scholarly journals COVID-19: step-by-step treatment strategies

2021 ◽  
pp. 155-162
Author(s):  
D. P. Salivonchik
Keyword(s):  
World War Ii ◽  
Survival Rate ◽  
High Risk ◽  
Oxygen Therapy ◽  
Treatment Strategies ◽  
Pulse Therapy ◽  
Adverse Outcomes ◽  
Control Group ◽  
Clinical Hospital ◽  
Risk Patients

Objective: to evaluate the effectiveness and safety of anticoagulant and glucocorticosteroid therapy in patients with COVID-19, to determine step-by-step solutions in the prescription of drug therapy at the inpatient stage.Materials and methods. We performed two randomized continuous prospective comparative studies including 1,801 patients diagnosed with COVID-19 pneumonia who were undergoing inpatient treatment in November-December 2020 (1,004 patients) in Gomel Regional Clinical Hospital for the Disabled of World War II and in February 2021 (797 patients) in Gomel City Clinical Hospital No. 3.Results. The step-by-step strategy for treating patients with pneumonia associated with COVID-19 is to divide the patients into groups of high and moderate risks of adverse outcomes (based on the developed predictors) on the first day of hospitalization. In moderate-risk patients, the “protocol” therapy stabilizes the condition; in high-risk patients, it is not effective. Early preemptive anticoagulant therapy (ACT) and individual hormone therapy (prior to pulse therapy) may stabilize the condition of the patients, increase the survival rate from 82.1 % to 96.8 %, p = 0.0001. The additional steps are: targeted use of tocilizumab in the Somatic Department before the Intensive Care Department (70 % survival, p = 0.031), oxygen therapy, pronposition, catheterization of patients, use of the domestic hepatoprotector, membrane-stabilizing antiischemic drug “Thiotriazoline” in patients with high blood lactate levels (lactate dehydrogenase (LDH)), which stabilizes metabolic processes in the affected organs (in dynamics by 342.7 ± 92.8 units/l for 5 days compared to the control group, p=0.0001). When the patient’s condition gets stabilized, the use of respiratory and physical rehabilitation are the final steps of the recovery strategy at the inpatient stage.Conclusion. Therapeutic anticoagulant and individual glucocorticosteroid therapy in combination with oxygen therapy, the use of thiotriazoline in some COVID-19 patients being at a high risk of adverse outcomes have led to an increased survival rate — from 82.1 % to 96.8 % at the hospital stage, p = 0.0001.

Neuroblastoma: An Updated Review on Biology and Treatment

2020 ◽  
Vol 20 (13) ◽  
pp. 1014-1022 ◽  
Author(s):  
Suresh Mallepalli ◽  
Manoj Kumar Gupta ◽  
Ramakrishna Vadde
Keyword(s):  
Survival Rate ◽  
High Risk ◽  
Molecular Mechanisms ◽  
Definitive Treatment ◽  
Therapeutic Drug ◽  
Mycn Amplification ◽  
Dependent Manner ◽  
High Risk Patients ◽  
Treatment And Prevention ◽  
Risk Patients

Background: Neuroblastoma (NB) is the second leading extracranial solid tumors of early childhood and clinically characterized by the presence of round, small, monomorphic cells with excess nuclear pigmentation (hyperchromasia).Owing to a lack of definitive treatment against NB and less survival rate in high-risk patients, there is an urgent requirement to understand molecular mechanisms associated with NB in a better way, which in turn can be utilized for developing drugs towards the treatment of NB in human. Objectives: In this review, an approach was adopted to understand major risk factors, pathophysiology, the molecular mechanism associated with NB, and various therapeutic agents that can serve as drugs towards the treatment of NB in humans. Conclusions: Numerous genetic (e.g., MYCN amplification), perinatal, and gestational factors are responsible for developing NB. However, no definite environmental or parental exposures responsible for causing NB have been confirmed to date. Though intensive multimodal treatment approaches, namely, chemotherapy, surgery &radiation, may help in improving the survival rate in children, these approaches have several side effects and do not work efficiently in high-risk patients. However, recent studies suggested that numerous phytochemicals, namely, vincristine, and matrine have a minimal side effect in the human body and may serve as a therapeutic drug during the treatment of NB. Most of these phytochemicals work in a dose-dependent manner and hence must be prescribed very cautiously. The information discussed in the present review will be useful in the drug discovery process as well as treatment and prevention on NB in humans.

