Common Treatment Modality Research Articles

“BEYOND JUST A SINGING GROUP”: PERCEPTIONS OF PARTICIPANTS, CAREGIVERS, AND LEADERS OF PARKINSON’S SINGING GROUPS

Abstract Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease after Alzheimer’s disease, and its prevalence is increasing. There is no cure, so symptom treatment is currently the only method to decrease the disease burden for individuals diagnosed with PD. A common treatment modality option that has been shown to improve both motor and non-motor symptoms in PD is therapeutic singing, often in a group setting. Previous literature has explored perceptions of singing groups for persons with PD (PwPD) and their caregivers (CGs) and has found overall positive experiences and outcomes. No study has sought to understand the perspectives of the leaders of the singing groups. The purpose of this study was to understand the perceptions and experiences of participants in singing groups (n=31), their caregivers (n=8), and those leading the groups (n=10) across several different singing groups in the United States. A qualitative phenomenological methodological framework was used with principles of grounded theory to make meaning from the transcripts. Three main themes emerged from the data: peer support, proactive PD management, and the effects of the pandemic. These findings indicate that even during a global pandemic, all three participant groups experienced positive outcomes resulting from peer support and either experiencing or witnessing effective management of PD symptoms. All three participant groups reported similar perceptions and experiences about their involvement which reinforces the rationale to use singing as a treatment modality for PD.

Clinicodemographic profile, management, and treatment outcomes in advanced retinoblastoma at a tertiary care center in North India.

The study was undertaken to look into the clinicodemographic profile, management, and clinical outcomes of advanced retinoblastoma at a tertiary care center. A prospective cohort study was conducted from Jan 2019 to Dec 2022. Forty-two patients of intraocular advanced retinoblastoma were assessed. The treatment protocol was formulated based on size, extension of tumor, and laterality. Primary outcome measure was response to the treatment in terms of regression of tumor and seeds and no evidence of recurrence after 12 month in enucleated eyes. Secondary outcome measures were complications like implant exposure, metastasis, and death associated with each treatment modality. The mean age of the study group was 13 months. The most common presentation was leukocoria with diminished vision. Most of the patients had group E retinoblastoma ( n = 40, 95%) as per the International Classification of Retinoblastoma. In 12 patients with group E retinoblastoma, primary enucleation was performed and in six patients, secondary enucleation was done, in which initially, globe salvage treatment was tried. In 30 patients, globe salvage treatment was attempted and we could manage to save 23 eyes. The most common treatment modality was intra-arterial chemotherapy using a triple-drug regimen. One patient developed intracranial spread and died due to systemic metastasis during the follow-up period. The current study showed that globe salvage is possible in advanced retinoblastoma if appropriate therapy is instituted depending upon the extent of the tumor and availability of latest treatment modalities. Intra-arterial chemotherapy using triple drugs can be offered as a first-line therapy in advanced unilateral retinoblastoma as it has been found to be very effective in the present study.

Analysis, treatment modality and demographic characteristics of urolithiasis patients visiting Korle-Bu Teaching Hospital in Ghana.

Globally urolithiasis is on the rise and gradually becoming a public health concern due to the associated complications. This study reviewed the demographic characteristics, the chemical composition of stones, treatment modality and duration of hospitalisation of urolithiasis patients at Korle-Bu Teaching Hospital, Accra, Ghana. This was a retrospective study conducted between March 2019 and April 2022. Data from consecutive patients treated for urolithiasis were used for this study. Data on demographic characteristics, stones chemical composition, urine factors, urolithiasis treatment modality and duration of hospital stay after therapy were collated and analysed using descriptive and inferential approaches. The age of the patients ranged from 2 to 75 years with a mean of 45 (±13.4). The predominant age group for stone formation was 30-39 years - 52(26.3%). Urolithiasis was common among patients in the formal employment sector: 81(40.9%). All stones had two or more chemical compositions, with the combination of calcium oxalate monohydrate, calcium oxalate dihydrate and uric acid being the predominant stone type: 88(57.5%). Ureteroscopy with semi-rigid and Percutaneous nephrolithotomy were the predominant treatment modalities: 105(53.0%) and 74(37.4%), respectively. Escherichia coli was responsible for most urinary tract infections in urolithiasis patients 8(4.0%) and the least duration of hospital stay after the procedure was associated with the use of semi-rigid ureteroscope as the treatment modality with a median duration of 2 days (1-2 days) with P < 0.0001. Urolithiasis was predominant among professionals in the formal sector. All stones were mixed with Calcium oxalate monohydrate, calcium oxalate dihydrate, and uric acid combination being the majority. Ureteroscopy with semi-rigid and percutaneous nephrolithotomy were the common treatment modality.

