scholarly journals Safety of procuring research tissue during a clinically indicated kidney biopsy from patients with lupus: data from the Accelerating Medicines Partnership RA/SLE Network

2021 ◽  
Vol 8 (1) ◽  
pp. e000522
Author(s):  
Kristina K Deonaraine ◽  
Philip M Carlucci ◽  
Andrea Fava ◽  
Jessica Li ◽  
David Wofsy ◽  
...  
Keyword(s):  
Complete Remission ◽  
Kidney Biopsy ◽  
National Institutes Of Health ◽  
New Drugs ◽  
Health Reporting ◽  
Complication Risk ◽  
Targeted Treatments ◽  
Remission Rates ◽  
The Usa ◽  
The Mean

ObjectivesIn lupus nephritis the pathological diagnosis from tissue retrieved during kidney biopsy drives treatment and management. Despite recent approval of new drugs, complete remission rates remain well under aspirational levels, necessitating identification of new therapeutic targets by greater dissection of the pathways to tissue inflammation and injury. This study assessed the safety of kidney biopsies in patients with SLE enrolled in the Accelerating Medicines Partnership, a consortium formed to molecularly deconstruct nephritis.Methods475 patients with SLE across 15 clinical sites in the USA consented to obtain tissue for research purposes during a clinically indicated kidney biopsy. Adverse events (AEs) were documented for 30 days following the procedure and were determined to be related or unrelated by all site investigators. Serious AEs were defined according to the National Institutes of Health reporting guidelines.Results34 patients (7.2%) experienced a procedure-related AE: 30 with haematoma, 2 with jets, 1 with pain and 1 with an arteriovenous fistula. Eighteen (3.8%) experienced a serious AE requiring hospitalisation; four patients (0.8%) required a blood transfusion related to the kidney biopsy. At one site where the number of cores retrieved during the biopsy was recorded, the mean was 3.4 for those who experienced a related AE (n=9) and 3.07 for those who did not experience any AE (n=140). All related AEs resolved.ConclusionsProcurement of research tissue should be considered feasible, accompanied by a complication risk likely no greater than that incurred for standard clinical purposes. In the quest for targeted treatments personalised based on molecular findings, enhanced diagnostics beyond histology will likely be required.

The Study of Efficacy of Excimer Light 308 Nanometers for Chronic Hand Dermatitis

2021 ◽  
Vol 104 (1) ◽  
pp. 32-37
Keyword(s):  
Complete Remission ◽  
Adverse Effects ◽  
Burning Sensation ◽  
Hand Dermatitis ◽  
Dermatological Disease ◽  
Significant Difference ◽  
Remission Rates ◽  
Severe Group ◽  
Melanin Index ◽  
The Mean

Background: Chronic hand dermatitis is one of the most common dermatological disease worldwide resulting from high incidence, prevalence, and recurrent rate. Nowadays, there are various kinds of treatments in chronic hand dermatitis. The previous studies only consisted of prospective non-randomized pilot study and retrospective cohort study of 308 nanometers excimer devices in chronic hand dermatitis. Objective: To study the efficacy and side effect of the excimer light 308 nanometer in chronic hand dermatitis. Materials and Methods: The researchers conducted a prospective non-randomized clinical trial to study the efficacy of 308 nanometers excimer light to treat chronic hand dermatitis. Thirty-five patients were enrolled in the eight weeks protocol. The efficacy of device was assessed by the HECSI, the PGA score, the erythema index by Mexameter MX16, and the NRS for pruritus level. In addition, the adverse effect of changing melanin index was assessed by the Mexameter MX16. The researchers also assessed the DLQI and the patient’s satisfaction score. Results: The results revealed that the mean of the HECSI, PGA, NRS, and erythema index were statistically significantly decreased after complete treatment (p<0.001). The result of subgroup analysis of percent of complete remission rates were 88.89 in mild group, 83.33 in moderate group, and 42.86 in severe group, which was statistically significant (p=0.029). In addition, the complete remission rates of pruritus were 88.89 in the mild group, 94.44 in the moderate group, and 57.14 in the severe group, and there was no statistically significant difference between the groups (p=0.21). On the other hand, the mean of melanin index demonstrated no statistically significant change in palmar and dorsal side of both hands (p=0.79, 0.57, 0.78, and 0.07, respectively). Furthermore, the DLQI was also statistically significantly improved (p<0.001), and the patients were very satisfied to the treatment. The adverse effects, which included burning sensation, skin dryness, and progressive itchiness, were observed (5.88, 5.88, and 8.82%, respectively) and spontaneously resolved within 24 hours without clinical skin change. Conclusion: The excimer light 308 nanometers is the alternative treatment of chronic hand dermatitis by reducing the severity score statistically significantly without hyperpigmentation after treatment. Mild adverse effects such as itchiness, dry skin, and burning sensation without major adverse event were observed. Keywords: Excimer light, Chronic hand dermatitis