scholarly journals Audio-guided self-hypnosis for reduction of claustrophobia during MR imaging: results of an observational 2-group study

2021 ◽  
Author(s):  
Adriane E. Napp ◽  
Torsten Diekhoff ◽  
Olf Stoiber ◽  
Judith Enders ◽  
Gerd Diederichs ◽  
...  
Keyword(s):  
High Risk ◽  
Mr Imaging ◽  
Odds Ratio ◽  
Control Group ◽  
Waiting Room ◽  
High Risk Patients ◽  
Imaging Results ◽  
Before And After ◽  
Risk Patients ◽  
And Coping

Abstract Objectives To evaluate the influence of audio-guided self-hypnosis on claustrophobia in a high-risk cohort undergoing magnetic resonance (MR) imaging. Methods In this prospective observational 2-group study, 55 patients (69% female, mean age 53.6 ± 13.9) used self-hypnosis directly before imaging. Claustrophobia included premature termination, sedation, and coping actions. The claustrophobia questionnaire (CLQ) was completed before self-hypnosis and after MR imaging. Results were compared to a control cohort of 89 patients examined on the same open MR scanner using logistic regression for multivariate analysis. Furthermore, patients were asked about their preferences for future imaging. Results There was significantly fewer claustrophobia in the self-hypnosis group (16%; 9/55), compared with the control group (43%; 38/89; odds ratio .14; p = .001). Self-hypnosis patients also needed less sedation (2% vs 16%; 1/55 vs 14/89; odds ratio .1; p = .008) and non-sedation coping actions (13% vs 28%; 7/55 vs 25/89; odds ratio .3; p = .02). Self-hypnosis did not influence the CLQ results measured before and after MR imaging (p = .79). Self-hypnosis reduced the frequency of claustrophobia in the subgroup of patients above an established CLQ cut-off of .33 from 47% (37/78) to 18% (9/49; p = .002). In the subgroup below the CLQ cut-off of 0.33, there were no significant differences (0% vs 9%, 0/6 vs 1/11; p = 1.0). Most patients (67%; 35/52) preferred self-hypnosis for future MR examinations. Conclusions Self-hypnosis reduced claustrophobia in high-risk patients undergoing imaging in an open MR scanner and might reduce the need for sedation and non-sedation coping actions. Key Points • Forty percent of the patients at high risk for claustrophobia may also experience a claustrophobic event in an open MR scanner. • Self-hypnosis while listening to an audio in the waiting room before the examination may reduce claustrophobic events in over 50% of patients with high risk for claustrophobia. • Self-hypnosis may also reduce the need for sedation and other time-consuming non-sedation coping actions and is preferred by high-risk patients for future examinations.

scholarly journals Sustained, local delivery of the PARP inhibitor talazoparib prevents the development of mammary gland hyperplasia in Brca1-deficient mice

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Di Zhang ◽  
Bijay Singh ◽  
Jessica Moerland ◽  
Owen Mitchell ◽  
Lizbeth Lockwood ◽  
...  
Keyword(s):  
High Risk ◽  
Parp Inhibitor ◽  
Tumor Development ◽  
Radical Mastectomy ◽  
Mammary Glands ◽  
Parp Inhibitors ◽  
Control Group ◽  
Emotional Challenges ◽  
Risk Patients ◽  
Deficient Mice

AbstractMutations in BRCA genes are the leading cause of hereditary breast cancer. Current options to prevent cancer in these high-risk patients, such as anti-estrogen drugs and radical mastectomy, are limited by lack of efficacy, undesirable toxicities, or physical and emotional challenges. We have previously shown that PARP inhibitors can significantly delay tumor development in BRCA1-deficient mice. Here, we fabricated the PARP inhibitor talazoparib (TLZ) into spacer implants (InCeT-TLZ) for localized and sustained delivery. We hypothesized that this novel formulation will provide an effective chemopreventive strategy with minimal toxicity. TLZ was released gradually over 30 days as implants degraded. InCeT-TLZ significantly decreased proliferation and increased DNA damage in the mammary glands of BRCA1-deficient mice. Notably, the number of mice that developed hyperplasia in the mammary glands was significantly lower with InCeT-TLZ treatment compared to the control group. Meanwhile, InCeT-TLZ was also better tolerated than oral TLZ, without loss of body weight or anemia. This study provides proof of concept for a novel and safe chemopreventive strategy using localized delivery of a PARP inhibitor for high-risk individuals. Future studies will directly evaluate the effects of InCeT-TLZ for preventing tumor development.

