Gemcitabine-Induced Cardiotoxicity in Patients Receiving Adjuvant Chemotherapy for Pancreatic Cancer: A Case Series

Gemcitabine is not considered a cardiotoxic agent generally; so far only very few case reports have been reported in the literature on different aspects of cardiac side effects. Here we report a case series of 3 patients who developed congestive cardiac failure, when treated with gemcitabine monotherapy in the adjuvant setting for pancreatic cancers. Adjuvant chemotherapy with gemcitabine has been the standard of care for pancreatic cancer patients after successful surgery since the results of the CONKO-001 and ESPAC3 study were published. Gemcitabine was administered on days 1, 8, and 15 of a 28-day cycle at 1,000 mg/m2. All 3 patients developed symptoms suggestive of cardiac failure with a drop in ejection fraction on echocardiography, and responded to conservative treatment for heart failure after withdrawal of gemcitabine therapy. Early withdrawal of gemcitabine chemotherapy is recommended in addition to a need for studies required to evaluate the mechanism of cardiotoxicity. As per available literature, patients with diabetes and having received a total dose greater than 15,000 mg/m2 are generally at a higher risk and require close surveillance.

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CURRENT THERAPEUTIC OPTIONS FOR CORONAVIRUS DISEASE-2019 – A PHARMACOLOGICAL REVIEW

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i8.38342 ◽

2020 ◽

pp. 42-50

Author(s):

SASMI MB ◽

MARIA JOSE ◽

PRAVEENLAL KUTTICHIRA

Keyword(s):

Case Reports ◽

Treatment Options ◽

Case Series ◽

Standard Of Care ◽

Therapeutic Options ◽

Cochrane Library ◽

Global Public Health ◽

Medical Subject Headings ◽

Published Evidence

Objectives: Coronavirus pandemic is currently a global public health emergency. With expanding knowledge of the virus and the disease, new therapeutic targets are emerging widely. There is limited evidence about the use of different treatment options in coronavirus disease-2019 (COVID-19). This review aims to summarize the available evidence regarding therapeutic options in treating coronavirus infection. Methods: We searched PubMed, Google Scholar, and Cochrane library using pre-specified Medical Subject Headings terms about the role of therapeutic options in COVID-19 patients. Results: The majority of the published evidence is either case reports or small observational studies. Antimalarial like hydroxychloroquine reported equivocal results with five studies got positive results and five without any added benefit compared with standard of care. Lopinavir/ ritonavir monotherapy does not show any significant role except in combination with other antiviral drugs but encouraging results are emerging with remdesivir. Studies with favipiravir are inconclusive with some exhibit benefit and others not. Limited case series have shown that tocilizumab and convalescent plasma to be useful as adjuvant therapy in critically ill patients. Conclusion: There is currently no strong evidence for the efficacy of different therapeutic agents in the treatment of COVID-19. More data from ongoing and future trials will add more insight into the role of various drugs.

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Ulipristal acetate (UPA) for fibroids–IVF outcomes following treatment with UPA after IVF failure: series of 2 case reports

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172959 ◽

2017 ◽

Vol 6 (7) ◽

pp. 3177 ◽

Cited By ~ 1

Author(s):

Ashish R Kale

Keyword(s):

Case Reports ◽

Uterine Fibroids ◽

Case Series ◽

Standard Of Care ◽

Infertile Woman ◽

Ulipristal Acetate ◽

Uterine Tumors ◽

Size Number ◽

Ivf Failure

Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Fibroids are present in 5-10% of infertile patients, and may be the sole cause of infertility in 1-2.4%. The removal of fibroids by hysteroscopy and laparoscopy has now become the standard of care depending upon the size, number and location of fibroids in an infertile woman. Off lately, there is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). Here, we report a case series of 2 women, with fibroids, who were put on UPA prior to IVF. These women had at least one previous IVF failure. The pre and post UPA fibroid characteristics were compared to see the effect of the drug. IVF was done post 3 month UPA therapy. Both the women showed a drastic reduction in the fibroid size, increased distance from endometrial cavity, and successful post UPA IVF cycles. Safety of the drug has been proven in few recent trials, but the role of UPA in infertile women with fibroids, who have had previous IVF failure, has opened new horizons in this field.

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Endovascular intervention for acute stroke due to infective endocarditis

Neurosurgical FOCUS ◽

10.3171/2011.11.focus11263 ◽

2012 ◽

Vol 32 (2) ◽

pp. E1 ◽

Cited By ~ 21

Author(s):

Haitham Dababneh ◽

V. Shushrutha Hedna ◽

Jenna Ford ◽

Ziad Taimeh ◽

Keith Peters ◽

...