scholarly journals Review of Treatment Options for the Management of Advanced Stage Hodgkin Lymphoma

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3745
Author(s):  
Hélène Vellemans ◽  
Marc P. E. André
Keyword(s):  
Hodgkin Lymphoma ◽  
New Drugs ◽  
Western World ◽  
Tumor Control ◽  
Advanced Stage ◽  
Line Treatment ◽  
First Line ◽  
Remission Rates ◽  
The Impact ◽  
First Line Treatment

Hodgkin lymphoma (HL) is a lymphoid-type hematologic disease that is derived from B cells. The incidence of this lymphoid malignancy is around 2–3/100,000/year in the western world. Long-term remission rates are linked to a risk-adapted approach, which allows remission rates higher than 80%. The first-line treatment for advanced stage classical HL (cHL) widely used today is doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) or escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPesc) chemotherapy. Randomized studies comparing these two regimens and a recently performed meta-analysis have demonstrated consistently better disease control with BEACOPPesc. However, this treatment is not the standard of care, as there is an excess of acute hematological toxicities and therapy-related myeloid neoplasms. Moreover, there is a recurrent controversy concerning the impact on overall survival with this regimen. More recently, new drugs such as brentuximab vedotin and checkpoint inhibitors have become available and have been evaluated in combination with doxorubicin, vinblastine, and dacarbazine (AVD) for the first-line treatment of patients with advanced cHL with the objective of tumor control improvement. There are still major debates with respect to first-line treatment of advanced cHL. The use of positron emission tomography-adapted strategies has allowed a reduction in the toxicity of chemotherapy regimens. Incorporation of new drugs into the treatment algorithms requires confirmation.

scholarly journals Hemodynamic Status During Endovascular Stroke Treatment: Association of Blood Pressure with Functional Outcome

2021 ◽  
Author(s):  
Min Chen ◽  
Dorothea Kronsteiner ◽  
Johannes Pfaff ◽  
Simon Schieber ◽  
Laura Jäger ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Standard Deviation ◽  
Functional Outcome ◽  
Scale Score ◽  
Endovascular Therapy ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
The Mean

