Predictors of mortality in a multiracial urban cohort of persons with type 2 diabetes and novel coronavirus 19.

BACKGROUND: Diabetes has been identified as a risk factor for intubation and mortality in patients with coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We seek to examine the impact of clinical variables such as glycosylated hemoglobin (HbA1c) on mortality and need for intubation, as well as demographic variables such as age, sex, and race on persons with type 2 diabetes and COVID-19. METHODS: Analyses were conducted on 4413 patients with an International Classification of Diseases and Related Health Problems (ICD-10) diagnosis of type 2 diabetes and COVID-19. Survival analysis was conducted using Kaplan-Meier curves and the log-rank test to compare subgroup analyses. RESULTS: In this multivariate analysis, male gender, older age, and hyperglycemia at admission were associated with increased mortality and intubation, but this was not seen for race, ethnicity, insurance type, or HbA1c. Based on Kaplan-Meier analysis, having comorbid conditions such as hypertension, chronic kidney disease, and coronary artery disease was associated with a statistically significant increased risk of mortality. CONCLUSIONS: Glycemic levels at admission have a greater impact on health outcomes than HbA1c. Older men and those with comorbid disease are also at greater risk for mortality. Further longitudinal studies need to be done to evaluate the impact of COVID-19 on type 2 diabetes.

Suspected Primary Adrenal Lymphoma (PAL) Associated With Hemophagocytic Lymphohistiocytosis (HLH).

Adrenal incidentalomas, masses noted on imaging performed for other purposes, are common, with 10% to 15% presenting as bilateral adrenal masses. These cases can be challenging as the differential diagnosis is broad, including metastatic disease, primary adrenal lymphoma (PAL), or infection, and often requiring a biopsy if initial biochemical workup is unrevealing. We present here a relevant case description, laboratory and radiologic imaging studies, and discussion of literature. A 62-year-old Korean woman presented with altered mental status and fevers. She was found to have bilateral adrenal incidentalomas and retained acupuncture needles. Adrenal workup did not show biochemical evidence of hormonal excess. Infectious workup was unrevealing, as was a metal/toxin workup due to retained acupuncture needles. Fevers and episodes of hypotension persisted which prevented the patient from obtaining an adrenal biopsy. Bone marrow biopsy was obtained for pancytopenia and revealed B-cell lymphoma with large cell morphology and few histiocytes with hemophagocytosis, raising concern for lymphoma-induced hemophagocytic lymphohistiocytosis (HLH). PAL associated with HLH was highly suspected in our patient, given the large (7 cm) bilateral adrenal masses and bone marrow biopsy findings of lymphoma. The patient was treated for diffuse large B-cell lymphoma, with clinical improvement. PAL is a rare but aggressive lymphoma with few reported cases. It should be considered in the differential for both unilateral and bilateral adrenal masses. An early diagnosis is crucial as the main treatment is chemotherapy rather than surgery and it confers a significant survival benefit.

BMI as a Risk Factor for Clinical Outcomes in Patients Hospitalized with COVID-19 in New York.

OBJECTIVE: This study examined the association between BMI and clinical outcomes among patients with coronavirus disease 2019 (COVID-19) infection. METHODS: A total of 10,861 patients with COVID-19 infection who were admitted to the Northwell Health system hospitals between March 1, 2020, and April 27, 2020, were included in this study. BMI was classified as underweight, normal weight, overweight, and obesity classes I, II, and III. Primary outcomes were invasive mechanical ventilation (IMV) and death. RESULTS: A total of 243 (2.2%) patients were underweight, 2,507 (23.1%) were normal weight, 4,021 (37.0%) had overweight, 2,345 (21.6%) had obesity class I, 990 (9.1%) had obesity class II, and 755 (7.0%) had obesity class III. Patients who had overweight (odds ratio [OR] = 1.27 [95% CI: 1.11-1.46]), obesity class I (OR = 1.48 [95% CI: 1.27-1.72]), obesity class II (OR = 1.89 [95% CI: 1.56-2.28]), and obesity class III (OR = 2.31 [95% CI: 1.88-2.85]) had an increased risk of requiring IMV. Underweight and obesity classes II and III were statistically associated with death (OR = 1.44 [95% CI: 1.08-1.92]; OR = 1.25 [95% CI: 1.03-1.52]; OR = 1.61 [95% CI: 1.30-2.00], respectively). Among patients who were on IMV, BMI was not associated with inpatient deaths. CONCLUSIONS: Patients who are underweight or who have obesity are at risk for mechanical ventilation and death, suggesting that pulmonary complications (indicated by IMV) are a significant contributor for poor outcomes in COVID-19 infection.

