Awake Implementation of Extracorporeal Life Support in Refractory Cardiogenic Shock

Background and objectives: Extracorporeal life support (ECLS) is a widely accepted and effective strategy for use in patients presenting with refractory cardiogenic shock. Implantation in awake and non-intubated patients allows for optimized evaluation of further therapy options while avoiding potential side effects associated with the need for sedation and intubation. The aim of the study was the assessment of safety and feasibility of awake ECLS implementation and of outcomes in patients treated with this concept. Materials and Methods: We retrospectively reviewed the concept of awake ECLS implantation in 16 consecutive patients (mean age 58 ± 8 years; male: 88%; ischemic cardiomyopathy: 50%) from 02/2017 to 01/2021. Study endpoints were survival to weaning or bridging to durable support or organ replacement and development of end-organ function and hemodynamic parameters on ECLS. Results: Fourteen patients (88%) were able to be successfully transitioned to definite therapy options. ECLS support stabilized end-organ function, led to a decrease in mean lactate levels (5.3 ± 3.7 mmol/L at baseline to 1.9 ± 1.3 mmol/L 12 h after ECLS start; p = 0.01) and improved hemodynamics (median central venous pressure 20 ± 5 mmHg vs. 10 ± 2 mmHg, p = 0.001) over a median duration of two days (1–8 days IQR). Two patients (13%) died on ECLS support due to multi-organ dysfunction syndrome. Survival to discharge of initially successfully bridged or weaned patients was 64%. Conclusions: Awake ECLS implantation is feasible and safe with the key advantage of omitting or delaying general anesthesia and intubation, with their associated risks in cardiogenic-shock patients, facilitating further decision making.

Balanoposthitis: issues of classification, diagnosis and approaches to therapy

Objective. To present a variant of the modern classification of the processes occurring with lesions of the genitals, to draw specialists’ attention to the peculiarities and variety of causes leading to inflammation of the glans and foreskin, as well as to discuss topical issues of external therapy of balanopostitis.Material and methods. Data from modern studies and clinical guidelines were used in the preparation of the publication.Results. The variety of variants of lesions of the glans and foreskin can be due to a number of reasons and can be either an independent local process or a fragment of dermatosis, where it is possible to be affected in the form of balanoposthitis. Also, when examining and selecting therapy options, it is important to consider the possible role of microorganisms, whose spectrum as a cause of balanoposthitis varies from aerobic and anaerobic, to viral and fungal microflora. Treatment approaches are determined by the etiological factors.Conclusions. Balanoposthitis is a heterogeneous group of nosologies. The choice of treatment is based on the identified cause or empirically when possible. External therapy and hygiene constitute an essential part of treatment. When choosing drugs for topical glucocorticosteroids, preferenceshould be given to drugs with a high therapeutic index and low atrophogenic potential. Dysplastic processes of the penis are associated with human papillomavirus infection, the treatment of which can be both conservative and destructive.

Tocilizumab: A promising treatment for COVID-19 patients

A novel Coronavirus was identified in China as SARS-CoV-2 in December 2019 and was later declared a pandemic by the World Health Organization [1]. In most patients, COVID-19 presents with mild or moderate symptoms such as fever, cough, fatigue, and myalgia. However, around 10% of patients develop more severe symptoms such as pneumonia and multiorgan failure, which can result in death [1-2]. Until vaccines are widely available, the only way to reduce fatality rates is to treat affected patients with existing drugs and therapy options.

CLOSURE OF MIDLINE DIASTEMA BY DIRECT COMPOSITE RESIN BUILD-UP USING PUTTY INDEX- A CASEREPORT

A common aesthetic concern among patient is maxillary anterior space or diastema. Labial frenulum, microdontia, mesiodens, peg-shaped lateral incisors, agenesis, cysts, habits such as finger sucking, tongue thrusting, or lip sucking, dental malformations, genetics, proclinations, dental-skeletal discrepancies, and imperfect coalescence of the interdental septum are some of the causes of midline diastema. For diastema closure there are a variety of therapy options. Many novel therapies have been applied, ranging from restorative procedures to surgery (frenectomies) and orthodontics for closure of diastema or a combination of procedures to meet the aesthetic and functional needs of patient’saesthetic. Recent advancement in direct dental composite resin allows dentists to do minimally invasive cosmetic dentistry that is both conservative and time-consuming. In diastema cases, direct composite resins give the dentist and patient entire control over the restriction and the construction of a natural smile. The purpose of this study is to present a case report of aesthetic management using putty index of maxillary anterior space, which includes the midline.

