Short- and long-term outcomes of patients with hyper or hypothyroidism following COVID vaccine

Since the beginning of the wide-scale anti-Coronavirus disease 2019 (COVID-19) vaccination program, sporadic cases of thyroid disease following vaccination have been reported. We describe 19 consecutive cases of COVID vaccine-related thyroid disease. Medical records were reviewed for 9 patients with Graves' disease (GD) and 10 with Thyroiditis, all of whom were diagnosed following COVID-19 vaccination. In the GD group, the median age was 45.5 years, female/male(F/M) ratio 5:4, thyroid-stimulating immunoglobulins were elevated in seven patients. The median time from vaccination to diagnosis was 3 months. Methimazole treatment was given to all but one patient. At a median follow-up of 8.5 months from vaccination, three patients were still on methimazole, five went into remission (data were missing for one). In the Thyroiditis group, the median age was 47 years, the F/M ratio 7:3. Thyroiditis was diagnosed after the first, second, and third doses in one, two, and seven patients, respectively. The median time from vaccination to diagnosis was 2 months. TPO antibodies were positive in three patients. All patients were euthyroid off medication at the last visit. Six patients were diagnosed in the hypothyroid phase at 2.5 months from vaccination. Four resolved spontaneously at 3, 6, 4, and 8 months; the other two were treated with thyroxine at 1.5 and 2 months from vaccination and remained on treatment at their last visit, at 11.5 and 8.5 months, respectively. Thyroid disease should be included among possible complications of COVID-19 vaccine and either a late onset or delayed diagnosis should be considered.

Components of metabolic syndrome in patients with multiple myeloma and smoldering multiple myeloma

BACKGROUND

The prevalences of diabetes mellitus and hypertension, both of which are components of metabolic syndrome, are known to be increased among patients with multiple myeloma (MM), but remain undetermined among patients with smoldering MM (SMM).

METHODS

Changes in various components of metabolic syndrome were investigated during the follow-up of patients with either MM or SMM compared to healthy controls. The data of 153 patients (105 with MM and 48 with SMM) and 138 controls were accessed from our medical center's records between 2008 and 2015. We analyzed the patients' data at diagnosis (baseline) and after 1, 3, and 5 years of follow-up.

RESULTS

Patients with SMM had a significantly higher prevalence of diabetes, hypertension, and dyslipidemia at baseline compared to controls. A multivariate Cox regression analysis revealed a higher risk to develop dyslipidemia after 1, 3, and 5 years of follow-up among the SMM patients. The MM patients had a higher risk to develop diabetes after 1 year, hypertension after 5 years, and dyslipidemia after 1, 3, and 5 years of follow-up.

CONCLUSIONS

These data demonstrate that patients with SMM and those with MM are more prone to develop various components of metabolic syndrome, and they stress the importance of following-up metabolic syndrome components in both groups of patients.

Multifocality Is not an Independent Prognostic Factor in Papillary Thyroid Cancer: A Propensity Score-Matching Analysis

BACKGROUND

Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. Despite its low mortality rate, the disease has a recurrence rate of up to 30%. The mainstay of treatment for PTC is surgery, followed by radioiodine ablation and thyroxine therapy in appropriately selected patients. PTC can appear as a unifocal solitary tumor, but also as two or more anatomically separate foci. A great deal of controversy surrounds the significance of multifocality as a prognostic factor, and it is considered a poor prognostic factor that prompts more aggressive treatment. The aim of this study was to investigate the prognostic value of tumor multifocality on disease recurrence and mortality in PTC patients.

METHODS

Data of 1039 consecutive PTC patients from two tertiary medical centers were reviewed. The baseline characteristics and short- and long-term outcome were analyzed to evaluate the prognostic significance of multifocal disease. The application of two different propensity score models followed multivariate analysis.

