Eltrombopag is a second-line therapy for refractory thrombocytopenia from immune thrombocytopenic purpura (ITP). The medication is generally well tolerated but can lead to adverse thromboembolic complications in rare instances. We present a case of lower extremity deep vein thrombosis with bilateral pulmonary embolism in an ITP patient receiving eltrombopag. The patient underwent catheter-directed thrombolysis for pulmonary embolism. Eltrombopag was stopped on discharge, considering the potential cause of venous thrombosis.

populations with lung cancer. Nowadays, investigations continue studying biomarkers which could be useful as predictive factors of response as if inflammatory markers might have some role. Method: The study design included patients with non-small cell lung cancer (NSCLC) that received immunotherapy with "Pembrolizumab" or "Nivolumab" in two private cancer centers of reference since January 2015 until January 2018. The adverse effects were evaluated by medical oncologists and classified by CTCAE v 4.0. The response were assessed by RECIST criteria. Furthermore, inflammatory markers results were obtained from blood work performed before immunotherapy started. All patients that received at least one dose of immunotherapy were taken into analysis. Result: A total of 158 patients with lung cancer were diagnosed in that period, only 18 patients were assessed, the mean age was 62, and the vast majority had adenocarcinoma. The mean number of cycles was 27 (2-52). The ORR was of 28%, 80% had partial response (PR) and 20% had complete response (CR). Thirty-nine percent had stable disease (SD) while 33% had progressive disease (PD). The median of time to achieve a response was of 11.5 weeks. The response according to the PD-L1 expression was stratified, founding clinical benefit in all the groups. The time to progression since immunotherapy was 15weeks. One case was reported as unconfirmed progressive disease by week 10. Markers of inflammation analyzed showed Neutrophil-lymphocyte rate (NLR) and Platelet-lymphocyte rate (PLR) means were 4.37 (1.42 e 21.6) and 270.19 (93.1-650.7) respectively. The values obtained according to response found that the group that progressed to therapy had 4.23 NLR and 343.9 PLR. The group who had clinical benefit, had 4.39 NLR and 229.9 PLR. 33% of the population present toxicity, from which 83% was graded G1-2 and 17% G3-4. Conclusion: A high PLR might be associated with an unfavorable prognosis although more studies are needed. This is the first study in Peruvian population that shows results of immunotherapy in lung cancer.

In recent years, immunotherapy has revolutionised the treatment landscape for oncology patients with improved survival rates in cancers which previously had a dismissal prognosis. These agents target specific pathways of inhibition such as programmed cell death -1 (PD-1), PD ligand-1 and cytotoxic T-lymphocyte-associated antigen 4 resulting in stimulation of T cell activity. This results in enabling an individual’s own immune system to fight against cancer, a different modality of treatment when compared with traditional chemotherapy. While attacking the tumour cells, there is an increased chance of host tissue immune reactions.We report a case of a patient who received immunotherapy for metastatic malignant melanoma. During the course of the treatment, development of a sarcoid-like reaction was histologically confirmed in the mediastinal lymph nodes. The patient had no respiratory symptoms and continued on the immunotherapy treatment with good clinical and radiological response.

Background Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide. In Ireland alone, there are over 2500 new cases of lung cancer diagnosed each year. It ranks fourth among the most common cancers and causes 21% of all cancer-related deaths. Lung cancers usually metastasize to the liver, brain, bone, and adrenal glands—rarely affecting the abdomen. To our knowledge, there are 8 previous studies in the literature to date which involve omental metastasis from NSCLC. Case presentation A 73-year-old lady presented with a history of productive cough for 18 months. A chest X-ray showed a suspicious 6 cm mass in the right lower zone. She went on to have an endobronchial biopsy which confirmed a moderately differentiated adenocarcinoma of the lung which was ALK positive. She went on to have staging PET and CT scans and was staged as cT3N2M0. She was not a suitable candidate for surgery so she had radical chemo-radiotherapy with 4 cycles of cisplatin pemetrexed followed by radical dose sequential radiotherapy. Post treatment CT showed the tumor to be more spiculated in appearance. She was ineligible for Durvalumab maintenance therapy due to the extensive pneumonitis following her radiotherapy which required a prolonged course of steroids. Interval scans every 3 months did not show any progression of disease. She presented to the hospital 13 months post her diagnosis with progressive abdominal swelling. Restaging CT scans showed extensive omental infiltration, the presence of multiple peritoneal nodules, and progression of her pulmonary disease with new brain metastasis. Cytological analysis of the ascitic fluid confirmed metastasis followed by omental biopsy which confirmed metastatic ALK-positive NSCLC. She went on to have targeted treatment with alectinib. She tolerated the treatment well. Restaging scans done 3 months later showed good partial response to therapy. Conclusion In conclusion, ALK-positive NSCLC with metastasis to the omentum is very rare. However, in patients with atypical symptoms like ascites, the possibility of a metastasis must be considered and repeat biopsy is always recommended. A targeted therapy in the selected patients has shown a more durable response than chemotherapy.

Developed and developing countries are trying to achieve sustainable growth in the present era. Unfortunately, despite being the world’s largest developing country, China is among those countries that have a high ecological footprint as it emits 27% of global carbon emissions in 2021. However, the encouraging fact is that China has become an emerging economy due to technological advancement. Many existing studies have suggested that technological innovation can overcome environmental degradation. Therefore, this study examines whether technological innovation has reduced environmental degradation in China from 1985 to 2018. This study uses the ecological footprint to measure environmental degradation in China. Furthermore, this study also explores the role of economic growth, trade openness, and population on environment. To estimate the models, ARDL cointegration technique is applied, and the findings are further validated using CCR, DOLS, FMOLS, and Granger causality techniques. Overall, empirical results indicate that technological advancement negatively impacts China’s short- and long-term ecological footprint. This is understandable because more innovation leads to better technology that consumes fewer resources and has lower ecological footprints. However, environmental degradation is exacerbated by economic growth and population growth, whereas trade openness helps to mitigate environmental degradation in China. The diagnostic analysis of the study confirms the absence of heteroscedasticity, multicollinearity, and model instability. The study recommends using eco-friendly technologies that can reduce the usage of harmful alternative energy sources. Furthermore, carbon emissions need to be taxed, and environment friendly technologies need to be supported to promote long-term economic growth. .