Delivering Lung Cancer Care During the COVID–19 Pandemic

Early and timely diagnosis of any disease, especially cancer; Increases the chances of treatment and recovery; Therefore, it is better to be aware of the symptoms of lung cancer in the continuation of this article. It is advisable to first get acquainted with the causes of lung cancer so that we can assess our situation. The most important causes of lung cancer are smoking and other tobacco products, genetic mutations and family history. Second- and third-hand cigarette smoke and environmental pollutants such as air pollution also play a role in the development of this cancer. Of course, the role of colorless gas and the smell of radon and occupational exposure to compounds such as asbestos, arsenic and nickel should not be overlooked. Once we know the causes of lung cancer, we can look at its symptoms in our body. The most important symptoms of lung cancer are persistent cough, fatigue and lack of energy, and unexplained weight loss. Coughs such as coughing up blood and shortness of breath are other important symptoms of this cancer. Stomach, back, shoulder, and chest pain, as well as pain in the head, neck, and jaw, are other symptoms. In order to prevent lung cancer, special points should be considered, which we will mention in the following. The main advice is to avoid smoking and also not to be exposed to secondhand smoke; Therefore, avoid using any tobacco and quit if you smoke. People who are in work situations and exposure to things like asbestos should try to minimize this exposure and use breathing masks. Opening windows and covering cracks in walls and floors is important to reduce radon concentrations. It is recommended to eat more vegetables and fruits, especially cabbage, orange vegetables and garlic. It is important to note that awareness of the symptoms of the disease is very important for early diagnosis and thus increase the chances of treatment. Keywords: Cancer; Cells; Tissues; Tumors; Prevention; Prognosis; Diagnosis; Imaging; Screening, Treatment; Management

Impact of COVID-19 Pandemic on Lung Cancer Treatment Scheduling

Early and timely diagnosis of any disease, especially cancer; Increases the chances of treatment and recovery; Therefore, it is better to be aware of the symptoms of lung cancer in the continuation of this article. It is advisable to first get acquainted with the causes of lung cancer so that we can assess our situation. The most important causes of lung cancer are smoking and other tobacco products, genetic mutations and family history. Second- and third-hand cigarette smoke and environmental pollutants such as air pollution also play a role in the development of this cancer. Of course, the role of colorless gas and the smell of radon and occupational exposure to compounds such as asbestos, arsenic and nickel should not be overlooked. Once we know the causes of lung cancer, we can look at its symptoms in our body. The most important symptoms of lung cancer are persistent cough, fatigue and lack of energy, and unexplained weight loss. Coughs such as coughing up blood and shortness of breath are other important symptoms of this cancer. Stomach, back, shoulder, and chest pain, as well as pain in the head, neck, and jaw, are other symptoms. In order to prevent lung cancer, special points should be considered, which we will mention in the following. The main advice is to avoid smoking and also not to be exposed to secondhand smoke; therefore, avoid using any tobacco and quit if you smoke. People who are in work situations and exposure to things like asbestos should try to minimize this exposure and use breathing masks. Opening windows and covering cracks in walls and floors is important to reduce radon concentrations. It is recommended to eat more vegetables and fruits, especially cabbage, orange vegetables and garlic. It is important to note that awareness of the symptoms of the disease is very important for early diagnosis and thus increase the chances of treatment. Keywords: Cancer; Cells; Tissues, Tumors; Prevention, Prognosis; Diagnosis; Imaging; Screening; Treatment; Management

Recurrent Graves’ disease post SARS-CoV-2 infection

A 22-year-old woman was diagnosed with thyrotoxicosis 8 weeks after the diagnosis of a mild COVID-19 infection. She had reported significant unexplained weight loss after testing positive for COVID-19, but failed to seek medical attention. She recovered well from COVID-19, but presented to the emergency department with worsening symptoms of thyrotoxicosis after 2 months. In view of her known history of previously treated Graves’ disease, a recurrence of Graves’ thyrotoxicosis was suspected. A positive thyroid stimulating hormone receptor antibody confirmed the diagnosis. She was started on carbimazole and propranolol treatment with significant improvement of her symptoms.

Immunoglobulin light chain amyloidosis diagnosis and treatment algorithm 2021

Immunoglobulin light chain amyloidosis (AL) commonly presents with nephrotic range proteinuria, heart failure with preserved ejection fraction, nondiabetic peripheral neuropathy, unexplained hepatomegaly or diarrhea, and should be considered in patients presenting with these symptoms. More importantly, patients being monitored for smoldering multiple myeloma and a monoclonal gammopathy of undetermined significance (MGUS) are at risk for developing AL amyloidosis. MGUS and myeloma patients that have atypical features, including unexplained weight loss; lower extremity edema, early satiety, and dyspnea on exertion should be considered at risk for light chain amyloidosis. Overlooking the diagnosis of light chain amyloidosis leading to therapy delay is common, and it represents an error of diagnostic consideration. Herein we provide a review of established and investigational treatments for patients with AL amyloidosis and provide algorithms for workup and management of these patients.

