scholarly journals Targeting the PD-1 Axis with Pembrolizumab for Recurrent or Metastatic Cancer of the Uterine Cervix: A Brief Update

2021 ◽  
Vol 22 (4) ◽  
pp. 1807
Author(s):  
Yannick Verhoeven ◽  
Delphine Quatannens ◽  
Xuan Bich Trinh ◽  
An Wouters ◽  
Evelien L.J. Smits ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Systemic Treatment ◽  
Advanced Disease ◽  
Metastatic Cancer ◽  
Public Health Problem ◽  
Treatment Modalities ◽  
Promising Strategy ◽  
Current Therapies ◽  
Clinical Potential ◽  
Great Public Health

Even though cervical cancer is partly preventable, it still poses a great public health problem throughout the world. Current therapies have vastly improved the clinical outcomes of cervical cancer patients, but progress in new systemic treatment modalities has been slow in the last years. Especially for patients with advanced disease this is discouraging, as their prognosis remains very poor. The pathogen-induced nature, the considerable mutational load, the involvement of genes regulating the immune response, and the high grade of immune infiltration, suggest that immunotherapy might be a promising strategy to treat cervical cancer. In this literature review, we focus on the use of PD-1 blocking therapy in cervical cancer, pembrolizumab in particular, as it is the only approved immunotherapy for this disease. We discuss why it has great clinical potential, how it opens doors for personalized treatment in cervical cancer, and which trials are aiming to expand its clinical use.

Systematic literature review of clinical outcomes in adults with metastatic or advanced synovial sarcoma

2020 ◽  
Vol 16 (35) ◽  
pp. 2997-3013
Author(s):  
Kentaro Kogushi ◽  
Michael LoPresti ◽  
Shunya Ikeda
Keyword(s):  
Synovial Sarcoma ◽  
High Frequency ◽  
Clinical Evidence ◽  
Systemic Treatment ◽  
Progression Free Survival ◽  
Treatment Modalities ◽  
Free Survival ◽  
New Treatment ◽  
Poor Outcomes

Background: Synovial sarcoma (SS) is a rare, aggressive soft tissue sarcoma with a poor prognosis after metastasis. The objective of this study was to conduct a systematic review of the clinical evidence for therapeutic options for adults with metastatic or advanced SS. Materials & methods: Relevant databases were searched with predefined keywords. Results: Thirty-nine publications reported clinical data for systemic treatment and other interventions. Data on survival outcomes varied but were generally poor (progression-free survival: 1.0–7.7 months; overall survival: 6.7–29.2 months) for adults with metastatic and advanced SS. A high frequency of neutropenia with systemic treatment and low quality of life post-progression were reported. Conclusion: Reported evidence suggests poor outcomes in adults with metastatic and advanced SS and the need for the development of new treatment modalities.

scholarly journals Human Chorionic Gonadotrophin (hCG) Trigger-Mediated Ovulation Induction in Infertility Management in South Indian Women Undergoing IVF/ICSI Regimens: A Pilot Sexual Medicine Study with Public Health Perspective

2021 ◽  
Vol 3 (1) ◽  
pp. 57-64
Author(s):  
Saumya Pandey
Keyword(s):  
Public Health ◽  
Tamil Nadu ◽  
Endometrial Thickness ◽  
Cardiac Activity ◽  
Public Health Problem ◽  
Predictive Biomarkers ◽  
Clinical Pregnancy ◽  
Treatment Modalities ◽  
Infertile Women ◽  
South Indian

