MP33-15 SHOULD MEN WITH POOR RESULTS AFTER TWO SERIES OF COLLAGENASE INJECTIONS FOR PEYRONIEʼS DISEASE CONTINUE THERAPY?

Abstract Introduction In TRED-HF, 40% of patients with recovered dilated cardiomyopathy (DCM) relapsed in the short-term during phased withdrawal of drug therapy. Non-invasive markers of relapse may be used to monitor patients who wish a trial of therapy withdrawal and provide insights into the pathophysiological drivers of relapse. Purpose To investigate the relationship between changes in heart rate (HR) and relapse amongst patients with recovered DCM undergoing therapy withdrawal in TRED-HF. Methods Patients with recovered DCM were randomised to phased withdrawal of therapy or to continue therapy for 6 months. After 6 months of continued therapy, those in the control arm underwent withdrawal of therapy in a single arm crossover phase. HR was measured at each study visit. Mean HR and 95% confidence intervals (CI) were calculated at baseline, 45 days after baseline, 45 days prior to the end of the study or relapse and at the end of the study or relapse. Patients were stratified by treatment arm and the occurrence of the primary relapse end-point. Heart rate at follow-up was compared amongst patients who had therapy withdrawn and relapsed versus those who had therapy withdrawn and did not. ANCOVA was used to adjust for differences in HR at baseline between the two groups. Results Of 51 patients randomised, 26 were assigned to continue therapy and 25 to withdraw therapy. In the randomised and cross-over phases, 20 patients met the primary relapse end-point; one patient withdrew from the study and one patient completed follow-up in the control arm but did not enter the cross-over phase. Mean HR (standard deviation) at baseline and follow-up for (i) patients in the control arm was 69.9 (9.8) & 65.9 (9.1) respectively; (ii) for those who had therapy withdrawn and did not relapse was 64.6 (10.7) & 74.7 (10.4) respectively; and (iii) for those who had therapy withdrawn and relapsed was 68.3 (11.3) & 86.1 (11.8) respectively [all beats per minute]. The mean change in HR between the penultimate visit and the final visit for those who had therapy withdrawn and did not relapse was −2.4 (9.7) compared to 3.1 (15.5) for those who relapsed. After adjusting for differences in HR at baseline, the mean difference in HR measured at follow-up between patients who underwent therapy withdrawal and did, and did not relapse was 10.4bpm (95% CI 4.0–16.8; p=0.002) (Figure 1 & Table 1). Conclusion(s) A larger increase in HR may be a simple and effective marker of relapse for patients with recovered DCM who have insisted on a trial of therapy withdrawal. Whether HR control is crucial to the maintenance of remission amongst patients with improved cardiac function, or is simply a marker of deteriorating cardiac function, warrants further investigation. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation

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Percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children: Is it effective?

African Journal of Urology ◽

10.1186/s12301-019-0009-y ◽

2019 ◽

Vol 25 (1) ◽

Cited By ~ 1

Author(s):

Hisham Ibrahim ◽

Ahmed Mahmoud Shouman ◽

Waseem Ela ◽

Waleed Ghoneima ◽

Ahmed Ismail Shoukry ◽

...

Keyword(s):

Overactive Bladder ◽

Nerve Stimulation ◽

Tibial Nerve ◽

Symptomatic Improvement ◽

Posterior Tibial Nerve ◽

Posterior Tibial Nerve Stimulation ◽

Therapeutic Success ◽

Posterior Tibial ◽

Tibial Nerve Stimulation ◽

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Abstract Background To assess the efficacy and durability of percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children. Results Twenty patients with a mean age of 7 ± 3.3 years were included in the study. Subjective success was found in 12 patients (60%) who considered their situation to be better and requested to continue therapy to maintain the response which was considered as a therapeutic success, while eight patients (40%) patients chose not to continue therapy because they did not have symptomatic improvement. Conclusion Posterior tibial nerve stimulation is an effective, minimally invasive method for treatment and is easily applied to induce improvement in overactive bladder symptoms and objective urodynamic changes with negligible side effects.

