IntroductionPleural mesothelioma constitutes about 80% of all mesotheliomas. The peak incidence of malignant mesothelioma estimated using the cancer registries was in early 1990 to 2000 in the United States. The disease is primarily associated with asbestos exposure. The latency period between asbestos exposure and the development of malignant pleural mesothelioma (MPM) can range anywhere from 15 to 60 years. Asbestos exposure was peaked during the industrial revolution and World War II due to military and shipyard exposures. It is often difficult for the pathologist to distinguish different histological subtypes; due to the disease's rarity and the inadequate tissue sample obtained. There is no available data on the difference in epidemiology of different subtypes of MPM. Surveillance Epidemiology and End Results (SEER), cancer incidence data include population-based registries covering approximately 34.6% of the U.S. population.Here in our study, we analyze malignant pleural mesothelioma epidemiology in the United States, emphasizing different histological subtypes. MethodsSEER data from 2000 to 2016 was used in our study. The primary site of cancer is selected as pleura, and malignant behavior only is selected as the filter. Data were analyzed using the SEER stat program. Overall epidemiology of MPM and epidemiology of epithelioid, fibrous, and biphasic histological subtypes were analyzed separately. We used annual percentage change (APC) to evaluate the trend in the epidemiology of MPM.

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Dabbing has been gaining popularity among young people in recent years due to its ability to deliver a high concentration of tetrahydrocannabinol. When produced illegally, it is usually contaminated by toxic substances and associated with multiple health hazards. We present the case of a 66-year-old woman who developed hypersensitivity pneumonitis after dabbing butane hash oil for the first time and was successfully treated with corticosteroids with complete resolution of her symptoms. This case report emphasizes the respiratory complications associated with using a noxious substance like butane hash oil and gives physicians an insight into the diagnosis and management of dabbing-induced hypersensitivity pneumonitis.

Home sleep apnea testing (HSAT) has been in use for years as an alternative to polysomnography for diagnosing obstructive sleep apnea. Primary care providers order the vast majority of HSAT. Major society guidelines recommend against HSAT in high-risk patients and people with possible false positive or negative results. Despite these recommendations, many primary care providers order HSAT in persons who might have initially qualified for polysomnography. Here in our study, we analyze the HSAT orders from two primary care clinics over three years.METHODS: Institutional review board (IRB) approval for the study was obtained from the respective IRB board. Data were analyzed using Microsoft excel. Severe Congestive heart failure, severe chronic obstructive pulmonary disease, Opioid dependency, severe depression, history of stroke, and oxygen dependency were selected as conditions that warranted direct polysomnography without HSAT.RESULTS: A total of 297 HSATs were ordered between January 2018 and December 2020. This comprised 159 female patients and 138 male patients; the median age was 54. Out of this, 44% (130) had at least one condition among the selected group of conditions. Among people who had HSAT despite disqualifying condition, 78% of people had positive HSAT (Vs. 65 % in the group without disqualifying condition). About 86% of the positive HSAT were followed by a laboratory-based sleep study, which confirmed the result in all the cases. CONCLUSIONS: HSAT is being ordered extensively in primary care clinics, but the exclusion criteria are not strictly followed. This is leading to an unnecessary burden on health care and patients.CLINICAL IMPLICATIONS: Increased awareness among primary care clinicians is needed to avoid unnecessary HSAT.

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