scholarly journals Adjuvant Gemcitabine-Oxaliplatin (GeMOX) after Curative Surgery in High-risk Patients with Cholangiocarcinoma

2009 ◽  
Vol 3 ◽  
pp. CMO.S3360
Author(s):  
Bernard Paule ◽  
Paola Andreani ◽  
Marie-Pierre Bralet ◽  
Catherine Guettier ◽  
René Adam ◽  
...  
Keyword(s):  
Survival Rate ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Disease Free Survival ◽  
Curative Surgery ◽  
Free Survival ◽  
High Risk Factors ◽  
Risk Patients ◽  
Disease Free Survival Rate ◽  
Disease Free

Background There is no standard adjuvant chemotherapy to prevent recurrent cholangiocarcinoma (CCA), a rare cancer with poor prognosis. We assessed the efficacy and safety of GEMOX on intrahepatic and hilar CCA with high-risk factors after curative surgery. Patients and Methods Twenty two patients (mean age: 57 years old) with CCA received 6 cycles of GEMOX: gemcitabine 1,000 mg/m2 on day 1 and oxaliplatin 85 mg/m2 on day 2, q3w after a curative surgery. Results All patients completed 6 cycles of GEMOX. EGFR membranous expression was present in 20 CCA. The 5-year survival rate was 56% (CI 95%: 25.7–85.4); 2-year disease free survival rate was 28% (CI 95%: 3.4–52.6). Median time to progression was 15 months. The rate of recurrence after surgery and chemotherapy was 63% (14/22). Two patients died of disease progression. Twelve patients received cetuximab/GEMOX at the time of relapse. Six died after 12 months (9–48 months), three are still alive suggesting a clinical applicability of EGFR inhibitors in CCA. Conclusion Adjuvant chemotherapy with GEMOX alone seems ineffective in intrahepatic and hilar CCA with a high risk of relapse. Additional studies including targeted therapies to circumvent such poor chemosensitivity are needed.

Relapsed Hodgkin Lymphoma in Older Patients: A Comprehensive Analysis From the German Hodgkin Study Group

2013 ◽  
Vol 31 (35) ◽  
pp. 4431-4437 ◽  
Author(s):  
Boris Böll ◽  
Helen Goergen ◽  
Nils Arndt ◽  
Julia Meissner ◽  
Stefan W. Krause ◽  
...  
Keyword(s):  
High Risk ◽  
Older Patients ◽  
Prognostic Score ◽  
Treatment Strategies ◽  
Study Group ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Early Relapse ◽  
Risk Patients

Purpose Progression or relapse of Hodgkin lymphoma (HL) is common among older patients. However, prognosis and effects of second-line treatment are thus far unknown. Patients and Methods We investigated second-line treatment and survival in older patients with progressive or relapsed HL. Patients treated within German Hodgkin Study Group first-line studies between 1993 and 2007 were screened for refractory disease or relapse (RR-HL). Patients with RR-HL age ≥ 60 years at first-line treatment were included in this analysis. Results We identified 105 patients (median age, 66 years); 28%, 31%, and 41% had progressive disease, early relapse, or late relapse, respectively. Second-line treatment strategies included intensified salvage regimens (22%), conventional polychemotherapy and/or salvage-radiotherapy with curative intent (42%), and palliative approaches (31%). Median overall survival (OS) for the entire cohort was 12 months; OS at 3 years was 31% (95% CI, 22% to 40%). A prognostic score with risk factors (RFs) of early relapse, clinical stage III/IV, and anemia identified patients with favorable and unfavorable prognosis (≤ one RF: 3-year OS, 59%; 95% CI, 44% to 74%; ≥ two RFs: 3-year OS, 9%; 95% CI, 1% to 18%). In low-risk patients, the impact of therapy on survival was significant in favor of the conventional polychemotherapy/salvage radiotherapy approach. In high-risk patients, OS was low overall and did not differ significantly among treatment strategies. Conclusion OS in older patients with RR-HL can be predicted using a simple prognostic score. Poor outcome in high-risk patients cannot be overcome by any of the applied treatment strategies. Our results might help to guide treatment decisions and evaluate new compounds in these patients.

scholarly journals Are infants born to high-risk patients with grand multiparity at increased risk of adverse outcomes?

