tbuckley/cabot-search huggingface dataset:
18F-FDG PET/CT for Detection of Immunotherapy-Induced Hypophysitis—A Case-Control Study
Authors: Alessa Fischer, Julia M. Martínez-Gómez, Joanna Mangana, Reinhard Dummer, Zoran Erlic, Svenja Nölting, Felix Beuschlein, Alexander Maurer, Michael Messerli, Martin W. Huellner, Stephan Skawran
Journal: Clinical Nuclear Medicine (2024)

Purpose Hypophysitis occurs in up to 10% of patients treated with immune-checkpoint inhibitors (ICIs). MRI shows no abnormalities of the pituitary gland in one third of patients. A delayed diagnosis increases the risk for life-threatening adrenal crisis, underscoring the need for early detection. This study evaluates the diagnostic accuracy FDG PET/CT in detecting ICI-induced hypophysitis in a cohort of melanoma patients. Materials and Methods Patients with metastatic melanoma and ICI-induced hypophysitis, who underwent FDG PET/CT 90 days before to 10 days after diagnosis, were compared with an age- and sex-matched control group of patients undergoing ICI treatment without signs of hypophysitis. The ratio of SUV max of the pituitary gland to the SUV mean of the blood pool (target-to-background ratio [TBR]) was calculated. Diagnostic accuracy of the TBR was assessed using area under the receiver operating characteristics curve analysis. Results A total of 28 patients was included. The majority of patients with hypophysitis received ipilimumab/nivolumab (64.3%, 9/14). Visual assessment of the TBR distribution demonstrated a positive correlation with decreasing time to diagnosis. To evaluate diagnostic performance, only patients with FDG PET/CT 50 days before to 8 days after diagnosis (11/14) were included. TBR was significantly higher in these compared with the control group (median [interquartile range], 2.78 [2.41] vs 1.59 [0.70], respectively; P = 0.034). A sensitivity of 72.7% and a specificity of 90.9% were achieved at a TBR threshold of 2.41 (area under the receiver operating characteristics curve = 0.769). Conclusions Our findings suggest that, in patients undergoing ICI treatment for metastatic melanoma, a pituitary TBR of approximately 2.4 may indicate impending ICI-induced hypophysitis.
Catheter-Related Thrombosis With Extremely High FDG Uptake on 18F-FDG PET
Authors: Sho Ishikawa, Ryusuke Nakamoto, Takeshi Yamamoto, Kanae Kawai Miyake, Yuji Nakamoto
Journal: Clinical Nuclear Medicine (2024)

Abstract A 38-year-old woman with exertional dyspnea and decreased ejection fraction underwent 18 F-FDG PET/CT, which showed extraordinarily high FDG uptake in a catheter-related thrombus formed along a central venous catheter. The thrombus’s uptake (SUV max , 127.3) was comparable to or greater than uptake seen in the bladder’s urine. This abnormal uptake was unusual for thrombi, suggesting additional factors like undiluted FDG solution stasis due to a fibrin sheath formation around the catheter and first-pass effect. A new peripheral venous route should be secured to administer FDG in case of suspected catheter-related thrombus to avoid potential complications including a pulmonary embolism.
Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome–Related Mortality
Authors: Pedro Rafael Vieira de Oliveira Salerno, Antoinette Cotton, Yakov E. Elgudin, Salim Virani, Khurram Nasir, Ian Neeland, Sanjay Rajagopalan, Naveed Sattar, Sadeer Al-Kindi, Salil V. Deo
Journal: JAMA Network Open (2024)

