Background The proportion of cancer cases in younger patients is increasing though colorectal cancer (CRC) screening guidelines recommend starting at age 50. The national treatment patterns and outcomes of these patients are largely unknown. Methods This is a population-based retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998-2011. Patients were categorized as being younger or older than the recommended screening age. Differences in stage at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, cox-proportional hazards regression, and Weibull survival analysis. Results Of 258,024 CRC patients, 37,847 (15%) were younger than 50. Young patients were more likely to present with regional (Relative risk ratio [RRR]: 1.3, p<0.001) or distant (RRR: 1.5, p<0.001) disease. CRC patients with distant metastasis were more likely to receive surgical therapy for their primary tumor in the younger age group (adjusted probability: 72% vs. 63%; p<0.001), and radiation therapy was more likely in younger RC patients (adjusted probability: 53% vs. 48%; p<0.001). Patients younger than screening age had better overall disease-specific survival (Hazard ratio: 0.77; p<0.001), despite a larger proportion presenting with advanced disease. Conclusions Colorectal cancer patients diagnosed before age 50 are more likely to present with advanced stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater proportion with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults.

More severe reactions, higher acute liver failure rates, and higher recurrence rates on re-challenge occur with supplement-related Drug Induced Liver Injury (DILI) (Medina-Caliz et al., 2018). We report a case of curcumin-induced hepatocellular DILI in a 78-year old female admitted with jaundice, with a one-month latency. Extensive evaluation for alternative etiologies of hepatotoxicity was unremarkable. The Roussel Uclaf Causality Assessment Method (RUCAM) score of 6 for the supplement indicated a probable association (score >8: highly probable association). Peak levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were >20 times upper limit of normal. A 48% decrease in AST and ALT levels was observed 7 days after discontinuation of the supplement, and resolution of transaminitis was observed in 42 days. No re-challenge was performed. In conclusion, this case emphasizes the importance of recognizing curcumin supplements as DILI triggers. Furthermore, it reiterates the need for careful evaluation of herbal and dietary supplements (HDS) consumed by patients to identify potential DILI culprits, and to ultimately prevent DILI reactions with significant morbidity and mortality.

Objectives Hypercalcemia of malignancy confers a poor prognosis. This systematic review evaluated published cases of hypercalcemia of malignancy presenting with acute pancreatitis (AP), in terms of clinical presentation and outcomes. Methods A comprehensive review of PubMed and Embase until March 18, 2020, was conducted. Studies were included if they reported on patients with hypercalcemia of malignancy and AP with attempts to exclude other etiologies of hypercalcemia and AP. Two independent reviewers selected and appraised studies using the Murad tool. Results Thirty-seven cases were identified. Mean (standard deviation) age was 44.8 (2.46) years. Mean (standard deviation) presenting corrected calcium was 14.5 (0.46) mg/dL. Parathyroid carcinoma (21.6%) and multiple myeloma (21.6%) were the most common malignancies. Cases were classified as severe (37.8%), mild (21.6%), and moderately severe (18.9%), whereas 21.6% did not report severity. Necrotizing pancreatitis developed in 21.6% of cases. Most cases were treated with intravenous hydration and bisphosphonates or calcitonin/calcitonin analogues. Mortality was 32.4% during the same presentation of AP. Among mortality cases, 10 of 12 had severe AP, and 5 of 12 had necrotizing pancreatitis. Degree of hypercalcemia did not influence mortality. Conclusion Acute pancreatitis associated with hypercalcemia of malignancy is rare. One in 3 patients with this presentation may not survive AP.

Conclusion:Our study shows that malnutrition was quite prevalent in hospitalized IBD patients. It was associated with increased mortality in the hospitalized cohort and prolonged length of stay. In addition, it resulted in increased hospital charges. Early recognition and intervention can improve health outcomes for patients with IBD. Future studies should also assess predictors for developing malnutrition in this patient population.

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