Abstract P641: Risk and Predictors of New Cancer Diagnoses After Acute Ischemic Stroke

Introduction: Acute ischemic stroke (AIS) may be the first sign of occult cancer. We aimed to better define the incidence of cancer in the year after AIS and to identify clinical factors associated with new cancer diagnoses. Methods: This was a retrospective cohort study using data from the Cornell Acute Stroke Academic Registry (CAESAR) on patients hospitalized at our center with AIS from 2011-2015. Patients with history of cancer were excluded. Through automated electronic data capture and manual abstraction of inpatient and outpatient medical records, we collected data on patients’ demographics, comorbidities, presentation, radiographic characteristics, stroke subtype, and clinical outcomes. Patients were followed for 1 year after the index AIS for a new diagnosis of pathologically-confirmed cancer. Cox hazards regression adjusting for the competing risk of death was used to evaluate associations between clinical factors and incident cancer. Factors significantly associated in multivariable analysis were entered into a risk stratification score, and this score’s discriminatory ability was evaluated by Harrell’s C-statistic. Results: After excluding 253 patients with history of cancer, this analysis included 963 patients with AIS. During a mean follow-up of 222 days, 16 patients (1.7%; 95% CI, 1.0-2.7%) were diagnosed with cancer. The most common cancers were lung (n=7) and leukemia (n=4) and the median time to cancer diagnosis was 13 days (IQR, 7-194 days). Among patients with cryptogenic stroke, the 1-year cancer incidence rate was 1.7% (95% CI, 0.6-3.7%). Clinical factors associated with incident cancer in multivariable analysis were venous thromboembolism during the AIS hospitalization (HR, 12.5; 95% CI, 3.3-47.0), unexplained weight loss within 6 months (HR 11.7; 95% CI, 3.3-42.0), and three-territory acute infarcts (HR, 4.1, 95% CI, 1.3-13.4). These factors were used to create a clinical score that had a C-statistic of 0.7 (95% CI, 0.5-0.8). Conclusions: In a large urban cohort of AIS, the estimated 1-year incidence of first-ever cancer was 1.7%. Unexplained weight loss, concomitant venous thromboembolism, and three-territory acute infarction pattern may serve as clues to occult cancer with AIS.

1650. Clinical Features and Risk Factors of Active Tuberculosis in Patients with Behçet’s Disease

Background Understanding the clinical characteristics and risk factors of active tuberculosis (ATB) in Behçet’s disease (BD) is of great significance to improve the treatment efficacy and guide the preventive treatment. However, the relevant studies are very limited. Methods We retrospectively reviewed medical records of BD patients admitted to our institute from 2010 to 2019. BD patients with ATB were enrolled as the case group, and the control group was selected by random number sampling from the remaining BD patients. Multivariate logistic regression analysis was performed to explore the potential risk factors of ATB in BD patients. Figure 1. Flowchart of the study Results Twenty-one ATB cases were identified from 386 BD patients, including four (19.0%) microbiologically confirmed and 17 (81.0%) clinically diagnosed. ATB patients can present with systemic symptoms (fever, night sweating, unexplained weight loss) and/or symptoms related to the infection site. Logistic regression analysis revealed that ESR>60mm/h (OR=13.710, 95%CI (1.101, 170.702)), increased IgG (OR=1.226, 95%CI (1.001, 1.502)), and positive T-SPOT.TB (OR=7.793, 95%CI (1.312, 48.464), for 24-200 SFC/106PBMC; OR=17.705 (2.503, 125.260), for >200 SFC/106PBMC) were potential risk factors for ATB in BD patients. Table 1. Past medical history and medication of BD patients with and without ATB Table 2. Clinical presentation and laboratory results of BD patients with and without ATB Table 3. Potential risk factors for ATB in BD patients Conclusion When BD patients have fever, night sweating, unexplained weight loss, or manifestations rarely occurred in BD, the diagnosis of ATB should be considered. Significantly elevated T-SPOT.TB indicates a high risk of ATB in BD patients. Disclosures All Authors: No reported disclosures

Fusobacterium Nucleatum Empyema: An Atypical Presentation

A 40-year-old man presented to the emergency room and was evaluated in the internal medicine department for unexplained weight loss, asthenia, anorexia and night sweats over the previous 2 months. After a loculated pleural effusion was identified on thoracic computed tomography, purulent fluid was drained from the lung and Fusobacterium nucleatum was isolated. The patient was successfully treated for 27 days with amoxicillin-clavulanic acid. This was an atypical presentation of a common micro-organism implicated in lung infections.

A CASE OF ACQUIRED GENERALIZED LIPODYSTROPHY ASSOCIATED WITH PEMBROLIZUMAB IN A PATIENT WITH METASTATIC MALIGNANT MELANOMA

Objective: To describe an unusual immune-related adverse event (irAE), acquired generalized lipodystrophy (AGL), from checkpoint inhibitor therapy in a patient treated with pembrolizumab. Methods: This is a case report of a 67-year-old male with metastatic melanoma who was treated with pembrolizumab. Prior to pembrolizumab, the patient was treated with another immune-checkpoint inhibitor and developed autoimmune hemolytic anemia. After starting pembrolizumab, he developed a scrotal mass consistent with panniculitis and after several subsequent cycles, he developed AGL. Results: Loss of subcutaneous fat, unexplained weight loss in combination with worsening insulin resistance and worsening hypertriglyceridemia after initiation of pembrolizumab were consistent with AGL. Autoimmune disorders and other etiologies were ruled out. Despite this irAE, the patient continued to receive pembrolizumab given stabilization of melanoma with treatment. Conclusion: We report the second case of a patient who developed AGL secondary to pembrolizumab, and the fourth case to report such complication secondary to antiprogrammed cell death receptor-1 inhibitors. As use of checkpoint inhibitors becomes more common to treat several types of cancer, it is vital for clinicians to recognize these rare irreversible complications that are not frequently reported in clinical trials.