Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are becoming more popular in managing type 2 diabetes mellitus (T2DM). Concerns linger over potential links to malignancies like pancreatic and thyroid cancers, requiring more research to clarify their safety profiles. Additionally, evidence suggests GLP-1 RAs may lower colorectal and pancreatic cancer risk, especially in obese and overweight individuals, indicating a protective effect beyond weight loss. Current studies leave a gap in comprehensively understanding cancer risks associated with GLP-1 RAs, which prompts further research to enhance our understanding of their overall safety. Methods: We queried the US Collaborative Network (63 health care organizations) of the TriNetX research database. Patients with T2DM were identified and divided into two cohorts: patients on GLP-1 RAs and patients not on GLP-1 RAs. We excluded tobacco use and alcohol use disorders, obese patients with a body mass index (BMI) of >25 kg/m², and those with a family history of gastrointestinal malignancy, infectious mononucleosis, chronic gastritis, pernicious anemia, helicobacter pylori infection, or gastroesophageal reflux disease (GERD). We used a 1:1 propensity score matching (PSM) model using patients’ baseline characteristics, medications, labs, and genetics. We compared the rate of gastric cancer and esophageal cancer at the seven-year mark. Results: A total of 2,748,431 patients with T2DM were identified. Of those, 6% (n = 167,077) were on a GLP-1 RA and 94% (n = 2,581,354) were not on a GLP-1 RA. After PSM, both cohorts included 146,277 patients. Patients with T2DM who were on a GLP-1 RA, compared to those who were not, had a statistically significant lower risk of both gastric cancer (0.05% vs. 0.13%, p < 0.0001) and esophageal cancer (0.04% vs. 0.13%, p < 0.0001) at the seven-year mark. Conclusion: The use of GLP-1 RAs in patients with T2DM does not significantly increase the risk of gastric or esophageal cancer. This finding supports the continued use of GLP-1 analogues as a therapeutic option in managing T2DM, considering their well-established benefits and low risk of complications. Based on the study results, these medications may even have a protective effect against these malignancies.

Background Reversible Cerebral Vasoconstriction Syndrome (RCVS) is characterized by multiple transient cerebral vasoconstrictions that typically resolve within three months, often presenting with sudden thunderclap headaches. Although the cause can be identified in 25% to 60% of cases, RCVS can also occur spontaneously. Common triggers include vasoactive substances and postpartum states, with the latter accounting for 50% to 60% of cases. This report discusses a case of RCVS following sumatriptan use. Case Report. A 58-year-old woman with controlled hypertension and obstructive sleep apnea presented with recurrent unilateral pulsating headaches, nausea, and photophobia. Initially diagnosed as migraine, she later developed right homonymous hemianopia. Imaging revealed bilateral occipital and parietal strokes with intracranial vasoconstriction. Cerebral angiography confirmed vasospasm, responsive to intra-arterial milrinone. Diagnosed with reversible cerebral vasoconstriction syndrome, she was treated with nimodipine, resulting in complete symptom resolution. Conclusion RCVS is a rare syndrome with varied triggers and clinical features, requiring careful evaluation and management. Early diagnosis and vasospasm-targeted therapies, such as nimodipine, are essential for preventing complications. This case underscores the importance of considering RCVS in patients with sudden severe headaches and neurological deficits, particularly those using serotonergic medications

Background: Cirrhosis causes an imbalance in the coagulation pathway and leads to a tendency for both bleeding and clotting. SARS-CoV-2 has been reported to be associated with a hypercoagulable state. This study examines SARS-CoV-2’s impact on hemostasis in compensated patients with cirrhosis. Methods: We analyzed the US Collaborative Network, which comprises 63 HCOs in the U.S.A. Compensated cirrhosis patients were split into two groups: SARS-CoV-2-positive and -negative. Patients’ baseline characteristics were used in a 1:1 propensity score-matched module to create comparable cohorts. We compared the risk of portal vein thrombosis (PVT), deep venous thrombosis (DVT), and pulmonary embolism (PE) at 6 months, and 1 and 3 years. Results: Of 330,521 patients, 27% tested positive and 73% remained negative. After PSM, both cohorts included 74,738 patients. Patients with SARS-CoV-2 had a higher rate of PVT compared to those without at 6 months (0.63% vs 0.5%, p < 0.05), 1 year (0.8% vs 0.6%, p < 0.05), and 3 years (1% vs. 0.7%, p < 0.05), a higher rate of DVT at 6 months (0.8% vs. 0.4%, p < 0.05), 1 year (1% vs. 0.5%, p < 0.05), and 3 years (1.4% vs. 0.8%, p < 0.05), and a higher rate of PE at 6 months (0.6% vs. 0.3%, p < 0.05), 1 year (0.7% vs. 0.4%, p < 0.05), and 3 years (1% vs. 0.6%, p < 0.05). Conclusions: The presence of SARS-CoV-2 infection in patients with compensated cirrhosis was associated with a higher rate of PVT, DVT, and PE at 6 months, and 1 and 3 years.

Https://doi.org/10.18632/oncoscience.628 Osama Mohiuddin, Rafi Aibani, Aarish Lalani, Faiqa Shabbir, Amir Aibani, Vivek Sharma

Erythropoiesis-stimulating agents (ESAs) are commonly used to treat cancer-related anemia by increasing hemoglobin levels and reducing transfusion requirements. However, randomized trials and meta-analyses have linked ESA use to increased thrombotic risk. Contemporary real-world data across diverse cancer populations and ESA formulations remain limited. We conducted a retrospective cohort study using the TriNetX Research Network (from 1 January 2015 to 31 July 2024) evaluating adult patients with cancer-related anemia. Patients receiving ESAs were propensity score-matched 1:1 with patients not receiving ESAs based on demographics, cancer type, and comorbidities. Individuals with previous thrombotic events or anticoagulant use were excluded. Outcomes included incident deep vein thrombosis (DVT), pulmonary embolism (PE), new anticoagulant use, and 1-year survival. Risk differences, relative risks, and Kaplan-Meier survival analyses were performed. After matching, 1606 patients were included in each cohort, with prostate, breast, bladder, colon, and kidney cancers being the predominant cancer. There was no significant difference in DVT (1.5% vs 2.1%; P = .19) or PE (0.75% vs 1.1%; P = .27) between ESA and non-ESA groups. New anticoagulant use was significantly lower in patients treated with ESAs (6.3% vs 10.2%; risk ratio, 0.52; 95% confidence interval [CI], 0.49-0.78; P < .001). One-year survival was higher in the ESA cohort (73% vs 69%; hazard ratio, 0.82; 95% CI, 0.72-0.94; P = .004). In this large real-world cohort, ESA use was not associated with increased short-term thrombotic risk and was associated with lower anticoagulant use and improved 1-year survival. These findings suggest that guideline-concordant ESA use may be safe in selected patients with cancer-related anemia.