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Treatment with cyclophosphamide i.v. pulse therapy is an option for effective treatment of skin fibrosis in patients with early systemic sclerosis

Rheumatology ◽

10.1093/rheumatology/kez487 ◽

2019 ◽

Vol 59 (7) ◽

pp. 1550-1555 ◽

Cited By ~ 2

Author(s):

Brigit E Kersten ◽

Nathan den Broeder ◽

Frank H J van den Hoogen ◽

Hanneke A K Knaapen-Hans ◽

Cornelia H M van den Ende ◽

...

Keyword(s):

Effective Treatment ◽

Pulse Therapy ◽

Shared Decision ◽

Regression Analyses ◽

Effective Treatment Option ◽

Internal Organs ◽

Modified Rodnan Skin Score ◽

Baseline Characteristics ◽

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Early Systemic Sclerosis

Abstract Objectives SSc is a autoimmune disease characterized by fibrosis of the skin and internal organs. There is a lack of evidence for the efficacy of i.v. CYC pulse therapy on skin thickening. We aimed to examine the response of i.v. CYC pulse therapy on skin thickening in our cohort of SSc patients and analysed factors that predict this response. Methods We retrospectively evaluated the data for 143 patients with SSc from baseline to 12, 24 and 36 months. All patients were treated with at least 6 i.v. CYC pulses (750 mg/m2/month). We applied the modified Rodnan Skin Score (mRSS) to assess skin thickening. A clinically relevant response was defined as a decrease in mRSS of 5 points and 25% from baseline. Different baseline variables for predicting response on month 12 were tested in logistic regression analyses. Results Baseline characteristics of the patients with dcSSc and lcSSc were collected. Forty-three percent (n = 42) of dcSSc patients had a clinically relevant response on month 12. Non-responding on month 6 predicts non-response on month 12 (odds ratio 37.1; 95% CI 4.5, 306.4). Conclusion We concluded that i.v. CYC pulse therapy should be considered as an effective treatment option for skin thickening in dcSSc patients, because 43% of this group of patients were found to have a clinically relevant response. Of the dcSSC patients who did not respond by month 6, only 29% had a response by month 12. This finding can help the physician and patient in shared decision making about whether or not to continue therapy.

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013 Should Men with Poor Results After Two Series of Collagenase Injections for Peyronie’s Disease Continue Therapy?

Journal of Sexual Medicine ◽

10.1016/j.jsxm.2019.11.016 ◽

2020 ◽

Vol 17 (1) ◽

pp. S6

Author(s):

M. Alom ◽

K. Sharma ◽

M. Ziegelmann ◽

J. Savage ◽

T. Kohler ◽

...

Keyword(s):

Peyronie’S Disease ◽

Peyronie's Disease ◽

Continue Therapy

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A Preliminary Report on the Use of Clomipramine in General Practice

Scottish Medical Journal ◽

10.1177/00369330750200s114 ◽

1975 ◽

Vol 20 (1_suppl) ◽

pp. 67-71 ◽

Cited By ~ 3

Author(s):

L. W. Wootton ◽

R. I. Bailey

Keyword(s):

General Practice ◽

Side Effects ◽

Combined Treatment ◽

Clinical Situation ◽

Illustrative Case ◽

Case Histories ◽

Drug Induced ◽

Practice Population ◽

History Of ◽

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The use of clomipramine in a large suburban general practice is reviewed. Three hundred and fifty patients have been treated to date out of a total practice population of twenty-one thousand. It is argued that phobic anxiety states are much commoner than is normally supposed and that they are usually associated with a history of separation or rejection in childhood. A combined treatment regime is employed for one month thereafter clomipramine alone is used. Side-effects may initially present a problem although they may not all be truly drug induced. Some patients use side-effects to manipulate the clinical situation. However proper interpretative management of side effects can assist the clinicians in persuading patients to continue therapy. Some impressive results have been obtained with clomipramine therapy. Illustrative case histories are provided.

