. and 33.2 (6.8) kg/m2, respectively. Participants lost an average of 10.7% (SD 5.2) of their body weight before enrolling. We recruited 39 primary care coaches over the same period.ConclusionThe study successfully identified and recruited primary care patients with recent intentional weight loss for participation in a weight maintenance program that uses EHR-based tools. We also successfully recruited and trained primary care staff as coaches.

A Narrative Review Comparing Nutritional Screening Tools in Outpatient Management of Cancer Patients.

Malnutrition during cancer has a negative impact on prognosis and quality of life. Therefore, it is important to identify those patients at higher nutritional risk to prevent its development. There are nutritional screening tools, such as MUST and NRS-2002, that focus on the patient on admission to hospital. However, most patients will develop malnutrition in the outpatient or ambulatory setting. This study aims to determine which nutritional screening tool is most effective in assessing nutritional risk in the outpatient oncology patient, highlighting the parameters analysed by these tools. Seventeen articles were reviewed, with the most important variables being tumour location, tumour stage, age, and gender, as well as recent weight loss, dietary intake, and digestive disorders. The Nutriscore, NRS-2002, and MUST tools are considered suitable, but the choice varies depending on these parameters. MNA is suitable for elderly patients, while SNAQ was not considered reliable in this population. In conclusion, MUST, NRS-2002, and Nutriscore are suitable tools, but their choice depends on specific characteristics. There is currently no universal tool for nutritional risk assessment in outpatients.

Cancer Diagnoses After Recent Weight Loss

Weight loss is common in primary care. Among individuals with recent weight loss, the rates of cancer during the subsequent 12 months are unclear compared with those without recent weight loss. To determine the rates of subsequent cancer diagnoses over 12 months among health professionals with weight loss during the prior 2 years compared with those without recent weight loss. Prospective cohort analysis of females aged 40 years or older from the Nurses' Health Study who were followed up from June 1978 until June 30, 2016, and males aged 40 years or older from the Health Professionals Follow-Up Study who were followed up from January 1988 until January 31, 2016. Recent weight change was calculated from the participant weights that were reported biennially. The intentionality of weight loss was categorized as high if both physical activity and diet quality increased, medium if only 1 increased, and low if neither increased. Rates of cancer diagnosis during the 12 months after weight loss. Among 157 474 participants (median age, 62 years [IQR, 54-70 years]; 111 912 were female [71.1%]; there were 2631 participants [1.7%] who self-identified as Asian, Native American, or Native Hawaiian; 2678 Black participants [1.7%]; and 149 903 White participants [95.2%]) and during 1.64 million person-years of follow-up, 15 809 incident cancer cases were identified (incident rate, 964 cases/100 000 person-years). During the 12 months after reported weight change, there were 1362 cancer cases/100 000 person-years among all participants with recent weight loss of greater than 10.0% of body weight compared with 869 cancer cases/100 000 person-years among those without recent weight loss (between-group difference, 493 cases/100 000 person-years [95% CI, 391-594 cases/100 000 person-years]; P < .001). Among participants categorized with low intentionality for weight loss, there were 2687 cancer cases/100 000 person-years for those with weight loss of greater than 10.0% of body weight compared with 1220 cancer cases/100 000 person-years for those without recent weight loss (between-group difference, 1467 cases/100 000 person-years [95% CI, 799-2135 cases/100 000 person-years]; P < .001). Cancer of the upper gastrointestinal tract (cancer of the esophagus, stomach, liver, biliary tract, or pancreas) was particularly common among participants with recent weight loss; there were 173 cancer cases/100 000 person-years for those with weight loss of greater than 10.0% of body weight compared with 36 cancer cases/100 000 person-years for those without recent weight loss (between-group difference, 137 cases/100 000 person-years [95% CI, 101-172 cases/100 000 person-years]; P < .001). Health professionals with weight loss within the prior 2 years had a significantly higher risk of cancer during the subsequent 12 months compared with those without recent weight loss. Cancer of the upper gastrointestinal tract was particularly common among participants with recent weight loss compared with those without recent weight loss.

