Chronic Eosinophilic Pneumonia Masquerading as a Lung Mass

Lung masses are becoming more common, and although most are tumors, benign or malignant, some are not solid masses. Many pathologies can present as lung nodules, including lung cancers, hamartomas, lung abscesses, granulomas, and eosinophilic pneumonia, to name a few. A 40-year-old woman with a long history of smoking presented with cough and left-sided chest pain. After multiple imaging studies, she was thought to have a lung malignancy; however, multiple biopsies proved this was not the case. The histology reports of 3 to 4 biopsies at separate times indicated chronic inflammation ongoing in the lungs without any cancer cells present. She was treated for chronic eosinophilic pneumonia with a resolution of symptoms. The purpose of this case report is to discuss a case that was initially thought to be a lung mass but found to be chronic eosinophilic pneumonia manifesting as a lung mass.

A Case of Failed Dual Antiplatelet Therapy With Oral Anticoagulant in the Prevention of Acute Ischemic Stroke

Cerebrovascular accidents (CVA) or strokes cause focal neurological deficits, which may be due to rupture or occlusion of blood vessels supplying areas of the brain. Atrial fibrillation (AF) is an independent and significant risk factor for ischemic CVA, mainly via the embolic pathway. This is evident as newly diagnosed patients with AF are typically started on anticoagulation therapy if their CHA2DS2-VASc score is equal to or greater than two. Furthermore, ischemic CVA may occur as a thrombotic phenomenon due to significant vessel atherosclerotic disease involving plaque ulceration and rupture. Such a phenomenon may be curtailed with antiplatelet therapy in at-risk patient populations, particularly as a form of secondary prevention. This case highlights the unfortunate incidence of an ischemic CVA in a patient using dual antiplatelet therapy (DAPT) and anticoagulation.

Passive social health surveillance and inpatient readmissions

OBJECTIVES

To determine whether self-identified social needs, such as financial assistance with utilities, food programs, housing support, transportation, and medication assistance, collected using a passive social health surveillance system were associated with inpatient readmissions.

STUDY DESIGN

Cross-sectional, retrospective observational study.

METHODS

This retrospective observational study linked social service referral data collected from a call center-based passive social health surveillance system with healthcare claims data extracted from a managed care organization (MCO). Mixed-effects logistic regression models calculated the odds of all-cause hospital readmissions within 30, 90, and 180 days among individuals with self-identified social service needs compared with those without.

RESULTS

Individuals who identified social service needs had 68% (odds ratio [OR], 1.68; 95% CI, 1.51-1.86), 89% (OR, 1.89; 95% CI, 1.74-2.05), and 101% (OR, 2.01; 95% CI, 1.87-2.17) higher odds of readmission within 30, 90, and 180 days, respectively, after controlling for other study variables. Examining each social service need separately, individuals had higher odds of hospital readmission within 30 days of discharge if they identified a financial (OR, 1.19; 95% CI, 1.07-1.33), food (OR, 1.32; 95% CI, 1.17-1.48), housing (OR, 1.31; 95% CI, 1.09-1.57), or transportation (OR, 1.21; 95% CI, 1.08-1.36) need compared with those without those social needs. In all study outcomes, medication assistance was not associated with readmissions.

CONCLUSIONS

An MCO created a passive social health surveillance program to more effectively integrate medical and social care. Understanding individual-level social health needs provides the insights needed to develop interventions to prevent hospital readmissions.

Trends in Demographics, Hospitalization Outcomes, Comorbidities, and Mortality Risk among Systemic Sclerosis Patients

Objective

This study determines trends in demographics and hospitalization outcomes among patients admitted for systemic sclerosis (SScl) and evaluates the differences between comorbidities.

Methods

The study used data from the Nationwide Inpatient Sample (NIS) for the years 2010–2014. We identified SScl as the primary diagnosis and the associated medical and psychiatric comorbidities using validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9­CM) codes. The differences in comorbidities and in-hospital mortality were quantified using multinomial logistic regression (odds ratio (OR)).

Results

Inpatient admissions for SScl decreased over the period 2010-2014 by 15.9% (p < 0.001). There was an increasing trend in the 61-80 years age group as they had a 29% increase in admissions and a higher risk of in-hospital mortality (OR = 2.113; p = 0.020). The differences between races showed weaker linear trends, with Caucasians (57.5%) showing an increasing trend, and African Americans (24.3%) and Hispanics (11.8%) having a decreasing trend (p < 0.001). However, Hispanics had the highest risk of mortality (OR = 1.295; p = 0.001) during hospitalization. In-hospital mortality had a linear decreasing trend, with a 10.3% decrease in deaths in 2010, and a 9.1% decrease in 2014 (p < 0.001). Hypertension (47.3%), pulmonary circulation disorders (40.1%), pulmonary fibrosis (29.7%), and congestive heart failure (24.4%) constituted the majority of comorbidities. Comorbid diabetes increased the risk of in-hospital mortality in SScl patients by four times (OR = 3.914; p = 0.003). Esophageal reflux disorder was present in only 6.7% of SScl patients, but it increased the risk of in-hospital mortality (OR = 2.643: p < 0.001). Among psychiatric comorbidities, depression (OR = 1.526; p = 0.001) and psychosis (OR = 1.743; p = 0.039) both increased the risk of in-hospital mortality.

Conclusion

We observed the various comorbidities that were associated with substantial and significant differences in the risk of in-hospital mortality. We assert that these findings indicate that comorbid conditions are influential factors that must be considered in models of health-related quality of life (HRQOL) in SScl. More attention needs to be paid to the elderly population at risk of having a higher risk of inpatient death. Further research to guide the development of clinical care models for targeting early diagnosis and treatment of comorbidities in SScl is necessary to reduce both mortality and morbidity, as well as improve the quality of care for these patients.