Ustekinumab treatment for moderate to severe psoriasis. Eight-year real-world follow-up of 61 cases in a tertiary level hospital

Background and objectives: Breast cancer is among the most common cancer types encountered during pregnancy. Here, we aimed to describe the characteristics, management, and outcomes of women with pregnancy-associated breast cancer at a tertiary-level hospital in Romania. Material and Methods: We retrospectively and prospectively collected demographic, oncological, and obstetrical data for women diagnosed with cancer during pregnancy, and who elected to continue their pregnancy, between June 2012 and June 2020. Complete data were obtained regarding family and personal medical history and risks factors, cancer diagnosis and staging, clinical and pathological features (including histology and immunohistochemistry), multimodal cancer treatment, pregnancy management (fetal ultrasounds, childbirth, and postpartum data), and infant development and clinical evolution up to 2020. Cancer therapy was administered following national guidelines and institutional protocols and regimens developed for non-pregnant patients, including surgery and chemotherapy, while avoiding radiotherapy during pregnancy. Results: At diagnosis, 16.67% of patients were in an advanced/metastatic stage, while 75% were in early operable stages. However, the latter patients underwent neoadjuvant chemotherapy rather than up-front surgery due to aggressive tumor biology (triple negative, multifocal, or HER2+). No patient achieved complete pathological remission, but only one patient relapsed. No recurrence was recorded within 12 months among early-stage patients. Conclusions: In this contemporary assessment of real-world treatment patterns and outcomes among patients with pregnancy-associated breast cancer, our findings were generally consistent with globally observed treatment outcomes, underscoring the need for a multidisciplinary team and reference centers.

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Transverse Preputial Island Flap for Hypospedias Repair: A Study in A Tertiary Level Hospital

Bangladesh Journal of Urology ◽

10.3329/bju.v23i1.50288 ◽

2020 ◽

Vol 23 (1) ◽

pp. 43-47

Author(s):

Hafiz Al Asad ◽

Md Selim Morshed ◽

Tasnim Alam Manzer ◽

Abu Naser Md Lutful Hasan ◽

Zulfia Zinat Chowdhury ◽

...

Keyword(s):

Cosmetic Outcome ◽

Island Flap ◽

Tertiary Level ◽

Challenging Problem ◽

Penile Skin ◽

Urethrocutaneous Fistula ◽

Urethral Plate ◽

Age Range ◽

Level Hospital

Introduction: Hypospadias continues to be a challenging problem for reconstructive surgeon. As urethral plate preservation got an important role, transverse preputial island flap (TPIF) urethroplasty is one of the preferred technique for sub-coronal and distal penile hypospadius. Methods: This study was conducted at urology department, DMCH, from February, 2014 to June, 2017 where 15 patients underwent TPIF urethroplasty. Inner preputial flap with its pedicle was developed and separated from the dorsal penile skin which was sutured to the urethral plate in an onlay manner over a stent by running suture. Glanuloplasty and meatoplasty was done and skin closed.SPC was done in every cases. Dressing was checked on 5th POD, stent was removed after 03 weeks. SPC was removed 2 to 3 days after satisfactory voiding. All patients were followed up at 6th and 12th week. Results: Among the 15 patients age range was 2-14 years and mean age. Sub-coronal in 4 and distal penile was in 11 patients. Following TPIF urethroplasty wound disruption was noted in one patient for that glans closure was done successfully. There was no meatal stenosis and urethrocutaneous fistula in follow up. Regarding cosmetic outcome 12 were good, 2 were acceptable and 1 was poor. Conclusion: Success rate of TPIF urethroplasty in case of sub-coronal and distal penile hypospadias is excellent. Cosmetic outcome should be considered most challenging and with experience of surgeons this aspect will be improved. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.43-47

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Analysis of adolescent oncology cases from 2008 through 2018 in a tertiary-level hospital: an opportunity for improvement

Future Oncology ◽

10.2217/fon-2020-0475 ◽

2021 ◽

Author(s):

