Efficacy of capecitabine in secondary prevention of skin cancer in solid organ-transplanted recipients (OTR)

1519 Background: Skin cancers are the most common malignancies in OTR. Topical 5% 5-FU has been used to successfully treat squamous cell carcinoma (SCC) in situ and actinic keratosis (AK). Capecitabine, an orally-administered prodrug of 5-FU, in combination with interferon was shown to be effective in the treatment of advanced SCC of the skin. This study was to determine the efficacy of low-dose capecitabine in secondary prevention of the skin cancers in OTR. Methods: OTR who developed recurrent skin cancers, SCC, and/or basal cell carcinoma (BCC), were given low-dose capecitabine 1g/m2 divided in two daily doses, day 1–14 of 21-day treatment cycle. Skin surveillances were performed by dermatologists every 1 to 3 months. Cumulative incidence rates of SCC, BCC, and AK before and after treatment were scored and statistically compared for each patient with a non-parametric Wilcoxon signed-rank test. Age and number of transplants were assessed with the Spearman non-parametric correlation analysis for their impact on the outcome. Results: 14 patients (12 males and 2 females) were enrolled with median age of 55 (range 40–73). 11 patients received kidney, two lung and one liver, one heart and one pancreas transplant. Two patients received double organ transplants. Mean incidence rates of SCC, BCC, and AK before treatment were 0.45, 0.05, and 4.99 lesions per month, respectively. Mean incidence rates of SCC, BCC, and AK after treatment were 0.22, 0.04, and 2.80 lesions per month, respectively. The differences in incidence rates of SCC, BCC, and AK before and after treatment were 0.24, 0.02, and 2.08 lesions per month with p value of 0.048, 0.844, and 0.151, respectively. Age and the number of transplants were not significantly related to the change in incidence rates for all skin lesion types. Six of the total of 14 patients experienced grade 3/4 toxicities, including mucositis (2), hand-foot syndrome (3), fatigue (2), nausea (1), diarrhea (2), hyperuricemia (1), and anemia (1), and all six needed capecitabine dose reduction or stopping therapy. Conclusions: Oral capecitabine significantly decreases the incidence rates of recurrent SCC in OTR and has manageable toxicity. No significant financial relationships to disclose.

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Low-Dose Acitretin for Secondary Prevention of Keratinocyte Carcinomas in Solid-Organ Transplant Recipients

Dermatology ◽

10.1159/000515496 ◽

2021 ◽

pp. 1-6

Author(s):

Efrat Solomon-Cohen ◽

Shiran Reiss-Huss ◽

Emmilia Hodak ◽

Batya Davidovici

Keyword(s):

Secondary Prevention ◽

Cell Carcinoma ◽

Low Dose ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Organ Transplant Recipients ◽

Pretreatment Period ◽

Solid Organ Transplant Recipients

Background: Keratinocyte carcinomas, particularly squamous cell carcinoma (SCC), occur more frequently and aggressively in solid-organ transplant recipients (SOTRs) than in the general population. Systemic retinoids are effective in secondary prevention of keratinocyte carcinomas in this population, but their use is limited by adverse effects including a rebound effect in cases of treatment discontinuation. Objective: Our aim was to determine whether low-dose acitretin is efficient in the secondary prevention of keratinocyte carcinomas in SOTRs. Methods: This retrospective case-crossover study was conducted at a specialized dermatology clinic for SOTRs in a large transplantation center in 2010–2017. Patients with at least 1 previous keratinocyte carcinoma who were treated with acitretin 10 mg/day for 2 years were included. The main outcome was the difference in the number of new keratinocyte carcinomas diagnosed during treatment compared to during the 2-year pretreatment period. Results: The cohort included 34 SOTRs. A significant reduction in the mean number of new keratinocyte carcinomas during treatment relative to the pretreatment period was observed (1.7 vs. 3.6, –53% p = 0.002). Similar results were noted on analysis by tumor type, for both SCC and basal cell carcinoma. Conclusion: This study of SOTRs demonstrated positive results for low-dose acitretin as a chemoprevention of keratinocyte carcinomas in this population.

