The US FDA approved pirtobrutinib (Jaypirca) for relapsed or refractory mantle cell lymphoma (MCL) after at least two lines of systemic therapy, including a Bruton’s tyrosine kinase (BTK) inhibitor. Pirtobrutinib is the first and only non-covalent BTK inhibitor.
Dose: 200 mg once-daily
Adverse reactions: Fatigue, musculoskeletal pain, diarrhea, edema, dyspnea, pneumonia, bruising, decreased neutrophil counts, lymphocyte counts, and platelet counts.
History: A 12-year-old boy presents with a sore throat, difficulty swallowing, inability to fully open his mouth, trismus, drooling, and a “hot-potato” voice. What is the diagnosis?
Answer: Peritonsillar abscess, aka quinsy is an accumulation of pus due to an infection behind the tonsil.
Symptoms: Fever, throat pain, trouble opening the mouth, and a change to the voice. Pain is usually worse on one side.
Complications: Blockage of the airway or aspiration pneumonitis, retropharyngeal abscess.
Cause: Commonly involved aerobic pathogens include Streptococcus, Staphylococcus, and Haemophilus. The most common anaerobic species include Fusobacterium necrophorum, Peptostreptococcus, Prevotella species, and Bacteroides.
Diagnosis: Medical imaging may include CT scan, MRI, or ultrasound.
Treatment: Antibiotics, volume repletion with fluids, and pain medication, in cases where airway obstruction or systemic sepsis occurs, surgical drainage may be necessary.
Two classes of drugs may be more effective than others for the treatment of gastroparesis, though the overall quality of evidence remains low to moderate and additional data are needed, according to a new report. Oral dopamine antagonists and tachykinin-1 antagonists appear superior to placebo. Only one drug, the dopamine antagonist metoclopramide, has US Food and Drug Administration approval for the treatment of gastroparesis (Gastroparesis is a chronic disorder which means delayed stomach emptying without a blockage).
History: A 16-year-old male patient who is known to have HBSS disease, presented with a history of chest and back pain for a few days prior to admission. He also complained of a nonproductive cough for 2 days but denied fever. On examination, his HR 110, RR 25, Temp – 103F. On chest exam, he had left basal crackles with decreased air entry. His chest x-ray showed left retrocardiac and left lower lung zone opacity suggesting left lower lobe consolidation. What is the likely diagnosis?
Answer: Acute chest syndrome is a vaso-occlusive crisis of the pulmonary vasculature commonly seen in people with sickle cell anemia. This condition commonly manifests with a new opacification of the lung(s) on a chest x-ray.
Signs and symptoms:
ACS is defined by a new pulmonary density on chest imaging involving at least one complete lung segment and at least one of the following [68]:
Investigations: CBC, CXR, Blood culture, LFT, KFT, ABG
Treatment: Bronchodilators, Antibiotics, Supplemental oxygen, Non-invasive/ invasive ventilation.
History: A 65 year old male with HTN presented to the ED with a 1-week history of progressive SOB. On physical examination, BP 140/62 mm Hg, HR 120 bpm, RR 30, and SP02 92% on 3L of O2 by nasal cannula. The cardiac examination was notable for a crescendo–decrescendo systolic murmur and a decrescendo diastolic murmur. The ophthalmologic examination revealed dilation and constriction of the pupils, synchronized with the patient’s heartbeat. What’s the diagnosis?
Answer: Landolfi’s sign is seen in patients with severe aortic regurgitation and is a manifestation of wide pulse pressure and large stroke volume in the iridial vessels, which causes systolic constriction and diastolic dilation of the pupils. Transthoracic echocardiography revealed severe aortic regurgitation with dilatation of the ascending aorta and a dissection flap. CT scan of the aorta showed a Stanford type A aortic dissection. The patient underwent the replacement of his ascending aorta and aortic valve (Bentall procedure). On discharge 10 days later, Landolfi’s sign was no longer present.
The US FDA has approved mosunetuzumab-axgb (Lunsumio) for use in patients with relapsed or refractory follicular lymphoma who have received at least two previous systemic therapies. This is a first-in-class bispecific antibody that is designed to target CD20 on the surface of B cells and CD3 on the surface of T cells. This dual targeting activates and redirects a patient’s existing T cells to engage and eliminate target B cells by releasing cytotoxic proteins into the B cells. Mosunetuzumab-axgb is administered as an intravenous infusion for a fixed duration, which allows for time off therapy, and can be infused in OPD.
Lenacapavir is the first of a new class of drugs called capsid inhibitors to be FDA-approved for treating HIV-1. The drug blocks the HIV-1 virus protein shell and interferes with essential steps of the virus evolution. Lenacapavir is administered only twice annually, but it is also combined with other antiretrovirals. After the initial doses are completed — given both orally and via subcutaneous injection — the drug is administered by injection every 6 months. The injections and oral tablets of lenacapavir are estimated to cost $42,250 in the first year of treatment and then $39,000 annually in the subsequent years.
The US FDA has approved Adagrasib (Krazati) for use in adults with KRAS G12C-mutated locally advanced or metastatic non–small cell lung cancer (NSCLC) that has progressed on at least one prior systemic therapy.
Dose: 600mg BD
Adverse reactions: Diarrhea, nausea, fatigue, vomiting, musculoskeletal pain, hepatotoxicity, renal impairment, dyspnea, edema, decreased appetite, cough, pneumonia, dizziness, constipation, abdominal pain, and QTc interval prolongation.
Laboratory abnormalities: Decreased lymphocytes, increased aspartate aminotransferase, decreased sodium, decreased hemoglobin, increased creatinine, and decreased albumin.
New more aggressive targets for blood pressure and lipids are among the changes to the annual American Diabetes Association (ADA) Standards of Care in Diabetes 2023. The new definition of hypertension in people with diabetes is ≥ 130 mmHg systolic or ≥ 80 mmHg diastolic blood pressure, repeated on two measurements at different times. Among individuals with established cardiovascular disease, hypertension can be diagnosed with one measurement of ≥ 180/110 mmHg. The goal of treatment is now less than 130/80 mmHg if it can be reached safely.
Investigators found that levels of formic acid, a metabolic product of formaldehyde found in urine, were significantly higher in individuals with Alzheimer disease including those with subjective cognitive decline, which may indicate very early stages of the disorder. Urinary formic acid and formaldehyde are likely to be new biomarkers independent of the existing AD diagnostic criteria. Researchers also compared formic acid and formaldehyde levels across different AD stages and found significantly higher levels across all stages compared with people who had no cognitive decline. Levels were also higher in patients with AD than in patients with MCI and those with cognitive impairment and no MCI, as well as in those with poorer neurologic test scores.
