Bioactive Heterocyclic Compounds as Potential Therapeutics in the Treatment of Gliomas: A Review

: Cancer is one of the most alarming diseases, with an estimation of 9.6 million deaths in 2018. Glioma occurs in glial cells surrounding nerve cells. The majority of the patients with gliomas have a terminal prognosis, and the ailment has significant sway on patients and their families, be it physical, psychological, or economic wellbeing. As Glioma exhibits, both intra and inter tumour heterogeneity with multidrug resistance and current therapies are ineffective. So the development of safer anti gliomas agents is the need of hour. Bioactive heterocyclic compounds, eithernatural or synthetic,are of potential interest since they have been active against different targets with a wide range of biological activities, including anticancer activities. In addition, they can cross the biological barriers and thus interfere with various signalling pathways to induce cancer cell death. All these advantages make bioactive natural compounds prospective candidates in the management of glioma. In this review, we assessed various bioactive heterocyclic compounds, such as jaceosidin, hispudlin, luteolin, silibinin, cannabidiol, tetrahydrocannabinol, didemnin B, thymoquinone, paclitaxel, doxorubicin, and cucurbitacins for their potential anti-glioma activity. Also, different kinds of chemical reactions to obtain various heterocyclic derivatives, e.g. indole, indazole, benzimidazole, benzoquinone, quinoline, quinazoline, pyrimidine, and triazine, are listed.

In the name of the family? Against parents’ refusal to disclose prognostic information to children

Parents frequently attempt to shield their children from distressing prognostic information. Pediatric oncology providers sometimes follow parental request for non-disclosure of prognostic information to children, invoking what we call the stability of the family argument. They believe that if they inform the child about terminal prognosis despite parental wishes, cohesion and family structure will be severely hampered. In this paper, we argue against parental request for non-disclosure. Firstly, we present the stability of the family argument in more detail. We, then, set out the (conceptual, legal, systemic) entitativity of the family and the kind of value the stability of the family argument assumes, before we set on to critically evaluate the argument. Our analysis shows that disclosure of prognostic information to children does not necessarily destabilize the family to a greater extent than non-disclosure. In fact, a systemic perspective suggests that mediated disclosure is more likely to result in a (long-term) stability of the family than non-disclosure. It is in the interest of the family to resist the initial aversive reaction to delivering bad news. In the final part, we draw a set of recommendations on how to facilitate decision-making in face of parental request for non-disclosure.

Rare but serious cause for hypokalaemia and hypertension

Adrenocortical carcinoma is a rare tumour but hypertension conversely is very common. We present the case of a woman in her 30s, with poorly controlled hypertension on four antihypertensive agents. She was referred to the accident and emergency department with hypokalaemia. For a year, she had experienced oedema, weight gain, acne, hirsutism and oligomenorrhea. She had a classic Cushingoid appearance and marked striae. Cushing’s syndrome was confirmed biochemically with an abnormal overnight dexamethasone suppression test. She was diagnosed with metastatic adrenocortical carcinoma following CT imaging. This was resected via a right adrenalectomy, nephrectomy and cholecystectomy. She also received mitotane. Unfortunately, she has a terminal prognosis having experienced a recurrence. This case demonstrates the value of a thorough clinical assessment. More importantly, it highlights the need to refer earlier patients under 40 with resistant hypertension to a specialist. Finally, it encourages clinicians to investigate hypokalaemia in the context of hypertension.

You Can’t Tell Him That!

Truth telling, also known as prognostic disclosure, is not always the norm in pediatric health care. With children who have limited understanding of illness and parents who make medical decisions on behalf of their children, pediatricians are accustomed to excluding their pediatric patients from medical discussions. However, as children become adolescents and adolescents become young adults, they have an increasing role in medical decision-making and therefore need increased prognostic disclosure. When dealing with a terminal prognosis, families may try to prevent providers from talking with their child about death. This chapter discusses the history and ethics of prognostic disclosure in pediatric health care with a focus on adolescents and families who are resistant to open conversation.