Domingo A Sánchez Martínez ◽

Marta Cañadilla-Ferreira ◽

Pilar Sánchez Henarejos ◽

José Luis Alonso Romero

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Retrospective Study ◽

Cancer Diagnosis ◽

Tertiary Level ◽

Cross Sectional ◽

Adolescent Patients ◽

Adolescent Oncology ◽

Level Hospital

Purpose: The purpose of this study was to disclose the variability of pathways currently taken in the treatment of adolescent patients from diagnosis to final follow-up with a view to developing a more homogenous system. Patients & methods: A cross-sectional, observational and retrospective study of the cancer diagnosis and assignment to medical care teams in adolescent patients (12–20 years) from January 2008 to December 2018 was conducted. A total of 345 adolescent patients aged between 12 and 20 years, diagnosed with cancer and treated at Hospital Clinico Universitario Virgen de la Arrixaca were included. Results: Central nervous system (CNS) tumors, followed by leukemia were the most frequent tumors. At the time of diagnosis, the highest incidences of patients were assisted in the pediatrics service adult oncology service (21.7%) and hematology (11%). Conclusion: Our aim is to highlight the need for a better transition for patients from pediatric to adult oncology and hematology services.

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928-P: Dulaglutide Has Higher Adherence and Persistence than Semaglutide and Exenatide QW: 6-Month Follow-Up from U.S. Real-World Data

Diabetes ◽

10.2337/db20-928-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 928-P

Author(s):

REEMA MODY ◽

MARIA YU ◽

BAL K. NEPAL ◽

MANIGE KONIG ◽

MICHAEL GRABNER

Keyword(s):

Real World ◽

Real World Data ◽

World Data ◽

Exenatide Qw

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Prior real-world experience influences non-linguistic statistical learning

10.31234/osf.io/yscn8 ◽

2020 ◽

Author(s):

Stephen Charles Van Hedger ◽

Ingrid Johnsrude ◽

Laura Batterink

Keyword(s):

Statistical Learning ◽

Real World ◽

Language Experience ◽

Pitch Range ◽

Test Items ◽

Instrument Measuring ◽

Statistical Regularities ◽

Context Free ◽

Specific Learning

Listeners are adept at extracting regularities from the environment, a process known as statistical learning (SL). SL has been generally assumed to be a form of “context-free” learning that occurs independently of prior knowledge, and SL experiments typically involve exposing participants to presumed novel regularities, such as repeating nonsense words. However, recent work has called this assumption into question, demonstrating that learners’ previous language experience can considerably influence SL performance. In the present experiment, we tested whether previous knowledge also shapes SL in a non-linguistic domain, using a paradigm that involves extracting regularities over tone sequences. Participants learned novel tone sequences, which consisted of pitch intervals not typically found in Western music. For one group of participants, the tone sequences used artificial, computerized instrument sounds. For the other group, the same tone sequences used familiar instrument sounds (piano or violin). Knowledge of the statistical regularities was assessed using both trained sounds (measuring specific learning) and sounds that differed in pitch range and/or instrument (measuring transfer learning). In a follow-up experiment, two additional testing sessions were administered to gauge retention of learning (one day and approximately one-week post-training). Compared to artificial instruments, training on sequences played by familiar instruments resulted in reduced correlations among test items, reflecting more idiosyncratic performance. Across all three testing sessions, learning of novel regularities presented with familiar instruments was worse compared to unfamiliar instruments, suggesting that prior exposure to music produced by familiar instruments interfered with new sequence learning. Overall, these results demonstrate that real-world experience influences SL in a non-linguistic domain, supporting the view that SL involves the continuous updating of existing representations, rather than the establishment of entirely novel ones.

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Current Practices and Challenges of Medical Services on Health Care System of Mandalay General Hospital

Myanmar Health Sciences Research Journal ◽

10.34299/mhsrj.00936 ◽

2019 ◽

Vol 31 (2) ◽

pp. 131

Keyword(s):

