Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiolo...Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiology,management,and outcomes of GI bleeding in critically ill patients.GI bleeding remains a significant concern,especially among patients with underlying risk factors such as coagulopathy,mechanical ventilation,and renal failure.Managing GI bleeding in the ICU requires a multidisciplinary approach,including resuscitation,endoscopic intervention,pharmacologic therapy,and sometimes surgical procedures.Even with enhanced management strategies,GI bleeding in the ICU is associated with considerable morbidity and mortality,particularly when complicated by multi-organ failure.This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients,aiming to enhance survival rates and improve the quality of care within the ICU setting.展开更多
AIM To evaluate the role of albumin at the time of ulcerative colitis(UC) diagnosis in predicting the clinical course of disease.METHODS Nationwide cohort of patients with newly diagnosed UC in the Veterans Affairs he...AIM To evaluate the role of albumin at the time of ulcerative colitis(UC) diagnosis in predicting the clinical course of disease.METHODS Nationwide cohort of patients with newly diagnosed UC in the Veterans Affairs health care system was identified and divided into two categories: hypoalbuminemia(i.e.,≤ 3.5 gm/dl) or normal albumin levels(i.e.,> 3.5 gm/dl) at the time of UC diagnosis. The exposure of interest was presence of hypoalbuminemia defined asalbumin level ≤ 3.5 g/dl at the time of UC diagnosis. Patients were then followed over time to identify the use of ≥ 2 courses of corticosteroids(CS),thiopurines,anti-TNF medications and requirement of colectomy for UC management. RESULTS The eligible study cohort included 802 patients,but 92(11.4%) patients did not have their albumin levels checked at the time of UC diagnosis,and they were excluded. A total of 710 patients,who had albumin levels checked at time of UC diagnosis,were included in our study. Amongst them,536 patients had a normal albumin level and 174 patients had hypoalbuminemia. Patients with hypoalbuminemia at diagnosis had a higher likelihood of ≥ 2 courses of CS use(adjusted HR = 1.7,95%CI: 1.3-2.3),higher likelihood of thiopurine or anti-TNF use(adjusted HR = 1.72,95%CI: 1.23-2.40) than patients with normal albumin level at diagnosis. There was a trend of higher likelihood of colectomy in hypoalbuminemic patients,but it was not statistically significant(Adjusted HR = 1.7,95%CI: 0.90-3.25).CONCLUSION Hypoalbuminemia at disease diagnosis can serve as a prognostic marker to predict the clinical course of UC at the time of diagnosis.展开更多
The gut microbiome plays an important role in the variation of pharmacologic response.This aspect is especially important in the era of precision medicine,where understanding how and to what extent the gut microbiome ...The gut microbiome plays an important role in the variation of pharmacologic response.This aspect is especially important in the era of precision medicine,where understanding how and to what extent the gut microbiome interacts with drugs and their actions will be key to individualizing therapy.The impact of the composition of the gut microbiome on the efficacy of newer cancer therapies such as immune checkpoint inhibitors and chimeric antigen receptor T-cell treatment has become an active area of research.Pancreatic adenocarcinoma(PAC)has a poor prognosis even in those with potentially resectable disease,and treatment options are very limited.Newer studies have concluded that there is a synergistic effect for immunotherapy in combination with cytotoxic drugs,in the treatment of PAC.A variety of commensal microbiota can affect the efficacy of conventional chemotherapy and immunotherapy by modulating the tumor microenvironment in the treatment of PAC.This review will provide newer insights on the impact that alterations made in the gut microbial system have in the development and treatment of PAC.展开更多
