Prevalence, Outcomes, and Complications of Vitamin D Deficiency Among Patients with Multiple Myeloma: Nationwide Burden of Disease

Multiple myeloma (MM), constituting 10% of hematological malignancies, poses significant morbidity and mortality, especially with skeletal involvement. Bisphosphonate use in MM may lead to severe hypocalcemia due to vitamin D deficiency (VDD), exacerbating bone marrow plasma cell burden. We aimed to assess VDD prevalence and its impact on outcomes in MM patients. A retrospective cross-sectional analysis (2008-2018) of nationwide inpatient data identified adult MM hospitalizations with VDD using ICD-10-CM codes. Univariate and multivariate analyses were conducted to evaluate prevalence, demographics, and outcomes, with significance set at p < 0.05. Among 330,175 MM hospitalizations, 3.48% had VDD. VDD was more prevalent among 50-75-year-olds (61.72% vs. 59.74%), females (53.36% vs. 44.34%), Blacks (23.34% vs. 22.94%), Whites (65.84% vs. 65.79%), higher income brackets (26.13% vs. 23.85%), and those with comorbidities like hypertension (71.12% vs. 69.89%), dyslipidemia (42.47% vs. 34.98%), obesity (13.63% vs. 10.19%), and alcohol abuse (1.61% vs. 1.34%). In regression analysis, VDD in MM patients correlated with higher morbidity (aOR: 1.24, 95%CI: 1.14-1.36) and major disability (aOR: 1.26, 95%CI: 1.20-1.30). MM patients with VDD exhibit worse outcomes, underscoring the importance of recognizing and managing VDD promptly. Further prospective studies are needed to validate our findings and explore the impact of vitamin D supplementation on MM patient outcomes.

Modeling Commodity Flow in the Context of Invasive Species Spread: Study of Tuta absoluta in Nepal

Trade and transport of goods is widely accepted as a primary pathway for the introduction and dispersal of invasive species. However, understanding commodity flows remains a challenge owing to its complex nature, unavailability of quality data, and lack of systematic modeling methods. A robust network-based approach is proposed to model seasonal flow of agricultural produce and examine its role in pest spread. It is applied to study the spread of Tuta absoluta, a devastating pest of tomato in Nepal. Further, the long-term establishment potential of the pest and its economic impact on the country are assessed. Our analysis indicates that regional trade plays an important role in the spread of T. absoluta. The economic impact of this invasion could range from USD 17-25 million. The proposed approach is generic and particularly suited for data-poor scenarios.

The renal transport of hippurate and protein-bound solutes

Measurement of the concentration of hippurate in the inferior vena cava and renal blood samples performed in 13 subjects with normal or near-normal serum creatinine concentrations confirmed the prediction that endogenous hippurate was cleared on a single pass through the kidney with the same avidity as that reported for infused para-amino hippurate. This suggests that a timed urine collection without infusion would provide a measure of effective renal plasma flow. Comparison of the arteriovenous concentration differences for a panel of protein-bound solutes identified solutes that were secreted by the renal tubule and solutes that were subjected to tubular reabsorption.

The Association of Mesalamine With Kidney Disease

The package inserts for products containing 5-aminosalicylic acid, or mesalamine, include the following language regarding the risk of adverse kidney effects: "renal impairment, including minimal change nephropathy, acute and chronic interstitial nephritis, and rarely renal failure, has been reported in patients given products such as mesalamine delayed-release tablets that contain mesalamine or are converted to mesalamine." In this article, we review the data regarding this nephrotoxicity and the recommendations regarding appropriate monitoring. Chronic interstitial nephritis is a rare occurrence in patients treated with these drugs for Crohn disease and ulcerative colitis. Patients often present with asymptomatic reductions in glomerular filtration rate, without accompanying pyuria, skin lesions, or eosinophilia, unlike cases of acute interstitial nephritis. Drug cessation is usually associated with improved kidney function. However, if left undetected, more prolonged exposure to the drug can lead to irreversible kidney failure and end-stage kidney disease. No convincing studies demonstrate efficacy of treatment with corticosteroids. Frequent monitoring of serum creatinine, especially in the first years after initiation of therapy, is recommended.

Unfavorable Socioeconomic Factors Underlie High Rates of Hospitalization for Complicated Thyrotoxicosis in Some Regions of the United States

OBJECTIVE

The authors' institution-a safety net, university, and tertiary-care hospital located in West Texas-has a high number of hospital admissions for complicated thyrotoxicosis. It was hypothesized that unfavorable socioeconomic conditions result in increased risk of poor outcomes in hyperthyroid patients, and increased rates of hospitalization for thyrotoxicosis in West Texas. The primary aim of this study was to identify factors associated with admission for complicated thyrotoxicosis in patients living in the Panhandle and Llano Estacado of Texas.

METHOD

A retrospective chart review of patients aged ≥18 years with a diagnosis of thyrotoxicosis evaluated at the authors' institution from January 2011 to January 2017. Patients were divided into two groups: a hospitalized group, consisting of patients who required hospitalization for complicated thyrotoxicosis, and an outpatient group. Demographics, clinical, and biochemical data were reviewed to identify factors associated with hospitalization for complicated thyrotoxicosis.

