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Sepsis during short bowel syndrome hospitalizations:Identifying trends,disparities,and clinical outcomes in the United States

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World Journal of Gastrointestinal Pathophysiology 2024年第1期15卷 26-36页

作者： Dushyant Singh Dahiya Jennifer Wachala Shantanu Solanki Dhanshree Solanki asim kichloo Samantha Holcomb Uvesh Mansuri Khwaja Saad Haq Hassam Ali Manesh Kumar Gangwani Yash R Shah Teresa Varghese Hafiz Muzaffar Akbar Khan Simon Peter Horslen Thomas D Schiano Syed-Mohammed Jafri Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Department of Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Division of Gastroenterology Hepatology&Nutrition The University of Texas MD Anderson Cancer CenterHoustonTX 77030United States Department of Medicine Institute for Foreign Medical Graduate EducationHoustonTX 77030United States Department of Internal Medicine MedStar Harbor HospitalBaltimoreMD 21225United States Department of Internal Medicine WellStar Spalding Regional HospitalGriffinGA 30224United States Division of Gastroenterology Hepatology and NutritionEast Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Gastroenterology and Hepatology University of Arkansas for Medical SciencesLittle RockAR 72205United States Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and Hepatology SUNY Upstate Medical UniversitySyracuseNY 13210United States Department of Pediatrics School of Medicine and UPMC Children’s Hospital of PittsburghUniversity of PittsburghPittsburghPA 15219United States Division of Liver Diseases Icahn School of Medicine at Mount SinaiNew YorkNY 10029United States Division of Gastroenterology and Hepatology Henry Ford HospitalDetroitMI 48202United States

BACKGROUND Short bowel syndrome(SBS)hospitalizations are often complicated with *** is a significant paucity of data on adult SBS hospitalizations in the United States and across the *** To assess trends and outcomes of SBS hospitalizations complicated by sepsis in the United *** The National Inpatient Sample was utilized to identify all adult SBS hospitalizations between *** study cohort was further divided based on the presence or absence of *** were identified,and hospitalization characteristics and clinical outcomes were *** of mortality for SBS hospitalizations complicated with sepsis were *** Of 247097 SBS hospitalizations,21.7%were complicated by *** SBS hospitalizations had a rising trend of hospitalizations from 20.8%in 2005 to 23.5%in 2014(P trend<0.0001).Compared to non-septic SBS hospitalizations,septic SBS hospitalizations had a higher proportion of males(32.8%vs 29.3%,P<0.0001),patients in the 35-49(45.9%vs 42.5%,P<0.0001)and 50-64(32.1%vs 31.1%,P<0.0001)age groups,and ethnic minorities,i.e.,Blacks(12.4%vs 11.3%,P<0.0001)and Hispanics(6.7%vs 5.5%,P<0.0001).Furthermore,septic SBS hospitalizations had a higher proportion of patients with intestinal transplantation(0.33%vs 0.22%,P<0.0001),inpatient mortality(8.5%vs 1.4%,P<0.0001),and mean length of stay(16.1 d vs 7.7 d,P<0.0001)compared to the non-sepsis cohort.A younger age,female gender,White race,and presence of comorbidities such as anemia and depression were identified to be independent predictors of inpatient mortality for septic SBS *** Septic SBS hospitalizations had a rising trend between 2005-2014 and were associated with higher inpatient mortality compared to non-septic SBS hospitalizations.

关键词： Short bowel syndrome Sepsis Outcomes Mortality Trends

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Challenges in hyperglycemia management in critically ill patients with COVID-19

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World Journal of Critical Care Medicine 2022年第4期11卷 219-227页

作者： Rajesh Kethireddy Darshan Gandhi asim kichloo Love Patel Division of Hospital Medicine Abbott Northwestern HospitalAllina HealthMinneapolisMN 55407United States Department of Diagnostic Radiology University of Tennessee Health Science CenterMemphisTN 38103United States Internal Medicine Central Michigan University School of MedicineMt PleasantMI 48859United States

Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit *** from the corona virus disease 2019(COVID-19)pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and *** proposed hypothesis for hyperglycemia in COVID-19 include insulin resistance,critical illness hyperglycemia(stress-induced hyperglycemia)secondary to high levels of hormones like cortisol and catecholamines that counteract insulin action,acute cytokine storm and pancreatic cell *** patients are more likely to have severe hyperglycemic complications including diabetic ketoacidosis and hyperosmolar hyperglycemic *** of hyperglycemia in COVID-19 is often complicated by use of steroids,prolonged total parenteral or enteral nutrition,frequent acute hyperglycemic events,and restrictions with fluid management due to acute respiratory distress *** managing hyperglycemia special attention should be paid to mode of insulin delivery,frequency of glucose monitoring based on patient and caregiver safety thereby minimizing exposure and conserving personal protective *** this article we describe the pathophysiology of hyperglycemia,challenges encountered in managing hyperglycemia,and review some potential solutions to address them.