Keyword(s):

Infective Endocarditis ◽

Acute Stroke ◽

Case Reports ◽

Case Series ◽

Standard Of Care ◽

Clinical Decision ◽

Neurological Complications ◽

Endovascular Interventions ◽

First Case ◽

Risk Of Hemorrhage

The overall incidence of neurological complications due to infective endocarditis is as high as 40%, with embolic infarcts more common than hemorrhagic strokes. The standard of care for typical strokes does not apply to infective endocarditis because there is a substantial risk of hemorrhage with thrombolysis. In the last decade there have been multiple case reports of intravenous and intraarterial thrombolysis with successful outcomes for acute strokes with related infective endocarditis, but successful endovascular interventions for acute strokes associated with infective endocarditis are rarely reported. To the authors' knowledge, this report is the first case in the literature to use a mechanical retrieval device in successful vegetation retrieval in an infective endocarditis acute stroke. Although an interventional approach for treatment of acute stroke related to infective endocarditis is a promising option, it is controversial and a cautious clinical decision should be made on a case-by-case basis. The authors conclude that this approach can be tested in a case series with matched controls, because this condition is rare and a randomized clinical trial is not a realistic option.

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Epidemiologic and Pathologic Study of Pancreatic Cancer in Hamadan, Iran (2008 to 2018)

10.21203/rs.3.rs-584615/v1 ◽

2021 ◽

Author(s):

Elham Khanlarzadeh ◽

Saman Nazari ◽

Mehdi Ghobakhlou ◽

Hossein Ranjbar ◽

Sasan Nazari

Keyword(s):

Pancreatic Cancer ◽

Significant Relationship ◽

Case Series ◽

Pancreatic Cancers ◽

Alcohol And Drugs ◽

Pathological Type ◽

Case Series Study ◽

Increasing Trend ◽

Series Study ◽

Sixth Decade

Abstract Purpose: Pancreatic cancer is the seventh leading cause of cancer death in cases. The study was conducted to determine the epidemiologic and pathologic of pancreatic cancer Methods: A case series study was conducted retrospectively at Beheshti Hospital in Hamadan, Iran. A total of 409 cases that had been diagnosed with pancreatic cancer from 2008 to 2018 were reviewed. The variables included age, gender, occupation, pathological type, location involved, early symptoms, metastasis status, prognosis and treatments, was extracted from the files and recorded in checklist. Data were analyzed by using SPSS/20 software. Results: Pancreatic cancer has been increasing trend in terms of time (2008-2018). Pancreatic cancer was most common age in the sixth decade of life and is more common in men than women. There was a significant relationship between aging and the incidence of pancreatic cancers (P<0.05). Most of the subjects were urban (50.4%). the frequency of smoking, alcohol and drugs were (34.5, 15.6 and 14.0%), respectively. Also, there was no statistically significant relationship between smoking, alcohol and drugs and pancreatic cancer (P>0.05). The frequency of pancreatic cancers included Adenocarcinomas (66.7%), Unknown (25.2%), Mucinous Adenocarcinomas (4.2%) and Carcinoma (3.9%), respectively. Conclusion: Pancreatic cancer has been increasing trend in terms of time. Pancreatic cancer was most common age in the sixth decade of life and is more common in men than women. The most common type of pancreatic cancer was Adenocarcinoma. Diagnosis usually occurs at higher stages. More preventive considerations were found to be beneficial among this population.

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A Systematic Review on the Outcomes of the Fillet Flap in Treating Diabetic and Ischemic Forefoot Ulcers

Plastic Surgery ◽

10.1177/2292550320936684 ◽

2020 ◽

pp. 229255032093668

Author(s):

Kaissar Yammine ◽

Chahine Assi

Keyword(s):

Systematic Review ◽

Healing Rate ◽

Case Reports ◽

Case Series ◽

Ulcer Recurrence ◽

Complication Rates ◽

Partial Necrosis ◽

Fillet Flap ◽

Patients With Diabetes ◽

Artery Disease

Background: Diabetic and ischemic foot ulcers are difficult to heal, and the mastering of numerous treatment methods is imperative to achieve healing. One of these methods is the fillet toe flap used to cover specific diabetic wounds of the forefoot associated with toe osteomyelitis. Instead of amputating the infected toe, phalanges are removed while keeping the viable surrounding soft tissue. Methods: A systematic review was performed searching electronic databases up to October 2019 to identify relevant articles reporting the outcomes of the fillet flap in forefoot ulcers of patients with diabetes or peripheral artery disease. All study designs were included. The healing rate was the primary outcome. Secondary outcomes were the time to heal, ulcer recurrence, and complication rates of such infection, partial necrosis, and total necrosis. Results: The 8 studies that met the inclusion criteria were all case series or case reports, with a total of 28 patients including 29 flaps. The mean healing rate was 92.8% (2/29); in both cases, total necrosis was due to infection (7.2%). No ulcer recurrence or partial necrosis was noted. Conclusions: Though having limited indications, the fillet flap illustrates the full optimization of the available resources for wound coverage. The consistent presence of an axial vessel makes the fillet flap a reliable local flap to be used in specific circumstances where the loss of a toe is unavoidable. Further research is needed with large prospective controlled trials to support the findings of the review.