Movement in the wrong direction: Inaccurate change in prognostic understanding and its predictors.

54 Background: Prognostic understanding research has primarily focused on improvements in the accuracy of patient understanding and factors driving such improvements. However, could patients with a terminal prognosis become more inaccurate in their understanding, and what factors predict such change? Methods: In a multi-site prospective study, 184 advanced cancer patients, whom oncologists expected to die within 6 months, were assessed twice (median time 5 weeks apart). Potential predictors were examined at the first assessment: age, gender, education, marital and insurance status, race, ethnicity, geographical region, cancer type, physical and psychological quality of life, and religious beliefs in end-of-life care. The accuracy of prognostic understanding was measured at both assessments using a 4-item index (understanding of terminal illness status, shortened life-expectancy, disease incurability, and advanced stage). Patients with lower prognostic understanding scores at the second assessment compared to the first assessment were categorized as demonstrating more inaccurate understanding. Results: 18.5% ( n = 34) of patients became more inaccurate in their prognostic understanding. Race ( p < .01), geographic region ( p = 0.03), and religious beliefs ( p < .01) emerged as significant correlates. Specifically, being non-white, being from South-Western/Western United States, and holding stronger religious beliefs were associated with higher likelihood of prognostic understanding becoming more inaccurate. Simultaneously examining these three predictors in a logistic regression model showed likely overlap in their predictive ability, with race ( p = 0.45) and geographic region ( p = .32 & .72, dummy coded) becoming non-significant, and religious beliefs retaining marginal significance ( p = .06). Conclusions: Some patients with a terminal prognosis may become more inaccurate in their prognostic understanding, and this may be more likely among those with stronger religious beliefs. The findings additionally raise the potential role of inaccurate prognostic understanding in contributing to the racial, religious, and regional disparities currently found in end-of-life care.

Clinical Work Intensity Among Medical Oncologists Practicing in National Community Oncology Research Program Community Sites

PURPOSE: This study (1) assesses the level of clinical work intensity medical oncologists and oncologic nurse practitioners experience providing care and (2) identifies patient, provider, and practice factors mediating intensity. PATIENTS AND METHODS: Seventeen medical oncologists (12 physicians and five nurse practitioners) from five national sites national reported on the level of work intensity associated with 339 patient visits. Data collection at each site occurred over a 2- to 6 week period; for each provider, five visits were randomly selected from each of 4 randomly selected clinic days, yielding 20 visits per provider. Intensity was measured by the NASA–Task Load Index. Patient and visit characteristics were abstracted from the medical record; provider characteristics were self-reported by questionnaire. RESULTS: Clinical work intensity increased monotonically with level of service and was greatest when the visit involved discussion of either chemotherapy or terminal prognosis. Provider characteristics (including age, sex, and years of experience) were unrelated to intensity. Dimensions of work intensity that correlated directly with level of service included mental, physical, and temporal demand; effort; frustration; and stress. Perceptions of performance and of satisfaction with the visit were unrelated to level of service. Visits related to chemotherapy had greater mental, physical, and temporal demand, and effort, but worse perception of performance. When the visit involved a discussion of a terminal prognosis, greater intensity was reflected in all dimensions; stress was also greater, whereas visit satisfaction was significantly lower. CONCLUSION: Clinical work intensity increases with level of service provided and is greater for visits involving discussion of either terminal prognosis or chemotherapy.

The Eighth Domain of Palliative Care

This chapter discusses palliative psychology competencies in the eighth domain of palliative care, which addresses the legal and ethical aspects of palliative care. Firstly, the chapter reviews psychology ethical standards and principles discussing their application and relevance to the palliative care setting. Palliative psychology competencies are presented. Additionally, principles of medical ethics related to decision making are discussed. Complex case scenarios are discussed with the aid of clinical case vignettes. In particular, the discussion focuses on the ethical issues related to disclosure of a terminal prognosis, family conflicts, and intimate partner violence of patients with advanced illness. Psychological approaches and interventions are discussed in the context of the interdisciplinary palliative care tem approach.