关键词： Hyperglycemia COVID-19 Critical care Diabetes Diabetic ketoacidosis

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Hyperkalemia:Major but still understudied complication among heart transplant recipients

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World Journal of Transplantation 2021年第6期11卷 203-211页

作者： Jagmeet Singh asim kichloo Navya Vipparla Michael Aljadah Michael Albosta Shakeel Jamal Sindhura Ananthaneni Sandesh Parajuli Department of Nephrology Guthrie Robert Packer HospitalSayrePA 18840United States Department of Internal Medicine Central Michigan University College of MedicineSaginawMI 48602United States Department of Internal Medicine Medical College of WisconsinMilwaukeeWI 53226United States Department of Nephrology University of Wisconsin School of Medicine and Public HealthMadisonWI 53706United States

Hyperkalemia is a recognized and potentially life-threatening complication ofheart transplantation. In the complex biosystem created by transplantation,recipients are susceptible to multiple mechanisms for hyperkalemia which arediscussed in detail in this manuscript. Hyperkalemia in heart transplantationcould occur pre-transplant, during the transplant period, or post-transplant. Pretransplantcauses of hyperkalemia include hypothermia, donor heart preservationsolutions, conventional cardioplegia, normokalemic cardioplegia, continuouswarm reperfusion technique, and ex-vivo heart perfusion. Intra-transplant causesof hyperkalemia include anesthetic medications used during the procedure,heparinization, blood transfusions, and a low output state. Finally, post-transplantcauses of hyperkalemia include hemostasis and drug-induced *** has been studied in kidney and liver transplant recipients, butthere is limited data on the incidence, causes, management, and prevention inheart transplant recipients. Hyperkalemia is associated with an increased risk ofhospital mortality and readmission in these patients. This review describes thecurrent literature pertaining to the causes, pathophysiology, and treatment ofhyperkalemia in patients undergoing heart transplantation and focuses primarilyon post-heart transplantation.

关键词： Transplantation Cardiovascular Hyperkalemia Heart transplant Medication Management

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Trends of alcoholic liver cirrhosis readmissions from 2010 to 2018:Rates and healthcare burden associated with readmissions

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World Journal of Hepatology 2021年第12期13卷 2128-2136页

作者： asim kichloo Zain El-Amir Dushyant Singh Dahiya Farah Wani Jagmeet Singh Dhanshree Solanki Ehizogie Edigin Precious Eseaton Asad Mehboob Hafeez Shaka Department of Internal Medicine Central Michigan University College of MedicineSaginawMI 48602United States Department of Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Department of Internal Medicine Rutgers UniversityNew BrunswickNJ 07103United States Department of Internal Medicine John H Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine University of Benin School of MedicineEdo 300213Nigeria Division of Gastroenterology Department of Internal MedicineCovenant HealthcareSaginawMI 48602United States

BACKGROUND Alcoholic liver cirrhosis(ALC)is a chronic liver disease with varying disease *** of ALC are associated with poor *** To identify and assess trends of readmissions for ALC over an eight-year *** This retrospective interrupted trend study analysed 30-d readmissions of ALC in the United States from 2010 to 2018 using the National Readmissions *** for ALC was the reason for index admission obtained using the International Classification of Diseases codes(571.2 and K70.3X).Biodemographic characteristics and hospitalization trends were highlighted over time.A multivariate regression analysis model was used to calculate the trend for riskadjusted odds of 30-d all-cause ALC readmissions,ALC specific readmission rate,ALC readmission proportion,inpatient mortality,mean length of stay(LOS)and mean total hospital cost(THC)following adjustments for age,gender,grouped Charlson Comorbidity Index,insurance,mean household income,and hospital *** There was a trend towards increasing total 30-d readmissions of ALC from 7660 in 2010 to 15085 in 2018(P<0.001).Patients readmitted for ALC were noted to have an increasing comorbidity burden over *** noted a rise in the risk-adjusted 30-d all-cause readmission of ALC from 24.9%in 2010 to 29.9%in 2018(P<0.001).ALC-specific readmission rate increased from 6.3%in 2010 to 8.4%in 2018(P<0.001)while ALC readmission proportion increased from 31.4%in 2010 to 36.3%in 2018(P<0.001).Inpatient mortality for 30-d readmissions of ALC declined from 10.5%in 2010 to 8.2%in 2018(P=0.0079).However,there was a trend towards increasing LOS from 5.6 d in 2010 to 6.3 d in 2018(P<0.001)and increasing THC from 13790 dollars in 2010 to 17150 dollars in 2018(P<0.001).The total days of hospital stay attributable to 30-d readmissions of ALC increased by 119.2%while the total attributable hospital costs increased by 149%by the end of *** There was an increase in th

