Correlation between great saphenous length of treatment zone and diameter with improvement in symptoms post-ablation

The successful therapy of hepatitis C viral infection requires that the illness is diagnosed before the development of structural changes of the liver. Testing is stepwise consisting of screening, diagnosis, and anti-viral therapy follow-up. For these steps there are different biochemical, serological, histological and molecular biological methods available. For screening, alanine aminotransferase and anti-HCV tests are used. The diagnosis of infection is confirmed using real-time polymerase chain reaction of the viral nucleic acid. Before initiation of the therapy liver biopsy is recommended to determine the level of structural changes in the liver. Alternatively, transient elastography or blood biomarkers may be also used for this purpose. Differential diagnosis should exclude the co-existence of other viral infections and chronic hepatitis due to other origin, with special attention to the presence of autoantibodies. The outcome of the antiviral therapy and the length of treatment are mainly determined by the viral genotype. In Hungary, most patients are infected with genotype 1, subtype b. The polymorphism type that occurs in the single nucleotide located next to the interleukin 28B region in chromosome 19 and the viral polymorphism type Q80K for infection with HCV 1a serve as predictive therapeutic markers. The follow-up of therapy is based on the quantitative determination of viral nucleic acid according to national and international protocols and should use the same method and laboratory throughout the treatment of an individual patient. Orv. Hetil., 2014, 155(26), 1019–1023.

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One‐year results of the Variation of Orthokeratology Lens Treatment Zone (VOLTZ) Study: a prospective randomised clinical trial

Ophthalmic and Physiological Optics ◽

10.1111/opo.12834 ◽

2021 ◽

Author(s):

Biyue Guo ◽

Sin Wan Cheung ◽

Randy Kojima ◽

Pauline Cho

Keyword(s):

Clinical Trial ◽

Randomised Clinical Trial ◽

Treatment Zone ◽

One Year

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Lonsurf (trifluridine/tipiracil): Assessing the impact of dose related toxicities and progression free survival in (refractory) metastatic colorectal cancer

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211017973 ◽

2021 ◽

pp. 107815522110179

Author(s):

Olivia R Court

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Dose Reduction ◽

Progression Free Survival ◽

Electronic Patient Records ◽

Free Survival ◽

Length Of Treatment ◽

Common Grade ◽

Grade 3 ◽

The Impact

In the RECOURSE trial which lead to its accreditation, Lonsurf (trifluridine/tipiracil) was shown to extend progression free survival (PFS) by 1.8 months in metastatic colorectal cancer. This Trust audit aims to assess the average quantity of cycles of Lonsurf received by participants and the length of time it extends PFS. Similarly, to identify how many participants required a dose-reduction or experienced toxicities which necessitated supportive therapies. Quantitative data was collected retrospectively from all participants who had received ≥1 cycle of Lonsurf from The Clatterbridge Cancer Centre (CCC) from 2016 until June 2020. Participant electronic patient records were accessed to identify toxicity grading, length of treatment received, the date progression was identified, if dose reductions were applied and if supportive therapies were administered. Lonsurf extends PFS in patients with metastatic colorectal cancer at CCC by 3.0 months (95% CI: 2.73–3.27) and average treatment length was 2.4 months. However, 78 participants (41.5%) received a dose reduction due to toxicities. A total of 955 toxicities were recorded by participants; the most commonly reported toxicities irrespective of grade were fatigue (33.8%), diarrhoea (13.8%) and nausea (12.3%). The most common grade ≥3 toxicities were constipation and infection. The most frequently utilised supportive therapies were loperamide (49.6%) and domperidone (49.1%). Granulocyte colony stimulating factor (GCSF) was required by patients on 5 occasions (0.3%) in total. Lonsurf extends median PFS in patients with metastatic colorectal cancer by 3.0 months. The most common grade ≥3 toxicities which necessitated supportive therapies or a dose reduction were gastrointestinal and infection.

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Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation

BMJ ◽

10.1136/bmj.m283 ◽

2020 ◽

pp. m283 ◽

Cited By ~ 12

Author(s):

Elizabeth M Oliva ◽

Thomas Bowe ◽

Ajay Manhapra ◽

Stefan Kertesz ◽

Jennifer M Hah ◽

...

Keyword(s):