Abstract Background Optimal blood pressure (BP) management during endovascular stroke treatment in patients with large-vessel occlusion is not well established. We aimed to investigate associations of BP during different phases of endovascular therapy with reperfusion and functional outcome. Methods We performed a post hoc analysis of a single-center prospective study that evaluated a new simplified procedural sedation standard during endovascular therapy (Keep Evaluating Protocol Simplification in Managing Periinterventional Light Sedation for Endovascular Stroke Treatment). BP during endovascular therapy in patients was managed according to protocol. Data from four different phases (baseline, pre-recanalization, post recanalization, and post intervention) were obtained, and mean BP values, as well as changes in BP between different phases and reductions in systolic BP (SBP) and mean arterial pressure (MAP) from baseline to pre-recanalization, were used as exposure variables. The main outcome was a modified Rankin Scale score of 0–2 three months after admission. Secondary outcomes were successful reperfusion and change in the National Institutes of Health Stroke Scale score after 24 h. Multivariable linear and logistic regression models were used for statistical analysis. Results Functional outcomes were analyzed in 139 patients with successful reperfusion (defined as thrombolysis in cerebral infarction grade 2b–3). The mean (standard deviation) age was 76 (10.9) years, the mean (standard deviation) National Institutes of Health Stroke Scale score was 14.3 (7.5), and 70 (43.5%) patients had a left-sided vessel occlusion. Favorable functional outcome (modified Rankin Scale score 0–2) was less likely with every 10-mm Hg increase in baseline (odds ratio [OR] 0.76, P = 0.04) and pre-recanalization (OR 0.65, P = 0.011) SBP. This was also found for baseline (OR 0.76, P = 0.05) and pre-recanalization MAP (OR 0.66, P = 0.03). The maximum Youden index in a receiver operating characteristics analysis revealed an SBP of 163 mm Hg and MAP of 117 mm Hg as discriminatory thresholds during the pre-recanalization phase to predict functional outcome. Conclusions In our protocol-based setting, intraprocedural pre-recanalization BP reductions during endovascular therapy were not associated with functional outcome. However, higher intraprocedural pre-recanalization SBP and MAP were associated with worse functional outcome. Prospective randomized controlled studies are needed to determine whether BP is a feasible treatment target for the modification of outcomes.

scholarly journals Costs per Treatment Phase for AML Patients Receiving High-Dose Chemoterapy in Sweden

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2154-2154
Author(s):  
Emma Hernlund ◽  
Josefine Redig ◽  
Åsa Rangert Derolf ◽  
Bjorn Paulsson ◽  
Martin Höglund ◽  
...  
Keyword(s):  
Complete Remission ◽  
Resource Use ◽  
Treatment Phase ◽  
High Dose ◽  
Curative Intent ◽  
Swedish Cancer Registry ◽  
The Mean ◽  
Mean Cost ◽  
First Admission

Introduction: AML affects all ages with an incidence rate of 5 per 100,000, but is much more frequent in older population. The overall lifetime risk of AML is estimated to be 0.5-1%. Long-term overall survival in younger (age < 60 years) is about 50%, but much worse among older population. Although AML therapy is one of the most resource-intensive cancer treatments, there are few estimates of the resource use and economic burden by treatment phase. Methods: This study was a retrospective database study performed on Swedish national data. Adult patients (age ≥18 years) diagnosed with AML in Sweden between 2007 and 2015 were identified in the Swedish Cancer Registry, along with vital status. Data on resource use were collected from national registers for inpatient- and outpatient specialized care and prescribed drugs. Information on diagnostics and treatment was accessed from the Swedish national AML Registry (SwAMLR). Data on sick leave (SL) and early retirement (ER) came from the Swedish Social Insurance Agency (absent days costed with the mean salary in Sweden). Hospital care resource use was costed using diagnosis-related group (DRG) remunerations, and include cost of inpatient drugs. The mean cost from the defined start of the treatment phase until the end of the treatment phase was divided by the mean number of days for the corresponding treatment phase to estimate the mean cost per day. The defined treatment phases were restricted to a maximum of 5 years. All costs are represented in US$. Results: Of the 2,954 patients identified in the Swedish Cancer Registry, 1,772 patients with a median age of 64 years were identified in the SwAMLR as fit for receiving high-dose chemotherapy . Of these, 1,243 were recorded with both curative intent of treatment and dates for achieving complete remission. Mean costs from the first AML-related hospital admission until the date of complete remission amount to $27,244. The mean number of days for the corresponding period were 45.16, resulting in a mean cost per day of $603 from first admission to first complete remission. The corresponding cost per day for patients recorded with curative intent but no complete remission (n=428) are $494. Time was counted from first AML-related admission until 90 days after first admission, or SCT or death, whichever occurred first. Costs after complete remission to either relapse, SCT, death or re-induction (n=1,237) amount to $50,793 for a mean of 438.63 days ($116/day). This treatment phase includes long-term survivors, whereas the costs from SCT, relapse or re-induction are not included. From relapse to death, the total cost is almost twofold for patients with re-induction (n=350) compared to palliative treatment (n=254). Cost per day amount to $179 for patients with palliative treatment and $256 for patients with re-induction treatment, respectively. The cost per day from date of SCT to death (n=511) is estimated to $192, incurred over a long period of time (mean number of days 844.02). The age of transplant recipients ranged between 18-71 years, with a median of 52 years. Conclusions: Costs of AML up to remission are feasible to estimate through DRG-costing methods, and studies have shown these costs are intense. Indeed this study shows that the highest cost per day is observed from first admission to complete remission. In addition results from our study show that there are high costs incurred also in the long-term, i.e. after remission. Of the included treatment phases the total cost from date of SCT to death is the largest, amounting to over $160,000. Approximately 20% are due to SL/ER, which is the second largest cost component after inpatient costs accounting for 60% of the total costs. Table. Disclosures Hernlund: ICON: Employment. Redig:ICON: Employment. Paulsson:Novartis: Employment. Vertuani:Novartis: Employment.