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Cutaneous Ewing Sarcoma and Ewing Sarcoma of the Bone: Distinct Diseases

Case Reports in Oncology ◽

10.1159/000492667 ◽

2018 ◽

Vol 11 (3) ◽

pp. 729-734 ◽

Cited By ~ 2

Author(s):

Montreh Tavakkoli ◽

Lisa Mueller

Keyword(s):

Adjuvant Chemotherapy ◽

Soft Tissue ◽

Skin Lesion ◽

Children And Adolescents ◽

Bone Tumor ◽

Ewing Sarcoma ◽

Case Reports ◽

Case Series ◽

Biological Explanation

Ewing sarcoma is an aggressive mesenchymal malignancy. It is the second most common bone tumor among children and adolescents and less commonly presents as a soft tissue or primary skin lesion. Cutaneous Ewing sarcoma has only been reported in case reports and case series. In this article, we describe a 12-year-old Hispanic female cured of localized, cutaneous Ewing sarcoma (pT1aN0M0) at the 40-month follow-up following surgical resection and adjuvant chemotherapy according to the COG AEWS1031 protocol for Ewing sarcoma of the bone. To our knowledge, this is the first article to provide a potential biological explanation for the differences in the prognosis of Ewing sarcoma of the bone, soft tissue, and skin.

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Laparoscopic Duodenojejunostomy for Superior Mesenteric Artery Syndrome

The American Surgeon ◽

10.1177/000313481007600316 ◽

2010 ◽

Vol 76 (3) ◽

pp. 321-324 ◽

Cited By ~ 8

Author(s):

Gitonga Munene ◽

Michel Knab ◽

Bhanot Parag

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Critical Appraisal ◽

Case Reports ◽

Case Series ◽

Standard Of Care ◽

Morbidity Rate ◽

Vascular Compression ◽

Sma Syndrome ◽

Uncommon Condition

Superior mesenteric artery (SMA) syndrome is an uncommon condition of duodenal obstruction secondary to extrinsic vascular compression. With the advent of laparoscopy, an emerging option to treat SMA syndrome is laparoscopic duodenojejunostomy. Given the rarity of the condition a critical appraisal of the effectiveness and safety of this relatively new surgical option has not been performed. Here we present a case report and a critical review of all published reports of laparoscopic duodenojejunostomy. A systematic literature review of all published reports describing laparoscopic duodenojejunostomy was performed by querying the MEDLINE database using keywords: laparoscopic duodenojejunostomy and SMA syndrome. Nine articles were reviewed which were mainly case reports and case series (level 5 data), reporting on a total of 13 patients, with 32 per cent of the patients being male and 68 per cent female. The diagnosis was established preoperatively in 62 per cent of the cases, the length of stay was 4.5 days, the morbidity rate was 7 per cent, and no mortalities were reported. The operation was considered successful in 100 per cent of patients. Laparoscopic duodenojejunostomy seems to be a safe and effective treatment for patients with SMA syndrome, but more data is required to recommend this operative option as the standard of care.

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Acute cardiac side effects after COVID-19 mRNA vaccination, a case series

10.21203/rs.3.rs-1157175/v1 ◽

2021 ◽

Author(s):

Noemi F. Freise ◽

Milena Kivel ◽

Olaf Grebe ◽

Christian Meyer ◽

Bahram Wafaisade ◽

...