Importance It is not well understood if and how various social and environmental determinants of health (SEDoH) are associated with mortality rates related to cardio-kidney-metabolic syndrome (CKM) across the US. Objective To study the magnitude of the association strength of SEDoH with CKM-related mortality at the county level across the US. Design, Setting, and Participants This cross-sectional, retrospective, population-based study used aggregate county-level data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) data portal from 2010-2019. Data analysis occurred from September 2023 to January 2024. Exposures A total of 7 diverse SEDoH were chosen, including median annual household income, percentage of racial and ethnic minority residents per county, fine particulate air pollution (PM 2.5 ) concentrations, high-school completion rate, primary health care access, food insecurity, and rurality rate. Main Outcomes and Measures The primary outcome was county-level age-adjusted mortality rate (aaMR) attributable to CKM. The association of county-level CKM-related aaMR with the 7 SEDoH was analyzed using geographically weighted models and the model median coefficients for each covariate studied. Results Data from 3101 of 3243 counties (95.6%) were analyzed. There was substantial variation in SEDoH between states and counties. The overall pooled median (IQR) aaMR (2010-2019) in the US was 505.5 (441.3-578.9) per 100 000 residents. Most counties in the lower half of the US had rates much higher than the pooled median (eg, Southern US median [IQR] aaMR, 537.3 [466.0-615.9] per 100 000 residents). CKM-related mortality was positively associated with the food insecurity rate (median [IQR] β = 6.78 [2.78-11.56]) and PM 2.5 concentrations (median [IQR] β = 5.52 [−11.06 to 19.70]), while it was negatively associated with median annual household income (median [IQR] β = −0.002 [−0.003 to −0.001]), rurality (median [IQR] β = −0.32 [−0.67 to 0.02]), high school completion rate (median [IQR] β = −1.89 [−4.54 to 0.10]), racial and ethnic minority rate (median [IQR] β = −0.66 [−1.85 to 0.89]), and primary health care access rate (median [IQR] β = −0.18 [−0.35 to 0.07]). Conclusions and Relevance In this cross-sectional study of county-level data across the US, there were substantial geographical differences in the magnitude of the association of SEDoH with CKM-related aaMR. These findings may provide guidance for deciding local health care policy.
Peritoneal Actinomycosis After Bariatric Surgery Mimicking a Peritoneal Carcinomatosis on 18F-FDG PET/CT
Authors: Agathe Fevrier, Matthieu Bailly, Flore Delalande, Gilles Metrard
Journal: Clinical Nuclear Medicine (2024)

Abstract A 54-year-old man with a history of bypass surgery 3 years ago presented with ascites, abdominal pain, and a decline in general health. CT and 18 F-FDG PET/CT suggested peritoneal carcinomatosis, but histology revealed peritoneal actinomycosis. This rare peritoneal infection can occur after digestive surgeries, such as bariatric procedures, due to disruption of the digestive barrier, allowing actinomycosis to spread outside its typical anatomical location. Clinicians should consider this diagnosis after bariatric surgery, even years later, especially in the absence of neoplastic disease.
Heart Failure Among Asian American Subpopulations
Authors: Yan Cheng, Adrienne N. Poon, Youxuan Ling, Wen-Chih Wu, Ali Ahmed, Tadas S. Vasaitis, Gurusher Panjrath, Mark Edberg, Mardi Gomberg-Maitland, Ying Yin, Stuart J. Nelson, Qing Zeng-Treitler
Journal: JAMA Network Open (2024)