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Vasopressin Deficiency and Pressor Hypersensitivity In Hemodynamically Unstable Organ Donors

Circulation ◽

10.1161/circ.100.suppl_2.ii-244 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Jonathan M. Chen ◽

Suzanne Cullinane ◽

Talia B. Spanier ◽

John H. Artrip ◽

Ranjit John ◽

...

Keyword(s):

Blood Pressure ◽

Diabetes Insipidus ◽

Low Dose ◽

Clinical Evidence ◽

Pressor Response ◽

Hemodynamic Instability ◽

Solid Organ ◽

Organ Donors ◽

Plasma Vasopressin ◽

Before And After

Background —Solid organ donors often develop hypotension due to vasodilation, and recently we observed that a variety of vasodilatory states are characterized by vasopressin deficiency and hypersensitivity. Thus, we investigated the prevalence of vasopressin deficiency in hypotensive solid organ donors without clinical evidence of diabetes insipidus; we also investigated the vasopressor effect of vasopressin replacement in hypotensive donors. Methods and Results —Fifty organ donors were evaluated for hemodynamic instability, (mean arterial pressure [MAP]≤ 70 mm Hg despite the use of catecholamine vasopressors), and in those unstable donors who were not already receiving exogenous vasopressin, low-dose vasopressin was administered as a continuous infusion (0.04 to 0.1 U/min). MAP, catecholamine requirements, serum vasopressin, and serum osmolality were obtained before and after vasopressin administration. Ten patients meeting the enrollment criteria received vasopressin and MAP increased from 72.2±3.5 to 89.8±4.2 mm Hg, ( P <0.05), allowing for complete discontinuation of catecholamine pressors in 4 (40%) patients and a decrement in pressor dose in 4 (40%). Plasma vasopressin levels (2.9±0.8 pg/mL) were low for the degree of hypotension. Conclusions —Hemodynamically unstable organ donors without clinically apparent diabetes insipidus display a defect in the baroreflex-mediated secretion of vasopressin. In these patients, low-dose vasopressin significantly increases blood pressure with a pressor response sufficient to reduce catecholamine administration.

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Skin Cancers and Lung Transplant

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0041-1728798 ◽

2021 ◽

Vol 42 (03) ◽

pp. 483-496

Author(s):

Reason Wilken ◽

John Carucci ◽

Mary L. Stevenson

Keyword(s):

Cell Carcinoma ◽

Lung Transplant ◽

Radiation Treatment ◽

Organ Transplant ◽

Adjuvant Radiation ◽

Solid Organ ◽

Transplant Recipients ◽

Organ Transplant Recipients ◽

Skin Cancers ◽

Increased Risk

AbstractIt is well known that solid-organ transplant recipients (SOTRs) have a 65- to 100-fold increase in the risk of developing skin cancer, namely, nonmelanoma skin cancers (NMSCs) such as cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC). In addition, these patients are also at increased risk for development of melanoma as well as other less common cutaneous malignancies (Merkel's cell carcinoma, Kaposi's sarcoma). SOTRs with NMSC (namely cSCC) are also at significantly increased risk of poor clinical outcomes including local recurrence, nodal and distant metastasis, and disease-specific death relative to patients who are not immunosuppressed. Increased surveillance and monitoring in patients at risk of aggressive disease and poor outcomes who are on immunosuppression is essential in patients with lung transplants given the high degree of immunosuppression. Increased awareness of risks, treatments, and management allows for improved outcomes in these patients. This article will provide an overview of the risk factors for the development of cutaneous malignancies in organ transplant recipients as well as a detailed discussion of various immunosuppressant and prophylactic medications used in this patient population that contribute to the risk of developing cutaneous malignancies, with an emphasis on NMSC (cSCC and BCC) in lung transplant recipients. Finally, this article includes a discussion on the clinical and dermatologic management of this high-risk immunosuppressed population including a review of topical and systemic agents for field therapy of actinic damage and chemoprevention of keratinocyte carcinomas. In addition, indications for additional treatment and preventive measures such as adjuvant radiation treatment after surgical management of cutaneous malignancies and potential modification of immunosuppressive medication regimens are discussed.