2022 ◽  
Vol 226 (1) ◽  
pp. S304
Author(s):  
Olivia Recabo ◽  
Alexander J. Gould ◽  
Phinnara Has ◽  
Nina K. Ayala ◽  
Martha B. Kole-White ◽  
...  
Keyword(s):  
High Risk ◽  
Adverse Outcomes ◽  
High Risk Patients ◽  
Grand Multiparity ◽  
Increased Risk ◽  
Risk Patients

Abstract 2471: Contemporary Results of Isolated Aortic Valve Replacement in High-Risk Patients in the Context of Emerging Percutaneous Approaches

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Pierre Voisine ◽  
Siamak Mohammadi ◽  
Josep Rodés-Cabau ◽  
Patrick Mathieu ◽  
Jean Perron ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Survival Benefit ◽  
Control Group ◽  
Perioperative Mortality ◽  
High Risk Patients ◽  
All Cause Mortality ◽  
Risk Patients ◽  
Related Mortality ◽  
Parsonnet Score

Percutaneous aortic valve replacement (AVR) is emerging as an alternative therapeutic approach for high-risk surgical patients, but criteria for patient selection are not clearly established. We sought to evaluate the perioperative and mid-term outcomes in a contemporary cohort of high-risk patients undergoing isolated AVR. Between 1997 and 2006, 855 consecutive patients underwent isolated AVR at our institution. High-risk patients (n=162, 19%) were defined by a preoperative Parsonnet score ≥ 30 or Euroscore ≥ 9. The remaining 693 patients (81%) composed the control group for comparison of perioperative mortality and mid-term freedom from all-cause and cardiac-related mortality. Mean follow up was 2.9±2.1 years. Perioperative mortality was 8.6% in the high-risk and 2.9% in the control group (p=0.0007), lower than that predicted by both scores (p<0.05). Freedom from all-cause mortality at 1 and 5 years were 94% and 82% for the control group and 87% and 65% for high-risk patients (p<0.0001). Freedom from cardiac-related mortality was also higher in the control (96% at 1 year, 91% at 5 years) than the high-risk (89% and 82%, p=0.0003) group. When considering patients who survived the 3-month perioperative period (537 in control, 114 in high-risk group), freedom from all-cause mortality was still higher in the former group at 1 and 5 years (99% vs 99% and 85% vs 75%, respectively, p=0.005), but freedom from cardiac-related mortality was not different (99% vs 100% and 94% vs 92%, respectively, p=0.3). By multivariate analysis, chronic renal failure, emergent procedures and reoperations were identified as independent predictors of mortality in high-risk patients. Contemporary perioperative mortality for isolated AVR in high-risk patients is lower than predicted by the Parsonnet score and Euroscore. Five-year survival in these patients is acceptable, and survivors of the operation experience the same cardiac-related survival benefit as those with standard perioperative risk. The perioperative survival benefit of percutaneous approaches for high-risk patients undergoing AVR remains to be demonstrated and, if present, should be weighed against mid-term outcome benefits of conventional surgical AVR.

scholarly journals Polysaccharide hemostatic powder to prevent bleeding after endoscopic submucosal dissection in high risk patients: A randomized controlled trial

Endoscopy ◽  
2020 ◽  
Author(s):  
Da Hyun Jung ◽  
Chan Hyuk Park ◽  
Hee Seok Moon ◽  
Jun Chul Park
Keyword(s):  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Controlled Trial ◽  
Gastric Neoplasms ◽  
Control Group ◽  
High Risk Patients ◽  
Randomized Controlled ◽  
Submucosal Dissection ◽  
Risk Patients ◽  
Hemostatic Powder

Background and aims: Bleeding after endoscopic submucosal dissection (ESD) is a severe adverse event. Several methods to prevent post-ESD bleeding (PEB) have been introduced; however, they have not been widely used because of technical difficulties. We aimed to investigate whether polysaccharide hemostatic powder (PHP), which is very easy to apply, can prevent early PEB, especially in patients with high risk of PEB. Methods: This was a prospective, multicenter, randomized, open-label, controlled trial. Patients with a high risk for PEB were enrolled. Patients with gastric neoplasms in whom the resected specimen size was expected to be >40 mm and those who were regularly taking antithrombotic agents were defined as high-risk patients. Patients were randomly assigned to the PHP or control group. Results: Between May 2017 and September 2018, 143 patients were enrolled (PHP group: 73, control group: 70). The total PEB rate was 6.3% (PHP group: 5% vs. control group: 7.1%, P=0.742). There was no bleeding within 7 days after ESD in the PHP group. Continued antithrombotic use was an independent risk factor of PEB. In subgroup analysis excluding patients who continued to take antithrombotics (n=129) during ESD, the rate of PEB was tended to be lower in the PHP group than in the control group (0% vs. 6.3%, P=0.058). Conclusion: PHP did not demonstrate a significant effect on the prevention of PEB in this study. Further larger-scale, randomized controlled trials are needed to confirm this.(ClinicalTrials.gov 03169569)