Importance Heart failure (HF) is a leading cause of death in the US. The current evidence on the burdens of HF in Asian American populations, especially Asian American subgroups, is limited and inconsistent. Objective To assess and compare the incidence and prevalence of HF in Asian American subgroups. Design, Setting, and Participants This retrospective cohort study used electronic health record data from patients 40 years or older with health care encounters from January 1, 2015, to December 31, 2019, recorded in the Oracle Electronic Health Record Real-World Data database, which has more than 100 health care systems across the US contributing to the database as of February 2024. For prevalence analysis, the study samples were those who had at least 1 encounter in the study calendar year. For incidence analysis, participants were additionally limited to those without HF before the study year who also had encounter(s) the year before the study year. Data analysis was performed from August 1, 2023, to July 31, 2024. Exposure Race and ethnicity were determined using patient self-reported data, which were categorized as Black, East Asian, South Asian, Southeast Asian, other Asian (without specified ethnicity), and White. Main Outcomes and Measures Outcomes were incidence and prevalence of HF, identified using recorded International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Age- and sex-standardized incidence and prevalence were used to calculate the risk ratio of each racial and ethnic group compared with White patients. Results Incidence and prevalence analyses were performed for 6 845 791 patients (mean [SD] age, 62.1 [12.5] years; 59.9% female; 2.8% Asian, 6.7% Black, and 90.5% White) and for 13 440 234 patients (mean [SD] age, 61.7 [12.7] years; 57.0% female; 2.9% Asian, 7.1% Black, and 90.0% White), respectively. Using the 2015 population as the standard, age- and sex-standardized HF incidence was 2.26% (95% CI, 2.07%-2.45%) for Southeast Asian patients, 1.56% (95% CI, 1.31%-1.82%) for South Asian patients, and 1.22% (95% CI, 1.06%-1.38%) for East Asian patients compared with 1.58% (95% CI, 1.57%-1.59%) for White patients and 2.39% (95% CI, 2.36%-2.42%) for Black patients. Similarly, heterogeneous rates in Asian American subgroups were also observed in the prevalence analysis. Conclusions and Relevance In this study of HF outcomes, the disparities between Southeast and East Asian patients were larger than those between Black and White patients, with the estimates in Southeast Asian patients being similar to those of Black patients. These findings reinforce that individual Asian ethnicities and cardiovascular risk factors should be considered in the assessment of HF risks.
Trends and Disparities in Initiation of Buprenorphine in US Emergency Departments, 2013-2022
Authors: Neeraj Chhabra, Dale Smith, Grayson Dickinson, Lily Caglianone, R. Andrew Taylor, Gail D’Onofrio, Niranjan S. Karnik
Journal: JAMA Network Open (2024)

This cross-sectional study assesses trends in buprenorphine initiation in US emergency departments and demographic and socioeconomic factors associated with its initiation.
Rates of Sudden Unexpected Infant Death Before and During the COVID-19 Pandemic
Authors: Emma G. Guare, Rong Zhao, Paddy Ssentongo, Erich K. Batra, Vernon M. Chinchilli, Catharine I. Paules
Journal: JAMA Network Open (2024)

Importance Infection has been postulated as a driver in the sudden infant death syndrome (SIDS) cascade. Epidemiologic patterns of infection, including respiratory syncytial virus and influenza, were altered during the COVID-19 pandemic. Comparing month-to-month variation in both sudden unexpected infant death (SUID) and SIDS rates before and during the pandemic offers an opportunity to generate and expand existing hypotheses regarding seasonal infections and SUID and SIDS. Objective To compare prepandemic and intrapandemic rates of SUID and SIDS, assessing for monthly variation. Design, Setting, and Participants This cross-sectional study assessed US mortality data provided by the Centers for Disease Control and Prevention for January 1, 2018, through December 31, 2021. Events with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for SIDS (R95), unknown (R99), and accidental suffocation and strangulation in bed (W75) causes of death were examined. The data analysis was performed between November 2, 2023, and June 2, 2024. Exposure COVID-19 pandemic. Main Outcomes and Measures The primary and secondary outcomes were the monthly rates of SUID and SIDS during the COVID-19 pandemic (March 1, 2020, to December 31, 2021) compared with the prepandemic period (March 1, 2018, to December 31, 2019) as measured using generalized linear mixed-effects models. Seasonal trends in RSV and influenza rates were also examined. Results There were 14 308 SUID cases from January 1, 2018, to December 31, 2021 (42% female infants). Compared with the prepandemic period, the risk of SUID increased during the intrapandemic period (intensity ratio [IR], 1.06; 95% CI, 1.05-1.07). Monthly assessments revealed an increased risk of SUID beyond the prepandemic baseline starting in July 2020, with a pronounced epidemiologic shift from June to December 2021 (ranging from 10% to 14%). Rates of SIDS were elevated throughout the intrapandemic period compared with the prepandemic baseline, with the greatest increase in July 2021 (IR, 1.18; 95% CI, 1.13-1.22) and August 2021 (IR, 1.17; 95% CI, 1.13-1.22). Seasonal shifts in RSV hospitalizations correlated with monthly changes in SUID observed during 2021. Conclusions and Relevance This cross-sectional study found increased rates of both SUID and SIDS during the COVID-19 pandemic, with a significant shift in epidemiology from the prepandemic period noted in June to December 2021. These findings support the hypothesis that off-season resurgences in endemic infectious pathogens may be associated with SUID rates, with RSV rates in the US closely approximating this shift. Further investigation into the role of infection in SUID and SIDS is needed.
Recurrent Fevers in a Patient With Splenomegaly
Authors: Darren D’Souza, Braulio Cuesta, Jennie Y. Law
Journal: JAMA Oncology (2024)