关键词： Alcoholic liver cirrhosis Readmissions Epidemiology Trends Mortality

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Increasing thirty-day readmissions of Crohn’s disease and ulcerative colitis in the United States:A national dilemma

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World Journal of Gastrointestinal Pathophysiology 2022年第3期13卷 85-95页

作者： Dushyant Singh Dahiya Abhilash Perisetti asim kichloo Amandeep Singh Hemant Goyal Laura Rotundo Madhu Vennikandam Hafeez Shaka Gurdeep Singh Jagmeet Singh Sailaja Pisipati Mohammad Al-Haddad Madhusudhan R Sanaka Sumant Inamdar Department of Internal Medicine Central Michigan University College of MedicineSaginawMI 48601United States Division of Gastroenterology Parkview Cancer InstituteFort WayneIN 46845United States Division of Gastroenterology and Hepatology Cleveland Clinic FoundationClevelandOH 44195United States Department of Internal Medicine The Wright Center for Graduate Medical EducationScrantonPA 18505United States Department of Internal Medicine Mercer University School of MedicineMaconGA 31207United States Department of Gastroenterology and Hepatology Sparrow Hospital/Michigan State University College of Human MedicineLansingMI 48912United States Department of Internal Medicine John H.StrogerJr.Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine Our Lady of Lourdes Memorial HospitalBinghamtonNY 13905United States Department of Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Division of Gastroenterology and Hepatology Mayo ClinicScottsdaleAZ 85259United States Division of Gastroenterology and Hepatology Indiana University School of MedicineIndianapolisIN 46202United States Division of Gastroenterology and Hepatology University of Arkansas for Medical SciencesLittle RockAR 72205United States

BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise *** rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare *** To identify trends and adverse outcomes for 30 d readmissions for CD and *** This was a retrospective,interrupted trends study involving all adult(≥18 years)30 d readmissions of CD and UC from the National Readmission Database(NRD)between 2008 and ***<18 years,elective,and traumatic hospitalizations were excluded from this *** identified hospitalization characteristics and readmission rates for each calendar *** of inpatient mortality,mean length of hospital stay(LOS)and mean total hospital cost(THC)were calculated using a multivariate logistic trend analysis adjusting for age,gender,insurance status,comorbidity burden and hospital ***,trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two ***®Version 16 software(StataCorp,TX,United States)was used for statistical analysis and P value≤0.05 were considered statistically *** Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for *** noted increasing trends for 30-day all-cause readmission rate of CD from 14.9%in 2010 to 17.6%in 2018(P-trend<0.001),CD specific readmission rate from 7.1%in 2010 to 8.2%in 2018(P-trend<0.001),30-day all-cause readmission rate of UC from 14.1%in 2010 to 15.7%in 2018(P-trend=0.003),and UC specific readmission rate from 5.2%in 2010 to 5.6%in 2018(P-trend=0.029).There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC ***,we found an increasing trend of mean THC for UC *** comparison,there w

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Readmissions Trends

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Histoplasmosis and inflammatory bowel disease: A case report

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World Journal of Gastrointestinal Endoscopy 2021年第1期13卷 24-32页

作者： Dushyant Dahiya asim kichloo Jagmeet Singh Michael Albosta Farah Wani Internal Medicine Central Michigan UniversitySaginawMI 48603United States Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States