Health Care ◽

General Hospital ◽

Health Care Providers ◽

Quality Care ◽

Healthcare Providers ◽

Medical Services ◽

Tertiary Level ◽

Care Providers ◽

Level Hospital ◽

Care System

In Myanmar, the main challenge to provide quality healthcare by Universal Health Care approach is documented as low health services coverage with substantial wealth-based inequality. To achieve the effective health care system, strong medical care system is essential. Understanding on challenges and needs in provision of medical services among patients and health care providers is critical to provide quality care with desirable outcomes. The aim of the study was to explore the patients’ and health care providers’ perceptions on the challenges in provision of medical services at the Mandalay General Hospital. This was a qualitative study conducted at the tertiary level hospital (Mandalay General Hospital). The data was collected by using focus group discussions and in-depth interviews with hospitalized patients or attendants, healthcare providers such as medical doctors, nurses, laboratory scientists and hospital administrators in March 2017. The qualitative data was analyzed using themes by themes matrix analysis. Most patients were satisfied with the care provided by the doctors because they believed that they received quality care. However, some patients complained about long waiting time for elective operation, congested conditions in the ward, burden for investigations outside the hospital for urgent needs and impolite manners of general workers. Healthcare providers reported that they had heavy workload due to limited human and financial resources in the hospital, poor compliances with hospital rules and regulation among patients and attendants, and inefficient referral practices from other health facilities. Other challenges experienced by healthcare providers were lack of ongoing training to improve knowledge and skills, limited health infrastructure and inadequate medicinal supplies. The findings highlighted the areas needed to be improved to provide quality health care at the tertiary level hospital. The challenges and problems encountered in this hospital can be improved by allocating adequate financial and human resources. The systematic referral system and hospital management guidelines are needed to reduce workload of health staff.

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In-Hospital Outcomes of Patients with Acute Kidney Injury Following Acute Coronary Syndrome in a Tertiary level Hospital

Annals of International medical and Dental Research ◽

10.21276/aimdr.2019.5.6.me1 ◽

2019 ◽

Vol 5 (6) ◽

Author(s):

MSI Tipu Chowdhury ◽

Khaled Md. Iqbal ◽

Zahidul Mostafa ◽

Md. Fakhrul Islam Khaled ◽

Sadia Sultana ◽

...

Keyword(s):

Acute Kidney Injury ◽

Acute Coronary Syndrome ◽

Kidney Injury ◽

Tertiary Level ◽

Hospital Outcomes ◽

Coronary Syndrome ◽

Level Hospital

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Effectiveness of Dulaglutide in the Real World and in Special Populations of Type 2 Diabetic Patients

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa204 ◽

2020 ◽

Vol 105 (7) ◽

pp. e2617-e2625 ◽

Cited By ~ 1

Author(s):

Mario Luca Morieri ◽

Vera Frison ◽

Mauro Rigato ◽

Michele D’Ambrosio ◽

Federica Tadiotto ◽

...

Keyword(s):

Body Weight ◽

Real World ◽

Disease Duration ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Body Weight Reduction ◽

Background Population ◽

Glucagon Like Peptide 1

Abstract Context In randomized controlled trials (RCTs) on type 2 diabetes (T2D) patients, the glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-RA) dulaglutide reduced HbA1c and body weight, but generalizability of such findings to real-world T2D patients is challenging. Objective We evaluated effectiveness of dulaglutide in routine clinical practice, especially in subgroups of patient that are underrepresented in RCTs. Design Retrospective multicenter study. Setting Diabetes outpatient clinics. Patients and intervention All consecutive patients who initiated dulaglutide between 2015 and 2018. Main outcome measures Changes in HbA1c and body weight were assessed up to 30 months after baseline. Effectiveness was analyzed in patient subgroups according to: prior use of GLP-1RA, persistence on treatment and dose, age, sex, disease duration, renal function, obesity, cardiovascular disease, or concomitant use of insulin or sulphonylurea. Results From a background population of 83,116 patients, 2084 initiated dulaglutide (15.3% switching from another GLP-1RA), 1307 of whom had at least 1 follow-up visit. Overall, dulaglutide reduced HbA1c by 1.0% and body weight by 2.9 kg at the end of observation. These effects were more pronounced in GLP-1RA-naïve patients and in those with shorter disease duration. Improvement in HbA1c was highly significant and consistent across all subgroups, including those aged ≥ 75 years, nonobese, or with chronic kidney disease. Body weight declined in all subgroups and significantly more with the 1.5-mg versus 0.75-mg dose. Conclusions In real-world T2D patients, effectiveness of dulaglutide on HbA1c and body weight reduction was highly consistent and significant even in subgroups of patients poorly represented in RCTs.