Opioid Analgesic ◽

Veterans Health Administration ◽

Fiscal Year ◽

Veterans Health ◽

Health Administration ◽

Opioid Treatment ◽

Risk Of Death ◽

Length Of Treatment ◽

Increased Risk ◽

Stopping Treatment

Abstract Objective To examine the associations between stopping treatment with opioids, length of treatment, and death from overdose or suicide in the Veterans Health Administration. Design Observational evaluation. Setting Veterans Health Administration. Participants 1 394 102 patients in the Veterans Health Administration with an outpatient prescription for an opioid analgesic from fiscal year 2013 to the end of fiscal year 2014 (1 October 2012 to 30 September 2014). Main outcome measures A multivariable Cox non-proportional hazards regression model examined death from overdose or suicide, with the interaction of time varying opioid cessation by length of treatment (≤30, 31-90, 91-400, and >400 days) as the main covariates. Stopping treatment with opioids was measured as the time when a patient was estimated to have no prescription for opioids, up to the end of the next fiscal year (2014) or the patient’s death. Results 2887 deaths from overdose or suicide were found. The incidence of stopping opioid treatment was 57.4% (n = 799 668) overall, and based on length of opioid treatment was 32.0% (≤30 days), 8.7% (31-90 days), 22.7% (91-400 days), and 36.6% (>400 days). The interaction between stopping treatment with opioids and length of treatment was significant (P<0.001); stopping treatment was associated with an increased risk of death from overdose or suicide regardless of the length of treatment, with the risk increasing the longer patients were treated. Hazard ratios for patients who stopped opioid treatment (with reference values for all other covariates) were 1.67 (≤30 days), 2.80 (31-90 days), 3.95 (91-400 days), and 6.77 (>400 days). Descriptive life table data suggested that death rates for overdose or suicide increased immediately after starting or stopping treatment with opioids, with the incidence decreasing over about three to 12 months. Conclusions Patients were at greater risk of death from overdose or suicide after stopping opioid treatment, with an increase in the risk the longer patients had been treated before stopping. Descriptive data suggested that starting treatment with opioids was also a risk period. Strategies to mitigate the risk in these periods are not currently a focus of guidelines for long term use of opioids. The associations observed cannot be assumed to be causal; the context in which opioid prescriptions were started and stopped might contribute to risk and was not investigated. Safer prescribing of opioids should take a broader view on patient safety and mitigate the risk from the patient’s perspective. Factors to address are those that place patients at risk for overdose or suicide after beginning and stopping opioid treatment, especially in the first three months.

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757 Does Increased Sampling of Cerebrospinal Fluid from External Ventricular Drains Lead to Increased Rates of Infection?

British Journal of Surgery ◽

10.1093/bjs/znab134.575 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

B Edwards ◽

A Zolnourian ◽

D Bulters

Keyword(s):

Research Study ◽

Average Length ◽

Risk Of Infection ◽

Suspected Infection ◽

Length Of Treatment ◽

Increased Risk ◽

Significant Difference ◽

Daily Sampling ◽

Frequent Sampling ◽

Strict Protocol

Abstract Introduction External ventricular drains (EVDs) are commonly used in the management of acute hydrocephalus after subarachnoid haemorrhage (SAH). Infection is the most common complication. There remains controversy over whether frequent sampling is associated with increased risk of infection. Method Two cohorts of patients requiring EVD after SAH were retrospectively analysed for suspected and proven CSF infection. The first clinical cohort was of 50 consecutive patients with twice weekly sampling. The second group had alternate daily sampling as part of a prospective research study. Results Female to male ratio were (32:18) and (29:15) in clinical vs research group respectively. Average age of both groups was 59. Average length of treatment with EVD in both groups was 10 days. 16/50 (32%) patients had a suspected infection vs 13/44 (30%) and 8/50 (16%) had a proven infection compared to 6/44 (14%) in clinical and research groups, respectively. There was no statistically significant difference between the two groups (suspected infections p = 0.7 and proven infections p = 0.7) Conclusions Increased rates in CSF sampling in the research cohort did not result in higher rates of CSF infection. This suggests that rate of sampling, if done following a strict protocol, is not associated with increased risk of infection.

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Polymyxin B Nephrotoxicity and Efficacy against Nosocomial Infections Caused by Multiresistant Gram-Negative Bacteria

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.47.8.2659-2662.2003 ◽

2003 ◽

Vol 47 (8) ◽

pp. 2659-2662 ◽

Cited By ~ 114

Author(s):

John P. Ouderkirk ◽

Jill A. Nord ◽

Glenn S. Turett ◽

Jay Ward Kislak

Keyword(s):

Renal Failure ◽

Renal Function ◽

Renal Toxicity ◽

Clinical Information ◽

Polymyxin B ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Length Of Treatment ◽

Baseline Renal Function ◽

Overall Mortality

ABSTRACT Reported rates of nephrotoxicity associated with the systemic use of polymyxins have varied widely. The emergence of infections due to multiresistant gram-negative bacteria has necessitated the use of systemic polymyxin B once again for the treatment of such infections. We retrospectively investigated the rate of nephrotoxicity in patients receiving polymyxin B parenterally for the treatment of infections caused by multiresistant gram-negative bacteria from October 1999 to September 2000. Demographic and clinical information was obtained for 60 patients. Outcome measures of interest were renal toxicity and clinical and microbiologic efficacy. Renal failure developed in 14% of the patients, all of whom had normal baseline renal function. Development of renal failure was independent of the daily and cumulative doses of polymyxin B and the length of treatment but was significantly associated with older age (76 versus 59 years, P = 0.02). The overall mortality was 20%, but it increased to 57% in those who developed renal failure. The organism was cleared in 88% of the patients from whom repeat specimens were obtained. The use of polymyxin B to treat multiresistant gram-negative infections was highly effective and associated with a lower rate of nephrotoxicity than previously described.

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