Treatment of medulloblastoma in pediatric patients over 3 years old: modern approaches with respect to molecular and biologic tumor features

Medulloblastoma (MB) treatment in pediatric patients is an open challenge in clinical oncology. Current treatment protocols are risk-adopted and risk group criteria continuously evolve by increasing data about molecular and biologic mechanisms of MB tumorogenesis. In the current issue it is reviewed modern treatment programs, which became a basis of Russian and International clinical recommendations. It is analyzed treatment results according to regimens of chemotherapy and irradiation, absence or presence of metastases, histologic variant and molecular and biologic tumor features.

EMERGENCY CONDITIONS AS SIMULATION MEDICAL SCENARIOS FOR APPLICANTS OF EDUCATION

Emergency conditions are very life-threatening situations and require fast actions and immediate intervention from medical stuff. For young doctors without extensive experience in the treatment of these important diseases, it is very crucial to know and timely apply modern treatment algorithms. Simulation medical scenarios are a good approach and can help to improve knowledge and practical skills. Authors provide frequent trainigs for students and interns for emergency medical conditions according to world standards and University syllabus. The main idea is to create new and improve old practical skills and competencies for students and interns.

A Case Study on Effective Management of Abhayantra Arsha by Kshara Karma

Arshas being the most common grievous ailment and one of the eight most intractable disorders (Ashta Mahagada) explicited by Acharya Susruta & Vagbhata. Haemorrhoids are the dilatation of the anal and perianal venous plexus. The disturbance of Jatharagni is the most accepted cause of ano rectal problems, which further contributes to constipation. Constipation increases the back pressure into the haemorrhoidal veins to produce piles. Arsha requires a surgical technique in modern treatment, such as haemorrhoidectomy, rubber band ligation, and so on. Kshara is a caustic chemical, alkaline in nature, derived from medicinal plant ashes. The effect of Kshara karma is highly commended, it can replace the Shastra karma as it does the functions of Chedana, Bhedana, Lekhana karmas without using Shastras. Kshara karma can be utilised efficiently in individuals who are afraid of surgery as a complement for surgical operations. A 48years-old male patient presented with complaints of some mass coming out during defecation and bleeding while passing stool to the anorectal unit, OPD, National Institute of Ayurveda, deemed to be university Jaipur Rajasthan. The patient was treated successfully with Kshara karma application. The pile mass and per rectal haemorrhage was gone in 8 days and the patient was free of all symptoms within 18-20 days. The findings revealed that there are maximum advantages which are shared in this case study.

Analysis of Survival Gains in Myelodysplastic Syndromes after a Decade of the Modern Treatment Paradigm

Introduction: The treatment of myelodysplastic syndromes (MDS) changed after the approval of lenalidomide in 2005, and 2 hypomethylating agents (HMA): azacitidine in 2004 and decitabine in 2006. Erythropoietin-stimulating agents (ESA) and reduced intensity conditioning stem cell transplantation (RIC-SCT) also became more widely utilized around that period. Analyses evaluating potential overall survival (OS) improvements in MDS since 2007 across different cancer registries have shown conflicting results. 'Real-world' survival trends are important to measure the true impact of these treatments outside clinical trials, especially as MDS treatment innovations may not reach all patients. We assessed the temporal change in OS and cancer-specific survival (CSS) of MDS patients in the US over the decade before (2001 - 2006) and after modern treatment options were established (2007 - 2016). Methods: Adult subjects diagnosed with MDS between 2001 and 2016 were identified in Surveillance, Epidemiology, and End Results (SEER), and categorized in 2 groups based on year of diagnosis: 2001 - 2006 (cohort 1) and 2007 - 2016 (cohort 2). MDS histologic risk was classified into low, intermediate, and high, using International Classification of Diseases for Oncology 3 rd Edition (ICD-O-3) codes. Cause of death (COD) reported to State registries (SEER recode) was used to determine CSS, defined as death from MDS or acute myeloid leukemia. Only cases with histologic confirmation of ICD-O-3 codes and complete follow up records were analyzed. Kaplan-Meier estimation was used to summarize unadjusted OS distribution. To assess the association of cohort 2 with OS and CSS gains, follow up duration was restricted to a maximum of 5 years in both cohorts and survival analysis was performed using multivariable Cox-proportional hazards regression model adjusting for age, sex, race, ethnicity, MDS risk, and geographic location. Results: We included a total of 42,217 patients with MDS, 13,633 (30.8%) in Cohort 1 (2001 - 2006) and 30,584 (69.2%) in Cohort 2 (modern treatment era). Subjects in cohort 2 were slightly older (mean age 73.8 vs 73.2 years, p<0.001) and included more males (58.6% vs 56.3%, p<0.001). Cohort 1 included more subjects with low MDS histologic risk (27.8% vs 17.2%) and fewer subjects with high MDS risk (18.4% vs 20.5%) (Table 1). Median OS for low, intermediate, and high risk MDS were 44 months (95%CI, 41.5 - 46.5), 27 months (95%CI, 25.7 - 28.3) and 10 months (95%CI, 9.3 - 10.7) in cohort 1, and 48 months (95%CI 45.9 - 50.1), 26 months (95%CI 25.3 - 26.7) and 11 months (95%CI 10.6 - 11.4) in cohort 2, but these differences were not significant. In the multivariable model adjusted for age, sex, race, ethnicity, MDS risk, and geographic location, cohort 2 was associated with a significantly lower hazard of overall death compared to cohort 1, HR for OS of 0.97 (95%CI, 0.95 - 0.99, p<0.001). Similarly, the modern era of treatment was associated with lower cancer-specific death compared to cohort 1, HR for CCS 0.93 (95%CI, 0.89 - 0.93, p=0.038). MDS histologic risk was the strongest factor associated with higher risk of overall and cancer-specific death. Other factors significantly associated with worse OS and CSS were advancing age, male sex, Hispanic ethnicity and unmarried status (Table 2). When analysis was restricted to patients with high risk MDS, cohort 2 was associated with a lower hazard of cancer-specific death, HR for CSS 0.90 (95%CI, 0.84 - 0.94, p=0.006), but no significant difference in overall death, HR for OS 0.96 (95%CI, 0.91 - 1.02, p=0.17). Discussion: In a SEER analysis, we found that the modern paradigm of MDS treatment, including access to lenalidomide, HMA, ESA and RIC-SCT, is associated with only modest survival gains at the population level. Across all MDS risk groups, improvements in cancer-specific death were larger than those seen for overall death and, in high risk MDS, a significant gain in CSS did not translate into longer OS. These data suggest there is a need for targeting non-cancer excess mortality in patients with MDS, who usually present with a high comorbidity burden. Strategies to optimize medical conditions coexisting with MDS and better supportive care may help consolidate the gains associated with currently available MDS-directed therapies. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

