Ball Memorial Hospital

Abstract BACKGROUND : The presence of cardiovascular disease (CVD) in patients with leukemia leads to worse clinical outcomes, but the disparities in this issue are still not fully examined. This research investigates differences in the CVD burden related to leukemia deaths across various demographic and geographic contexts using CDC WONDER data from 1999 to 2020. METHODOLOGY : A disproportionality analysis was conducted to calculate reporting odds ratio (ROR) of CVD burden in leukemia patients compared to all-cause deaths across age groups 15–85 years. A ROR greater than 1 indicated a higher burden of CVD in cancer patients. Average Annual Percentage Changes (AAPCs) were calculated to evaluate trends, with p-values determining significance. RESULTS : The highest ROR was found in the 15–24 age cohort (2.565), decreasing with age but rising slightly in older adults (85+: 0.56). The 55–64 age group experienced the most significant annual increase (AAPC: 2.02). Males consistently showed higher RORs compared to females, however, the most notable rise was in middle-aged females (AAPC: 1.51). Among racial groups, young Hispanics had the highest ROR (2.637), whereas NH Whites (55–64 AG) experienced the largest AAPC (1.43). Midwest had the lowest ROR but also exhibited the steepest regional increase (45–54: 1.78). Urban regions reported higher RORs than rural areas, with medical facilities displaying the highest RORs. CONCLUSION : These results highlight the importance of developing focused cardiovascular care strategies, especially for high-risk groups such as younger individuals, males, Hispanics, and those residing in urban areas. Public health initiatives should target these disparities to enhance outcomes for patients with leukemia.

Abstract Background Cardiovascular disease (CVD) and cancer are the leading causes of mortality in the U.S., with significant overlap in risk factors and outcomes. This study examines the burden of CVD in cancer-related deaths using the Reporting Odds Ratio (ROR) to identify disparities by sex, race, region, and urbanization from 1999 to 2020. Methods A disproportionality analysis was conducted to calculate ROR of CVD burden in cancer patients compared to non-cancer population across age groups 15–85 years. A ROR greater than 1 indicated a higher burden of CVD in cancer patients. Average Annual Percentage Changes (AAPCs) were calculated to evaluate trends, with p-values determining significance. Results The highest ROR across age groups was in the 15–24 group at 1.83, declining to 0.34 in ages 55–64, and rising to 0.56 in ages 85+. The yearly trends showed ROR increased in all groups, with the highest increase in 55–64 group (AAPC: 1.69). Males exhibited higher RORs than females, with the steepest increase in middle-aged females (AAPC: 2.59). Young Hispanics had the highest ROR among racial groups (15–24: 2.558), while the Midwest showed the highest regional ROR (15–24: 2.311). Urban areas had higher RORs than rural areas, with medical facilities reporting the highest RORs. Conclusion This study highlights significant disparities in CVD burden among cancer patients, with younger individuals, males, Hispanics, and urban residents at higher risk. The trends underscore the need for targeted cardio-oncological interventions, to mitigate the increasing burden of CVD and cancer. Addressing systemic disparities in healthcare access and delivery is critical to improving outcomes.

Background: Septicemia often results in cardiovascular collapse and cardiac arrest (ICD-10 I46); however, national mortality trends within this population are not yet thoroughly analyzed. Hypothesis: We postulated that the age-adjusted mortality rates (AAMR) for cardiac arrest in adults aged 25 years and older with septicemia have significantly altered from 1999 to 2024 and that disparities are present based on demographic and geographic factors . Methods: CDC WONDER multiple cause-of-death data (1999–2024) were analyzed for U.S. decedents aged ≥25 years with both ICD-10 A41 and I46 codes. Total deaths and proportions by place of death (medical facility, home, nursing home, hospice, other) were tabulated. Annual AAMRs per 100,000 population were calculated. Joinpoint regression estimated average annual percent change (AAPC) in AAMR. Analyses were stratified by sex, race/ethnicity, U.S. Census region, and urban versus rural residence. Results: A total of 669,989 fatalities were recorded among adults aged ≥25 years due to septicemia and cardiac arrest (330,729 men; 339,260 women). The overall AAMR remained stable from 1999 to 2018, increased sharply from 2018 to 2021 (AAPC +7.2%, p < 0.001), and subsequently declined from 2021 to 2024 (AAPC –8.4%, p < 0.001). Men consistently exhibited higher rates than women, peaking at 17.2 per 100,000 compared to 12.4. When analyzed by race and ethnicity, non-Hispanic Black adults had the highest AAMR at 21.8, followed by Hispanic at 17.0. Hispanic adults experienced the steepest increase from 2018 to 2021 (AAPC +10.8%, p < 0.05) as well as the most significant decline thereafter (AAPC –11.0%, p < 0.05). Regionally, the Northeast exhibited the highest average AAMR at 16.3, whereas the Midwest reported the lowest average AAMR of 5.7. Urban areas surpassed rural areas in mortality rates (2020: 13.5 vs. 11.9). State AAMRs varied significantly, ranging from 27.7 in Nevada to 2.0 in Minnesota/Wisconsin. Most deaths occurred in medical facilities (90.2%), followed by nursing homes (5.4%). Conclusions: Cardiac arrest mortality in adults with septicemia was flat until 2018, surged during 2018–2021, then declined through 2024. Persistent disparities by sex, race/ethnicity, region, and urbanization highlight the need for targeted clinical and public health interventions to prevent and manage sepsis-related cardiac arrest during infectious disease surges.

