Great Ormond Street Hospital treatment guidelines for use of propranolol in infantile isolated subglottic haemangioma

AbstractObjective:Treatment options for large subglottic haemangioma include steroids, laser ablation, open excision, tracheostomy and, more recently, propranolol. This article aims to present the Great Ormond Street Hospital guidelines for using propranolol to treat infantile isolated subglottic haemangioma by ENT surgeons.Methods:The vascular malformations multidisciplinary team at Great Ormond Street Hospital has developed guidelines for treating infantile haemangioma with propranolol.Results:The Great Ormond Street Hospital guidelines for propranolol treatment for infantile subglottic haemangioma include investigation, treatment and follow up. Propranolol is started at 1 mg/kg/day divided into three doses, increasing to 2 mg/kg/day one week later. On starting propranolol and when increasing the dose, the pulse rate and blood pressure must be checked every 30 minutes for the first 2 hours. Lesion response to treatment is assessed via serial endoscopy.Conclusion:Recent reports of dramatic responses to oral propranolol in children with haemangioma and acute airway obstruction have led to increased use. We advocate caution, and have developed guidelines (including pre-treatment investigation and monitoring) to improve treatment safety. Propranolol may in time prove to be the best medical treatment for subglottic haemangioma, but at present is considered to be still under evaluation.

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A comparison of risperidone and olanzapine in the acute treatment of persistent delusional disorder: Data from a retrospective chart review

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2011 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S544-S544

Author(s):

K. Kulkarni ◽

R. Arasappa ◽

K. Prasad ◽

A. Zutshi ◽

P. Chand ◽

...

Keyword(s):

Chart Review ◽

Second Generation ◽

Treatment Guidelines ◽

Treatment Options ◽

Specific Treatment ◽

Retrospective Chart Review ◽

Delusional Disorder ◽

Response To Treatment ◽

Second Generation Antipsychotics ◽

Competing Interest

IntroductionThere is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.Objectives and aimsWe aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.ResultsA total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).ConclusionOur study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Long-term survival of the nasal NK/T cell lymphoma

Orvosi Hetilap ◽

10.1556/oh.2008.28330 ◽

2008 ◽

Vol 149 (17) ◽

pp. 801-805

Author(s):

Péter Rajnics ◽

László Krenács ◽

András Kenéz ◽

Zoltán Járay ◽

Enikő Bagdi ◽

...

Keyword(s):

T Cell ◽

Treatment Guidelines ◽

Cell Lymphoma ◽

Treatment Options ◽

Diagnostic Procedures ◽

T Cell Lymphoma ◽

Term Survival ◽

Barr Virus ◽

Significant Difference ◽

Nk T Cell

The nasal NK/T cell lymphoma is a rare, extranodal non-Hodgkin lymphoma in western civilizations, which has poor prognosis. The Epstein–Barr virus can be detected in tumor cells in nearly all cases. There are no definite treatment guidelines in our days. There is no significant difference in survival between radiotherapy and chemotherapy according to Asian studies. In this case study we show our diagnostic procedures, our treatment options and we present the summary of this illness based on the data found in the literature.

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Personalized treatment options for chronic diseases using precision cohort analytics

Scientific Reports ◽

10.1038/s41598-021-80967-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kenney Ng ◽

Uri Kartoun ◽

Harry Stavropoulos ◽

John A. Zambrano ◽

Paul C. Tang

Keyword(s):

Decision Making ◽

Chronic Diseases ◽

Primary Care Physicians ◽

Treatment Guidelines ◽

Point Of Care ◽

Data Extraction ◽

Treatment Options ◽

Personalized Treatment ◽

Medical Decision ◽

Similarity Model

AbstractTo support point-of-care decision making by presenting outcomes of past treatment choices for cohorts of similar patients based on observational data from electronic health records (EHRs), a machine-learning precision cohort treatment option (PCTO) workflow consisting of (1) data extraction, (2) similarity model training, (3) precision cohort identification, and (4) treatment options analysis was developed. The similarity model is used to dynamically create a cohort of similar patients, to inform clinical decisions about an individual patient. The workflow was implemented using EHR data from a large health care provider for three different highly prevalent chronic diseases: hypertension (HTN), type 2 diabetes mellitus (T2DM), and hyperlipidemia (HL). A retrospective analysis demonstrated that treatment options with better outcomes were available for a majority of cases (75%, 74%, 85% for HTN, T2DM, HL, respectively). The models for HTN and T2DM were deployed in a pilot study with primary care physicians using it during clinic visits. A novel data-analytic workflow was developed to create patient-similarity models that dynamically generate personalized treatment insights at the point-of-care. By leveraging both knowledge-driven treatment guidelines and data-driven EHR data, physicians can incorporate real-world evidence in their medical decision-making process when considering treatment options for individual patients.