RESULTS

The median follow-up was 10.1 years, and 534 (51.4%) patients had multifocal disease and 505 (48.6%) unifocal disease. Patients with the multifocal disease were significantly older, were more frequently male, had more extrathyroidal extension, more lymph node metastases, more advanced disease (stage III/IV), and a higher American Thyroid Association recurrence risk. Multifocal PTC patients had more persistence at one year (26.6% vs. 16.4%; p < 0.001), more recurrence during follow-up (12.7% vs. 6.6%; p = 0.002), and a higher overall mortality rate (15.5% vs. 9.7%; p = 0.002). However, there were no significant differences in recurrence, last-visit persistency, and mortality rates when adjusting for confounding variables by using propensity score matching.

CONCLUSION

This propensity score-matching study provides the best available data to support the assertion that multifocality in PTC patients is a marker of more extensive disease at presentation, but not an independent prognostic factor for long-term outcomes.

Abstract P2-02-02: Dynamics of ctDNA changes during neoadjuvant chemotherapy in triple-negative breast cancer patients

Background:

Liquid biopsies to monitor response to treatment are a minimally invasive and highly attractive method for clinical application. Detection of ctDNA in plasma is now highly sensitive thanks to the use of novel highly sensitive and specific techniques such as ddPCR. In the present study we set out to analyze the utility of using ctDNA to monitor response to treatment in patients receiving standard neoadjuvant chemotherapy in triple negative breast cancer.

Methods:

Serial blood was collected from triple negative breast cancer patients participating in the Q-CROC-03 clinical trial (NCT01276899). The trial recruited triple negative breast cancer patients undergoing standard neoadjuvant chemotherapy. Paired biopsies were collected prior and at the end of treatment and serial bloods collected throughout the study. Whole exome sequencing was performed on tissues collected and we identified mutated genes of interest. Cell free DNA (cfDNA) was extracted from 3 ml of plasma and 4-10 variants per patient were analyzed by ddPCR in serial plasma samples collected before and during treatment. Response was measured by evaluating residual cancer burden (RCB), and non-responders were RCBII-III, responders RCB0-I.

Results:

For the present analysis, we identified 60 variants in tumors from 12 patients (9 RCBII-III and 3 RCB0-I). Except for TP53, none of the genes were shared among the tumors. 20% of the variants were not detected in ctDNA at any time point and we did not find any correlation between cfDNA levels and tumor size or response to treatment. The average variant allele frequency (VAF) of all detected variants at baseline was higher in RCBII-III patients than in RCB0-I patients (7.0 vs 0.7 respectively). Interestingly, variants that were detected either only in the pre-chemo tumor or in the post-chemo tumor were frequently detected throughout neoadjuvant therapy, highlighting the ability of ctDNA to capture tumor heterogeneity. In almost all cases, we observed a dramatic decrease in ctDNA VAF after one cycle of chemotherapy, including 30% to non-detectable levels. By the 5th cycle of chemotherapy 97% of detected variants had decreased (average 95% decrease). This decrease in ctDNA VAF was independent of RCB score. In some RCBII-III cases, ctDNA VAF increased prior to surgery, reflecting residual tumor presence.

Conclusion:

ctDNA could be detected in plasma of all early TNBC patients undergoing neoadjuvant chemotherapy with the majority of variants detected in plasma collected at baseline prior to chemotherapy. Once treatment started, the abundance of ctDNA markedly decreased in plasma independently of tumor response. The effect of chemotherapy on levels of ctDNA needs further investigation.

Citation Format: Cavallone L, Adriana A-M, Aldamry M, Lafleur J, Cathy L, Alirezaie N, Bareke E, Majewski J, Ferrario C, Mihalciou C, Roy J-A, Markus E, Robidoux A, Pelmus M, Aleynikova O, Discepola F, Basik M. Dynamics of ctDNA changes during neoadjuvant chemotherapy in triple-negative breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-02-02.