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40-Year Trends in Skin Cancer in British Columbia, Canada, 1973 to 2003

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2011.11001 ◽

2012 ◽

Vol 16 (2) ◽

pp. 83-91 ◽

Cited By ~ 11

Author(s):

David I. Mclean ◽

Norm Phillips ◽

Youwen Zhou ◽

Richard Gallagher ◽

Tim K. Lee

Keyword(s):

British Columbia ◽

Skin Cancer ◽

Cell Carcinoma ◽

Incidence Rate ◽

Incidence Rates ◽

Cutaneous Malignant Melanoma ◽

Skin Cancers ◽

Canadian Population ◽

Novel Method ◽

Over Time

Background: Skin cancer is common in North America. Incidence rate trends are potentially important in the assessment of the effects of measures to increase sun awareness in the population as well as measures to reduce sun damage. Objective: To determine the incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and cutaneous malignant melanoma (CMM) in a geographically defined Canadian population over a 40-year period. Methods: Data were obtained from the BC Cancer Registry for the calendar years 1973, 1983, 1993, and 2003. Results: Age-standardized incidence rates increased significantly from 1973 to 2003 for BCC, SCC, and CMM. Limitations: The ethnic makeup of British Columbia has changed over time, and a novel method of accounting for the effect of this on skin cancer rates is presented. Conclusion: The incidence rate for skin cancers continued to rise in British Columbia, but there appears to have been a decline in the incidence of CMM and BCC in the youngest cohorts.

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PENGARUH PEMBERIAN MINUMAN KUNYIT ASAM TERHADAP INTENSITAS NYERI MENSTRUASI PADA REMAJA PUTRI

JURNAL KEBIDANAN KESTRA (JKK) ◽

10.35451/jkk.v3i1.491 ◽

2020 ◽

Vol 3 (1) ◽

pp. 55-60

Author(s):

Ika Nur Saputri ◽

Dwi Handayani ◽

Jurpia Yasara

Keyword(s):

High School ◽

Sample Selection ◽

Rank Test ◽

P Value ◽

Acid Extract ◽

Menstrual Pain ◽

Natural Event ◽

Before And After ◽

Quasi Experimental ◽

Wilcoxon Sign Rank

Menstruation is a natural and natural event, but in reality many women experience menstrual problems, including menstrual pain or dysmenorrhoea. Nonpharmacological menstrual pain management can be done by giving turmeric acid extract. This study aims to determine the effect of giving turmeric acid extract on the intensity of menstrual pain in adolescent girls in State High School 1 Serdang Bedagai Regency in 2020. The research method is quantitative. This type of research is a quasi-experimental design with one-group pretest-posttest design. The study population was 150 class X and XI students of State High School 1 Serdang Bedagai Regency as many as 150 people. The sample selection using purposive sampling as many as 36 people. The results of the study using Wilcoxon sign rank test showed p-value of 0,000 <0.05. The conclusion is there are differences before and after giving turmeric acid drink to the intensity of menstrual pain (dysmenorrhea). It is expected that schools can provide information to students about the use of turmeric acid as a non-pharmacological treatment in reducing menstrual pain.