Introduction: Infertility is a global public health problem; cost-effective patient-friendly treatment modalities along with psychosexual intervention strategies are essential for infertility control/prevention/management among ethnically disparate populations. Objectives: This study aimed to assess differential in vitro fertilization (IVF) success trends among infertile women of South Indian ethnicity. Materials and Methods: Prospective, observational study designed in a hospital-based setting with active enrollment of infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) at Indira IVF Center, Chennai, Tamil Nadu, India (April-September 2019); inclusion criteria: age >35 years, South Indian ethnicity, married >1 year, absence of full-term clinical pregnancy, endometrial thickness <6 mm/thin endometrium; exclusion criteria: prior ≥2 IVF failures, fibroids/adenomyosis/cervical cancer/endometriosis. IVF success was determined by evaluating total frozen embryos transferred/month, average oocyte yield/donor, oocyte quality, M-II oocytes, biochemical/clinical pregnancy (beta-human chorionic gonadotropin positivity/fetal cardiac activity). Mycobacterium tuberculosis positivity was assessed by GeneXpert polymerase chain reaction-based technology, and psychosexual intervention-incorporated marital relationship counseling sessions/therapy, referrals for psychiatric assessments (cognitive impairment/schizophrenia/depression). Written informed consent of participants was taken and study was approved by Institutional Review Board. Results: Mean age and endometrial thickness of study participants were 33.3 years (SD ±1.9) and 8.7 mm (SD ±0.5), respectively; average Body Mass Index (BMI) and anti-müllerian hormone (AMH) levels were 28.4 kg/m2 and 4.7 ng/mL, respectively. Embryos transferred/month: 7 in April/13 in May/24 in June/36 in July/24 in August/30 in September, and pregnancies: 4/8/17/26/20/22 for the months of April, May, June, July, August, and September 2019, respectively. Subgroup stratification demonstrated M-II vs total oocytes retrieved were 76%, 73%, 60%, 71%, 77%, and 77%. Overall IVF success rates were 57% in April/62% in May/71% in June/72% in July/83% in August/73% in September; frozen embryo transfer success was 0 in April-May/67% in June/73% in July/89% in August/100% in September 2019. English/Tamil-speaking infertile women self-reported treatment-related satisfaction rates of 80% to 100%. Conclusion: M-II oocytes’ yield, sociodemographics of infertile women, and increasing age/aberrant AMH/BMI profiles/endometrial receptivity/diminished ovarian reserve are promising predictors of IVF/ICSI success in genetically distinct patient population subset(s). Future multicentric gene epidemiology studies with larger sample size and precision-based psychiatric assessments/interventions are warranted for development of predictive biomarkers in infertility management.

scholarly journals Postoperative Radiochemotherapy Using Modern Radiotherapy Techniques in Elderly Patients with Head and Neck Squamous Cell Carcinoma: The Challenge of Weighing up Benefits and Harms of Treatment Modalities in Clinical Practice

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3384
Author(s):  
Martin Leu ◽  
Christoph Patzer ◽  
Manuel Guhlich ◽  
Jacqueline Possiel ◽  
Yiannis Pilavakis ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Head And Neck ◽  
Squamous Cell ◽  
Systemic Treatment ◽  
Locally Advanced ◽  
Treatment Modalities ◽  
Younger Patients ◽  
Radiotherapy Techniques ◽  
Postoperative Radiochemotherapy ◽  
Modern Radiotherapy

Locally advanced head and neck squamous cell carcinomas (HNSCC) are often managed with surgery followed by postoperative radiochemotherapy (RCT). With the general increase in life expectancy, the proportion of elderly patients with HNSCC is expected to grow rapidly. Until now, a deeper understanding of specific management strategies for these patients in clinical routine was lacking. In the present study, we compared elderly patients (≥70 years, n = 52) and younger patients (n = 245) treated with postoperative RCT for HNSCC at our tertiary cancer center. All patients were irradiated with modern radiotherapy techniques (IMRT/VMAT). Patients ≥70 years of age had more comorbidities. Additionally, elderly patients less frequently received concomitant systemic treatment. The rates of mucositis and dermatitis were lower in patients ≥70 years. Elderly patients had significantly worse overall and progression-free survival. Locoregional and distant control were comparable in elderly and younger patients. In conclusion, postoperative RCT is a safe and effective treatment option in patients ≥70 years. In light of comorbidities and poor overall survival rates, benefits and harms of radiotherapy and concomitant systemic treatment should be weighed carefully. When exclusively applying up-to-date radiotherapy techniques with, at the same time, careful use of concomitant systemic therapy, favorable acute toxicity profiles are achieved.

