ABSTRACT
Background: Pancreatic cancer patients have poor quality of life. Testosterone deficiency is associated with constitutional symptoms and sexual dysfunction which may contribute to poor quality of life. We investigated the prevalence of screening for and presence of testosterone deficiency in male pancreatic cancer patients. Methods: To determine the frequency of screening for testosterone deficiency in pancreatic cancer patients, our institution's electronic medical record system was queried for male patients diagnosed with a pancreatic mass between 2006 and 2020 and an available testosterone level. In a separate analysis, total testosterone was measured in serum samples from a cohort of 89 male pancreatic ductal adenocarcinoma (PDAC) patients. Low serum testosterone was defined as <300 ng/dL. Results: One thousand five hundred and sixty-six male patients were identified with a pancreatic mass, and 35 (2.2%) also had a testosterone level. In our analysis cohort, 44 of 89 patients (49.4%) were found to have low serum testosterone. Symptoms consistent with testosterone deficiency were documented for 70% of these patients, with fatigue being the most common. Testosterone level had no significant association with progression-free survival (PFS) (P=0.66) or overall survival (OS) (P=0.95). Conclusions: Testosterone deficiency is common but rarely assessed in male patients with pancreatic cancer. Further studies are warranted to explore the possibility of testosterone supplementation to improve quality of life in this patient population.
ABSTRACT
BACKGROUND: Acute abdominal pain is one of the most common complaints that patients present with in the emergency room and has long been a challenge to effectively manage without relying on opioid analgesia. The use of ultrasound-guided peripheral nerve blocks (UGRA) represents a new frontier in multimodal pain control regimens in the acute setting. An erector spinae plane (ESP) block is believed to mediate pain relief in multiple dermatomes through blockage of both visceral and somatic nerves. Analgesia provided by a single injection can help keep a patient comfortable for hours without breakthrough pain and the subsequent need for frequent redosing of opioid pain medication. To this date, there is very limited evidence of an ESP block in the utilization of acute appendicitis in the emergency department. CASE REPORT: This case report presents a 26-year-old female with a past medical history of polycystic ovarian syndrome (PCOS) and a tubal ligation that presented with 7/10 right lower quadrant abdominal pain that began 1 h prior to arrival. She stated that she felt like this was similar to her PCOS exacerbations in the past. During her evaluation, she underwent a computed tomography (CT) scan of her abdomen and pelvis that was remarkable for acute, uncomplicated appendicitis. She was given 4 mg of morphine for her pain with little response, so the offer was made for an erector spinae block that the patient elected to receive. After being consented both for the procedure and for research, she received a right-sided erector spinae block with 20 mL's of 0.2% ropivacaine (2 mg/mL) at the L1 vertebral level. After approximately 15 min, she stated that she had a reduction in her pain from a 6/10 to a 1/10 that persisted throughout the rest of her stay in the emergency department.
ABSTRACT
OBJECTIVE: To gather medical student perceptions and learner preferences regarding virtual advanced electives. DESIGN: An 8-question survey regarding perceived usefulness and preferred structure of virtual advanced electives as well as miscellaneous suggestions and concerns. SETTING: University of Iowa in Iowa City, IA, a tertiary care center, as well as social media. PARTICIPANTS: Eighty-four self-identified academic staff and medical students taking part in the upcoming 2021 residency match, of which 74 of 84 (88%) identified as applicants for the 2021 residency application cycle. RESULTS: Preferred structure of electives is 2 weeks or less, lasting 5 hours or less per day. Desired structural components in over 30% of responses included networking with a program, didactics, departmental conferences, and operating room interaction. Primary objectives in over 30% of responses included sharing program information, networking, getting to know the residents, and assessing fit. CONCLUSIONS: Virtual advanced electives may provide a viable replacement for away rotations. If pursued, student perceptions and preferences of virtual advanced electives should guide the creation of these educational offerings.
Subject(s)
Internship and Residency , Students, Medical , Urology , Humans , Perception , Surveys and QuestionnairesABSTRACT
Membrane transport proteins are fundamental components of blood-tissue barriers and affect the absorption, distribution and elimination, and interactions of many of the drugs commonly used in veterinary medicine. A quantitative, simultaneous measurement of these proteins across dog tissues is not currently available, nor is it possible with current immune-based assays such as western blot. In the present study, we aimed to develop a sensitive and specific liquid chromatography tandem-mass spectrometry (LC/MS/MS) based quantitation method that can simultaneously quantitate 14 ATP-binding cassette transporters. We applied this method to a panel of normal canine tissues and compared the LC/MS/MS results with relative messenger RNA (mRNA) abundance using quantitative real-time polymerase chain reaction (qRT-PCR). Our LC/MS/MS method is sensitive, with lower limits of quantitation ranging from 5 to 10 fmol/µg of protein. We were able to detect and/or quantitate each of the 14 transporters in at least one normal dog tissue. Relative protein and mRNA abundance within tissues did not demonstrate a significant correlation in all cases. The results presented here will provide for more accurate predictions of drug movement in dogs through incorporation into physiologically based pharmacokinetic (PBPK) models; the method described here has wide applicability to the quantitation of virtually any proteins of interest in biologic samples where validated canine antibodies do not exist.