RESULTS

The hospitalized group consisted of 80 patients, and the outpatient group consisted of 294 patients. Thyrotoxicosis accounted for 0.05% of all-cause hospital admissions during the study period. Patients with thyrotoxicosis and a lack of health insurance had 12 times higher odds of being hospitalized for complicated thyrotoxicosis compared to patients with commercial insurance. Conversely, the odds of hospitalization for complicated thyrotoxicosis were reduced by 63% in patients with a higher median income, and by 33% in those with college or university studies versus high school studies. Thirty-two percent of patients hospitalized for complicated thyrotoxicosis presented with thyroid storm, and this accounted for 7% of the studied cohort.

CONCLUSION

Socioeconomic conditions are the main factors associated with the odds of being admitted to a hospital in West Texas for complicated thyrotoxicosis, including thyroid storm. Patients without healthcare insurance have higher odds of admission, while patients with higher education and living in areas of higher income have lower odds of hospital admission due to thyrotoxicosis.

A Case of Relapsing Polyarthritis Associated With Hidradenitis Suppurativa: Case Report and Review of Literature

Hidradenitis suppurativa (HS) is a chronic, inflammatory follicular skin disease with recurrent skin nodules, sinus tracts, and scarring. We observed a case of HS associated with relapsing polyarthritis. On presentation the patient had a flare of polyarthritis with an increase in the number and size of pustular nodules. He has had similar episodes 1 to 2 times yearly subsiding with antibiotic treatment. Radiographs revealed erosions and demineralization. Symptoms improved following institution of anti-inflammatory and antibiotic therapy. HS is associated with several inflammatory conditions, and dysregulation in innate immunity may play an important role in etiopathogenesis. Spondyloarthritis/sacroiliitis is the most common joint manifestation in HS and mechanism(s) underlying arthropathy is unknown. Treatment of arthritis in HS is anecdotal.

Intracranial aneurysm and sildenafil

Sildenafil is one of the most commonly used drugs for the treatment of erectile dysfunction. To date, we found five reported cases of intracerebral bleeding and two reported cases of subarachnoid hemorrhage related to sildenafil use. We report a 49-year-old hypertensive and diabetic patient who presented with acute pulmonary edema and loss of consciousness following ingestion of 100 mg of sildenafil prior to sexual intercourse. He was not previously aware of the presence of an aneurysm and had no family history of it. Computed tomography of his head revealed a subarachnoid hemorrhage due to rupture of a saccular aneurysm with subsequent repeat hemorrhage within a few hours of presentation. A sudden increase in blood pressure led to pulmonary edema. Studies have shown that sildenafil acts on phosphodiesterase-1, -2 and -5 receptors and leads to a secondary increase in intracerebral circulation and vasodilatory effects, leading to sympathetic overactivity which increases the risk for intracranial bleeding.

Sensitivity of Diffusion Dynamics to Network Uncertainty

Simple diffusion processes on networks have been used to model, analyze and predict diverse phenomena such as spread of diseases, information and memes. More often than not, the underlying network data is noisy and sampled. This prompts the following natural question: how sensitive are the diffusion dynamics and subsequent conclusions to uncertainty in the network structure? In this paper, we consider two popular diffusion models: Independent cascade (IC) model and Linear threshold (LT) model. We study how the expected number of vertices that are influenced/infected, for particular initial conditions, are affected by network perturbations. Through rigorous analysis under the assumption of a reasonable perturbation model we establish the following main results. (1) For the IC model, we characterize the sensitivity to network perturbation in terms of the critical probability for phase transition of the network. We find that the expected number of infections is quite stable, unless the transmission probability is close to the critical probability. (2) We show that the standard LT model with uniform edge weights is relatively stable under network perturbations. (3) We study these sensitivity questions using extensive simulations on diverse real world networks and find that our theoretical predictions for both models match the observations quite closely. (4) Experimentally, the transient behavior, i.e., the time series of the number of infections, in both models appears to be more sensitive to network perturbations.

Fostering research skills in undergraduate medical students through Mentored Student Projects: Example from an Indian medical school

Background Healthcare decision-making is largely reliant on evidence–based medicine; building skills in scientific reasoning and thinking among medical students becomes an important part of medical education. Medical students in India have no formal path to becoming physicians, scientists or academicians. Objectives This study examines students’ perceptions regarding research skills improvement after participating in the Mentored Student Project programme at Melaka Manipal Medical College, Manipal Campus, India. Additionally, this paper describes the initiatives taken for the continual improvement of the Mentored Student Project programme based on faculty and student perspectives. Methods At Melaka Manipal Medical College, Mentored Student Project was implemented in the curriculum during second year of Bachelor of Medicine and Bachelor of Surgery programme with the intention of developing research skills essential to the career development of medical students. The study design was cross-sectional. To inculcate the spirit of team work students were grouped (n=3 to 5) and each group was asked to select a research project. The students’ research projects were guided by their mentors.  A questionnaire (Likert’s five point scale) on students’ perceptions regarding improvement in research skills after undertaking projects and guidance received from the mentor was administered to medical students after they had completed their Mentored Student Project . The responses of students were summarised using percentages. The median grade with inter-quartile range was reported for each item in the questionnaire. The median grade for all the items related to perceptions regarding improvement in research skills was 4 which reflected that the majority of the students felt that Mentored Student Project had improved their research skills. The problems encountered by the students during Mentored Student Project were related to time management for the Mentored Student Project and mentors. Results This study shows that students acknowledged that their research skills were improved after participating in the Mentored Student Project programme. Conclusions The Mentored Student Project programme was successful in fostering positive attitudes among medical students towards scientific research. The present study also provides scope for further improvement of the Mentored Student Project programme based on students’ and faculty perspectives.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6215 Kathmandu Univ Med J 2010;8(3):294-8