Integrative chemo-immune-radiological treatment of HER2 positive breast cancer combined with a review of potential microRNAs involved and analysis of experimental results from sub-THz vibrational spectroscopy

In this paper we present the results of a Breast Cancer study by integrative analysis of a NIH approved treatment for HER2 positive breast cancer. This study is combined with analysis of Micro-RNA involvement from application of sub-THz spectroscopy for visualization of molecules circulating in blood by measuring saliva. The combination of Taxol-Generic Name-Paclitaxel (PT-J9267) and Trastuzumab-ANNS 0/0 and KadcylaTM (Genetic Name Ado-Trastuzumab Emtansine) were used in 3-stages of combined chemotherapeutic and immune-treatments followed by Radiation treatment. The goal of using PT was to stop spread of the disease to other organs outside of the breast and under arm lymph nodes, as well as to shrink the size of the tumor to facilitate surgery and radiology in continuation of the treatment. Trastuzumab (TZ) was added to PT in the 2nd step to prevent the development of chemoresistance. Intravenous infusion of Kadcyla was used mainly to prevent metastasis. Integrative analysis of microRNA participation was conducted based on literature review and sub-Terahertz vibrational spectroscopy measurements of absorption spectra from samples taken weekly before and after each treatment, using Vibratess’ spectrometer. The results from sub-THz spectroscopy in this work demonstrate dramatical modification of spectroscopic signatures from patient samples following disease development and the initial steps in the course of treatment. These changes reflect the deep global regulation (reduction) of the initially participating microRNAs amounts and changes in the microRNAs contributing to the spectra.

Isolated acute renal infarction in an obese patient

Background: Uncontrolled cardiovascular (CV) risk factors is been related to a higher incidence of atherosclerosis. Obesity itself could predispose to significant cardiac disease including arterial atheromatous leading to acute events. Case: A 46 years old obese patient who presented with left abdominal pain radiating to the left quadrant and left testicle. No significant abnormality was observed in the laboratories, but imaging showed left renal lower pole may be due to renal infarct (Figure 1), and CT-Angiography (CTA) of the abdomen showed infarction of the anterior two-thirds of the lower pole of the left kidney (Figure 2) secondary to occlusion of the supplying small inferior segmental artery and minimal atherosclerosis. Transthoracic Echocardiogram (TTE) showed a density in the LVOT may be artifact vs. calcification (Figure 3). A transesophageal echocardiogram (TEE) showed Grade III atherosclerotic changes of descending aorta (Figure 4), aortic arch, and a mobile plaque seen in the thoracic aorta. Conclusion: Cardiovascular risk factors have been associated with multiple vascular complications. Obesity as a single cardiovascular risk factor is associated with advanced arterial disease; our case is an example of an unstable atheromatous lesion causing thrombosis and ischemia in the kidney in a patient without another risk factor for thrombosis.

Hidradenitis suppurativa, holistic approach and surgical reconstruction

We present a young adult male patient with chronic Hidradenitis Suppurativa (HS) stage Ⅱ-Ⅲ, mostly involving buttocks, thighs and perineum. The patient has been followed initially by a dermatologist for 2 years with trials of Biologic treatments. The ongoing purulent discharges made him quite dysfunctional. Patient was offered a definitive and extensive surgical option. Considering this conditions’ devastating social, psychological effects, such patients should be managed with a multidisciplinary team, elaborated education and counseling. Initial line of treatment plans should be considered as preparatory to the definitive surgical excisional therapy. Patient’s acceptance to the entire package that goes with the definitive surgery is fundamental for a successful and lasting outcome. Complete surgical resection of the disease and reconstruction remains to be the only available option for cure in a fully established HS.

The role of beta-agonist therapy for chronic obstructive airway disease in patients with coexistent atrial fibrillation

Background: New advances have been made in medicine, but the incidence and prevalence of chronic obstructive pulmonary disease (COPD) are evident, and it is established as the fourth cause of death in the United States representing a high cost for the healthcare system. This condition has been related to atrial fibrillation due to the changes in the lungs and vasculature. Based on this history, we seek to evaluate the outcome of AF in the patients with COPD and its relationship with medical therapy utilized to treat this pulmonary condition with the objective of establishing the relationship between the use of beta-agonist therapy for obstructive airway disease in patients with AF. Discussion: Cell receptors participate in multiple reactions and the sympathetic response is received via the alpha- and betareceptors are related to the hemodynamic of the vasculature of the lungs and cardiovascular system. The beta-blockade agents are one of the most common medication classes used for rate control in cardiac arrhythmias, but the side effect could be COPD exacerbation; on the other hand, beta-adrenergic or beta-agonist as a therapy for this pulmonary condition could increase the heart rate leading to AF decompensation. There is a clear dilemma in our patients who have airway disease and AF since the treatment for one might worsen the other. The clear benefit in morbidity and mortality of beta-blocker therapy, especially beta1- selective, outweighs the potential for any pulmonary side-effects related to ex-acerbation of COPD or airway disease. Conclusion: There is clear data showing the evidence of the potential paradoxical side-effect between COPD and AF therapies, given the exacerbation of one due to treatment of the other, benefits versus risks should be discussed and the medical decision should be made based on them. The deteriorated cardiac condition can rapidly predispose to critical complications leading to death, which is why the use of beta-blockade agents will be chosen over possible complications with pulmonary disease. In other words, the benefit should outweigh the risk based on the best outcome for the patient.