A 36-year-old man presented with 10 weeks of recurrent fevers, malaise, night sweats, unintentional weight loss, and dyspnea. What is your diagnosis?
A Digital Cognitive Behavioral Therapy Program for Adults With Alcohol Use Disorder
Authors: Brian D. Kiluk, Bryan Benitez, Elise E. DeVito, Tami L. Frankforter, Donna M. LaPaglia, Stephanie S. O’Malley, Charla Nich
Journal: JAMA Network Open (2024)

Importance Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use, yet patient access is limited and may be enhanced through digital therapeutics. Objective To evaluate the efficacy of a digital CBT program (Computer-Based Training for Cognitive Behavioral Therapy [CBT4CBT]) or clinician-delivered CBT compared with standard treatment for reducing alcohol use. Design, Setting, and Participants A 3-arm randomized clinical trial was conducted at outpatient substance use treatment facilities in Connecticut between February 14, 2017, and December 31, 2021, that included an 8-week treatment period with a 6-month follow-up period. Treatment-seeking adults were included who met criteria for current alcohol use disorder and reported drinking at least 14 (men) or 7 (women) drinks per week in the past month and were sufficiently stable for outpatient treatment. Interventions Participants were randomly assigned to 1 of the following groups: (1) treatment as usual (TAU) consisting of weekly group or individual counseling, (2) CBT delivered weekly by trained and fidelity-monitored clinicians, or (3) web-based CBT plus brief weekly clinical monitoring. Main Outcomes and Measures Rates of alcohol use were measured weekly during the treatment period and at 1-, 3-, and 6-month follow-up using the timeline follow-back method. The primary outcome was the percentage of days abstinent (PDA) from alcohol per month. Intention-to-treat analyses were conducted. Results Of the 99 randomized participants (mean [SD] age, 45.5 [12.7]), 66 were male (66.7%); 39 identified as Black/African American (39.8%), 19 (19.2%) as Hispanic, and 47 (48.0%) as White. Mean (SD) rates of PDA from baseline to 6-month follow-up were 49.3% (27.8%) to 69.6% (34.4%) for TAU; 53.7% (29.8%) to 70.2% (35.1%) for CBT; and 47.6% (31.8%) to 82.6% (25.3%) for digital CBT. Results of random-effects regression showed a significant increase in PDA during the study period, with those assigned to digital CBT increasing PDA at a faster rate than TAU ( t 733 = 2.55; P = .01) and CBT ( t 733 = 3.36; P &amp;amp;lt; .001). However, there was no statistically significant difference between treatment groups during the 8-week treatment period. Conclusions and Relevance In this randomized clinical trial, while there was no significant difference between treatment groups during the 8-week treatment period, there was differential change between treatments during the 8-month study period that provides support for the efficacy of this digital CBT program. Trial Registration ClinicalTrials.gov Identifier: NCT02742246
Estimation of Tax Benefit of US Nonprofit Hospitals
Authors: Elizabeth Plummer, Mariana P. Socal, Ge Bai
Journal: JAMA (2024)