scholarly journals Prophylactic Application of an Intra-Aortic Balloon Pump in High-Risk Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Cardiology ◽  
2015 ◽  
Vol 131 (2) ◽  
pp. 109-115 ◽  
Author(s):  
WenJun Ding ◽  
Qiang Ji ◽  
Qiang Wei ◽  
YunQing Shi ◽  
RunHua Ma ◽  
...  
Keyword(s):  
High Risk ◽  
Artery Bypass ◽  
Control Group ◽  
Bypass Grafting ◽  
Surgical Mortality ◽  
Low Cardiac Output ◽  
Off Pump ◽  
High Risk Patients ◽  
Risk Patients ◽  
Pump Coronary Artery Bypass

Background: An intra-aortic balloon pump (IABP) is the most commonly used circulatory assist device in cardiac surgery. We hypothesized that prophylactic application of an IABP improves early clinical outcome of high-risk patients undergoing scheduled off-pump coronary artery bypass grafting (OPCABG). Methods: From January 2010 to December 2013, hemodynamically stable, high-risk patients undergoing scheduled OPCABG with preincision use of an IABP were recruited to the IABP group. Using the propensity score-matching method, every patient in the IABP group was matched with another patient (the control group) with a similar propensity score who received an IABP on an as-needed basis during or after OPCABG. Surgical mortality and major morbidity rates were compared between groups. Results: A total of 116 patient pairs were included in this study. In patients in the IABP group, postoperative low cardiac output and respiratory as well as renal failure were less frequent, intensive care unit stay was shorter, and surgical mortality was lower compared to patients in the control group. In multivariate logistic regression, timing of IABP implantation, as an independent risk factor, was associated with postoperative low cardiac output (OR = 2.02, 95% CI 1.28-5.76), respiratory failure (OR = 1.86, 95% CI 1.19-4.27), renal failure (OR = 2.96, 95% CI 1.51-6.63) and surgical mortality (OR = 2.45, 95% CI 1.42-6.07). Conclusions: Prophylactic application of an IABP improves postoperative cardiac performance, reduces respiratory and renal complications, and consequently lowers surgical mortality in high-risk patients undergoing scheduled OPCABG.

Outcome of patients with early ovarian cancer undergoing three courses of adjuvant chemotherapy following complete surgical staging

2005 ◽  
Vol 15 (4) ◽  
pp. 601-605 ◽  
Author(s):  
M. Shimada ◽  
J. Kigawa ◽  
Y. Kanamori ◽  
H. Itamochi ◽  
T. Oishi ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Survival Rate ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Surgical Staging ◽  
High Risk Patients ◽  
Platinum Based Chemotherapy ◽  
Early Ovarian Cancer ◽  
Risk Patients ◽  
Stage Ia

We conducted the present study to determine the outcome of patients with early ovarian cancer who underwent three courses of adjuvant chemotherapy after complete surgical staging. One hundred consecutive patients with stage I–II epithelial ovarian cancer who had undergone complete surgical staging and received three courses of platinum-based chemotherapy were entered in this study. Twenty-one patients were low risk, defined as stage IA–B, grade 1 and histologic types except for clear cell adenocarcinoma, and remaining 79 were high risk. All patients with stage IA or IB, whatever histologic type and histopathologic grade, were alive without disease. The 5-year survival rate was 89.4% for patients with stage IC and 76.2% for those with stage II. The 5-year survival rate for low- and high-risk patients was 100% and 89.4%, respectively. The survival rate for grade 1 was significantly better than that for grade 2 or 3. Multivariate analysis revealed that histologic grade was an independent prognostic factor in stage IC–II ovarian cancer. The outcome of patients with early ovarian cancer undergoing three courses of chemotherapy after complete surgical staging was favorable even in high-risk patients

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