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Ten-day decitabine with venetoclax (DEC10-VEN) in AML and high-risk (HR) MDS.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7519 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7519-7519 ◽

Cited By ~ 3

Author(s):

Abhishek Maiti ◽

Courtney Denton Dinardo ◽

Naveen Pemmaraju ◽

Tapan M. Kadia ◽

Caitlin R Rausch ◽

...

Keyword(s):

Tumor Lysis Syndrome ◽

Primary Objective ◽

Prior Therapy ◽

Treatment Naïve ◽

Previously Treated ◽

Ecog Ps ◽

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Clinical Trial Information ◽

Count Recovery

7519 Background: VEN-based low intensity regimens have shown promise in older pts with newly diagnosed (ND) AML. We hypothesized that adding VEN to 10-day (d) DEC may improve outcomes in AML and HR MDS. Methods: Pts received VEN 400 mg daily or equivalent with DEC 20 mg/m2 for 10d every 4-8 weeks for induction and DEC 5d with VEN for consolidation after CR/CRi. If cycle 1 day 21 bone marrow showed ≤5% blasts, VEN was held to enable count recovery. VEN duration could be further reduced for myelosuppression. FLT3 and IDH inhibitors were allowed for applicable pts. All pts received tumor lysis syndrome (TLS) prophylaxis. Primary objective was overall response rate (ORR). Secondary objectives were safety and overall survival (OS). Data cut-off date was February 6, 2020. Results: Between January 2018 and December 2019 we enrolled 184 pts with ND AML (>60 yrs), untreated secondary AML (sAML), treated sAML, relapsed/refractory (R/R) AML and HR MDS (Table). 58% pts were ≥70 yrs, 30% pts had ECOG PS ≥2, 67% pts had ELN adverse risk AML. Previously treated pts (n=96) had received a median of 1 prior therapy (range 1-8) including HMA (62), intensive chemotherapy (49) and stem cell transplantation (SCT, 27). 30d mortality was 3.3% and 60d mortality was 7.6%. 30d mortality in ND AML was 1.4%. Most common G3/4 adverse events were infections with G3/4 neutropenia (46%), febrile neutropenia (28%), infections with ANC ≥1x109/L (6%) and TLS (3%). Outcomes are shown in Table. 25 pts (14%) proceeded to SCT including treatment naive AML (ND+ untreated sAML, 12), previously treated AML (treated sAML + R/R, 11) and HR MDS (2). 100d post-SCT mortality was 4%. Median OS in treatment naïve AML pts undergoing SCT was not reached (1yr OS 100%) and for previously treated AML pts was 22.1 months (mo). After a median follow up of 15 mos, 25% PTS continue therapy. Additional analyses by molecular subgroups will be presented. Conclusions: DEC10-VEN is safe and highly effective in ND AML and can serve as an effective bridge to SCT in previously treated pts. Trial continues to accrue (NCT03404193). Clinical trial information: NCT03404193 . [Table: see text]

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Psychiatric, psychological and ethical determinants of the phenomenon of self-stigmatization of mental illness – literature review

Current Problems of Psychiatry ◽

10.2478/cpp-2020-0006 ◽

2020 ◽

Vol 21 (2) ◽

pp. 59-69

Author(s):

Ewelina Soroka ◽

Marian Zdzisław Stepulak

Keyword(s):