Therapy Options Received and Impact of Pharmacist-Led Interventions on Self-Care Management of Adverse Events among Cervical Cancer Patients in a Nigerian Tertiary Hospital

The available services for the treatment of premalignant and malignant cervical cancer (CC) lesions are grossly inadequate in Nigeria. Drug-oriented self-care education programmes are lacking in our healthcare facilities. Pharmacist interventions as an expert in drug therapy management are needed. This study assessed the therapy options received and impact of pharmacist-led interventions on self-care management of AEs among CC patients in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, North-Western Nigeria. The study used a prospective longitudinal design with a 12-week patient follow-up. Instrument used was an intervieweradministered questionnaire, which was developed and pre-tested for reliability. Fifty-six eligible CC patients completed the pre- and post-interventions survey conducted over a period of eight months (From October, 2019 to May, 2020). Data analysis was done with appropriate descriptive (frequencies, percentages, means, and standard deviations) and inferential statistics (Paired sample t-test, Pearson’s Chi-square and Correlation) using SPSS Inc., Chicago, IL, USA V. 20 for windows. P< 0.05 was considered statistically significant. The mean age of the patients was 53.8±7.7years and 22(39.2%) have no formal education. Chemoradiation (CRT) and chemotherapy (CT) were the major therapy options received by the 25(44.6%) and 16 (28.6%) of the patients respectively. Before the interventions, the patients scored 57.7±18.7% and 50.8±7.1% overall mean knowledge and practice scores respectively. After the interventions, there was significant increase in the patients’ overall mean knowledge and practice, 17.6% and 6.7%, (p<0.05) scores respectively. There were significant association between patients’ age and total post-intervention knowledge (r=-0.614, p<0.001), and practice, (r=-0.424, p=0.001) scores. There were significant association between the patients’ level of education and total preand post-intervention knowledge (r=0.952, p<0.001 and

Therapy of Angiosarcoma with Thalidomide and Lenalidomide

Angiosarcoma is an uncommon malignancy with a poor prognosis. Systemic therapy options for patients with metastatic disease generally have limited effectiveness. In this case study, a 73-year-old male with metastatic angiosarcoma who previously declined chemotherapy and developed progressive disease after checkpoint inhibitor immunotherapy elected to try thalidomide based on 6 case reports describing its effectiveness. Thalidomide resulted in stable disease for 9 months, but due to severe neuropathy as a side effect, lenalidomide was then substituted for thalidomide. The patient continued to have stable disease on lenalidomide for an additional 16 months and ongoing. This is the first case study to report on effective treatment of angiosarcoma with lenalidomide. Further investigation of lenalidomide in the management of angiosarcoma is warranted.

The New Era of Biologics in Atopic Dermatitis: A Review

Atopic dermatitis (AD) is a prevalent inflammatory skin disorder affecting all ages and ethnic groups. The age-dependent varying appearance and extent of pruritic lesions are accompanied by distinct individual suffering, highlighting the importance of effective treatment options. Over the past years, systemic drugs have considerably extended therapeutic approaches of patients with moderate to severe AD, in particular, new biologics, most notably dupilumab has appeared as major breakthrough. In addition to monoclonal blockade of IL-4 and IL-13 pathway, more cytokines have been found to play a substantial role in AD pathogenesis, presenting potential targets for new therapy options.

AGO Algorithms for the Treatment of Breast Cancer: Update 2021

Therapy options shown in the algorithms are based on the current AGO recommendations, but cannot represent all evidence-based treatment options, since prior therapies, performance status, comorbidities, patient preference, etc. must be taken into account for the actual treatment choice. In individual cases, other evidence-based treatment options may also be appropriate and justified. Regardless of approval status, the algorithms only take into account drugs that were available in Germany at the time the algorithm was last updated. Here we present the 2021 update of AGO treatment algorithms for early and metastatic breast cancer, which are intended to intensify structured treatment decision by providing reproducible and evidence-based treatment paths and may be helpful for a broad treatment landscape.