Case Report: Differential Genomics and Evolution of a Meningeal Melanoma Treated With Ipilimumab and Nivolumab

Primary melanocytic tumors of the CNS are extremely rare conditions, encompassing different disease processes including meningeal melanoma and meningeal melanocytosis. Its incidence range between 3-5%, with approximately 0.005 cases per 100,000 people. Tumor biological behavior is commonly aggressive, with poor prognosis and very low survivability, and a high recurrence rate, even after disease remission with multimodal treatments. Specific genetic alterations involving gene transcription, alternative splicing, RNA translation, and cell proliferation are usually seen, affecting genes like BRAF, TERT, GNAQ, SF3B1, and EIF1AX. Here we present an interesting case of a 59-year-old male presenting with neurologic symptoms and a further confirmed diagnosis of primary meningeal melanoma. Multiple therapy lines were used, including radiosurgery, immunotherapy, and chemotherapy. The patient developed two relapses and an evolving genetic makeup that confirmed the disease’s clonal origin. We also provide a review of the literature on the genetic basis of primary melanocytic tumors of the CNS.

Does second-look endoscopy reduce the bleeding after gastric endoscopic submucosal dissection for patients receiving antithrombotic therapy?

Background In patients with average risk of bleeding, second-look endoscopy does not reportedly reduce bleeding after gastric endoscopic submucosal dissection. However, effectiveness of second-look endoscopy for patients with a high risk of bleeding, such as those who are taking antithrombotic agents, is unclear. Hence, this study aims to clarify the effectiveness of second-look endoscopy for patients with antithrombotic therapy. Methods We studied 142 consecutive patients with 173 gastric epithelial neoplasms who were routinely taking antithrombotic agents and were treated by endoscopic submucosal dissection at Tonan Hospital between November 2013 and December 2019. They were classified into two groups: those with second-look endoscopy (SLE group, 69 patients with 85 lesions) and those without second-look endoscopy (non-SLE group, 73 patients with 88 lesions). The incidence of post-endoscopic submucosal dissection bleeding was compared between the SLE and non-SLE groups. Results There were no statistical differences in the rate of patients undergoing single antiplatelet therapy, single anticoagulant therapy, and multiple therapy between the SLE and non-SLE groups (SLE group vs. non-SLE group; 32 [46.4%], 16 [23.2%], and 21 [30.4%] patients vs. 37 [50.7%], 20 [27.4%], and 16 [21.9%] patients, respectively; p = 0.50). Post-endoscopic submucosal dissection bleeding incidence was 21.7% (15/69) and 21.9% (16/73) in the SLE and non-SLE groups, respectively, and did not significantly differ between the two groups (p = 0.98). Conclusions For patients taking antithrombotic agents, the incidence of post-endoscopic submucosal dissection bleeding was not reduced by second-look endoscopy.

Rapid sensitive bioscreening of remdesivir in COVID-19 medication: Selective drug determination in the presence of six co-administered therapeutics

The widespread coronavirus 2019 (COVID-19) pandemic, attributed to the severe acute respiratory syndrome coronavirus-2, has resulted in global lockdowns and excess mortality. Remdesivir (RM) is the first and only antiviral drug that the US Food and Drug Administration (FDA) has approved so far for COVID-19. The treatment protocol involves multidrug combinations, basically depending on RM, in addition to antimicrobials, antipyretics, corticosteroids, and anticoagulants. This study develops and validates sensitive and selective RM screening in spiked human plasma in the presence of commonly co-administered drugs. Hydroxychloroquine, azithromycin, paracetamol, dexamethasone, and anticoagulants (rivaroxaban and edoxaban) have been detected simultaneously with RM in the same biological matrix. Separation has been efficiently achieved by simple reversed phase HPLC with dual detectors. Diode array detector and fluorimetric detection have been used to compare their sensitivity and selectivity. Both assays have been validated according to bioanalytical FDA validation parameters. Chromatographic separation and quantitation of RM along with concomitant drugs instantly bioscreen COVID-19 multiple therapy medication in 10 min run time. Furthermore, the proposed in vitro study takes the lead for prospective testing of possible drug–drug interactions that alter the pharmacokinetic profiles of drugs.

Current trends and therapies in orchialgia management

The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.

Does second-look endoscopy reduce the bleeding after gastric endoscopic submucosal dissection for patients receiving antithrombotic therapy?

Background: In patients with average risk of bleeding, second-look endoscopy does not reportedly reduce bleeding after gastric endoscopic submucosal dissection. However, effectiveness of second-look endoscopy for patients with high risk of bleeding such as those who are taking antithrombotic agents remains controversial. Hence, this study aims to clarify the effectiveness of second-look endoscopy for patients with antithrombotic therapy.Methods: We studied 142 consecutive patients with 173 gastric epithelial neoplasms who were routinely taking antithrombotic agents and were treated by endoscopic submucosal dissection at Tonan Hospital between November 2013 and December 2019. They were classified into two groups: those with second-look endoscopy (SLE group, 69 patients with 85 lesions) and those without second-look endoscopy (non-SLE group, 73 patients with 88 lesions). The incidence of post-endoscopic submucosal dissection bleeding was compared between the SLE and non-SLE groups.Results: There were no statistical differences in the rate of patients undergoing single antiplatelet therapy, single anticoagulant therapy, and multiple therapy between the SLE and non-SLE groups (SLE group vs. non-SLE group; 32 [46.4%], 16 [23.2%], and 21 [30.4%] patients vs. 37 [50.7%], 20 [27.4%], and 16 [21.9%] patients, respectively; p = 0.50). Post-endoscopic submucosal dissection bleeding incidence was 21.7% (15/69) and 21.9% (16/73) in the SLE and non-SLE groups, respectively, and did not significantly differ between the two groups (p = 0.98).Conclusions: For patients taking antithrombotic agents, the incidence of post-endoscopic submucosal dissection bleeding was not reduced by second-look endoscopy.

Multiple Therapy Approach for Stage 3 Coats Disease: Long-Term Follow-Up

Purpose. To assess long-term efficacy of a multiple therapy approach in the treatment and management of unilateral stage 3 Coats disease with exudative retinal detachment. Methods. 2 eyes of 2 young patients suffering from unilateral stage 3 Coats disease underwent a multiple therapy approach consisting of surgical drainage of exudative subretinal fluid + one simultaneous and up to one subsequent intravitreal injection of bevacizumab + multiple (up to 3) laser photocoagulation sessions of retinal nonperfusion areas and leaking Coats vasculature. Results. Complete reabsorption of SRF and retinal reattachment were observed in both cases over the follow-up. In no cases, we observed progression to phthisis bulbi. No bevacizumab-related complications were observed. Epiretinal membrane onset was detected in one eye at the end of follow-up. Conclusion. The management and treatment of this rare and degenerative disease in young subjects are still a challenge. The described technique is less invasive than conventional intraocular surgery and may be preferable to halt the devastating progression of the disease.