Associations between low body weight, weight loss, and medical instability in adults with eating disorders.

The physical complications of atypical anorexia nervosa remain understudied, with most studies completed in adolescents. This study seeks to examine the impact of various weight measures as predictors of medical instability in a large cohort of adult eating disorder patients. In this retrospective cohort study, the impact of admission body mass index (BMI), weight suppression, and recent weight loss (the rate of weight loss within the last 12 months) toward the development of medical complications of malnutrition were examined. Multivariable logistic regression assessed the association of binary clinical outcomes of interest with recent weight loss and weight suppression (adjusting for age, admission BMI, gender, and purging behaviors). Odds ratios (OR) and 99% confidence intervals were reported. Greater recent weight loss increased the odds of developing low prealbumin and reduced hand grip strength. A greater weight suppression was associated with increased likelihood of amenorrhea, reduced systolic blood pressure, nadir hemoglobin, and weekly weight gain upon nutritional rehabilitation. Lower admission BMI was predictive of all the medical outcomes examined, with the exception of bradycardia, and was generally the strongest predictor based on standardized coefficients. Recent weight loss and weight suppression are predictive of some of the physiologic changes of malnutrition, although low BMI is seemingly the greatest predictor for the development of these complications. These findings suggest that some patients with aggressive weight suppression and/or acute weight loss would benefit from medical stabilization, although this needs to be further defined. In adults, low BMI seems to be a better predictor of medical complications than weight suppression or aggressive recent weight loss. In adults, greater weight suppression is associated with increased likelihood of amenorrhea, reduced systolic blood pressure, nadir hemoglobin, and weight gain upon nutritional rehabilitation.

Xanthogranulomatous Cholecystitis. Case Report and Review of Literature.

Xanthogranulomatous cholecystitis (XGC) is a rare but benign form of chronic cholecystitis representing a small proportion of gallbladder disorders and may mimic carcinoma. The present case is of a 59-year-old male that endorsed a six-month history of vague complaints of diarrhea, anorexia, dark urine, yellowing of his eyes, and recent weight loss without prior work up for his symptoms. Laboratory values showed elevated alkaline phosphatase, gamma-glutamyl transferase (GGT), Cancer antigen 19-9, Chromogranin A, and Lactate Dehydrogenase (LDH). Computer tomography (CT) scan revealed annular-like wall thickening in the body of the gallbladder, wall calcifications in the region of the fundus, and cholelithiasis. Magnetic resonance cholangiopancreatography (MRCP) showed focal narrowing at the mid-gallbladder with restricted diffusion and ill-defined enhancement in this region and a few prominent right upper quadrant lymph nodes. Diagnostic laparoscopy revealed a liver lesion that was resected, and frozen analysis was negative for malignancy. The laparoscopic cholecystectomy was converted to an open procedure due to significant scar tissue in the cystic triangle. The final pathology report revealed xanthogranulomatous cholecystitis (XGC) with no evidence of malignancy identified in the gallbladder or liver parenchyma.

A morbidly obese patient with large incisional hernia managed with posterior compartment separation sub-lay mesh placement

Most of the incisional hernias are diagnosed in first 3 years after the major abdominal surgery but some may take 9-10 years before the presentation after surgery. Risk factors to develop incisional hernia includes patient factors; advanced age, hypertension, diabetes, obesity, anemia, smoking, chronic obstructive pulmonary disease (COPD), immunosuppression, previous coronary intervention, renal disease requiring dialysis, recent weight loss and malnutrition. Surgery related risk factors includes intraoperative complication, suture technique, surgical site infections, fascial dehiscence and other postoperative complications. We are presenting of large incisional hernia, which have managed with posterior compartment separation. Large incisional ventral hernias following abdominal surgeries can pose significant challenges in management and quality of life for both patients. The Rives-Stoppa repair technique provides authentic and essential solution for management of large complex ventral hernias with reducing the risk of recurrence and providing long-term support to the abdominal wall.