Status of Histopathology Services In Ethiopia

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S120-S120
Author(s):  
G O Yeabyo
Keyword(s):  
Addis Ababa ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Status ◽  
Prevention Of Cancer ◽  
Great Public Health ◽  
Cancer Diseases

Abstract Introduction/Objective Cancer is one of a great public health problem in developing countries like Ethiopia and scarcity of histopathology laboratory is another burden for diagnosis and follow up of cancer diseases. The main purpose of this study is to evaluate the accessibility of histopathology services in Ethiopia. Methods Cross sectional study design were used to analyze the status of histopathology services in Ethiopia. Results There are 13 histopathology laboratories in the nation and a survey was conducted at these institutions. Out of these 13 Histopathology services seven are located in the capital, Addis Ababa and six found out of the capital located in four different regions. About 40,239,100 habitants have no histopathology service around their catchment area. Conclusion There are very limited histopathology laboratories, as a result diagnosis and prevention of cancer diseases are inadequate throughout the country.

Morbidity and mortality of pelvic exenteration for cervical cancer at a German referral center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17505-e17505
Author(s):  
Jelena Boekhoff ◽  
Luisa terGlane ◽  
Uwe Wagner ◽  
Axel Hegele
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Pelvic Exenteration ◽  
Survival Rates ◽  
Operation Time ◽  
Previous Treatment ◽  
University Hospital ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Recurrent Cervical Cancer

e17505 Background: The purpose of this study was to evaluate data regarding the outcome of pelvic exenteration (PE) when performed for advanced or recurring cervical cancer. Methods: A total of 24 patients underwent PE for cervical cancer at the University Hospital Marburg between 2011 and 2016. Their data were retrospectively assessed and statistically analyzed. Survival was evaluated using the Kaplan-Meyer method. Results: Mean age was 52.2 years (29.7 to 72.6 years), mean BMI was 23.4 kg/m2. Most common indication was squamous cell carcinoma, whereas 3 patients underwent PE for adenocarcinoma. The majority of the tumors (62.5%) were stage pT4. Negative margins could be achieved in 70.8%. Lymph nodes could be assessed in 55% and were tumor-afflicted in 20.8%. 45.8% were treated for recurrent cancer; median recurrence free time between previous treatment and PE was 16 months. Up-front PE was performed in 20.8%. Another 79.2% received treatment prior to PE: 20.8% received all 3 treatment modalities whereas 37.5% had two treatments before (29.2% underwent chemo- and radiotherapy, 8.3% had surgery and radiotherapy) and 20.8% underwent one type of treatment. Anterior PE (APE) and total PE (TPE) were performed in 62.5% and 37.5%, respectively. Median operation time was 324min. Blood products were administered perioperatively in 75%; 37.5% needed 2 or more. Median hospital stay was 25 days. Major complications (Clavien Dindo≥3) were observed in 41.7% and 16.7% had no complications. Overall Survival (OS) was 29.2%; median overall survival was 19.1 months. 2- and 3-year survival rates for curative PE were 50% and 35% respectively. 4 patients underwent PE with palliative intent. Overall survival correlated significantly with R1- (p = 0.012), N1- (p = 0.047) and M1-status p < 0.01), TPE (p = 0.034) and surgical time > 6 h (p = 0.003). Conclusions: In cases of advanced or recurrent cervical cancer gynecologists struggle to find suitable therapeutic options, especially since most patients have already received radio- and/or chemotherapy. PE is a valid option for selected patients that may represent a cure with tolerable complication rates.

scholarly journals Cervical cancer in Iquitos, Peru: local realities to guide prevention planning