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Treatment options and long-term outcomes in pediatric spinal cord vascular malformations: a case report and review of the literature

Child s Nervous System ◽

10.1007/s00381-020-04624-4 ◽

2020 ◽

Vol 36 (12) ◽

pp. 3147-3152

Author(s):

Helen J. Zhang ◽

Nicole Silva ◽

Elena Solli ◽

Amanda C. Ayala ◽

Luke Tomycz ◽

...

Keyword(s):

Spinal Cord ◽

Case Report ◽

Vascular Malformations ◽

Treatment Options ◽

Review Of The Literature ◽

Long Term Outcomes

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130 Inspiring the future generation in Paediatrics during the pandemic – Great Ormond Street Hospital Summer School 2020

10.1136/leader-2020-fmlm.130 ◽

2020 ◽

Author(s):

Shuang Liu ◽

Jonathan Smith ◽

Abbie Tutt ◽

Justin Poisson ◽

Simon Blackburn ◽

...

Keyword(s):

Summer School ◽

Future Generation ◽

Street Hospital ◽

Great Ormond Street Hospital ◽

The Future

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Predictors of mortality in patients with hereditary hemorrhagic telangiectasia

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-020-01579-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

K. P. Thompson ◽

◽

J. Nelson ◽

H. Kim ◽

L. Pawlikowska ◽

...

Keyword(s):

Hereditary Hemorrhagic Telangiectasia ◽

Cox Regression ◽

Clinical Symptoms ◽

Vascular Malformations ◽

Smoking Status ◽

Treatment Options ◽

Gi Bleeding ◽

Cox Regression Analysis ◽

Predictors Of Mortality

Abstract Background Retrospective questionnaire and healthcare administrative data suggest reduced life expectancy in untreated hereditary hemorrhagic telangiectasia (HHT). Prospective data suggests similar mortality, to the general population, in Denmark’s centre-treated HHT patients. However, clinical phenotypes vary widely in HHT, likely affecting mortality. We aimed to measure predictors of mortality among centre-treated HHT patients. HHT patients were recruited at 14 HHT centres of the Brain Vascular Malformation Consortium (BVMC) since 2010 and followed annually. Vital status, organ vascular malformations (VMs) and clinical symptoms data were collected at baseline and during follow-up (N = 1286). We tested whether organ VMs, HHT symptoms and HHT genes were associated with increased mortality using Cox regression analysis, adjusting for patient age, sex, and smoking status. Results 59 deaths occurred over average follow-up time of 3.4 years (max 8.6 years). A history of anemia was associated with increased mortality (HR = 2.93, 95% CI 1.37–6.26, p = 0.006), as were gastro-intestinal (GI) bleeding (HR = 2.63, 95% CI 1.46–4.74, p = 0.001), and symptomatic liver VMs (HR = 2.10, 95% CI 1.15–3.84, p = 0.015). Brain VMs and pulmonary arteriovenous malformations (AVMs) were not associated with mortality (p > 0.05). Patients with SMAD4 mutation had significantly higher mortality (HR = 18.36, 95% CI 5.60–60.20, p < 0.001) compared to patients with ACVRL1 or ENG mutation, but this estimate is imprecise given the rarity of SMAD4 patients (n = 33, 4 deaths). Conclusions Chronic GI bleeding, anemia and symptomatic liver VMs are associated with increased mortality in HHT patients, independent of age, and in keeping with the limited treatment options for these aspects of HHT. Conversely, mortality does not appear to be associated with pulmonary AVMs or brain VMs, for which patients are routinely screened and treated preventatively at HHT Centres. This demonstrates the need for development of new therapies to treat chronic anemia, GI bleeding, and symptomatic liver VMs in order to reduce mortality among HHT patients.