BACKGROUND Extramedullary multiple myeloma(MM)(EMM)is a rare and aggressive subentity of MM that can be present at diagnosis or develop anytime during the disease course.There is a paucity of data on the clinical char...BACKGROUND Extramedullary multiple myeloma(MM)(EMM)is a rare and aggressive subentity of MM that can be present at diagnosis or develop anytime during the disease course.There is a paucity of data on the clinical characteristics and overall epidemiology of EMM.Furthermore,there is a scarcity of data on how the interaction of age and gender influences the survival of EMM.AIM To evaluate the clinical characteristics of patients with EMM over the past 2 decades and to identify epidemiologic characteristics that may impact overall prognosis.METHODS A total of 858 patients diagnosed with EMM,between 2000 and 2017,were ultimately enrolled in our study by retrieving the Surveillance,Epidemiology,and End Results database.We analyzed demographics,clinical characteristics,and overall mortality(OM)as well as cancer-specific mortality(CSM)of EMM.Variables with a P value<0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors,with a hazard ratio(HR)of greater than 1 representing adverse prognostic factors.RESULTS From a sample of 858 EMM,the male gender(63.25%),age range 60-79 years(51.05%),and non-Hispanic whites(66.78%)were the most represented.Central Nervous System and the vertebral column was the most affected site(33.10%).Crude analysis revealed higher OM in the age group 80+[HR=6.951,95%confidence interval(95%CI):3.299-14.647,P=0],Non-Hispanic Black population(HR=1.339,95%CI:1.02-1.759,P=0.036),Bones not otherwise specified(NOS)(HR=1.74,95%CI:1.043-2.902,P=0.034),and widowed individuals(HR=2.107,95%CI:1.511-2.938,P=0).Skin involvement(HR=0.241,95%CI:0.06-0.974,P=0.046)and a yearly income of$75000+(HR=0.259,95%CI:0.125-0.538,P=0)had the lowest OM in the crude analysis.Crude analysis revealed higher CSM in the age group 80+,Non-Hispanic Black,Bones NOS,and widowed.Multivariate cox proportional hazard regression analyses only revealed higher OM in the age group 80+(HR=9.792,95%CI:4.403-21.774,P=0)and widowed individuals(HR=1.609,95%CI:1.101-2.35,P=0.014).Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups.Eyes,mouth,and ENT involvement had the lowest CSM in the multivariate analysis.There was no interaction between age and gender in the adjusted analysis for OM and CSM.CONCLUSION EMM is a rare entity.To our knowledge,there is a scarcity of data on the clinical characteristics and prognosis factors of patients with extramedullary multiple myeloma.In this retrospective cohort,using a United States-based population,we found that age,marital status,and tumor site were independent prognostic factors.Furthermore,we found that age and gender did not interact to influence the mortality of patients with EMM.展开更多
文摘Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiology,management,and outcomes of GI bleeding in critically ill patients.GI bleeding remains a significant concern,especially among patients with underlying risk factors such as coagulopathy,mechanical ventilation,and renal failure.Managing GI bleeding in the ICU requires a multidisciplinary approach,including resuscitation,endoscopic intervention,pharmacologic therapy,and sometimes surgical procedures.Even with enhanced management strategies,GI bleeding in the ICU is associated with considerable morbidity and mortality,particularly when complicated by multi-organ failure.This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients,aiming to enhance survival rates and improve the quality of care within the ICU setting.
文摘AIM To evaluate the role of albumin at the time of ulcerative colitis(UC) diagnosis in predicting the clinical course of disease.METHODS Nationwide cohort of patients with newly diagnosed UC in the Veterans Affairs health care system was identified and divided into two categories: hypoalbuminemia(i.e.,≤ 3.5 gm/dl) or normal albumin levels(i.e.,> 3.5 gm/dl) at the time of UC diagnosis. The exposure of interest was presence of hypoalbuminemia defined asalbumin level ≤ 3.5 g/dl at the time of UC diagnosis. Patients were then followed over time to identify the use of ≥ 2 courses of corticosteroids(CS),thiopurines,anti-TNF medications and requirement of colectomy for UC management. RESULTS The eligible study cohort included 802 patients,but 92(11.4%) patients did not have their albumin levels checked at the time of UC diagnosis,and they were excluded. A total of 710 patients,who had albumin levels checked at time of UC diagnosis,were included in our study. Amongst them,536 patients had a normal albumin level and 174 patients had hypoalbuminemia. Patients with hypoalbuminemia at diagnosis had a higher likelihood of ≥ 2 courses of CS use(adjusted HR = 1.7,95%CI: 1.3-2.3),higher likelihood of thiopurine or anti-TNF use(adjusted HR = 1.72,95%CI: 1.23-2.40) than patients with normal albumin level at diagnosis. There was a trend of higher likelihood of colectomy in hypoalbuminemic patients,but it was not statistically significant(Adjusted HR = 1.7,95%CI: 0.90-3.25).CONCLUSION Hypoalbuminemia at disease diagnosis can serve as a prognostic marker to predict the clinical course of UC at the time of diagnosis.