2004 ◽  
Vol 20 (1) ◽  
pp. 160-171 ◽  
Author(s):  
Jennifer L. Hunter
Keyword(s):  
Cervical Cancer ◽  
Screening Program ◽  
Public Health Problem ◽  
Ethnographic Study ◽  
Herbal Remedies ◽  
Pap Smears ◽  
Major Public Health Problem ◽  
Medical Systems ◽  
Cervical Cancer Screening Program ◽  
Cancer Experience

Cervical cancer is a major public health problem in Latin America, and in much of the underdeveloped world. This issue has not historically been addressed as a health priority, but in recent years is receiving increased attention and funding. This ethnographic study on the experience of cervical cancer was conducted in Iquitos, Peru, between August 1998 and May 1999. Research methodologies included: (1) observation and household interviews to obtain background knowledge about the region, medical systems, and local cultural understanding of illness; (2) cancer experience interviews; and (3) case studies of women in various stages of cervical cancer or diagnosis. Findings are presented related to local knowledge and experience of Pap smears and cervical cancer and the ineffectiveness of a recently initiated cervical cancer screening program. The findings guide recommendations for interventions in the region in relation to: (1) needed changes in health education, (2) screening frequency and age, (3) sites for screening and treatment, (4) type and availability of treatment, (5) payment issues, (6) documentation of care, and (7) the potential of herbal remedies.

scholarly journals Describing the Programme on Methadone Maintenance Therapy in Selangor, Malaysia

2020 ◽  
Vol 12 (9) ◽  
pp. 151
Author(s):  
Vengketeswara Rao ◽  
Nor Asiah Muhamad ◽  
Salmah Nordin ◽  
Ruziaton Hasim ◽  
Siti Nurhani Rafan ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Drug Use ◽  
Maintenance Therapy ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Methadone Maintenance ◽  
Public Health Problem ◽  
Methadone Maintenance Therapy ◽  
Treatment Modalities ◽  
Drug Use Disorders

INTRODUCTION: Drug addiction and drug abuse is a serious public health problem worldwide. Millions of people worldwide suffered from drug use disorders, directly and indirectly, attributable to drug use and included deaths related to HIV and hepatitis C acquired through unsafe injecting practices. Many parts of the world have a shortfall in prevention and treatment for drug use disorders, with only less than 10% of people with drug use disorders receiving treatment yearly. Medication-assisted treatment of opioid dependence like Methadone is used in maintenance therapy or detoxification helps people with drug use disorders. MATERIAL AND METHODS: Secondary data from an existing electronic dataset in Ministry of Health (MOH) from 2015 until 2019, which includes registered patients who had undergone Methadone Maintenance Therapy (MMT) either government or private facilities were included. The dataset divided into few domains namely socio-demographic, treatment modalities, clinic location and history of infection. RESULTS: A total of 37 various government and private facilities deliver MMT programme in the state of Selangor offered to a total of 5337 patients. The youngest patients were in the early twenties and oldest were in late seventies. The median age of patients was 45 years and the majority were males. Most of them were having secondary education (SPM holder) and below. Most of MMT programme takers were opioid drug users then followed by Amphetamine Type Stimulant (ATS) as the second most used. Among MMT programme takers, about 34.1% were reactive for Hepatitis C, 6.6% reactive for HIV, 4.2% reactive for Hepatitis B and 1.7% acquired tuberculosis infection. Almost 5% of MMT takers had passed away, which the three main causes of death were AIDS, alleged motor vehicle accident and septic shock. None of MMT takers was died due to methadone. CONCLUSION: It is a great concern of the nation in combating drug-related problems due to the growing number of substance abusers. This review concluded that the MMT programme that widely available had shown a positive outcome by keeping lower mortality among MMT patients.

scholarly journals Experience of performing radical trachelectomy with uterine transposition in organ-preserving treatment of stage IB-II invasive cervical cancer