Compensatory eating disorder and full threshold DSM eating disorders: A comparison of eating-disorder-related psychiatric impairment and symptomatology

IntroductionCompensatory eating disorder (CED) is a newly proposed ‘other specified feeding and eating disorder’ characterized by recurrent non-purging compensatory behaviors (e.g., compulsive exercise and/or food restriction), overvaluation of weight/shape, the absence of objective binge-eating episodes, and the absence of low weight or recent significant weight loss. This study compared individuals with CED to individuals with anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED) on measures of psychiatric impairment, eating-disorder (ED) symptomatology, and comorbid internalizing disorders. MethodAdults (N = 187) with CED, AN, BN, or BED completed measures of ED-related-psychiatric impairment and ED symptomatology. Structured clinical interviews were administered to assess ED and internalizing-disorder diagnoses. ResultsLinear regression models were fit to compare the CED group to full-threshold ED groups on psychiatric impairment, body dissatisfaction, cognitive restraint, negative attitudes towards obesity, and weight suppression. A chi-square difference test examined group differences on internalizing-disorder prevalence. Results indicated that the CED group had high levels of psychiatric impairment, yet psychiatric impairment was significantly lower in the CED group compared to other groups. The AN group had significantly lower body dissatisfaction than the CED group. Individuals with CED had similar cognitive restraint, negative attitudes towards obesity, internalizing psychopathology, and weight suppression compared to other ED groups. ConclusionIndividuals with CED had substantial ED psychopathology and internalizing-disorder prevalence, comparable to individuals with full-threshold EDs. Individuals with CED had high levels of psychiatric impairment, but their impairment was lower than individuals with full-threshold EDs. Our results indicate that CED is a clinically significant disorder.

THU450 Looking Beyond The Usual Suspects: A Rare Case Of Teriparatide Induced Gynecomastia

Abstract Disclosure: B.P. Ramchandani: None. F.S. Mirza: None. Introduction: Teriparatide (TP) is a parathyroid hormone analogue used as anabolic therapy for treatment of osteoporosis. Common side effects include nausea, headache and orthostatic hypotension. We hereby describe the first case of gynecomastia that developed shortly after starting treatment with TP, and resolved a couple of months after discontinuation of therapy. Clinical Case: A 61 year old male physician with severe osteoporosis presented to the endocrinology clinic with bilateral nipple tenderness and a firm lump under the left areolar region four months after starting therapy with TP. There was no associated bleeding or nipple discharge. He denied having any erectile dysfunction or decline in sexual function. His medications included vitamin D, lansoprazole and rosuvastatin. Family history was significant for osteoporosis and ductal carcinoma in situ in mother, and bilateral hip fractures after falls in his father at the age of 80. He denied any alcohol or recreational drug use. He was physically active but denied any recent weight loss. Other than the firm glandular tissue under left lateral areola, no other findings including nipple inversion or lymphadenopathy were noted on exam. Laboratory testing showed normal total and free testosterone level at 360 ng/dl and 68 pg/ml respectively, estradiol 39 pg/ml, LH 1.44 mIU/ml, FSH 4.44 mIU/ml, TSH 1.71 uIU/L, Prolactin 4.54 ng/ml and HCG &amp;lt;2 IU/ml, along with normal creatinine and liver enzymes. Mammogram showed left greater than right flame-shaped focal asymmetry contiguous with the nipple compatible with gynecomastia. Breast ultrasound showed left greater than right retroareolar dendritic slightly hypoechoic soft tissue correlating with the mammographic findings. Due to significant discomfort associated with gynecomastia, a decision was made to stop TP and treatment with risedronate was initiated. Following the discontinuation of the drug, the patient reported that his symptoms gradually improved and the nipple sensitivity and the palpable swelling of the left breast completely resolved at his follow up visit four months later. Conclusion: The temporal association between the initiation of teriparatide treatment and onset of gynecomastia, and improvement of the symptoms and physical findings upon discontinuation of the drug suggests that teriparatide was the likely cause of gynecomastia in our patient. Presentation: Thursday, June 15, 2023

FRI498 Paraneoplastic Hyperthyroidism In A Patient With B-hCG Secreting Gastric Carcinoma