Tonsillectomy, appendectomy and splenectomy: sequels and malignant evolution

The excision of secondary lymphoid organs might not be harmless. Although the procedure itself, is less and less performed presently, infectious sequels in total splenectomy might occur and are possibly fatal. Among further complications, thromboembolic and immune alterations should also be expected. The most debatable of consequences, probably associated with an immune adjustment, concerns the development of malignancies. Considering post-splenectomy tumors, discrepancies emerge between their occurrence in humans, and their consequent protective effect in experimental animals. It is recommended that surgeons aspire at preserving as much of lymphoid tissues a feasible, when performing such resections.

Assessing behavioural prevention strategies to reduce dental caries in the primary schools of the state of qatar-case study

Introduction: Multiple case studies were conducted using a public school and a private school to understand why the prevalence of dental caries was high among primary school children despite previous oral health strategies. The study is aimed to inform the refinement of current dental caries prevention behavioural strategies in Qatar for school children in both public and private settings. Methods: Purposive sampling was used to select 5 pupils, 5 parents, 5 teachers and 2 school nursese for the case study. A semi-structured in-depth interview was conducted with the participants to understand issues relating to prevalence and control of dental caries among school pupils. Results: The study found that home context plays a crucial role in terms of oral health motivation in Qatar. It was found that children are taught the most basic daily oral hygiene-related behaviours at home, including tooth brushing and dental flossing. Discussion: The study revealed the role of parents at home in supporting oral health activities to motivate and empower children to take part in such behaviours. Also, parents and teachers work in collaboration to enhance oral health behaviours in children.

Trimodal bladder-preserving treatment including high-tech radiotherapy in invasive bladder carcinoma-dissertation project with literature review

Over the last two decades, there has been a significant evolution of the complex treatment of the invasive bladder carcinoma (BC), including both surgery methods and high-tech radiotherapy (RT), often combined with chemotherapy (Ch). Different protocols supporting multimodal treatment and the concept of the bladder preservation are currently developed. New high-tech radiation methods were presented combined with Ch to preserve the bladder as a healing alternative to radical cystectomy. The purpose of this overview is to present the place and healing effect of high-tech RT in the contemporary treatment approach to invasive BC. The expected contributions from this research project are: 1) For the first time in Bulgaria, modern bladder-sparing strategies combine maximal transurethral resection of bladder tumor (TURBT) followed by an induction course of concurrent radiation therapy (RT) and sensitizing chemotherapy will be held. 2) Disease-free survival, overall survival, local control and early radical toxicity in two patient groups after self intensity modulated radiation therapy (IMRT) and after concurrent chemoradiotherapy (CChRT) with VMAT will be analyzed. It is important to improve the quality of life by preserving the bladder in the invasive bladder carcinoma.

A case in which TAS-102 produced disease control without severe adverse events in a patient with recurrent colorectal cancer and dihydropyrimidine dehydrogenase deficiency

Fluoropyrimidine is commonly used to treat unresectable cases of metastatic colorectal cancer or as an adjuvant therapy for colorectal cancer. Dihydropyrimidine dehydrogenase (DPD) is an enzyme encoded by the DPYD gene, which is responsible for the rate-limiting step in pyrimidine catabolism and breaks down >80% of standard doses of 5-fluorouracil (5-FU). Reductions in DPD activity increase the half-life of 5-FU, resulting in excess 5-FU accumulation and toxicity, which can lead to life-threatening side effects. There have been several published case reports about DPD deficiency in colorectal cancer patients from Western countries. However, case reports of DPD deficiency in Japanese colorectal cancer patients are rare because the measurement of DPD activity is not covered by the public medical insurance system in Japan, and DPD activity is not currently measured in daily clinical practice. Furthermore, there have not been any reports about anticancer drug therapy for Japanese patients with DPD deficiency. In this report, we describe a case in which a Japanese patient with colorectal cancer was diagnosed with DPD deficiency. The DPD deficiency arose as a severe adverse effect of mFOLFOX6/CapOX treatment for recurrent colorectal cancer, and the patient was subsequently treated with TAS-102, without experiencing any severe adverse effects. We report this case along with a review of the literature.

Pembrolizumab induced cardiotoxicity

Background: Pembrolizumab is a monoclonal antibody-based chemotherapy infusion, recently approved for unresectable or metastatic solid tumors with certain genetic anomalies. Discussion: Pembrolizumab is an IV infusion therapy for treating non-surgical or metastatic melanoma and non-small cell lung cancer. Multiple cardiac complications have been related to this drug, the mechanism is not precise, but a possibility is immune events involving the cytotoxic T-cell resulting in fibrosis of the cardiac cells. Conclusion: New oncologic medications have emerged with a potential reversible or irreversible cytotoxicity, including inflammation, dysfunction, or apoptosis that could represent a life-threatening condition. There is not enough data to establish proper therapy to avoid cardiotoxicity on monoclonal therapies, but an early approach and immunosuppressive therapy are thought to improve the outcome.

Treatment of diabetic neuropathy induced non healing foot ulcer using merisistm supercellplatelet rich fibrin matrix: a clinical study

Objective: Non healing foot ulcers are a major debilitating condition in diabetic patients which leads to limb amputation.In this study we discuss the use ofMERISISTM Supercell plus Platelet Rich Fibrin Matrix (PRFM) kitfor point of care treatments towards limb salvation. Method: We selected diabetic mellitus patients havingDiabetic foot ulcer (DFU) grade 1 or higher. Use of MERISISTM Supercell plus PRFM is a biological matrix of extracellular matrix (ECM) protein plus growth factors derived from peripheral blood to treat the DFU 45 days over. Result: Following treatment the patients showed quick recovery and complete healing of the ulcers. Conclusion: Supercellplus PRFM therapy promotes wound healing in patients suffering from chronic non-healing diabetes foot ulcers. Supercells plus PRFM dressing is a safe and effective treatment modality to promote wound contraction in patients suffering from non-healing diabetic foot ulcers.