Eric Brucks

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Scholarly Contributions

Journals/Publications

• Brucks, E., Ibrahim, R., & Terrani, K. (2023). Integrating Evidence-Based Medicine into Resident Education. Journal of Investigative Medicine. doi:10.1177/10815589231189489
• Arif-Tiwari, H., Babiker, H. M., Brucks, E., Martinez, F., Mehnoor, H., Otsuji, J., & Recio-Boiles, A. (2021).

  Using Advanced Molecular Profiling to Identify the Origin of and Tailor Treatment for an Intracranial Mass of Unknown Primary

  . JCO Precision Oncology, 981-987. doi:10.1200/po.20.00243
• Babiker, H. M., Brucks, E., Chipollini, J., Dashkevych, U., McBride, A., Recio Boiles, A., & Saboda, K. (2021).

  A retrospective real-world major bleeding (MB) comparison of direct oral anticoagulants (DOAC) and low molecular weight heparin (LMWH) in genitourinary cancer-associated venous thromboembolism (GU-CAVTE) with reported randomized clinical trials (RTC).

  . Journal of Clinical Oncology, 39(6_suppl), 410-410. doi:10.1200/jco.2021.39.6_suppl.410
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  410 Background: MB is a serious complication in patients with CAVTE receiving treatment with DOAC or LMWH. The most recent meta-analysis of the four major RCT showed that MB events rate were similar among the DOAC and LMWH group, however, it was noted that MB occurred at GU site 4.9 times more in DOAC than LMWH patients. While GUCA (e.g. bladder and testicular) are considered to be high-risk based on the Khorana Score, they were underrepresented among the RCT ( < 12%). We present a Real-World retrospective cohort study analyzing the MB rates in patients presenting with GU-CAVTE treated either by a DOAC or LMWH compared to those of the RTC. Methods: We performed a retrospective chart review of patients with a diagnosed GUCA and VTE who presented to The University of Arizona Cancer Center (UACC) and were subsequently placed on anticoagulant therapy with either a DOAC or LMWH from 11/2013-4/2020. MB outcome was defined as documented Hgb drop of ≥2 g/dL, ≥2 units of PRBC, MB in a critical site, or contributing to death. MB was extracted and compared from the SELECT D, ADAM VTE, and Caravaggio for DOAC and Hokusai for the LMWH control arm with the GUCA subgroup. Recurrent VTE was collected. In situations where there was insufficient data to categorize individuals, those individuals were excluded from the analysis. The proportion of MB reported in each study were compared using a binomial test. Results: Our review included 56 patients with similar baseline characteristics to the RCT, who were prescribed enoxaparin (n = 13), apixaban (n = 27) and rivaroxaban (n = 16). Our UACC data was compared to the RCT reported MB outcomes with rivaroxaban (12% vs 8%, [p = 0.63]), apixaban (11% vs 6%, [p = 0.40]), and LMWH (both 0 vs 1% [p = 0.67]). No statistical difference among DOAC selection [p = 0.90]. Our UACC rate of MB in patients with GUCA for both DOAC combined versus LWMH were 11.6% (5/43) and 0% [p = 0.1910], compared to the RCT GU subgroup was 5.7% (6/104) [p = 0.02] and 0.6% (1/175) [p = 1.0], respectively. Furthermore, our data found no statistical significance difference among the recurrent VTE rate among DOAC, LMWH, UACC Retrospective or RCT events. Conclusions: In agreement with the four major RCT, our study demonstrated that patients with high-risk GUCA and underlying VTE treated with a DOAC had a non-significant higher incidence of MB compared to those treated with LMWH. Further, our Real-World experience showed that GUCA DOAC had a significantly higher MB event rate compared to the RCT subgroup population. We acknowledge there are inherent biases in all retrospective studies and RCT. These data support the idea that DOAC should be further studied and used with caution in patients with a high risk of bleeding. We recommend LMWH being the safest anticoagulation modality for High-Risk Bleeding GU malignancy.
• Brucks, E., Ferreira, J. P., Joshi, K., & Newman, C. R. (2021).