BACKGROUND Infection with Histoplasma capsulatum can lead to a disseminated disease involving the gastrointestinal tract presenting as diffuse abdominal pain and inflammatory diarrhea which may mimic inflammatory bowel disease(IBD).CASE SUMMARY In the current report,we discuss the case of a 41-year old male who presented to the emergency department with complaints of high-grade intermittent fevers and severe abdominal pain with associated diarrhea and *** results demonstrated transaminitis and elevated erythrocyte sedimentation rate,C-reactive protein and ferritin *** patient’s presentation was thought to be an exacerbation of his underlying IBD,but further investigations revealed a positive Histoplasma antigen in the *** patient was offered a colonoscopy and biopsy to confirm the diagnosis;however,he *** was treated with itraconazole and showed significant improvement of his symptoms,thereby confirming the diagnosis of gastrointestinal *** Here within,we provide a review of IBD,evaluation of chronic diarrhea,and gastrointestinal histoplasmosis.

关键词： Histoplasmosis Inflammatory bowel disease Intestine Endoscopy Gastroenterology Case report

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Gastrointestinal amyloidosis: A focused review

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World Journal of Gastrointestinal Endoscopy 2021年第1期13卷 1-12页

作者： Dushyant Singh Dahiya asim kichloo Jagmeet Singh Michael Albosta Farah Wani Internal Medicine Central Michigan UniversitySaginawMI 48603United States Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Family Medicine Samaritan Medical CenterWatertownNY 13601United States

Amyloidosis,a heterogenous group of disorders,is characterized by the extracellular deposition of autologous,insoluble,fibrillar misfolded *** extracellular proteins deposit in tissues aggregated inß-pleated sheets arranged in an antiparallel fashion and cause distortion to the tissue architecture and *** the current literature,about 60 heterogeneous amyloidogenic proteins have been identified,out of which 27 have been associated with human *** as a rare disease,amyloidosis is known to have a wide range of possible etiologies and clinical *** exact incidence and prevalence of the disease is currently *** both systemic and localized amyloidosis,there is infiltration of the abnormal proteins in the layers of the gastrointestinal(GI)tract or the liver *** gold standard test for establishing a diagnosis is tissue biopsy followed by Congo Red staining and apple-green birefringence of the Congo Red-stained deposits under polarized ***,not all patients may have a positive tissue confirmation of the *** these cases additional workup and referral to a gastroenterologist may be *** with symptomatic management,the treatment for GI amyloidosis consists of observation or localized surgical excision in patients with localized disease,and treatment of the underlying pathology in cases of systemic *** this review of the literature,we describe the subtypes of amyloidosis,with a primary focus on the epidemiology,pathogenesis,clinical features,diagnosis and treatment strategies available for GI amyloidosis.

关键词： Gastroenterology Hepatology Amyloidosis Dysmotility Endoscopy Therapeutics

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Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic

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World Journal of Critical Care Medicine 2021年第1期10卷 1-11页

作者： asim kichloo Akshay Kumar Rawan Amir Michael Aljadah Najiha Farooqi Michael Albosta Jagmeet Singh Shakeel Jamal Zain El-Amir Akif kichloo Nazir Lone Department of Internal Medicine Central Michigan UniversitySaginawMI 48603United States Department of Cardiothoracic Surgery University of PittsburghPittsburghPA 15260United States Department of Internal Medicine University of MarylandBaltimoreMD 20742United States Department of Internal Medicine Medical College of WisconsinMilwaukeeWI 53226United States Department of Surgery Central Michigan UniversitySaginawMI 48603United States Department of Nephrology and Transplant Nephrology Guthrie Robert Packer HospitalSayrePA 18840United States Department of Anesthesiology and Critical Care Saraswathi Institute of Medical SciencesUttar Pradesh 245304India Department of Pulmonology and Critical Care Northwell HealthRiverheadNY 11901United States

The ongoing outbreak of severe acute respiratory syndrome coronavirus-2[SARSCoV-2,or coronavirus disease 2019(COVID-19)]was declared a pandemic by the World Health Organization on March 11,***,more than 65 million people have been infected with this SARS-CoV-2 virus,and over 1.5 million people have died due to the viral *** a tremendous amount of medical progress has been made since its inception,there continues to be ongoing research regarding the pathophysiology,treatments,and *** a vast majority of those infected develop only mild to moderate symptoms,about 5%of people have severe forms of infection resulting in respiratory failure,myocarditis,septic shock,or multi-organ *** maximal cardiopulmonary support and invasive mechanical ventilation,mortality remains *** membrane oxygenation(ECMO)remains a valid treatment option when maximal conventional strategies *** of ECMO in the pandemic is challenging from both resource allocation and ethical *** article reviews the rationale behind its use,current status of utilization,and future considerations for ECMO in critically ill COVID-19 patients.