文摘The gut microbiome plays an important role in the variation of pharmacologic response.This aspect is especially important in the era of precision medicine,where understanding how and to what extent the gut microbiome interacts with drugs and their actions will be key to individualizing therapy.The impact of the composition of the gut microbiome on the efficacy of newer cancer therapies such as immune checkpoint inhibitors and chimeric antigen receptor T-cell treatment has become an active area of research.Pancreatic adenocarcinoma(PAC)has a poor prognosis even in those with potentially resectable disease,and treatment options are very limited.Newer studies have concluded that there is a synergistic effect for immunotherapy in combination with cytotoxic drugs,in the treatment of PAC.A variety of commensal microbiota can affect the efficacy of conventional chemotherapy and immunotherapy by modulating the tumor microenvironment in the treatment of PAC.This review will provide newer insights on the impact that alterations made in the gut microbial system have in the development and treatment of PAC.
文摘BACKGROUND Extramedullary multiple myeloma(MM)(EMM)is a rare and aggressive subentity of MM that can be present at diagnosis or develop anytime during the disease course.There is a paucity of data on the clinical characteristics and overall epidemiology of EMM.Furthermore,there is a scarcity of data on how the interaction of age and gender influences the survival of EMM.AIM To evaluate the clinical characteristics of patients with EMM over the past 2 decades and to identify epidemiologic characteristics that may impact overall prognosis.METHODS A total of 858 patients diagnosed with EMM,between 2000 and 2017,were ultimately enrolled in our study by retrieving the Surveillance,Epidemiology,and End Results database.We analyzed demographics,clinical characteristics,and overall mortality(OM)as well as cancer-specific mortality(CSM)of EMM.Variables with a P value<0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors,with a hazard ratio(HR)of greater than 1 representing adverse prognostic factors.RESULTS From a sample of 858 EMM,the male gender(63.25%),age range 60-79 years(51.05%),and non-Hispanic whites(66.78%)were the most represented.Central Nervous System and the vertebral column was the most affected site(33.10%).Crude analysis revealed higher OM in the age group 80+[HR=6.951,95%confidence interval(95%CI):3.299-14.647,P=0],Non-Hispanic Black population(HR=1.339,95%CI:1.02-1.759,P=0.036),Bones not otherwise specified(NOS)(HR=1.74,95%CI:1.043-2.902,P=0.034),and widowed individuals(HR=2.107,95%CI:1.511-2.938,P=0).Skin involvement(HR=0.241,95%CI:0.06-0.974,P=0.046)and a yearly income of$75000+(HR=0.259,95%CI:0.125-0.538,P=0)had the lowest OM in the crude analysis.Crude analysis revealed higher CSM in the age group 80+,Non-Hispanic Black,Bones NOS,and widowed.Multivariate cox proportional hazard regression analyses only revealed higher OM in the age group 80+(HR=9.792,95%CI:4.403-21.774,P=0)and widowed individuals(HR=1.609,95%CI:1.101-2.35,P=0.014).Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups.Eyes,mouth,and ENT involvement had the lowest CSM in the multivariate analysis.There was no interaction between age and gender in the adjusted analysis for OM and CSM.CONCLUSION EMM is a rare entity.To our knowledge,there is a scarcity of data on the clinical characteristics and prognosis factors of patients with extramedullary multiple myeloma.In this retrospective cohort,using a United States-based population,we found that age,marital status,and tumor site were independent prognostic factors.Furthermore,we found that age and gender did not interact to influence the mortality of patients with EMM.