  Disseminated Gonococcal Infection in an Immunosuppressed Patient

  . The American Journal of Medicine. doi:10.1016/j.amjmed.2020.06.048
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  Gonococcal infection primarily affects the mucosal surfaces of the urogenital tract, and rarely causes bacteremia and sepsis due to dissemination.1 Disseminated gonococcal infection is prevalent in the United States, with a rate of 0.5%-3% in patients infected with Neisseria gonorrhoeae.2 The main presentation of disseminated gonococcal infection is tenosynovitis, dermatitis, and polyarthralgia, with cutaneous lesions present in 60%-90%.1 It is important that healthcare providers have high clinical suspicion of disseminated gonococcal infection, especially in patients presenting with sepsis and immunocompromised status, given the risk of severe complications.
• Anwer, F., Brucks, E., Farooqui, A. A., Harris, Z., Hinchman, A., Iftikhar, R., Kapoor, V., Latif, A., Majeed, A., McBride, A., Mossad, S. B., Riaz, I. B., Tamizhmani, K., & Tariq, M. J. (2020).

  Revisiting Role of Vaccinations in Donors, Transplant Recipients, Immunocompromised Hosts, Travelers, and Household Contacts of Stem Cell Transplant Recipients

  . Biology of Blood and Marrow Transplantation. doi:10.1016/j.bbmt.2019.10.030
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  Abstract Vaccination is an effective strategy to prevent infections in immunocompromised hematopoietic stem cell transplant recipients. Pretransplant vaccination of influenza, pneumococcus, Haemophilus influenza type b, diphtheria, tetanus, and hepatitis B, both in donors and transplant recipients, produces high antibody titers in patients compared with recipient vaccination only. Because transplant recipients are immunocompromised, live vaccines should be avoided with few exceptions. Transplant recipients should get inactive vaccinations when possible to prevent infection. This includes vaccination against influenza, pneumococcus, H. influenza type b, diphtheria, tetanus, pertussis, meningococcus, measles, mumps, rubella, polio, hepatitis A, human papillomavirus, and hepatitis B. Close contacts of transplant recipients can safely get vaccinations (inactive and few live vaccines) as per their need and schedule. Transplant recipients who wish to travel may need to get vaccinated against endemic diseases that are prevalent in such areas. There is paucity of data on the role of vaccinations for patients receiving novel immunotherapy such as bispecific antibodies and chimeric antigen receptor T cells despite data on prolonged B cell depletion and higher risk of opportunistic infections.
• Babiker, H. M., Brucks, E. B., Halder, R., Leiva, J. A., Martinez, F. J., McBride, A., Recio-Boiles, A., Roe, D., Saboda, K., & Veeravelli, S. (2020).

  Retrospective Real-World Analysis of the Primary Safety Outcomes in Venous Thromboembolism of High-Risk Major Bleeding Cancer Patients Receiving Therapeutic Anticoagulation

  . Blood, 136(Supplement 1), 15-16. doi:10.1182/blood-2020-139641
• Brucks, E. S., Hendricks, A. J., Kromenacker, B. W., Maarouf, M., & Shi, V. Y. (2019).

  5‐fluorouracil‐induced erythema and transepidermal water loss associated with complete actinic keratosis resolution

  . Dermatologic Therapy, 32(3). doi:10.1111/dth.12890
• Brucks, E. S., Hendricks, A., Kromenacker, B. W., Maarouf, M., & Shi, V. Y. (2019).

  Reducing unpleasant side effects of topical 5-Fluorouracil treatment for actinic keratosis: a randomized controlled trial

