Sound Shore Medical Center

688 Background: Pancreatic cancer is one of the leading causes of cancer-related death and is associated with poor overall survival. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), widely prescribed for diabetes and obesity, have been investigated for potential impact in patients with pancreatic cancer, although their safety and clinical effects remain uncertain. This study evaluates the association between GLP-1RA use and clinical outcomes in a real-world cohort of patients with pancreatic cancer. Methods: Using the TriNetX Network database (72 healthcare organizations), we identified patients with pancreatic cancer who were prescribed GLP-1 receptor agonists (GLP-1RAs; n = 1,972) from 2010 to 2022, and matched controls without exposure to GLP-1RAs (n = 57,645). Propensity score matching balanced demographics and comorbidities, yielding 1,821 patients in each group. The primary outcomes were all-cause mortality and overall survival, assessed with Kaplan–Meier survival curves. Secondary outcomes included hospitalization, postoperative infection/sepsis, venous thromboembolism (VTE), acute kidney injury (AKI), and chronic kidney disease (CKD). Risk ratios (RRs) with 95% confidence intervals were estimated over a three-year follow-up period. Results: After propensity matching, the mean age was 72.0 years in the GLP-1RA group and 71.8 years in the non-GLP-1RA group. GLP-1RA users had lower all-cause mortality compared with non-users (40.6% vs 44.3%; risk ratio [RR] 0.92, 95% CI 0.85–0.99; p = 0.025) and longer median survival (1,065 vs 824 days; hazard ratio [HR] 0.90, 95% CI 0.81–0.997; p = 0.043). Hospitalization was less frequent in GLP-1RA users (40.2% vs 46.1%; RR 0.87; p = 0.040). Postoperative infection/sepsis (18.1% vs 21.3%; RR 0.85; p = 0.023) was also significantly lower in the GLP-1RA group. No significant differences were observed for VTE (15.1% vs 16.4%; p = 0.335), AKI (18.7% vs 20.2%; p = 0.317), or CKD (10.4% vs 8.4%; p = 0.073). Conclusions: GLP-1RA use was associated with lower mortality, longer survival, and reduced risks of hospitalization and postoperative infection/sepsis in patients with pancreatic cancer, without increased risk of VTE or renal complications. Prospective studies are warranted to confirm these findings and further clarify the role of GLP-1RAs in pancreatic cancer care.

BackgroundPulmonary arterial hypertension (PAH) is known to impact other pulmonary disease outcomes, but there is a lack of data showing the degree of its impact. This study aims to elucidate the burden that PAH brings to patients admitted due to asthma.MethodsThe National Inpatient Sample (NIS) Database 2016-2020 was used to identify patients admitted due to asthma exacerbation. Patients admitted with a primary diagnosis of asthma, with or without a secondary diagnosis of PAH, were identified using International Classification of Diseases, 10th Edition (ICD-10) codes. PAH was classified using ICD-10 codes, specifically Group 3 PAH. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were length of stay, resource utilization, and the necessity for endotracheal intubation. STATA v.13 (StataCorp LLC, College Station, TX, USA) was used for univariate and multivariate analysis. Data were considered statistically significant at p < 0.05.ResultsFrom 2016 to 2020, 491,990 patients were admitted due to asthma, and 7,860 had PAH. Patients with asthma and PAH had a 226% higher chance of dying during the index admission (OR 2.26; 95% CI 1.27-4.03; p = 0.006), an additional 0.75 days of hospital stay (regression coefficient 0.75; 95% CI 0.54-0.95; p < 0.001), and an average of $11,558.41 more spent per hospital stay (regression coefficient 11,558.41; 95% CI 8,657.33-14,459.49; p < 0.001). These patients had no statistically significant difference in endotracheal intubation rates (OR 1.69; 95% CI 0.80-1.94; p = 0.42).DiscussionAsthma patients with PAH experience higher all-cause in-hospital mortality compared to those with asthma alone. These results highlight the increased risk associated with the coexistence of PAH and asthma, potentially due to the added hemodynamic burden imposed by PAH, which exacerbates respiratory and cardiovascular compromise. Activation of the transcription factor nuclear factor of activated T cells (NFAT) is an important marker known to link PAH and asthma. Due to its activation in both diseases, it may serve as a critical pathway for developing more effective therapeutic strategies targeting both conditions. There is also some research suggesting that increased neutrophils in asthma are correlated with PAH. Some limitations of using the NIS database are that it is subject to coding errors, misclassification, and variability across institutions, potentially affecting diagnostic and procedural accuracy.ConclusionPAH significantly impacts in-hospital outcomes in patients admitted due to asthma; thus, physicians should be aware of this difference. Future studies are needed to differentiate PAH patients by severity and to verify whether PAH treatment reverses this impact.

Objective: This study examined the prevalence of anxiety, low mental well-being, loneliness, depression, and insomnia among older adults in a district of western Nepal and identified factors associated with each of these conditions. Methods: A community-based cross-sectional study was conducted in Dang, Nepal from August 2023 to January 2024 among adults aged 60 years or older using purposive sampling technique (n = 814). Validated tools were used to assess each mental health conditions. Multivariate logistic regressions were conducted to identify factors associated with each condition. Results: Five percent of older adults had low mental well-being, 7.25% experienced loneliness, 14.13% showed signs of general anxiety disorder (GAD), 6.58% had depression, and 1.97% had insomnia. Older adults of Dalit ethnicity, those with chronic illnesses, and those with a family history of mental illness had a disproportionately higher odds of developing one or more mental health conditions compared with their counterparts. Conclusion: Mental health conditions such as anxiety, depression, sleep difficulties and loneliness, and low mental well-being were less prevalent in Dang compared to previous studies in Nepal, and were associated with caste, chronic illnesses, and family history of mental illnesses. These findings highlight the need for targeted mental health screening and culturally sensitive interventions-such as community-based programs that acknowledge caste-based stigma, strengthen family and social support systems, and integrate local language counseling- to address mental health needs of vulnerable older adults. Future nationally representative studies are needed to provide a broader understanding of mental health among older adults in Nepal.