scholarly journals Adjuvant treatment of colorectal cancer

2002 ◽  
Vol 49 (2) ◽  
pp. 15-18
Author(s):  
J.A. Wils
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Treatment ◽  
Large Scale ◽  
New Drugs ◽  
Morbidity And Mortality ◽  
The Past ◽  
The Future ◽  
The Usa

Colorectal cancer is a leading cause of morbidity and mortality, with approximately 300,000 new cases and 200,000 related deaths in Europe and the USA each year. Adjuvant treatment of colorectal cancer is now widely accepted and can reduce mortality with approximately 10%. This can be considered as one of the major achievements in oncology from the past decade. Current results will be discussed and strategies for the future will be outlined, including on-going or planned large-scale trials with new drugs and approaches.

scholarly journals Correlation of neutrophil-to-lymphocyte ratio and clinical outcome of acute thrombotic stroke in patients with COVID-19

Narra J ◽  
2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Rizky Sarengat ◽  
Mohammad S. Islam ◽  
Mohammad S. Ardhi
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
National Institutes Of Health ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Lymphocyte Ratio ◽  
Life Threatening ◽  
The Mean

The coronavirus disease 2019 (COVID-19) pandemic has caused millions of deaths worldwide. Acute ischemic stroke is a life-threatening risk factor for COVID-19 infection. Neutrophil-to-lymphocyte ratio (NLR) is one of the predictors of poor prognosis in acute ischemic stroke. The aim of this study was to assess the correlation between NLR values and the clinical outcome of acute thrombotic stroke patients with COVID-19 that was measured using the National Institutes of Health Stroke Scale (NIHSS). A cross-sectional hospital-based study was conducted in Dr. Soetomo General Hospital Surabaya, Indonesia. Patients with acute thrombotic stroke and COVID-19 admitted between 1 March 2020 and 31 May 2021 were recruited. The NLR values and the NIHSS scores were assessed during the admission and the correlation between NLR and NIHSS scores was calculated. This study included 21 patients with acute thrombotic stroke and COVID-19, consisting of 12 males and 9 females. The mean age was 57.6 years old. The mean NLR values was 8.33±6.7 and the NIHSS scores ranging from 1 to 33. Our data suggested a positive correlation between NLR values and NIHSS scores, r=0.45 with p=0.041. In conclusion, the NLR value is potentially to be used as a predictor of the clinical outcome in acute thrombotic stroke patients with COVID-19. However, further study is warranted to validate this finding.

scholarly journals Multiple drug resistance in hookworms infecting greyhound dogs in the USA