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PENGARUH REBUSAN BUNGA ROSELLA TERHADAP PENURUNAN TEKANAN DARAH (HIPERTENSI) PADA PASIEN DI WILAYAH KERJA PUKESMAS SUKAMERINDU BENGKULU

Jurnal Sains Kesehatan ◽

10.37638/jsk.26.2.53-60 ◽

2019 ◽

Vol 26 (2) ◽

pp. 53-60

Author(s):

Vellyza Colin ◽

Buyung Keraman ◽

Evan Aditya Pratama

Keyword(s):

Public Health ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Health Center ◽

Rank Test ◽

P Value ◽

Wilcoxon Sign Rank Test ◽

Before And After ◽

Wilcoxon Sign Rank ◽

Sign Rank Test

The Effect of Rosella Stew to Decreasing of Blood Pressure (Hypertension) in Patients at Working Area of Sukamerindu Public Health Center BengkuluABSTRAKPengaruh rebusan bunga rosella terhadap penurunan tekanan darah (Hipertensi) pada pasien diwilayah kerja Puskesmas Sukamerindu Bengkulu. Hipertensi adalah peningkatan tekanan darah sistolik lebih dari 140 mmHg dan diastolik lebih dari 90 mmHg. Penelitian ini bertujuan untuk mempelajari pengaruh rebusan bunga rosella digunakan untuk menurunkan tekanan darah oleh sebagian masyarakat. Penelitian ini merupakan penelitian kuantiatif dengan desain pra exsprimental. Populasi dalam penelitian ini pasien hipertensi yang berobat di Puskesmas Sukamerindu Kota Bengkulu pada bulan Januari-Desember 2018 sebanyak 52 orang dewasa yang terkena hipertensi. Teknik pengambilan sample dengan total sampling dengan kriteria inkulasi dan ekslusi sehingga sample yang diambil 30 orang yang memenuhi kriteria dalam pemberian rebusan bunga rosella dan 22 orang yang tidak memenuhi kriteria dalam pemberian bunga rosella untuk penurunan tekanan darah hipertensi. Pengumpulan data dalam penelitian ini menggunakan data sekunder dengan melihat cacatan dokumentasi di Poli Umum Di Puskesmas Sukamerindu Bengkulu.Hasil penelitian didapatkan: uji statistik Wilcoxon Sign Rank Test Hasil tekanan darah sistolik sebelum dan sesudah perlakuan didapatkan nilai Z = -4,293 dengan p=value=0,0000,05 berarti signifikan, maka Ho ditolak dan Ha diterima. Jadi Ada pengaruh pemberian rebusan bunga rosella terhadap penurunan tekanan darah sistolik pada pasien diwilayah kerja Puskesmas Sukamerindu Kota Bengkulu. Hasil tekanan darah diastol sebelum dan sesudah perlakuam didapatkan nilai Z = -3,075 dengan p=value=0,0020,05 berarti signifikan, maka Ho ditolak dan Ha diterima. Jadi Ada pengaruh pemberian rebusan bunga rosella terhadap penurunan tekanan darah diastolik pada pasien diwilayah kerja Puskesmas Sukamerindu Kota Bengkulu. Kata Kunci : hipertensi, tekanan darah, rebusan rosella ABSTRACT Effect of rosella stew on blood pressure (hypertension) reduction in patients in the Pukesmas area Sukamerindu Bengkulu. Hypertension is an increase in systolic blood pressure of more than 140 mmHg and diastolic of more than 90 mmHg. This study discusses the benefits of rosella stew used for reducing blood pressure by most people. This research is a quantitative research with pre-exemplary design. The population in this study were hypertensive patients seeking treatment at the Sukamerindu Public Health Center in Bengkulu City in January-December 2018 as many as 52 adults affected by hypertension. Sampling technique with total sampling with inclusion and exclusion criteria so that the samples taken were 30 people who met the criteria in the provision of rosella stew and 22 people who did not meet the criteria for rosella stew for decreasing hypertension. Data collection in this study uses secondary data by looked at documentation records at Puskesmas Sukamerindu Bengkulu.The results of this study showed: Wilcoxon Sign Rank Test statistical test Results of systolic blood pressure before and after treatment obtained a value of Z = -4.293 with p = value = 0.000 0.05 means significant, then Ho is rejected and Ha is accepted. So there is Effect of rosella stew to Decreasing of blood pressure (hypertension) in patients at area of Pukesmas Sukamerindu Bengkulu. The results of diastolic blood pressure before and after the treatment showed that the value of Z = -3.075 with p = value = 0.002 0.05 means significant, then Ho was rejected and Ha was accepted. So there is Effect of rosella stew to Decreasing of blood pressure (hypertension) in patients at area of Pukesmas Sukamerindu Bengkulu. Keywords: blood pressure, hypertension, rosella stew