Importance Nonprofit hospitals are under increasing scrutiny to justify the generous tax benefit they receive due to their tax-exempt status. Quantifying the value of the tax benefit they receive at the federal, state, and local levels is critical for designing informed public health policies and ensuring nonprofit hospitals’ taxpayer accountability. Objective To estimate the financial benefit that nonprofit hospitals derive from their tax-exempt status and assess how the benefit is distributed across state and local communities. Design, Setting, and Participants Using methodologies and measures consistent with current tax law and practice and data from 2021 Medicare Cost Reports, this study calculated the total financial benefit from nonprofit hospitals’ tax-exempt status for all US nonprofit hospitals with the required Cost Reports data. Main Outcomes and Measures Nonprofit hospitals’ total tax benefit, which equals the sum of federal and state income tax, sales tax, property tax, the fair market value of charitable contributions from donors, savings from tax exemptions on issued bonds, and federal unemployment tax. Results A total of 2927 US nonprofit hospitals received a $37.4 billion total tax benefit in 2021 from federal income tax ($11.5 billion; 31%), sales tax ($9.1 billion; 24%), property tax ($7.8 billion; 21%), state income tax ($3.7 billion; 10%), charitable contributions ($3.2 billion; 8%), bond financing ($2.1 billion; 6%), and federal unemployment tax ($200 million; &amp;amp;lt;1%). Tax benefit varied substantially across states, from $25 098 (Delaware) to $159 464 (Massachusetts) per hospital bed and from $19 (Alabama) to $275 (Massachusetts) per capita. Tax benefit was highly concentrated, with 7% (n = 212) of hospitals accounting for half of the total amount. Conclusion and Relevance This study highlights the wide variation of nonprofit hospitals’ tax benefit across states, its high concentration among a small number of hospitals, and the primary role played by state and local taxes. Policy efforts to strengthen nonprofit hospitals’ taxpayer accountability are likely to be more effective when pursued at the local level. The detailed standardized estimation road map can be used by various stakeholders to estimate tax benefit for external valuation and reporting purposes, updated as laws change, and improved upon as better data sources become available.
Price and Variability in Hospital Charges for Generic Indomethacin Suppositories
Authors: Noah M. Feder, Inmaculada Hernandez, William B. Feldman, Mathavan Murali, Aaron S. Kesselheim, B. Joseph Elmunzer, Walid F. Gellad
Journal: JAMA Network Open (2024)

This cross-sectional study examines how list prices for indomethacin have changed since 2019 and characterizes variation in hospital charges for the drug, including gross charges and discounted cash prices.
Chronic Spontaneous Urticaria
Authors: Pavel Kolkhir, Hanna Bonnekoh, Martin Metz, Marcus Maurer
Journal: JAMA (2024)

Importance Chronic spontaneous urticaria affects approximately 1% of the general population worldwide, including approximately 3 million people in the US, impairs patients’ quality of life, and is associated with multiple comorbidities. Observations Chronic spontaneous urticaria affects patients of any age but is most common in females aged 30 to 50 years. Diagnosis is based on clinical presentation, ie, spontaneously recurring wheals, angioedema, or both. Chronic spontaneous urticaria persists for more than 1 year in most patients (1 or repeated episodes) and may present with comorbidities including chronic inducible urticaria (&amp;amp;gt;10%), autoimmune thyroiditis (approximately 20%), metabolic syndrome (6%-20%), and anxiety (10%-31%) and depression (7%-29%). Known autoimmune endotypes (subtypes of urticaria defined by distinct pathogenesis) of chronic spontaneous urticaria are mediated by mast cell–activating IgE and/or IgG autoantibodies (&amp;amp;gt;50%). Approximately 40% of patients with chronic spontaneous urticaria have a Dermatology Life Quality Index of more than 10, corresponding to a very large or extremely large negative effect on quality of life. Second-generation H 1 antihistamines are first-line treatment; partial or complete response, defined as a reduction in urticaria symptoms of greater than 50%, is observed in approximately 40% of patients. The 2022 international urticaria guideline recommends the monoclonal anti-IgE antibody omalizumab as second-line treatment for antihistamine-refractory chronic spontaneous urticaria. However, at least 30% of patients have an insufficient response to omalizumab, especially those with IgG-mediated autoimmune urticaria. Cyclosporine, used off-label, can improve symptoms in approximately 54% to 73% of patients, especially those with autoimmune chronic spontaneous urticaria and nonresponse to omalizumab, but has adverse effects such as kidney dysfunction and hypertension. Conclusions and Relevance Chronic spontaneous urticaria is an inflammatory skin disease associated with medical and psychiatric comorbidities and impaired quality of life. Second-generation H 1 antihistamines are first-line treatment, omalizumab is second-line treatment, and cyclosporine is third-line treatment for chronic spontaneous urticaria.