Abstract Disclosure: F. Perreault: None. M. Tehfe: None. M. Laskine: None. L. Ste-Marie: None. R. Comtois: None. B. Nguyen: None. J. Murphy-Lavallée: None. A. Rakel: None. Introduction: Human chorionic gonadotropin (hCG) has thyrotropic activity, due to a similar structure to TSH. Increased hCG serum levels can cause hyperthyroidism secondary to TSH-receptor activation. hCG can be increased in conditions outside of pregnancy, such as gestational trophoblastic disease and other tumors. Common hCG secreting tumors are non-seminomatous germ cell tumors, including choriocarcinoma and teratoma1. Even if gastric adenocarcinomas can secrete ß-hCG, the serum level is rarely elevated2. Clinical Case: A 75-year-old man presented to the hospital for abdominal pain, diarrhea, and important recent weight loss. The patient was known for hypertension, dyslipidemia, type 2 diabetes, and chronic kidney disease. He had been investigated for sub-clinical hyperthyroidism one year prior (TSH 0.27 mUI/L (N 0.38-5.33), T4 14 pmol/L (N 8.0-20.0), T3 4.7 pmol/L (N 3.8-6.0), normal thyroid ultrasound and normal uptake at scintigraphy). At physical examination, the patient looked anxious, had a light lid lag, sinus tachycardia (120 BPM) and a new systolic heart murmur. The thyroid exam was normal and there was no pretibial myxedema nor exophthalmia. The blood tests showed normocytic anemia (Hb 113 g/L, N&amp;gt;130), low TSH (&amp;lt; 0.01 mUI/L), and elevated free T4 (74.1 pmol/L) and T3 (22.5 pmol/L). A work-up for hyperthyroidism revealed normal anti-TPO (4 UI/mL, N&amp;lt;9) and TSH receptor (1.2 UI/L, N&amp;lt;1.8) antibodies levels. Tc-99m thyroid scintigraphy showed homogeneous and intense uptake, with no nodule. Additionally, the abdominal CT-scan revealed multiple retroperitoneal lymphadenopathies and liver hypodensities, suspicious of neoplasia. In this context, the patient underwent gastroscopy, and a gastric antral mass was discovered. Neoplastic markers were measured and, unexpectedly, ß-hCG was strongly elevated (&amp;gt;1 080 800 U/L, N&amp;lt;2.0). Testicle ultrasound was normal. The antral mass biopsy was consistent with infiltrating gastric adenocarcinoma, with ring cells containing intracellular mucin and expressing hCG. The patient was treated with methimazole and propranolol. Free T3 and T4 initially decreased with this treatment (to 7.1 pmol/L and 46.4 pmol/L respectively), but one month later, the serum values were higher (14.9 pmol/L and 69.2 pmol/L). No follow-up was possible for this patient as he passed away before receiving treatment for cancer. Conclusion: ß-hCG induced hyperthyroidism can aggravate patients’ malignant manifestations and should be considered in cases presenting with concomitant cancer and hyperthyroidism.

Early mortality in German patients with lung cancer: risk factors associated with 30-and 60-day mortality

Despite therapeutic advances, early mortality in lung cancer is still prevalent. In this study, we aimed to assess risk factors for 30- and 60-day mortality in German lung cancer patients. In this retrospective cross-sectional analysis, we used data of lung cancer patients treated at LMU Hospital Munich between 2015 and 2019. We categorized patients into 30-day mortality, 60 day-mortality, and longer survival. We used Student’s t-test and ANOVA to compare means and Chi2-test to compare frequencies. We used logistic regression analysis to identify factors associated with a risk for early mortality. Of the 2454 lung cancer patients, 2.0% (n = 50) died within 30 and 1.7% (n = 41) within 30 to 60 days of diagnosis. Older age and advanced stage at diagnosis were significantly associated with early mortality in the univariate and the multivariate analysis. Patients in the 30-day mortality group significantly more often did not receive tumor-directed therapy. They were also more likely to die in an acute care setting compared to the 60-day mortality group. The group of patients who died unexpectedly (12.0%) was dominantly female, with a high proportion of patients with unintentional weight loss at the time of diagnosis. Our results suggest that in the treatment of patients with lung cancer there is a need for a greater focus on older patients. Moreover, physicians should pay special attention to females with recent weight loss and patients with a comorbidity of diabetes mellitus or renal impairment. Engaging a case manager focused on detecting patients with the above characteristics could help improve overall care.