Abstract Introduction: Lipoid pneumonia is a rare and often overlooked diagnosis, typically presenting with symptoms like chronic cough, breathlessness, and hemoptysis. It arises weeks or even months after an initial insult, commonly due to aspiration or inhalation of fat-containing products. Diagnosing lipoid pneumonia is challenging, as it can mimic multiple pulmonary conditions, including lung cancer, making it difficult for healthcare providers to diagnose. Case Presentation: A 57-year-old non-smoking female presented to her primary care physician with exertional chest pain. Initial chest X-ray revealed bibasilar opacities, predominantly in the left lower lobe, consistent with pneumonia, and the patient was started on antibiotics and steroids. Despite treatment, her symptoms persisted, and repeated chest X-rays continued to show infiltrates, suggesting recurrent pneumonia despite multiple courses of antibiotics. Subsequently, a CTA chest was performed, revealing multifocal pneumonia and multiple underlying pulmonary nodules. Fungal and autoimmune workup were negative, prompting a referral to pulmonology for further investigation. A follow-up CT scan demonstrated persistent consolidation, particularly in the left lower and right middle lobes, with low-density areas suggestive of lipoid pneumonia. On further questioning, the patient disclosed using mineral oil laxatives for constipation. Although reassured that the findings were not cancerous, the patient opted for a biopsy due to a family history of lung cancer. Given the potential for false positives on PET scans, the decision was made to proceed with a CT-guided biopsy, which confirmed lipoid pneumonia. Discussion: The patient's condition likely represents exogenous lipoid pneumonia, resulting from aspiration of bland oil-based laxatives. Such laxatives, due to their lack of irritants, often fail to elicit a protective cough reflex, leading to aspiration in elderly patients. Imaging plays a crucial role in diagnosing lipoid pneumonia; on CT, areas of fat attenuation as low as -30 Hounsfield units within consolidated regions and nodules can suggest this diagnosis. However, superimposed inflammation can obscure fat attenuation, complicating radiologic interpretation. While FDG-PET scans are instrumental in lung cancer diagnosis, they can yield false positives in lipoid pneumonia, mimicking malignancy. Therefore, a definitive diagnosis of lipoid pneumonia often necessitates a biopsy. This case highlights the need for careful history-taking, especially regarding laxative use, in patients with persistent pulmonary infiltrates.

Abstract Introduction: Primary diffuse large B-cell lymphoma (DLBCL) of the lung is an extremely rare neoplasm, accounting for only 0.5 – 1% of primary pulmonary malignancies. It is typically found in elderly or immunocompromised patients. Clinically, patients often present with non-specific symptoms, and radiologically, it is challenging to differentiate from other lung malignancies, such as bronchogenic carcinoma, due to overlapping features. Case Presentation: A 73-year-old female presented to the pulmonary clinic following the discovery of a pulmonary nodule. Initially, she had come to the emergency department due to worsening dyspnea. A CT scan revealed a 2 cm irregular mass in the apex of the left upper lobe, along with a smaller 1 cm lobulated nodule in the inferior base of the right upper lobe, raising concerns for malignancy. Repeat imaging showed an increase in the size of the left apical nodule, with mild enlargement in multiple mediastinal lymph nodes, which were thought to be reactive. A PET scan was ordered, revealing tracer avidity in the left apical nodule, measuring 1.6 cm, along with prominent, non-enlarged mediastinal lymph nodes considered reactive. Since a CT-guided biopsy was not feasible due to the challenging location of the nodule and the patient lacked significant risk factors, such as smoking or compromised health, a decision was made to consult cardiothoracic surgery. A wedge excision biopsy was performed, confirming a diagnosis of diffuse large B-cell lymphoma. Immunohistochemical stains were positive for CD20, PAX5, CD10, BCL6, and MUM1. The patient was subsequently referred to oncology for further management. Discussion: Primary pulmonary DLBCL is difficult to diagnose due to its rarity and non-specific presentation, often resulting in misdiagnosis or delayed diagnosis. The actual incidence of primary DLBCL of the lung may be underestimated due to its rapid spread to the mediastinum and extra-thoracic sites. Awareness of this malignancy is essential, as accurate diagnosis has significant therapeutic and prognostic implications. Primary pulmonary DLBCL generally requires aggressive early-stage treatment. However, due to its rarity, no randomized clinical trials have been conducted to determine the optimal treatment approach. Radiation therapy has limited efficacy and carries potential lung toxicity. Systemic chemotherapy with the CHOP regimen has shown promising clinical and radiological responses in primary DLBCL. A recent study failed to demonstrate improved outcomes with the addition of rituximab to CHOP, suggesting that the decision to include rituximab should be individualized based on the patient's overall condition and treatment goals.

Yasmin, Farah MBBS; Najeeb, Hala MBBS; Moeed, Abdul MBBS; Ali, Eman MBBS; Umar, Muhammad MD; Ullah, Irfan MBBS, MPH; Shah, Nishant MD; Alraies, M. Chadi MD Author Information