Midline spikes

Midline spikes are characterized by spike foci recorded at Cz, Fz, or Pz with amplitude ranging from 20 to 350 microvolts. Out of 7,929 EEGs performed at the Neurodiagnostics Laboratory, Kaiser Permanente Medical Center, Anaheim, California, between 1996 and 2006, 17 EEGs (0.21%) were identified as having interictal midline spikes with or without other epileptiform discharges. Eight EEGs showed midline spikes at Cz, 2 at Fz, 2 at Cz and Fz, 1 at Cz and C3, 1 at Cz, C3, and P3, 1 at Cz and F8, 1 at Cz and T4, and 1 at Cz with 2 Hz generalized spike and slow wave complex. Midline spikes were recorded in 10 males and 7 females. The age ranged from 4 days to 38-years-old with a mean age of 10.8 years. Twelve patients (70.6%) were children. Twelve patients (70.6%) had generalized tonic-clonic seizures and 5 had partial motor seizures. Of the 17 patients, 14 had no known causes, 1 had an agenesis of corpus callosum, 1 had a left frontal arteriovenous malformation, and 1 had a left frontal area stroke. We postulate that the mechanism for the genesis of midline spikes may be heterogeneous. Midline spikes may be triggered by thalamocortical network in a generalized tonic-clonic seizure, or may originate in the parasagittal cortex in a partial motor seizure.

Connecticut Pictorial Learning Test: a pictorial version of the California Verbal Learning Test

This paper describes the development of a pictorial version of the California Verbal Learning Test. The new instrument, named the Connecticut Pictorial Learning Test (COPLT), was tested in two experiments. The first experiment involved selection and testing of new verbal stimuli to be adapted for pictorial use. Results suggest that these new items are approximately equivalent in difficulty to the original CVLT stimuli. These stimuli can serve as CVLT alternate Form III for use in clinical verbal memory research. Recall means and standard deviations are provided for the new stimulus set with a young adult sample. The second experiment explores the psychometric properties of the new COPLT after stimuli were translated into pictorial form. The psychometric evidence suggests that the pictorial test has good internal consistency and concurrent validity with widely-used clinical memory tests. Furthermore, verbally-mediated information processing serves successful pictorial learning and subsequent recall performance in normal healthy control subjects when verbally-encodable pictorial stimuli are used. The use of semantic organization appears to be even more important for optimal performance using pictorial stimuli than with verbal stimuli. Scoring rules for the COPLT are included in the Appendix.

A comparative study of Jewish and Arab battered women presenting in the emergency room of a general hospital

Domestic violence has been well documented in the past few years in both social work and medical journals. Our study seeks to determine the comparison between two cultures regarding this important issue. Five domains regarding demographic variables, components of battering, coping skills, social services offered and discharge objectives are discussed. Our findings suggest that the differences in several areas of battering in the two ethnic groups reflect to a large extent differences in the two cultures. Issues that warrant further research are child abuse and substance abuse in the Arab culture both on individual issues and in relationship to domestic violence.

[The course of rehabilitation in patients with locked-in syndrome]

On the basis of observations of the course taken by 5 patients with so-called Locked-in Syndrome (LIS), the level of functional performance that can be achieved by long-term rehabilitation notwithstanding very severe initial symptoms is set out. The priority measures in the early phases of the condition and the particular problems of long-term rehabilitation are summarized in a checklist. Technical aids to ameliorate communication are dealt with in some detail. Special importance is attributed to patient-centered psychotherapeutic support and to family involvement.

Laparoscopic appendectomy incidental to gynecologic procedures

1. The advantages of laparoscopic appendectomy over the traditional "open" method include decreased chance of wound infection, early ambulation and resumption of normal daily activities, decreased postoperative pain, improved diagnostic accuracy, better visualization of intra-abdominal anatomy, improved cosmetic results, and avoidance of "open" appendectomy if pathology is found during routine gynecologic laparoscopic surgery. 2. Single-puncture laparoscopy has several advantages over the multiple-puncture approach, including simplicity, expediency, lower cost, avoidance of potential complications associated with multiple punctures, improved cosmetic results, and flexibility to be converted into multiple-puncture laparoscopy or laparotomy when indicated. 3. Laparoscopy is expected to eventually replace laparotomy as the primary approach for most cases of diseases of the appendix. It is not suitable in cases of dense adhesions with distorted anatomy, malignancy, or severe pelvic peritonitis.