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Hematological profiles of visceral leishmaniasis patients before and after treatment of anti-leishmanial drugs at University of Gondar Hospital; Leishmania Research and Treatment Center Northwest, Ethiopia

BMC Infectious Diseases ◽

10.1186/s12879-021-06691-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Elias Shiferaw ◽

Fadil Murad ◽

Mitikie Tigabie ◽

Mareye Abebaw ◽

Tadele Alemu ◽

...

Keyword(s):

Visceral Leishmaniasis ◽

Blood Cell ◽

Pearson Correlation ◽

Hematological Parameters ◽

Parasite Load ◽

Treatment Center ◽

Rank Test ◽

P Value ◽

Before And After ◽

The Mean

Abstract Background Visceral leshimaniasis is a parasitic disease characterized by systemic infection of phagocytic cells and an intense inflammatory response. The progression of the disease or treatment may have an effect on hematological parameters of these patients'. Thus, the current study sought to compare the hematological profiles of visceral leishmaniasis patients before and after treatment with anti-leishmaniasis drugs. Method An institutional-based retrospective cohort study was conducted among visceral leishmaniasis patients admitted to the University of Gondar comprehensive specialized referral hospital leishmaniasis research and treatment centre between September 2013 and August 2018. Hematological profiles were extracted from the laboratory registration book before and after treatment. Data were entered to Epi-info and exported to SPSS for analysis. Descriptive statistics were summarized using frequency and percentage to present with the table. The mean, standard deviation, median, and interquartile range were used to present the data. Furthermore, using the paired t-test and the Wilcoxon Signed rank test, the mean difference for normally and non-normally distributed data was compared. Spearman and Pearson correlation analysis were used to describe the relationship between hematological parameters and various variables. A P value of 0.05 was considered statistically significant. Result With the exception of the absolute neutrophil count, all post-treatment hematological parameters show a significant increase when compared to pre-treatment levels. Prior to treatment, the prevalence of anemia, leukopenia, and thrombocytopenia was 85.5, 83.4, and 75.8%, respectively, whereas it was 58.3, 38.2, and 19.2% following treatment. Furthermore, parasite load was found to have a statistically significant negative correlation with hematological profiles, specifically with white blood cell and red blood cell parameters. Conclusion According to our findings, patients with visceral leishmaniasis had improved hematological profiles after treatment. The effect of treatment on parasite proliferation and concentration within visceral organs, in which the parasite load could directly affect the patient's hematological profiles, may be associated with the change in hematological profiles.

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Group Education Model Improving The Knowledge of School Age Children in Protecting of Sexual Violence

Journal of Education Research and Evaluation ◽

10.23887/jere.v3i4.22346 ◽

2019 ◽

Vol 3 (4) ◽

pp. 204

Author(s):

I Ketut Labir ◽

Ni Luh Kompyang Sulisnadewi ◽

I Nyoman Ribek

Keyword(s):