  . Journal of Dermatological Treatment, 31(2), 175-179. doi:10.1080/09546634.2019.1589638
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  Introduction: 5-Fluorouracil (5-FU) for prophylactic treatment of diffuse actinic keratosis results in an exuberant inflammatory reaction, contributing to patient noncompliance and dissatisfaction.Design: This 5-week split-faced, double-blind, randomized controlled trial involved 30 subjects with diffuse facial AK who received twice daily 5-FU treatment for 2 weeks. This was followed by pre-randomized twice daily use of one of three topical interventions on one half of the face. TEWL, pH, and hydration were assessed on each quadrant of the face at all visits. Additionally, photographs were subjectively graded by three blinded trained observers.Results: Thirty subjects were enrolled, and had an average 27.1 (SD 11.8, range: 13-62) palpable AKs at baseline. Average resolution of baseline AK count was 98.1% by week 4. Clobetasol propionate is best at decreasing TEWL (p = .034), while petrolatum jelly most significantly improves hydration (p = .019) and erythema (p = .014). Though controlled release skin barrier emulsion trended towards improvement in TEWL (p = .17) and hydration (p = .19), there was no significant decrease in erythema (p = .257). Patient free-text response identified erythema as the most bothersome symptom.Conclusions: Given the low cost, wide availability, and ability to significantly reduce erythema, petrolatum should be used for post-5-FU treatment for diffuse AK.
• Brucks, E., Kromenacker, B., Maarouf, M., & Shi, V. Y. (2019).

  Expedited Resolution of 5-Fluorouracil-Induced Erythema and Barrier Dysfunction with White Petrolatum

  . Skin. doi:10.25251/skin.3.4.9
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  Actinic keratoses (AK) are precancerous lesions that develop on chronically sun-exposed skin. They frequently require prophylactic field treatment due to the risk of progression to squamous cell carcinoma. Topical treatment with 5-fluorouracil (5-FU) yields near complete AK resolution, yet leaves a patient with an exuberant erythematous treatment site, which may be embarrassing and/or uncomfortable. We report a case of a patient with diffuse facial AK who was treated with 5-FU twice daily for 2 weeks, resulting in fiery-red erythema and disrupted barrier indices. Application of pure ultra white petroleum jelly, an emollient preferred by dermatologists for post-operative wound healing, resulted in drastic decreased erythema and recovery time of post-treatment transepidermal water loss and hydration, compared to the contralateral, non-petrolatum-treated side. Additionally, petrolatum use did not disrupt the AK resolution endpoint. We suggest that petroleum jelly be used for the repair of 5-FU-induced barrier disruption and erythema to promote greater patient adherence.
• Brucks, E., Robinson, E. A., Scott, S., & Starobinska, E. (2018).

  Marantic endocarditis: incidental infarcts leading to diagnosis of pancreatic cancer

  . Case Reports. doi:10.1136/bcr-2018-224529
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  Non-bacterial thrombotic endocarditis (NBTE) is a well-described phenomenon associated with malignancies due to hypercoaguable state. In the setting of pancreatic cancer, NBTE is more commonly diagnosed postmortem. We describe a case of a man who was diagnosed with pancreatic carcinoma after incidental finding of NBTE. Imaging incidentally revealed multiple strokes, bilateral renal and splenic infarcts, while subsequent workup for cardioembolic source demonstrated a 1.1×0.7 cm mitral valve vegetation. As multiple blood cultures were sterile and patient lacked clinical signs of infection, an underlying malignancy was suspected. CT abdomen demonstrated a dilated pancreatic duct, MRI showed a 2.8×2.2 cm pancreatic head mass. Endoscopic biopsy of the mass revealed pancreatic adenocarcinoma. Other than NBTE, there were no other clinical or laboratory findings to clearly suggest pancreatic cancer. Thus, incidental discovery of this mitral valve vegetation led to the diagnosis of pancreatic malignancy.

Presentations

• Brucks, E., & Gunderspm, J. (2022). Donation Trends from the American College of Physicians and American Academy of Family Physicians Political Action Committees: A 2006-2020 Analysis of Partisan Contributions. 2022 American Medical Association Research Challenge.

Poster Presentations

• Brucks, E., Ferreira, J. P., Mikrut, E., & Lougheed, C. (2023). A case of Cutaneous Mucormycosis at the Site of Adhesive Lumbar Puncture Dressing. Society of General Internal Medicine.
• Brucks, E., & Terrani, K. (2022, October). Interpreting a Delayed Workup of Idiopathic Inflammatory Myopathy. American College of Physicians Arizona Chapter Meeting.