Keyword(s):

Chest Pain ◽

Side Effects ◽

Clinical Information System ◽

Case Reports ◽

Case Series ◽

Clinical Information ◽

Cardiac Symptom ◽

Cardiac Side Effects ◽

Cardiac Symptoms ◽

Magnetic Resonance Imaging Mri

Abstract Background: Since development and approval of the world´s first mRNA vaccines, created under pressure of the global pandemic caused by SARS-CoV-2, potential side effects have naturally been a much-debated topic. Vaccination may be one, if not the only way out of the pandemic claiming more than 4 million deaths worldwide to date. Potential side effects from vaccination have long been controversial, and case reports of fatal side effects have been published. Therefore, data are needed to identify persons being at high risk for potential side effects. Until September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© in young adults were registered by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©).Patients and Methods: Eight patients between 13-56 years of age, vaccinated with mRNA vaccine either BNT162b2 or mRNA-1273 between January and August 2021 developed cardiac side effects shortly after either their first or second vaccination. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after onset of symptoms and investigated further in severe cases. Symptoms were defined as dyspnea, chest pain, cardiac arrhythmia as determined by electrocardiography.Results: Eight patients (five males and three females) developed cardiac symptoms compatible with myocarditis according to CDC criteria shortly after SARS-CoV-2 mRNA vaccination. Three patients (two males, one female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within seven days after symptom onset Conclusion: Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.

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Sports Injuries to the Latissimus Dorsi and Teres Major

The American Journal of Sports Medicine ◽

10.1177/0363546516676062 ◽

2016 ◽

Vol 45 (10) ◽

pp. 2428-2435 ◽

Cited By ~ 8

Author(s):

Benjamin F. Donohue ◽

Marc G. Lubitz ◽

Timothy E. Kremchek

Keyword(s):

Latissimus Dorsi ◽

Sports Injuries ◽

Case Reports ◽

Case Series ◽

Standard Of Care ◽

Operative Management ◽

Nonoperative Treatment ◽

Return To Play ◽

Surgical Patient ◽

Teres Major

Injuries to the latissimus dorsi and teres major muscles, while rare, are debilitating. They are seen in a variety of sports, although disproportionately in the throwing shoulder of baseball pitchers. There have been 25 case reports and 2 case series published on the nonoperative and operative management of these injuries. Latissimus dorsi and teres major muscle anatomy, function, and common injury patterns are well described in these case reports. Also well detailed are the typical patient presentation, physical examination, and imaging findings. Latissimus dorsi tendon injuries are sometimes treated operatively, whereas latissimus dorsi muscle belly or isolated teres major injuries are treated nonoperatively. Nonoperative treatment includes oral anti-inflammatories and shoulder physical therapy. A number of surgical patient positions, approaches, and fixation constructs have been described, although 2 techniques of positioning and surgical approach are used most commonly. Fixation is most often performed with suture anchors. Return-to-play timing, shoulder strength, and healing on magnetic resonance imaging are variable. No standard of care currently exists for the treatment of latissimus dorsi or teres major injuries. If treating a patient with an injury to either muscle, the clinician should be familiar with accumulated experience as reported in the published literature.

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Prognosis of Pancreatic Cancer in Hamadan, Iran (2008-2018): A case Series Study

10.21203/rs.3.rs-827808/v1 ◽

2021 ◽

Author(s):

Elham Khanlarzadeh ◽

Saman Nazari ◽

Mehdi Ghobakhloo ◽

Hossein Ranjbar ◽

Sasan Nazari

Keyword(s):

Pancreatic Cancer ◽

Survival Rates ◽

Case Series ◽

Early Symptoms ◽

Pancreatic Cancers ◽

Pathological Type ◽

Case Series Study ◽

The Mean ◽

Series Study ◽

Head Of Pancreas

Abstract Background: The present study aimed to determine the prognosis of pancreatic cancer from 2008 to 2018 in Hamadan, Iran. A case series study was conducted retrospectively at Beheshti Hospital in Hamadan, Iran. Methods: A total of 409 cases that had been diagnosed with pancreatic cancer from 2008 to 2018 were assessed. The variables included age, gender, pathological type, location involved, early symptoms, metastasis, prognosis and treatments, was extracted from the files and recorded in checklist. Data were analyzed by using SPSS/20 software. Results: The mean of age was 66.23±13.06 year. The most frequent of pancreatic cancers was Adenocarcinomas (66.7%). The highest frequency of early symptoms was jaundice (53.1%) and weight loss (12.7%). The highest frequency of pancreatic cancer lesions was more in the head of pancreas (68.7%). Most patients had metastasis at the beginning of diagnosis (82.3%). Most metastases were in liver (31.5%) and peritoneum (25.2%). The prognosis of the pancreatic cancer is significantly related to the lesion location and the consumption of alcohol, cigarettes and substance abuse (p <0.05), but it wasn’t correlated with age, sex and pathological type (p> 0.05). The 1-year and 5-year survival rates were (22.3%) and (9.5%), respectively. The lowest and the highest in 5-year survival rate were (7.8%) and (18.8%) in adenocarcinoma and carcinoma type. Conclusion: More preventive considerations were found to be beneficial among this population.

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