New therapeutic options in psoriasis

The biological therapy of moderate-to-severe psoriasis has a history of almost two decades. During this period our knowledge of the pathomechanism of the disease has become more accurate, leading to the development of more and more targeted therapies. Increased efficacy through more specific inhibition is accompanied by less adverse events. In this article, the authors summarize the current possibilities for the modern treatment of psoriasis and the key clinical insights into these options. They discuss the future therapeutic directions and new agents.

Fever and hyperpyrexia in children. Emergency care and modern treatment options

The article considers the practical issues of providing emergency care to children with febrile conditions from the mo-dern point of view. The main data reflecting the pathogenesis of fever are presented. Recommendations for the selection of groups of patients at high risk of threatening bacterial infections and approaches to their examination and treatment are provided. A review of modern pharmacological possibilities of antipyretics is also given.

A Comparative Clinical Study to Evaluate the Efficacy of Guduchyadi Kashaya and Rajrukshadipachana Kashaya in the Management of Eka Kushta w.s.r to Psoriasis

In Ayurveda, all skin diseases have been described under the umbrella of Kushtha. Ekakusta is considered as the most commonest skin disease that can affect an individual. Acharya Charak has described the involvement of Vata-Kapha in Eka Kushtha. In the present study Eka kushtha is compared with psoriasis due to resemblance of signs symptoms and causative factors with it. Psoriasis is a papulosquamous disorder of the skin, characterized by sharply defined erythematosquamous lesions this illness exhibits a prompt response if treated carefully, left it may run a very chronic course extending into larger area of the body. Ayurveda focuses more on curative management than palliative management. The drug used in the treatment of Ayurveda does not have complications like modern treatment. Repeated Sodhana prevent the recurrence of the disease. Similarly various preparations have been advocated for the management of Psoriasis. The drugs used in this study are Guduchyadi Kashaya & Rajrukshadi Pachana Kashaya. Both the Kashayas are said to be effective in skin diseases. As per Yogaratnakara, Guduchyadhi Kwath has been mentioned as one of the drug having curative effect on all types of Kustha. Hence for present study the orally Guduchyadi Kwath is taken for EkaKustha treatment. The drugs in Guduchyadi Kwatha are Kusthaghana, Twachya, Swedal, Tridosh shamaka, as well as with Rasayan properties, which is beneficial to break down the pathogenesis of disease. As per Gadanigraha, as mentioned in Kayachikitsakhanda, Rajvrukshadipachana Kashaya is mentioned for the treatment of Ekakushtha. Ingredients in Rajvrukshadi Pachana Kashaya reduce Kapha dosha and most of them act on the skin. Kwatha dravyas are Rasadushtihara, Kaphapittahara, Deepana, Twachya, and also having antibacterial, antimicrobial, antiparasitic and anti-inflammatory properties, Hence, it is helpful for clearing the skin infections.