Improvement of Giant Cell Lesions of the Jaw Treated With High and Low Doses of Denosumab: A Case Series.

Giant cell tumors (GCTs) and central giant cell granulomas (CGCGs) are aggressive lesions that appear in the jaw. These lesions occur in the second and third decades of life and often arise in the mandible. Clinical manifestations of these lesions vary from asymptomatic to symptomatic tooth displacement with cortical perforation. GCTs, which are characterized by multinucleated osteoclast-type giant cells that express receptor activator of nuclear factor-κB (RANK) ligand, rarely present in the jaw and have overlapping histopathologic features with CGCGs, which are composed of fibroblastic stromal cell lesions. GCTs and CGCGs have overlying histopathologic features that make distinction between the two challenging. There is a real controversy as to whether giant cell tumors and central giant cell granulomas are in fact, one and the same lesion. The majority of GCTs occur in the long bone, with surgery being the typical therapeutic option. Denosumab as a treatment modality is a fairly new concept that has been used effectively in GCTs affecting long bones. There is less experience, however, with its use for jaw lesions. This seven-case series describes the effective use of both low-dose and high-dose denosumab in the treatment of GCTs and CGCGs affecting the jaw and special dosing considerations for younger patients who present with disease. © 2017 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

Athermal Robotic Technique of prostatectomy in patients with large prostate glands (>75 g): technique and initial results.

OBJECTIVE: To report our experience with robotic radical prostatectomy (rRP) for prostate glands of >75 g, as this technique is developing rapidly. PATIENTS AND METHODS: Between January 2005 and November 2005, 30 men with prostates of >75 g had rRP. Their clinicopathological and operative data were reviewed. Technical considerations for successful rRP in patients with large glands are discussed, including the importance of surgical exposure and multiple traction sutures. RESULTS: The mean (range) specimen weight was 116.1 (75.3-346.0) g, the patient age 65.0 (56-72) years, the body mass index 28.4 (21-41) kg/m2, the preoperative International Prostate Symptom Score 10 (0-32), and the prostate-specific antigen (PSA) level 7.54 (1.9-20.1) ng/mL. The clinical stage was T1c in 26 men and T2a in four. The biopsy Gleason scores were 3 + 3 = 6 in 25 men, 3 + 4 = 7 in four and 4 + 3 = 7 in one. The mean (range) estimated blood loss was 208 (100-600) mL and the operative duration 193 (150-270) min. The cancer was organ-confined in all patients and all surgical margins were negative. The mean (range) duration of indwelling catheterization was 12.7 (11-14) days. There were no complications during or after rRP, and the PSA level was undetectable in all patients after surgery. CONCLUSIONS: RP for patients with large prostates is technically challenging. The robotic approach does not appear to compromise oncological control. We show the feasibility of rRP for men with large glands.

Future directions of robotic surgery: a case study of the Cornell athermal robotic technique of prostatectomy.

Robotic radical prostatectomy (RRP) has become an effective modality in the treatment of localized prostate cancer. We detail the experience at our institution and provide a perspective for future considerations of RRP with respect to improved preoperative imaging and surgical instrumentation.