Mental Illness ◽

Literature Review ◽

Present Article ◽

Moral Obligation ◽

Psychiatric Patients ◽

Topical Issue ◽

Negative Stereotypes ◽

Stigma Of Mental Illness ◽

Psychological Assistance ◽

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AbstractIntroduction: In psychiatry and psychology stigmatization consists in labelling a person suffering from a disorder with the stigma of mental illness, associated with numerous negative stereotypes that are established in both individual and social mentality.Objective: The aim of the present article is to present the phenomenon of self-stigma from the perspective of psychiatric patients, including patients suffering from schizophrenia, to scientific consideration.The state of knowledge: The available data on this subject suggests that schizophrenia is particularly stigmatized, and the degree of stigmatization of patients with this diagnosis is worsening. Self-stigma plays a significant role in various areas of patients’ lives, sometimes discouraging them to continue therapy. Psychiatric patients have to face not only the symptoms of their disorders, but also stigmatization. In the event patient’s self-stigmatization of mental illness occurs, a responsible psychiatrist and psychologist conducting the therapy has the moral obligation to supervise the process of psychiatric and psychological assistance in the context of the aforelisted issues.Conclusions: The problem of self-stigmatization of a psychiatric patients is a topical issue that is well worth further exploration in order to better understand and help patients more effectively.

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Hepatosplenic candidiasis--a contraindication to marrow transplantation?

Blood ◽

10.1182/blood.v84.8.2811.bloodjournal8482811 ◽

1994 ◽

Vol 84 (8) ◽

pp. 2811-2814

Author(s):

JW Bjerke ◽

JD Meyers ◽

RA Bowden

Keyword(s):

Amphotericin B ◽

Marrow Transplant ◽

Fungal Species ◽

Ct Scans ◽

Prior History ◽

Absolute Contraindication ◽

Before And After ◽

History Of ◽

Hepatosplenic Candidiasis ◽

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To determine whether a prior history of hepatosplenic candidiasis resulted in increased Candida-associated morbidity and mortality after marrow transplant, 15 consecutive patients with biopsy-proven hepatosplenic candidiasis were observed prospectively. All patients received amphotericin B before transplant. Amphotericin B was continued at a dose of 0.5 mg/kg/day from conditioning through marrow engraftment, at which time it was discontinued if computerized tomography (CT) evidence of disease was stable or improved. Patients were observed for progression of candidiasis for the first 100 days after transplant. The amount and duration of antifungal therapy received before transplant varied widely. The majority of patients (73%) had persistently abnormal CT scans before transplant. After transplant, 3 of 15 died (20%) with evidence of fungal disease, although fungal species differed from those diagnosed pretransplant, compared with a historical mortality rate of 90% in posttransplant patients with documented hepatosplenic candida. Comparison CT scans obtained before and after transplant showed improvement in 9 of 15 (60%), complete resolution in 2 of 15 (13%), and none showed progression. We conclude that hepatosplenic candidiasis is not an absolute contraindication to marrow transplant when patients receive amphotericin B therapy before transplant and continue therapy until engraftment is established.

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Primary laryngeal tuberculosis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191749 ◽

2019 ◽

Vol 5 (3) ◽

pp. 777

Author(s):

Aditya Brahmono ◽

Nyilo Purnami ◽

Muhtarum Yusuf

Keyword(s):

Fiber Optic ◽

Intensive Therapy ◽

Systemic Symptom ◽

Chain Reaction ◽

Common Causes ◽

Polymerase Chain ◽

Microlaryngeal Surgery ◽

Histopathology Examination ◽

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Laryngeal Tuberculosis

Primary laryngeal tuberculosis (TB) is a very rare disease that became the most common causes of granuloma disease in the larynx. The manifestasion of tuberculosis on the laryngeal is commonly local without systemic symptom. This case reported was 21 year old male that complained of hoarseness for 6 months. The results of the fiber optic laryngoscopy (FOL) is generally believed a papilloma of the larynx. Biopsy extraction with microlaryngeal surgery was a mandatory procedure that apparently showing an overview of TB based on the results of histopathology and polymerase chain reaction (PCR). Anti-tuberculosis drugs were given to the patients, the evaluation carried out six months after the patient obtain intensive therapy and continue therapy with good result. Due to the non spesific laryngeal sign that was observed on clinical examination, clinicians must consider the possibility of primary laryngeal tuberculosis. Biopsy the lession on larynx continued with histopathology examination must not hesitate to confirm the diagnosis. PCR can be considered the better way to detect the TB bacteria. <p> </p>

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