2021 ◽  
Vol 67 (1) ◽  
pp. 85-90
Author(s):  
Alyena Chernyshova ◽  
Vitaly Аntipov ◽  
Larisa Коlomiets ◽  
Vladimir Chernov ◽  
Victor Gyunter ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Assisted Reproductive Technologies ◽  
Invasive Cervical Cancer ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Treatment Modalities ◽  
Combined Modality Treatment ◽  
Radical Trachelectomy ◽  
Stage Ib

The development and implementation of organ-preserving treatment modalities is the priority trend in the current cancer treatment of patients of the reproductive age. Methods of expanding indications for organ-preserving treatment in cancer patients are becoming relevant. We present our experience in performing radical trachelectomy with uterine transposition in patients with stage IB-II cervical cancer. Our surgical technique allows the preservation of the uterus and adnexa in patients with invasive cervical cancer, who need to receive combined modality treatment including extended surgery followed by chemotherapy or radiation therapy to the pelvis. Transposition of the uterus and adnexa after radical abdominal or laparoscopic trachelectomy allows the movement of the uterus and ovaries out of the radiation field. After completion of radiation therapy, the uterus with adnexa is repositioned into the pelvis and uterine-vaginal anastomosis is formed using an implant made of titanium nickelide. Independent pregnancy and the use of assisted reproductive technologies are permitted after passing the time when distant metastases are most likely to develop.  

scholarly journals Nosocomial infections in the Intensive care unit: global problem of modern medicine

2018 ◽  
Vol 1 (2) ◽  
pp. 5-19
Author(s):  
Zara Vezirova
Keyword(s):  
Nosocomial Infections ◽  
Metastatic Cancer ◽  
Intensive Therapy ◽  
Treatment Modalities ◽  
Critical Conditions ◽  
Special Treatment ◽  
Surgical Interventions ◽  
Hospital Acquired Infections ◽  
The Us ◽  
Hospital Acquired

Increased volume of surgical interventions, improvement of efficiency of special treatment modalities and modes of respiratory support, as well as development of new generation antibiotic medications has led to significant improvement of clinical outcomes of intensive therapy for critical conditions. At the same time, introduction of innovative and largely invasive interventions resulted in the emergence of new disease entities. Presently, the development of hospital-acquired infections (HAI) has become one of the riveting and serious problems of modern hospitals. These infections often lead to prolonged hospital stay, which in turn adds to the morbidity and mortality, worsen patient quality of life and also has significant economic consequences [1-5]. There are number of varying definitions of infections related to medical care [6]. According to the WHO, infections that develop 48 hours after hospitalization, excluding the incubation period, are called hospital-acquired or nosocomial infections. Some authors also include here infections that develop 4 weeks after patient’s discharge from hospital or 30 days after surgical interventions are also included in this category. Infections that develop within 30 days after last chemotherapy in patients with metastatic cancer are also included as additional criteria according to a medical literature [7]. Other authors conclude that readmission of patients with established infection that was the result of previous hospitalization as well as any infectious diseases of hospital employee that develops secondary to the work in the hospital, irrespective to the time of onset of symptoms (during or after the hospital visit or stay) shall also be regarded as the hospital-acquired infections (HAI) [8-10]. The average prevalence of HAI is around 3.5-10.5% or 9.0-91.7 cases per 1000 patient-days [11]. It is estimated that the probability of infectious complications increases after five days of hospitalization [12]. According to the modern medical knowledge, the prevalence of HAI of various causes among the hospitalized patients in North America and Europe is around 5-10% and those in Latin America and Asia is around 40% [13,14]. The mortality among patients with HAI is seven times higher than among other patients aligned based on age, sex, main disease and comorbidities and severity of disease. According to the official statistics, HAIs are fourth most common cause of mortality in the US leading to 90.000 deaths annually. Annual economic burden and additional costs associated with the treatment of HAIs in the US is about 2.4-4.5 billion US dollars [15-17].

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