Publications by authors named "Dayna Isaacs"

Posterior reversible encephalopathy syndrome (PRES) is a neurologic condition with a constellation of symptoms, including altered mentation, headaches, and often seizures. Immunosuppressive therapies and, more recently, immunotherapy have been identified as risk factors for PRES. We describe the first documented case of PRES associated with a combination of pembrolizumab and cetuximab therapy.

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  • - The study aimed to assess the occurrence and impact of immune-related adverse events (irAEs) in cancer patients with pre-existing autoimmune conditions, focusing on morbidity, mortality, management, and outcomes following ICI treatment.
  • - Researchers conducted a retrospective case-control study involving 3,130 patients, identifying 28 with autoimmune diseases and matching them with 56 controls based on several criteria, including age and cancer type.
  • - Results showed no significant differences in the incidence of severe irAEs or overall survival between the two groups, with the majority of irAEs resolving successfully after treatment.
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  • Immune checkpoint inhibitors (ICI) are effective for many cancers but can cause serious side effects, particularly in patients with autoimmune diseases like type 1 diabetes mellitus (T1DM), who are often excluded from clinical trials.
  • A study analyzed the safety and outcomes of ICI in 11 cancer patients with preexisting T1DM, noting that most received anti-PD1 therapy and experienced some immune-related adverse events (IRAEs).
  • The findings indicated that while some patients had severe IRAEs requiring treatment interruptions, the overall risk of IRAEs in T1DM patients was similar to that in matched patients without T1DM.
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Bladder cancer is one of the most commonly diagnosed genitourinary malignancies. For many years, the primary treatment for metastatic urothelial cancer (mUC) was predicated on the use of platinum-based chemotherapy. More recently, immune checkpoint inhibitors (ICIs) were approved by regulatory agencies such as the US FDA for use in both the first- and second-line settings.

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This commentary explores the clinical conundrums arising when caring for patients with acute pulmonary embolism isolated to the subsegmental pulmonary arteries. We discuss ways to confirm the radiologic diagnosis, how to distinguish patients for whom anticoagulation is indicated from those who are eligible for structured surveillance without anticoagulation, what surveillance entails, and why ensuring continuity of care matters. We report a case from our own experience that illustrates these decision-making crossroads and highlights the importance of cross-disciplinary collaboration.

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Purpose: The evidence for the effectiveness of outpatient treatment of low-risk patients with acute pulmonary embolism (PE) continues to mount. However, lack of definitional clarity may hinder understanding of this emerging management strategy and impede translation into clinical practice. We describe the range of definitions provided in the primary outpatient PE literature.

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Background: The management and outcomes of patients diagnosed with acute pulmonary embolism in primary care have not been characterized.

Objective: To describe 30-day outcomes stratified by initial site-of-care decisions DESIGN: Multicenter retrospective cohort study PARTICIPANTS: Adults diagnosed with acute pulmonary embolism in primary care in a large, diverse community-based US health system (2013-2019) MAIN MEASURES: The primary outcome was a composite of 30-day serious adverse events (recurrent venous thromboembolism, major bleeding, and all-cause mortality). The secondary outcome was 7-day pulmonary embolism-related hospitalization, either initial or delayed.

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A healthy, active woman in her 70s reported intermittent exertional dyspnoea for 2 months, notable during frequent open-water swimming. Symptoms were similar to an episode of travel-provoked pulmonary embolism 3 years prior. She denied chest pain, cough, fever, extremity complaints and symptoms at rest.

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Background: For patients with acute pulmonary embolism (PE) diagnosed in the primary care setting, transfer to a higher level of care, like the emergency department, has long been the convention. Evidence is growing that outpatient management, that is, care without hospitalization, is safe, effective, and feasible for selected low-risk patients with acute PE. Whether outpatient care can be provided in the primary care setting has not been well-studied.

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Rationale: The evidence for outpatient pulmonary embolism (PE) management apart from hospitalization is expanding. The availability and ease of direct oral anticoagulants have facilitated this transition. The literature, however, is sparse on the topic of comprehensive management of pulmonary embolism in the primary care clinic setting.

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