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Real-World Outcomes of Ivacaftor Treatment in People with Cystic Fibrosis: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10071527 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1527

Author(s):

Jamie Duckers ◽

Beth Lesher ◽

Teja Thorat ◽

Eleanor Lucas ◽

Lisa J. McGarry ◽

...

Keyword(s):

Systematic Review ◽

Cystic Fibrosis ◽

Real World ◽

Safety Profile ◽

Clinical Trial Data ◽

Patient Characteristics ◽

Healthcare Resource Utilization ◽

Patient Reported ◽

Clinical Benefits

Cystic fibrosis (CF) is a rare, progressive, multi-organ genetic disease. Ivacaftor, a small-molecule CF transmembrane conductance regulator modulator, was the first medication to treat the underlying cause of CF. Since its approval, real-world clinical experience on the use of ivacaftor has been documented in large registries and smaller studies. Here, we systematically review data from real-world observational studies of ivacaftor treatment in people with CF (pwCF). Searches of MEDLINE and Embase identified 368 publications reporting real-world studies that enrolled six or more pwCF treated with ivacaftor published between January 2012 and September 2019. Overall, 75 publications providing data from 57 unique studies met inclusion criteria and were reviewed. Studies reporting within-group change for pwCF treated with ivacaftor consistently showed improvements in lung function, nutritional parameters, and patient-reported respiratory and sino-nasal symptoms. Benefits were evident as early as 1 month following ivacaftor initiation and were sustained over long-term follow-up. Decreases in pulmonary exacerbations, Pseudomonas aeruginosa prevalence, and healthcare resource utilization also were reported for up to 66 months following ivacaftor initiation. In studies comparing ivacaftor treatment to modulator untreated comparator groups, clinical benefits similarly were reported as were decreases in mortality, organ-transplantation, and CF-related complications. The safety profile of ivacaftor observed in these real-world studies was consistent with the well-established safety profile based on clinical trial data. Our systematic review of real-world studies shows ivacaftor treatment in pwCF results in highly consistent and sustained clinical benefit in both pulmonary and non-pulmonary outcomes across various geographies, study designs, patient characteristics, and follow-up durations, confirming and expanding upon evidence from clinical trials.

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Real-World Experience with Bezlotoxumab for Prevention of Recurrence of Clostridioides difficile Infection

Journal of Clinical Medicine ◽

10.3390/jcm10010002 ◽

2020 ◽

Vol 10 (1) ◽

pp. 2

Author(s):

Rosa Escudero-Sánchez ◽

María Ruíz-Ruizgómez ◽

Jorge Fernández-Fradejas ◽

Sergio García Fernández ◽

María Olmedo Samperio ◽

...

Keyword(s):

Clinical Trials ◽

Real World ◽

Recurrence Rates ◽

Factors Associated ◽

Clostridioides Difficile ◽

Multicentre Cohort Study ◽

Clostridioides Difficile Infection ◽

Prevention Of Recurrence ◽

Multicentre Cohort

Bezlotoxumab is marketed for the prevention of recurrent Clostridioides difficile infection (rCDI). Its high cost could be determining its prescription to a different population than that represented in clinical trials. The objective of the study was to verify the effectiveness and safety of bezlotoxumab in preventing rCDI and to investigate factors related to bezlotoxumab failure in the real world. A retrospective, multicentre cohort study of patients treated with bezlotoxumab in Spain was conducted. We compared the characteristics of cohort patients with those of patients treated with bezlotoxumab in the pivotal MODIFY trials. We assessed recurrence rates 12 weeks after completion of treatment against C. difficile, and we analysed the factors associated with bezlotoxumab failure. Ninety-one patients were included in the study. The cohort presented with more risk factors for rCDI than the patients included in the MODIFY trials. Thirteen (14.2%) developed rCDI at 12 weeks of follow-up, and rCDI rates were numerically higher in patients with two or more previous episodes (25%) than in those who had fewer than two previous episodes of C. difficile infection (CDI) (10.4%); p = 0.09. There were no adverse effects attributable to bezlotoxumab. Despite being used in a more compromised population than that represented in clinical trials, we confirm the effectiveness of bezlotoxumab for the prevention of rCDI.

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