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The introduction of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment standards and significantly enhanced patient prognoses. However, the utilization of these groundbreaking therapies has led to the observation and reporting of various types of adverse events, commonly known as immune-related adverse events (irAEs). In the following article, we present four patients who encountered uncommon toxicities induced by ICIs. The first patient was a 59-year-old female diagnosed with stage 4 lung adenocarcinoma. She received immunotherapy (pembrolizumab) together with chemotherapy and subsequently developed autonomic neuropathy (AN). The next two patients also received chemo-immunotherapy (pembrolizumab) and were both 63-year-old males with stage 4 lung adenocarcinoma. One of the two experienced palmoplantar keratoderma, while the other presented with Reiter’s syndrome (urethritis, conjunctivitis and arthritis). The 4th patient, an 80-year-old male with stage 4 squamous cell carcinoma of the lung, received chemo-immunotherapy (pembrolizumab) and developed myasthenia gravis.

Some sleep disorders have been linked to hypertension, but few studies have examined the relationship between daytime sleepiness and blood pressure (BP). This study attempted to determine whether scores on a short questionnaire assessing daytime sleepiness (Epworth Sleepiness Scale [ESS]) were associated with BP and could be used to predict hypertension after 5 years in healthy older adults who had not previously been diagnosed with hypertension. A group of 157 healthy men and women 55 to 80 years of age completed an extensive medical examination, a series of psychosocial tests, and two 24-h ambulatory BP sessions. After 5 years the procedures were repeated in 133 (85%) of the subjects. Psychosocial variables and BP were compared in subjects scoring high (score of ≥10) and low (<10) on the ESS. Compared to individuals with low ESS sores, those scoring high had increased casual and sleep BP as well as higher systolic BP levels and diastolic BP variability during waking hours, and reported higher levels of anger, depression, anxiety, and intensity of psychological symptoms as well as lower defensiveness. Individuals with high ESS scores were more likely to be diagnosed with hypertension 5 years later. Groups with high and low ESS scores did not differ significantly on any other variables. The ESS, a simple measure of daytime sleepiness, identified individuals at risk for hypertension. Future studies should investigate the possibility that diagnosis and treatment of daytime sleepiness could aid in BP reduction and ultimately in decreased morbidity and mortality from cardiovascular disorders.

Family history of hypertension is a primary predictor of high blood pressure (BP). This study attempted to determine whether there is a gradual increase in BP between individuals with two hypertensive parents, one hypertensive parent, and normotensive parents and whether this increase is apparent with both ambulatory and casual BP assessments in men as well as in women. A total of 220 healthy men and women, aged 22 to 50 years, completed two 24-h ambulatory BP sessions (one work day and one off work day). Based on family history information obtained from parents, three groups were formed: subjects with two hypertensive parents, one hypertensive parent, and normotensive parents. Work and off work days did not differ; analyses were based on mean values of the 2 days. Men with two hypertensive parents had higher daytime and night-time ambulatory BP than men with normotensive parents. Those with one hypertensive parent had intermediate BP levels. Ambulatory BP was not associated with family history in women. Also, men with one or two hypertensive parents had higher ambulatory BP than women with hypertensive parents, whereas offspring of normotensive parents exhibited no sex differences in BP. Elevated systolic and diastolic BP throughout the day and night seems to characterize men with two hypertensive parents. In evaluating the relationship between family history of hypertension and BP, it is important to use ambulatory BP measures, differentiate between individuals with one and with two hypertensive parents, and focus on gender differences in BP.

This study assessed 5-year changes in ambulatory blood pressure (ABP) in healthy, older individuals and determined the extent to which it could be predicted from earlier BP measures and other cardiovascular risk factors. A total of 162 men and women, aged 55 to 79 years, with no prior medical disorders, completed a medical examination and two 24-h ABP sessions. The procedures were repeated 5 years later in 80% (130) of these subjects. A modified hierarchical regression analysis was used to determine whether initial ABP and casual blood pressure (CBP) measures and demographic and physical examination data could predict ABP in 5 years. The CBP and most ABP levels during waking and sleep increased after 5 years. However, CBP remained in the normotensive range for 73% of the subjects. The ABP variability tended to decrease over time. The ABP and CBP measures accounted for at least 50% of the variance in the prediction of ABP level after 5 years. In comparison, the predictability of ABP variability was quite low, particularly during sleep (<30% of the variance accounted for). The ABP and CBP were good predictors of future ABP level in healthy older subjects, but ABP variability was more difficult to predict. Except for age, none of the standard cardiovascular risk factors contributed significantly to the prediction of ABP level or variability.

Immune checkpoint inhibitors (ICIs) have transformed the therapeutic approach to diverse malignancies, leading to substantial enhancements in patient prognosis. However, along with their benefits, ICIs also increase the incidence of immune-related adverse events (irAEs). In the present paper, we highlight four cases of carpal tunnel syndrome (CTS) as an uncommon manifestation of toxicity induced by ICIs. Although diagnosed with different malignancies, the patients were undergoing ICI therapy when they developed CTS-consistent side effects accompanied by severe neuropathy. Prompt treatment with corticosteroids, intravenous immunoglobulins, or methotrexate resulted in complete symptomatic relief for all patients. This article therefore emphasizes the importance of recognizing and managing rare adverse events associated with ICI use to ensure optimal patient care.

This study explored the relationship between anorexic behavior and selected dimensions of body image. Anorexic behavior was assessed by two scales, the Eating Attitudes Test (EAT 26) (Garner, Olmstead, Bohr, & Garfinkel, 1982) and the Eating Disorders Inventory (EDI) (Garner, Olmstead, & Polivy, 1983). Predictor variables, selected dimensions of body image, physical attractiveness, self-esteem, and physical effectiveness, were measured by scales adapted by Lerner and Karabenick (1974) and Lerner, Orlos, and Knapp (1976). Multiple regression techniques were used to determine how much of the tendency toward anorexic behavior can be predicted by selected dimensions of body image. The major focus of the analysis was to explore the contributions of each of the dimensions of body image to predicting tendencies toward anorexic behavior in adolescents. The research sample consisted of 169 high school students, aged 15 to 18, who were enrolled in health, physical education, or psychology classes in the spring of 1983. Results indicated that the dimension of self-esteem was the major factor in the prediction of anorexic behaviors as measured by the Eating Disorders Inventory.