An unusual cause of obstructive jaundice, abdominal pain, and weight loss

A 71-year-old female patient presented to the emergency department after having developed generalized icterus for one week, associated with inappetence due to epigastric pain with a recent weight loss of 15 kg

Transudative Tuberculous Pleural Effusion Mimicking Massive Pericardial Effusion: A Case Report

The presentation of a patient with a pleural effusion can range from an incidental finding to a serious condition, which can lead to being hemodynamically compromised. Here, we discuss a 24-year-old male with a history of childhood tuberculosis who presented with shortness of breath (SOB), a non-productive cough, and recent weight loss. On examination, he was dyspnoeic but alert. On echocardiographic evaluation, a massive effusion that looked like a massive pericardial effusion was seen, while a further CT scan of the thorax showed a massive unilateral left-sided pleural effusion. Although no tuberculosis (TB) was seen in the sample of thoracocentesis, the patient was referred to a TB centre because of a history of previous tuberculosis and recent weight loss. Pleural effusion and pericardial effusion can be differentiated using echocardiography. In conditions where it is impossible, further imaging, like computer tomography, may be needed to differentiate between them. Keywords:Pleural effusion; Tuberculosis; Pericardial effusion; Cardiac tamponade

Streptococcus mutans endocarditis resulting in severe aortic and mitral valve dysfunctionand congestive heart failure.

A patient in his 40s with no known cardiac history presented to the emergency department with midsternal chest pain worse on inspiration for the past 1 week. He also complains of recent weight loss, dry coughand night sweats during this time. He describes significant dental pain as well. Electrocardiogram showed no acute ischemic changes. Transesophageal echocardiography showed a nodular echodensity affecting the mitral valve with severe regurgitation, and echodensity affecting the aortic valve with severe regurgitation. Blood cultures grew Streptococcus mutans in multiple samples. He was treated with intravenous antibiotics and had a mechanical aortic and mitral valve replacement. He continued to have persistent left and right ventricular dysfunction several months later despite medical and surgical treatment.

Multidisciplinary physician survey assessing knowledge of the female athlete triad and relative energy deficiency in sport

BackgroundShort and long-term health consequences surrounding Low Energy Availability can be mitigated by recognizing the risk factors and making early diagnosis of the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S). While awareness of the Triad among physicians and allied health professionals has been studied, there are very few studies that assess physician awareness of both the Triad and RED-S.MethodsOur study assesses Low Energy Availability, the Triad, and RED-S knowledge with an electronic survey, educational handout, and follow up survey among physicians across multiple specialties at a single academic institution.ResultsAmong 161 respondents, respective Triad and RED-S awareness among surveyed specialties was highest in Orthopedic surgeons (100%, 100%), followed by Physical Medicine & Rehabilitation (70%, 53%), Family Medicine (67%, 48%), Internal Medicine (54%, 36%), Obstetrics and Gynecology (46%, 32%), Pediatrics (45%, 29%), Endocrinology (33%, 33%), and Other (33%, 33%). Comparing the initial survey results to the follow-up survey results, there was an increase from 37 to 72% of physicians who correctly identified that the presence of low BMI or recent weight loss is not a required component of the Triad or RED-S. Both the initial and follow-up survey revealed a continued misperception surrounding the use of hormonal contraception to resume menstrual cycles, with 33% of physicians on initial survey and 44% of physicians on follow-up survey incorrectly answering that question.ConclusionsMultidisciplinary physicians have various levels of knowledge surrounding the Triad and RED-S, and there is a need for improved physician awareness, diagnosis, and treatment of the Triad and RED-S. Misperceptions exist surrounding the role of hormonal contraception in female athletes with the Triad and RED-S to regain and regulate menses.