2021 ◽  
Author(s):  
Pablo D. Jimenez Castro ◽  
Abhinaya Venkatesan ◽  
Elizabeth Redman ◽  
Rebecca Chen ◽  
Abigail Malatesta ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Multiple Drug Resistance ◽  
Infection Intensity ◽  
The United States ◽  
Post Treatment ◽  
Multiple Drug ◽  
Fecal Samples ◽  
The Usa ◽  
The Mean ◽  
Β Tubulin

AbstractThe hookworm Ancylostoma caninum is the most prevalent nematode parasite of dogs. Recently, we confirmed multiple-drug resistance (MDR) in several A. caninum isolates to all anthelmintic drug classes approved for the treatment of hookworms in dogs in the United States (USA). Cases of MDR hookworms appear to be highly overrepresented in greyhounds, suggesting that the MDR worms evolved on racing greyhound farms/kennels. The aims of this study were to evaluate the range of drug-resistant phenotypes and genotypes of the A. caninum infecting greyhounds. Fecal samples from recently retired greyhounds originating from geographically diverse areas of the USA were acquired from two greyhound adoption kennels, one active greyhound racing kennel, and three veterinary practices that work with adoption kennels. Fecal egg counts (FECs) were performed on fecal samples from 219 greyhounds, and despite almost all the dogs having been treated with one or more anthelmintics in the previous two to four weeks, the mean FEC was 822.4 eggs per gram (EPG). Resistance to benzimidazoles and macrocyclic lactones were measured using the egg hatch assay (EHA) and the larval development assay (LDA) respectively. We performed 23 EHA and 22 LDA on either individual or pooled feces, representing 81 animals. Mean and median IC50 and IC95 values for the EHA were 5.3 uM, 3.6 uM, and 24.5 uM, 23.4 uM respectively. For the LDA, mean and median IC50 values were 749.8 nM, >1000 nM respectively. These values range from 62 to 68 times higher than those we measured in our susceptible laboratory isolates. Pre-treatment fecal samples could not be obtained, however, post-treatment samples representing 219 greyhounds were collected. For samples collected <10 days post-treatment with albendazole, moxidectin, or a combination of febantel-pyrantel-moxidectin, the mean FEC were 349, 333, and 835 EPG, respectively. Samples collected 10-21 days post-treatment with albendazole, moxidectin, or pyrantel, yielded mean FEC of 1874, 335, and 600 EPG, respectively. Samples collected >21 days post-treatment with albendazole or moxidectin yielded mean FEC of 1819 and 1117 EPG, respectively. We obtained DNA from hookworm eggs isolated from 70 fecal samples, comprised of 60 individual dogs and 10 pools from multiple dogs. Deep sequencing of the isotype 1 β-tubulin gene revealed the presence of the F167Y (TTC>TAC) resistance polymorphism in 99% of these samples, with 69% having ≥75% resistant allele frequency. No resistance-associated polymorphisms were seen at any of the other β-tubulin codons previously reported as associated with benzimidazole resistance in Strongylid nematodes. These clinical, in vitro, and genetic data provide strong evidence that racing and recently retired greyhound dogs in the USA are infected with MDR A. caninum at very high levels in terms of both prevalence and infection intensity.

scholarly journals Steroid switching in dystrophinopathy treatment: a US chart review of patient characteristics and clinical outcomes

2021 ◽  
Author(s):  
Jessica R Marden ◽  
Claudio Santos ◽  
Brian Pfister ◽  
Richard Able ◽  
Henry Lane ◽  
...  
Keyword(s):  
Muscular Dystrophy ◽  
Clinical Outcomes ◽  
Clinical Characteristics ◽  
Chart Review ◽  
Patient Characteristics ◽  
Becker Muscular Dystrophy ◽  
Slow Disease Progression ◽  
Primary Physician ◽  
The Usa ◽  
The Mean

