No abstract

No abstract

Introduction: Stroke outcomes in patients with LDL levels <70mg/dl and the utility of statins in these settings are uncertain given the scarcity of data. Our study aims to develop a unique registry, prospectively follow patients with CVA and an LDL < 70 (with and without Statin), and study their fatal/nonfatal cardiovascular outcomes over five years. Method: The study includes patients admitted for stroke and LDL <70 between January 2021 and May 2022. Chart review performed from the stroke registry. We compared two groups (A: Patients on statin before admission vs. B: statin naive patients). Result: Among 469 patients admitted for the stroke, 119(25%) patients had LDL <70. 51.3% were on a statin before index admission, and 48.7% were statin naïve. Mean NIHSS was 9.52 in the statin naive group vs 7.39 in patients already on statin. Prevalence of comorbidities were less in group B: DM(45% vs 64%), CHF(7% vs 28%), CAD(14%vs34%), Atrial Fibrillation(8.6% vs 16%), Valvular heart disease(0% vs 6.6%). Incidence of hemorrhagic stroke was higher in Group B(23% vs 8%). Among group B, 53.4%, 20.7% and 25.9% patients had low (0-5), moderate(6-14) and high NIHSS(>14) respectively vs 57.4%, 24.6% and 18% in group A. Mortality was higher in group B in patients admitted with moderate (33.3% vs 13.3%) and severe NIHSS score(18.2% vs 6.7%). Within group B, patients who were started on statin during admission had a lower modified Rankin Scale (mRS) on discharge, compared to patients who were not started on statin(mRS 0 36.6% vs 0%, mRS 4-17.1% vs 29.4%, mRS 5- 9.8% vs 17.6%). Also, mortality was higher in patients not started on statin. Conclusion: Patients who were not on statins had higher incidence of hemorrhagic stroke, worse functional status on discharge, and higher mortality than those who were already on statin. Patients who were started on statin during index admission had better functional status on discharge and lower mortality than patients who were never started on statin. Our study highlights the better outcomes at discharge with statin use in stroke patients with LDL<70. Further studies are required to validate these findings and to determine the protective effects of statins in these patients.

Patient: Male, 80-year-old Final Diagnosis: COVID 19 infection • primary bone marrow diffuse large B cell lymphoma Symptoms: Fatigue • fever • weight loss Medication: — Clinical Procedure: Bone marrow biopsy Specialty: Hematology • Infectious Diseases • Oncology Objective: Rare disease Background: Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). While bone marrow (BM) involvement is common in lymphoma, primary bone marrow (PBM) DLBCL is extremely rare. We present a case of PBM DLBCL discovered in a patient with COVID-19. Case Report: An 80-year-old man presented with generalized abdominal pain, weight loss, fever, fatigue, anorexia, and watery diarrhea over a 3-month period. Physical examination was unremarkable. Laboratory workup revealed anemia, thrombocytopenia, and elevated inflammation markers. SARS-COV-2 PCR was positive, while blood cultures were negative. A rapid decline in the white blood cell count in the following days prompted a BM biopsy, confirming the diagnosis of PBM DLBCL. Computed tomography (CT) did not show thoracic or abdominal lymphadenopathy. The patient received packed red blood cell and platelet transfusions, granulocyte colony-stimulating factor (G-CSF) for pancytopenia, and empirical antibiotics for suspected infection. Due to active COVID-19 and advanced age, cytotoxic chemotherapy was delayed. Rituximab and prednisone were initiated on day 9, followed by an infusion reaction, which led to treatment discontinuation. He died 2 days later. Conclusions: Diagnosing PBM malignancy is challenging, especially with coexisting infection. It is essential to suspect underlying BM malignancy in patients with clinical deterioration and worsening pancytopenia despite adequate treatment. The diagnosis of PBM DLBCL requires the absence of lymphadenopathy, and the presence of histo-logically confirmed DLBCL. Prompt management with combination chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with/without hematopoietic stem cell transplant can improve the prognosis.