Sexual Violence ◽

Sampling Technique ◽

School Age Children ◽

Rank Test ◽

Average Score ◽

P Value ◽

School Age ◽

Significance Level ◽

Before And After ◽

Signed Rank Test

Cases of sexual violence and abuse in Indonesia are increasingly common. Not only in adults, children are now victims. Some cases of victims or perpetrators involve underage children. Many parents feel taboo to talk about early childhood education with children. This causes children not to get information that is supposed to protect themselves from sexual violence. Need to do various efforts to provide education to children about knowledge to protect themselves from sexual violence. The purpose of this study was to determine the effect of sexual violence education on children on efforts to protect from sexual violence. This study uses pre-experimental design with approach pretest-posttest design. The number of samples is 195 children taken by purposive sampling technique. Analyze data using different Wilcoxon Signed Rank test with 95% significance level, p ≤ (0.05). The results showed that the average age of the respondents was 10.2 years and most of the men were 52.8%. Before giving education, the average score of respondents' knowledge about efforts to protect themselves from sexual violence was 6.7 and increased to 7.79 after giving education. There is a difference in knowledge about efforts to protect themselves from sexual violence before and after being given education (p value ≤ 0.001; <α = 0.05). It is recommended that the provision of information about sexual violence be given regularly by teachers and parents.Keywords: Education - Elementary School Age Knowledge - Efforts to Protect Themselves from Sexual Violence

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Aromaterapi Lavender dapat Menurunkan Intensitas Nyeri Perineum pada Ibu Post Partum

Jurnal Ners dan Kebidanan Indonesia ◽

10.21927/jnki.2016.4(3).123-128 ◽

2017 ◽

Vol 4 (3) ◽

pp. 123

Author(s):

Wiwin Widayani

Keyword(s):

Post Partum ◽

Sampling Technique ◽

Complementary Therapy ◽

Perineal Pain ◽

Rank Test ◽

P Value ◽

Relieve Pain ◽

Signed Rank ◽

Before And After ◽

Signed Rank Test

Perineals pain affects woman ability to mobilize so that it can cause complications such as post-partum haemoragik. Trauma to the perineum also cause discomfort and dyspareunia, therefore, perineal pain management is important. Currently the handling used to relieve pain is complementary therapy aromatherapy with essential oils of lavender, because lavender has the properties of anticonvulsant, antidepressant, anxiolytic, and also soothing. Aromatherapy stimulates the hypothalamus to secrete chemical mediators that serve as pain relievers and give rise to feelings of happiness. The purpose of this study was to determine the effect of lavender aromatherapy to the perineal pain intensity in post partum women. This study is a quasy experiment pre and post non random control in postpartum women at Bidan Praktik Mandiri in Bandung. Sampling this study using consecutive sampling technique. The data taken using the instrument in the adaptation of a Visual Analog Scale (VAS) and analyzed by using the wilcoxon signed rank test. The result is there was a decrease in pain intensity before and after the administration of inhaled lavender aromatherapy (Z=-3.77) with p-value 0.001. Lavender aromatherapy can be a complementary alternative therapy to reduce pain in postpartum women but more research necessary is needed with more respondents.

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The effect of education on knowledge and attitudes in using halal cosmetic products

Journal of Halal Product and Research ◽

10.20473/jhpr.vol.4-issue.2.83-89 ◽

2021 ◽

Vol 4 (2) ◽

pp. 83

Author(s):

Siti Lailaturrohmah ◽

Alviyana Lutviyani

Keyword(s):

Sampling Technique ◽

Rank Test ◽

P Value ◽

Cosmetic Products ◽

Knowledge And Attitudes ◽

Analysis Technique ◽

Cosmetic Ingredients ◽

Before And After ◽

Wilcoxon Sign Rank ◽

High Level

Consumers' awareness of halal cosmetics is still low. The high level of dependence on a product and the lack of consumer knowledge of cosmetic ingredients makes it difficult for consumers to switch to cosmetic products that are halal certified. Minimal education that is easily accessible regarding the halalness of a cosmetic product among the community is a problem that results in the lack of awareness of halal. This study aims to obtain information about the effect of halal education on knowledge and attitudes in the use of cosmetics. The method used in this study is an experimental design with a sample size of 30 respondents who are active users of cosmetics both labeled halal and not labeled halal. The sampling technique used was accidental sampling. Data on the knowledge and halal attitudes of respondents before and after education were obtained from filling out questionnaires which were carried out online. The data analysis technique used was the Wilcoxon Sign Rank Test using SPSS 16. The results of the respondents' research indicated that there were significant differences in their knowledge and attitudes towards the use of cosmetics before and after halal education with p value ≤ 0.05.

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