Introduction: Plasmablastic lymphoma (PBL) is a rare subtype of large B-cell lymphoma first described in 1997 in a small cohort of persons living with HIV (HIV-PBL). Since then, it has been observed post-transplant (P...
Introduction: Plasmablastic lymphoma (PBL) is a rare subtype of large B-cell lymphoma first described in 1997 in a small cohort of persons living with HIV (HIV-PBL). Since then, it has been observed post-transplant (PTLD-PBL) and even in otherwise immunocompetent patients (IC-PBL). With no current well-defined standard of care, prognosis of PBL has historically been poor (median overall survival (OS) 7-15 months), although recent studies suggest modest improvements in survival. We aimed to better characterize disease characteristics, treatment patterns, and factors associated with outcomes in a large contemporary US cohort. Methods: Patients (pts) ≥ 18 years old with PBL diagnosed between 1/2005 and 12/2022 from 20 academic centers in the United States were identified. Data on pt and disease characteristics and treatment were collected from medical records. OS, progression-free survival (PFS), lymphoma-specific survival (LSS), treatment-related mortality (TRM), and non-relapse mortality (NRM) were calculated using the Kaplan-Meier method. Cox regression and Fine-Gray competing risk regression were used to assess the association between clinical factors and survival outcomes. Results: 331 pts with PBL were identified. The median age at diagnosis was 53 years (range 20-91y). 78% were male (n = 257). 46% had HIV-PBL (n = 151), 35% had IC-PBL (n = 117), 6% had PTLD-PBL (n = 20), and 13% had PBL with other immunosuppressed states (n = 43). 66% of pts were White (n = 219), 18% were Black/African American (n = 58), and 31% were Hispanic (n = 104). 74% of Black/African American and 52% of Hispanic pts were diagnosed with HIV-PBL, compared with only 37% of White pts. The median age at diagnosis was greater in the IC-PBL group (68y) than in the HIV-PBL and PTLD-PBL groups (46y and 55y, respectively; p < 0.001). Most pts presented with Stage IV disease (61%, n = 220). Bone marrow (BM) involvement was present in 22% (n = 73). 92% of pts had extranodal sites involved at presenta
BackgroundInvasive mold infections (IMI) such as aspergillosis and mucormycosis are often fatal among immunosuppressed patients and have caused high-profile outbreaks. Surveillance for IMI is challenging because disti...
Background
Invasive mold infections (IMI) such as aspergillosis and mucormycosis are often fatal among immunosuppressed patients and have caused high-profile outbreaks. Surveillance for IMI is challenging because distinguishing a case from colonization or contamination is complex. The established case definition, Mycoses Study Group (MSG) criteria, lacks sensitivity. Because the need for surveillance remains, we designed a pilot IMI surveillance system within the Georgia Emerging Infections program. Here, we describe cases identified through this system, using both the MSG criteria and a novel, more sensitive clinical case definition.
Methods
To identify potential IMI cases, we captured fungal cultures positive for mold, histopathology specimens with evidence of fungal tissue invasion, and positive galactomannan results within a 60-day window at three large hospitals in Atlanta during March 2017–2018. We excluded dimorphic fungi and hair and nail specimens. Of 194 potential cases, we selected 24 for complete medical chart review. Two physicians classified cases as proven, probable, or non-case according to MSG criteria. Cases that partially met MSG probable criteria and included antifungal treatment were classified as clinical cases; definitions were mutually exclusive (Figure 1).
Results
Of 24 potential IMI cases, 16 (66%) met an IMI case definition, including 5 proven, 2 probable and 9 clinical cases. Inter-rater agreement was 92%., Most (5/7) MSG cases involved
Aspergillus
and were more likely to have cancer, a transplant, or other immunosuppression compared with clinical cases (Figure 2 and 3). Clinical cases included conditions not specified in MSG criteria, including burns (1), wounds (1) or eye (4) infections. MSG and clinical cases more often had antifungal treatment (16/16 vs. 1/8) or died (4/16 vs. 0/8) compared with non-cases.
Conclusion
In this preliminary analysis of potential IMI cases, most represented true invasive infections, indicating effective ex
AbstractObjectivesExamine the relationship between household food insecurity (HFS; i.e., access to nutritionally adequate and safe food) and disordered eating behaviors (i.e., restriction, bingeing, insulin manipulati...
AbstractObjectivesExamine the relationship between household food insecurity (HFS; i.e., access to nutritionally adequate and safe food) and disordered eating behaviors (i.e., restriction, bingeing, insulin manipulation, etc.) among a sample of young adults with youth-onset type 1 (T1D) or type 2 diabetes (T2D). MethodsWe used cross-sectional data from the SEARCH for Diabetes in Youth Study. Individuals ( n = 792) ages ≥18 years completed the U.S. Household Food Security Survey Module and the Diabetes Eating Problem Survey-Revised (DEPS-R) between 2016 and 2019. We converted HFS scores to a 10-point scale and dichotomized scores into food secure (HFS ≤ 2.2) vs. food insecure (HFS > 2.2). Multivariable linear regression was used to evaluate the association of HFS with continuous DEPS-R score (i.e., 0–80, with a greater score indicating greater symptoms of disordered eating), adjusting for potential confounders (i.e., sex, age, race/ethnicity, education, household income, insurance, depressive symptoms, and duration of diabetes). We further stratified analyses by diabetes type. ResultsParticipants were on average 23.8 ± 3.7 years, 59.6% female, 49.6% non-Latino white, and had a mean diabetes duration of 11.5 ± 3.1 years. The overall mean DEPS-R score was 17.3 ± 10.0 points. Mean DEPS-R scores in individuals living in food secure households ( n = 709) and food insecure households ( n = 83) were 16.6 ± 9.45 and 23.4 ± 12.4, respectively. The adjusted DEPS-R scores were 3.6 points (95% CI = 1.5, 5.7; P < 0.001) higher in food insecure compared to food secure households. In individuals with T1D ( n = 600), the adjusted DEPS-R scores were 5.0 points (95% CI = 2.6, 7.4; P < 0.001) higher in food insecure ( n = 55) compared to food secure ( n = 545) households. In individuals with T2D ( n = 192), there was no significant difference in mean DEPS-R scores between food insecure ( n = 28) versus food secure ( n = 164) households in unadjusted or adjusted models ( P > 0.05). Conc
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