Necrotizing soft tissue infection (NSTI) is a rare but life-threatening disease characterized by rapid spread and necrosis of the skin, subcutaneous tissue, fascia, and muscle. We present a fatal case of atraumaticNSTI involving the left lower extremity in an 80-year-old female with advanced myelodysplastic syndrome. Blood cultures grew Clostridium septicum and Staphylococcus epidermidis, the latter thought to be a blood contaminant. The patient rapidly progressed to septic shock and died within 34 hours of presentation. Our case emphasizes the need for a high index of suspicion for NSTI in patients with advanced malignancies.

Myocardial infarction (MI), heart failure (HF) exacerbation, and atrial fibrillation/atrial flutter (AF) affect millions of patients every year, and thrombocytopenia is a common laboratory finding in hospitalized patients. This study aimed to investigate the impact of thrombocytopenia in patients admitted due to MI, HF, or AF in terms of mortality, length of stay, resource utilization, and need for intubation. Methods: This is a National Inpatient Sample Database analysis from 2016-2020. Patients admitted with a primary diagnosis of MI, HF, or AF, with or without a secondary diagnosis of thrombocytopenia, were identified using ICD-10-CM codes. The primary outcome of our analysis was mortality. Secondary outcomes included length of stay, resource utilization, and necessity for endotracheal intubation. Univariate analysis was done for hospital-level and patient baseline characteristics such as age, gender, race, Charlson comorbidity index, insurance, hospital location, size, region, and teaching status. Baseline characteristics with p-value < 0.2 were considered significant and were adjusted in a multivariate analysis. Data was statistically significant if p-value <0.05. Results: Among 3,093,479 patients who had a primary diagnosis of MI between 2016 and 2020, 5.13% (N=158,755) had thrombocytopenia. Among 1,187,164 patients who had a primary diagnosis of HF exacerbation, 5.92% (N=70,225) had thrombocytopenia. Of the 2,292,194 patients admitted due to AF, 3.53% (N=80,935) also had thrombocytopenia. Overall, outcomes were poor for all groups. Adjusted outcomes showed that in-hospital mortality was significantly higher in thrombocytopenic patients of all three groups: MI (OR 1.82; 95% CI 1.73 - 1.91; p<0.001), HF exacerbation (OR 2.13; 95% CI 1.96 - 2.32; p<0.001), AF (OR 2.29; 95% CI 2.02 - 2.6; p<0.001). Length of stay was significantly longer in thrombocytopenic patients of all three groups: MI (Regression coefficient 3.65; 95% CI 3.53 - 3.76; p<0.001), HF (Regression coefficient 2.39; 95% CI 2.19 - 2.59; p<0.001), AF (Regression coefficient 1.35; 95% CI 1.26 - 1.45; p<0.001). Resource utilization was significantly higher in thrombocytopenic patients of all three groups: MI (Regression coefficient 80,272.54; 95% CI 76,853.92 - 83,691.16; p<0.001), HF (Regression coefficient 40,802.52; 95% CI 36,367.31 - 45,237.74; p<0.001), AF (Regression coefficient 15,330.34; 95% CI 13,579.82 - 17,080.86; p<0.001). The need for endotracheal intubation was also increased in thrombocytopenic patients of all three groups: MI (OR 2.39; 95% CI 2.28 - 2.5; p<0.001), HF (OR 2.51; 95% CI 2.26 - 2.79; p<0.001), and AF (OR 2.88; 95% CI 2.53 - 3.28; p<0.001). Thrombocytopenia has substantial negative outcomes in hospitalized patients with MI, HF, or AF. Thrombocytopenia could be a marker of poor prognosis, and greater awareness among physicians could potentially guide patient risk stratification, treatment decisions, resource allocation, and patient/ family counseling during hospitalization.

Chronic ketamine use can lead to sphincter of oddi dysfunction (SOD), causing various hepatobiliary complications. Recognizing substance abuse history is vital for early detection. Timely intervention can prevent irreversible liver and pancreas damage. Ketamine is commonly abused as a recreational drug worldwide due to its ability to induce euphoria-like effects. Ketamine abuse is associated with many hepatobiliary side effects ranging from cholestasis to biliary sepsis and death. Here we present a case of a young 29-year female with upper abdominal pain due to SOD resulting from chronic use of ketamine. SOD can result in obstruction or dysfunction of the bile and pancreatic ducts. Ketamine induces SOD by activation of the muscarinic receptors in the sphincter of oddi. Detail history of substance abuse is crucial for early identification of ketamine-induced SOD. Early identification and treatment of this rare condition can prevent permanent injury to the liver and pancreas.

This case report explores the intricate diagnostic challenges encountered in a 30-year-old male patient with abdominal pain, jaundice, and a history of acetaminophen use. Initially presenting as a potential case of drug-induced hepatitis due to acetaminophen overdose, the diagnosis took an unexpected turn when the patient tested positive for hepatitis B surface antigen. The case highlights the complexity of diagnosing acute hepatitis, considering multiple potential etiologies, including viral and drug-induced factors. Differential diagnoses for this case involve considering drug-induced hepatitis, autoimmune hepatitis, various viral hepatitis types, and the potential contribution of cocaine-induced hepatitis as individual possibilities or in combination.This case emphasizes the need for a comprehensive evaluation, the consideration of multiple potential causes, and the importance of ongoing monitoring and follow-up to ensure optimal patient care in cases of acute hepatitis.