关键词： Extracorporeal membrane oxygenation COVID-19 Critical care Acute respiratory distress syndrome Shock Research

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Emerging therapeutics in the management of COVID-19

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World Journal of Virology 2021年第1期10卷 1-29页

作者： asim kichloo Michael Albosta Akshay Kumar Michael Aljadah Mohamed Mohamed Zain El-Amir Farah Wani Shakeel Jamal Jagmeet Singh Akif kichloo Department of Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Internal Medicine Central Michigan UniversitySaginawMI 48602United States Department of Cardiothoracic Surgery University of PittsburghPittsburghPA 15260United States Deparment of Internal Medicine Medical College of WisconsinMilwaukeeWI 53226United States Department of Family Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Transplant Nephrology Geisinger Commonwealth School of MedicineSayrePA 18510United States Department of Anesthesiology and Critical Care Saraswathi Institue of Medical SciencesUttar Pradesh 245304India

Abstract The severe acute respiratory syndrome coronavirus 2(coronavirus disease 2019,COVID-19)pandemic has placed a tremendous burden on healthcare systems *** for treatment of the virus are extremely inconsistent due to the lack of time evaluating drug efficacy in clinical ***,there is a deficiency of published literature that comprehensively discusses all therapeutics being considered for the treatment of COVID-19.A review of the literature was performed for articles related to therapeutics and clinical trials in the context of the current COVID-19 *** used PubMed,Google Scholar,and *** to search for articles relative to the topic of *** used the following keywords:“COVID-19”,“therapeutics”,“clinical trials”,“treatment”,“FDA”,“ICU”,“mortality”,and“management”.In addition,searches through the references of retrieved articles was also *** this paper,we have elaborated on the therapeutic strategies that have been hypothesized or trialed todate,the mechanism of action of each therapeutic,the clinical trials finished or inprocess that support the use of each therapeutic,and the adverse effects associated with each ***,there is no treatment that has been proven to provide significant benefit in reducing morbidity and *** are many clinical trials for numerous different therapeutic agents currently *** looking back and measuring successful strategies from previous pandemics in addition to carrying out ongoing research,we provide ourselves with the greatest opportunity to find treatments that are beneficial.

关键词： COVID-19 Therapeutics Infectious disease SARS-CoV-2 Pharmacology Virology

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Systemic adverse effects and toxicities associated with immunotherapy:A review

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World Journal of Clinical Oncology 2021年第3期12卷 150-163页

作者： asim kichloo Michael Albosta Dushyant Dahiya Jean Claude Guidi Michael Aljadah Jagmeet Singh Hafeez Shaka Farah Wani Akshay Kumar Manidhar Lekkala Department of Internal Medicine Central Michigan UniversitySaginawMI 48603United States Department of Internal Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Internal Medicine Medical College of WisconsinMilwaukeeWI 53201United States Department of Nephrology Guthrie Robert Packer HospitalSayrePA 18840United States Department of Internal Medicine John H Stroger Jr.Hospital of Cook CountyChicagoIL 60612United States Department of Family Medicine Samaritan Medical CenterWatertownNY 13601United States Department of Surgery University of PittsburghPittsburghPA 15213United States Department of Hematology and Oncology University of Rochester Medical CenterRochesterNY 14642United States

Immunotherapy is rapidly evolving secondary to the advent of newer immunotherapeutic agents and increasing approval of the current agents by the United States Food and Drug Administration to treat a wide spectrum of *** agents have gained immense popularity due to their tumorspecific *** is slowly transforming into a separate therapeutic entity,and the fifth pillar of management for cancers alongside surgery,radiotherapy,chemotherapy,and targeted ***,like any therapeutic entity it has its own adverse *** the increasing use of immunotherapeutic agents,it is vital for physicians to acquaint themselves with these adverse *** aim of this review is to investigate the common systemic adverse effects and toxicities associated with the use of different classes of immunotherapeutic *** provide an overview of potential adverse effects and toxicities associated with different classes of immunotherapeutic agents organized by organ systems,as well as an extensive discussion of the current recommendations for treatment and clinical trial *** we continue to see increasing usage of these agents in clinical practice,it is vital for physicians to familiarize themselves with these effects.

关键词： Immunotherapy Cancer Malignancy Adverse effects Immune checkpoint inhibitor Monoclonal antibody

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