EUH Morning Report: Should physicians consider patients in or formerly in the military with occupational exposure to radar higher risk for hemolymphatic cancers?

The Bottom Line: Though there is a possible connection supported by some case reports and a few retrospective cohort studies, a definitive causation of military occupational exposure to radar with hemolymphatic and other cancers has not been established. However, physicians can still consider hemolymphatic cancer in their differential diagnosis if they know their patient has had occupational exposure to radar.

In their retrospective cohort study of a previously published case series of 47 patients diagnosed with cancer following years of occupational exposure to radiofrequency radiation (RFR), Peleg (2018) found “the consistent association of RFR and highly elevated HL cancer risk in the four groups spread over three countries, operating different RFR equipment types and analyzed by different research protocols, suggests a cause-effect relationship between RFR and HL cancers in military/occupational settings.”

In 2023, Peleg et. al published a second study analyzing data from a new case series of 46 patients diagnosed with cancer that had exposure to radar in a military setting and comparing them with similar groups from other studies, finding “a consistent, statistically significant, and well-documented atypically high HL PF, distinctly higher than expected in the community (Cancer Registry) or computed from unexposed comparison groups.”

(Peleg)

Midtown Morning Report: What are the risk factors and therapies for Blastocystis in HIV+ patients?

The Bottom Line: “Univariate analysis has revealed that drinking water, raising livestock, HIV infection route, CD4 + T cell count and HIV virus load were closely association with Blastocystis infection (Table 1). In addition, the potential risks (P < 0.20) for the Blastocystis infection were gender and washing hand after defecation.” (Zhang)

Click link for full table
(Zhang)

EUH Morning Report: What are the likelihood ratios for cardiac tamponade? What are the features of Beck’s Triad?

The Bottom Line: In the absence of chest trauma, cardiac tamponade should be considered in patients with pericardial effusions identified on echocardiography. Once a pericardial effusion is notified, the most common underlying diagnoses of moderate to large effusions are acute idiopathic pericarditis (20%), iatrogenic effusion (16%), malignancy (13%), chronic idiopathic effusion (9%), acute myocardial infarction (8%), end-stage renal disease (6%), congestive heart failure (5%), collagen vascular disease (5%), and tuberculosis or bacterial infection (4%). (Simel)

Simel

Midtown Morning Report: What are the risk factors for clear cell bladder cancer?

The Bottom Line: “Renal cell carcinoma accounts for most malignant renal cancers, with clear cell as the most common subtype.  Established risk factors for renal cell carcinoma, and to some extent to upper tract urothelial carcinoma, include male gender, smoking, hypertension, obesity, and end stage renal diseases.” (Ng)

Venyo

EUH Morning Report: What is the risk of infection from Bacillus Calmette–Guérin in the treatment of carcinoma?

The Bottom Line: “Intravesical vaccine instillation of Bacillus Calmette–Guérin (BCG) is considered first-line treatment for superficial bladder tumors and carcinoma in situ. Treatment with this biologic therapy is complicated by systemic or local BCG infection in <5% of cases.  Less common genitourinary infections that accompany BCG instillation include prostatitis in 1% to 3% of patients, epididymitis in 0.2%, and, in rare cases, testicular abscesses, bladder ulcers, local skin infections, or renal infection. Reflux may be a risk factor for the rare complication of BCG pyelonephritis. Localized genitourinary infection tends to have a delayed onset and is usually not apparent clinically until more than 3 months after BCG treatment.” (Nicolle)

EUH Morning Report: What are the likely etiologies of stroke recrudescence?

The Bottom Line: “Data on the following potential triggers were collected for the Previous stroke related (PSR) group and the control admissions group: fever, infection (eg, peripheral white blood cell count >10 000 cells/mm³, urinary tract infection, pneumonia, and gastroenteritis), anemia (hematocrit <40% for men and <36% for women), hypoglycemia or hyperglycemia (blood glucose level, <60 or >200 mg/dL), hyponatremia or hypernatremia (serum sodium level, <135 or >145 mEq/L), hypokalemia or hyperkalemia (serum potassium level, <3.4 or >4.6 mEq/L), dehydration, hypotension, hypertension, congestive heart failure, acute renal failure, and acute liver failure (as documented, per clinical judgment). (To convert white blood cell count to ×10⁹ per liter, multiply by 0.001; hematocrit to a proportion of 1, multiply by 0.01; and glucose level to millimoles per liter, multiply by 0.0555. Conversion of sodium and potassium levels to millimoles per liter is 1:1.) Other potential triggers included alcohol intoxication and medication use.” (Topcuoglu)