Aim: To describe reasons for switching from prednisone/prednisolone to deflazacort and associated clinical outcomes among patients with Duchenne and Becker muscular dystrophy (DMD and BMD, respectively) in the USA. Methods: A chart review of patients with DMD (n = 62) or BMD (n = 30) who switched from prednisone to deflazacort (02/2017–12/2018) collected demographic/clinical characteristics, reasons for switching, outcomes and common adverse events. Results: The mean ages at switch were 20.1 (DMD) and 9.2 (BMD) years. The primary physician-reported reasons for switching were ‘to slow disease progression’ (DMD: 83%, BMD: 79%) and ‘tolerability’ (67 and 47%). Switching was ‘very’ or ‘somewhat’ effective at addressing the primary reasons in 90–95% of patients. Conclusion: Physician-reported outcomes were consistent with deflazacort addressing patients' primary reasons for switching.

scholarly journals Assessing direct costs of treating metastatic triple-negative breast cancer in the USA

2020 ◽  
Author(s):  
Karen E Skinner ◽  
Amin Haiderali ◽  
Min Huang ◽  
Lee S Schwartzberg
Keyword(s):  
Breast Cancer ◽  
Emergency Department ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Emergency Department Visits ◽  
Monthly Cost ◽  
Effective Interventions ◽  
The Usa ◽  
The Mean ◽  
Record Review

Aim: Evaluation of monthly cost during metastatic triple-negative breast cancer (mTNBC) treatment. Patients & methods: Retrospective electronic medical record review of US females aged ≥18 years diagnosed with mTNBC between 1 January 2010 and 31 January 2016. Mean monthly costs per patient were evaluated from start of mTNBC treatment until transfer to hospice, end of record or 3 months prior to death. Results: The mean monthly cost of first line was $21,908 for 505 treated patients; 50.2% of cost was attributable to hospitalization and emergency department visits, and 32.7% to anticancer therapy. Similar patterns were observed for subsequent lines of therapy. Conclusion: The majority of costs were attributable to hospitalization and emergency department services, suggesting a need for effective interventions to reduce utilization of costly services.

scholarly journals Clot composition of embolic strokes of undetermined source: a feasibility study

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Amre Nouh ◽  
Tapan Mehta ◽  
Mohamed Hussain ◽  
Xianyuan Song ◽  
Martin Ollenschleger
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
National Institutes Of Health ◽  
Carotid Dissection ◽  
Stroke Patients ◽  
Stroke Etiology ◽  
The Mean ◽  
Undetermined Etiology ◽  
A Prospective Study

Abstract Background A number of emerging studies have evaluated clot composition in acute ischemic stroke. Studies of clot composition of embolic strokes of undetermined strokes are lacking. Objectives We sought to analyze the RBC to platelet ratios in clots and correlated our findings with stroke etiology. Methods This was a prospective study analyzing clots retrieved by mechanical thrombectomy in acute ischemic stroke patients at our institution. All clots were stained and scanned at 200x magnification by using a Scanscope XT digital scanner (Apergio, Vista, California). Image-J software (National Institutes of Health, Bethesda, Maryland) was used for semi quantitative analysis of percentage RBC’s and platelets. Unpaired t-test was used to compare means of RBC to Platelet ratios. Correlation of RBC to Platelet ratios with stroke etiology was performed. Results A total of 33 clots from 33 patients were analyzed. Stroke etiology was undetermined in 6 patients, cardioembolic in 14, large vessel atherosclerosis (LVA) in 9, and carotid dissection in 4. The mean RBC to platelet ratio was 0.78:1 (+/− 0.65) in cardioembolic clots, 1.73:1 (+/− 2.38) in LVA and 1.4:1(+/− 0.70) in carotid dissections. Although patients with undetermined etiology had a similar clot composition to cardioembolic stroke (0.36:1+/− 0.33), (p = 0.19), it differed significantly from LVA and dissections respectively (p = 0.037, p = 0.01). Conclusion In our study, a low RBC to Platelet ratio was found among patients with embolic strokes of undetermined source, however shared similar characteristics with cardioembolic thrombi. Ongoing collection and analysis is needed to confirm these findings and its significance in evaluating stroke etiology.

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