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Pharmacological Treatment of Schizophrenia: Japanese Expert Consensus

Pharmacopsychiatry ◽

10.1055/a-1324-3517 ◽

2021 ◽

Author(s):

Hitoshi Sakurai ◽

Norio Yasui-Furukori ◽

Takefumi Suzuki ◽

Hiroyuki Uchida ◽

Hajime Baba ◽

...

Keyword(s):

Relapse Prevention ◽

Negative Symptoms ◽

Japanese Society ◽

Treatment Guidelines ◽

Treatment Options ◽

Standard Deviation Score ◽

Expert Consensus ◽

Depression And Anxiety ◽

First Line ◽

A Current

Abstract Introduction Conventional treatment guidelines of schizophrenia do not necessarily provide solutions on clinically important issues. Methods A total of 141 certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology evaluated treatment options regarding 19 clinically relevant situations in the treatment of schizophrenia with a 9-point scale (1=“disagree” and 9=“agree”). Results First-line antipsychotics varied depending on predominant symptoms: risperidone (mean±standard deviation score, 7.9±1.4), olanzapine (7.5±1.6), and aripiprazole (6.9±1.9) were more likely selected for positive symptoms; aripiprazole (7.6±1.6) for negative symptoms; aripiprazole (7.3±1.9), olanzapine (7.2±1.9), and quetiapine (6.9±1.9) for depression and anxiety; and olanzapine (7.9±1.5) and risperidone (7.5±1.5) for excitement and aggression. While only aripiprazole was categorized as a first-line treatment for relapse prevention (7.6±1.0) in patients without noticeable symptoms, aripiprazole (8.0±1.6) and brexpiprazole (6.9±2.3) were categorized as such for social integration. First-line treatments in patients who are vulnerable to extrapyramidal symptoms include quetiapine (7.5±2.0) and aripiprazole (6.9±2.1). Discussion These clinical recommendations represent the expert consensus on the use of a particular antipsychotic medication for a particular situation, filling a current gap in the literature.

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Establishment of a Pretreatment Nomogram to Predict the 6-Month Mortality Rate of Patients with Advanced Biliary Tract Cancers Undergoing Gemcitabine-Based Chemotherapy

Cancers ◽

10.3390/cancers13133139 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3139

Author(s):

Chiao-En Wu ◽

Wen-Kuan Huang ◽

Wen-Chi Chou ◽

Chia-Hsun Hsieh ◽

John Wen-Cheng Chang ◽

...

Keyword(s):

Liver Metastasis ◽

Mortality Rate ◽

Biliary Tract ◽

Mortality Risk ◽

Treatment Options ◽

Univariate Analysis ◽

Cytotoxic Agents ◽

Response To Treatment ◽

Tract Cancer ◽

Additional Information

Background: The estimation of mortality risk among patients diagnosed with advanced cancer provides important information for clinicians and patients in clinical practice. Currently, gemcitabine-based chemotherapy regimens are the standard treatment for patients with advanced biliary tract cancer (BTC). We aimed to develop a nomogram to predict the 6-month mortality rate among patients with advanced BTC to help physicians evaluate treatment options and outcomes. Patients: We conducted a retrospective analysis to evaluate the 6-month mortality rate among patients with advanced BTC who underwent gemcitabine-based chemotherapy from 2012 to 2018. Data regarding pretreatment factors and the clinical response to treatment were collected. Univariate and multivariate analyses were performed to identify independent factors for nomogram creation. Results: A total of 202 advanced BTC patients who were treated with gemcitabine-based chemotherapy were included in this analysis. No difference in survival was identified between patients undergoing gemcitabine monotherapy and those treated with gemcitabine combined with other cytotoxic agents. The univariate analysis revealed 10 significant factors, while the multivariate analysis identified four independent factors, including gender, monocyte to lymphocyte ratio (MLR), alkaline phosphatase (ALP), and liver metastasis, which were used to establish the nomogram. The performance of this nomogram for the prediction of 6-month mortality risk was found to be promising and feasible based on logistic regression. Conclusion: A nomogram based on four independent pretreatment factors, including gender, MLR, ALP, and liver metastasis, was established to predict the 6-month mortality risk in patients with advanced BTC; it can provide clinicians and patients with additional information when evaluating treatment outcomes.

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