Evaluation of therapeutic effect of oral Ursodeoxycholic Acid on indirect hyperbilirubinemia in term neonates undergoing phototherapy: A randomized controlled clinical trial

Introduction and aims Phototherapy is the most common treatment modality of neonatal hyperbilirubinemia. We aimed to evaluate the therapeutic effect of oral Ursodeoxycholic Acid (UDCA) on indirect hyperbilirubinemia in term neonates undergoing phototherapy. Materials and methods This randomized controlled clinical trial was performed on 106 full-term neonates with jaundice who were admitted to the neonatal ward of 17 Shahrivar Hospital in Rasht, Iran. The neonates were randomly assigned to two groups of intervention (10 mg/kg UDCA+phototherapy) and control (phototherapy alone). Total serum bilirubin (TSB) was measured at the time of admission, during first 12, 24, and 48 hours after admission and at the time of discharge. The duration of hospitalization and side effects were also assessed in both groups. IBM SPSS Statistics for Windows, version 20 was used to analyze the data. Results Results showed that in the intervention group, 28 (52.8%) of neonates were boys with the mean age of 5.1±1.25 days. While, in the control group 29 (54.7%) of them were boys with the mean age of 5.19±2.26 days. Bilirubin levels in both groups decreased significantly after hospitalization (at 12, 24 and 48 hours) (P &lt;0.001). The mean of bilirubin at 12, 24 and 48 hours in the intervention and control groups were 17.1, 13.2, 10.2 mg / dl and 17.1, 14.2 and 11.3 mg / dl, respectively. At the time of discharge, TSB in the former compared to the latter group was significantly reduced (7.74± 1.39 vs. 8.67±1.35) (P = 0.001). In addition, the duration of hospitalization was considerably shorter in the intervention compared to the control group (P = 0.038) and no side effects were observed. Conclusions Administering UDCA plus phototherapy reduced TSB and length of hospital stay with proper safety and efficacy. Therefore, it seems that this combination can be an appropriate treatment modality in neonatal hyperbilirubinemia.

The Rare Sore Throat: A Case of Thyroid Storm and Agranulocytosis.

Thyroid storm is a rare but potentially life-threatening metabolic disorder that presents unique management challenges in the emergency department. Thionamides are commonly used as monotherapy for first-line treatment of hyperthyroidism. In this case, a 26-year-old male presented to the emergency department with sore throat, fever, and diarrhea. He was found to have thyrotoxicosis as well as methimazole-induced bone marrow suppression resulting in agranulocytosis. Thyroid storm is a rare condition that carries a high risk of mortality and can further compromise a patient's immune system due to complications of common treatment modalities. It can potentially be misdiagnosed as sepsis due to tachycardia, febrile state, and tachypnea. This case report includes a discussion of diagnostic studies, as well as medical and surgical treatment modalities that led to the patient's recovery.

OBSTETRIC CHOLESTASIS IN FIRST TRIMESTER-UNUSUAL PRESENTATION OF THE DISEASE: CASE REPORT

Obstetric cholestasis (OC) presents mainly in the third trimester and uncommonly in the second trimester of pregnancy. It is characterised by pruritus, abnormal liver enzymes and raised total serum bile acids (TSBA). Cholestasis resolves after delivery. OC presenting in first trimester is rare, therefore the management guidelines are unclear. The present case is being reported as a case of first trimester OC, unresponsive to common treatment modalities. The patient was diagnosed with OC at 12 weeks. She didn't respond to the therapeutic doses of ursodeoxycholic acid (UDCA) and cholestyramine. Finally, rifampicin was added, which gave clinical relief, improved liver enzyme levels and allowed the pregnancy to continue till 32 weeks.

Abstract A025: Combination of anti-CTLA4 and radiation induce synergistic tumor control in radiorecurrent prostate cancer

Abstract Background: Advanced prostate cancer (PCa) is a leading cause in cancer death and can elicit significant morbidity and mortality. A common treatment modality for advanced PCa is radiation therapy (RT). Currently, salvage of local disease recurrence after RT is a major clinical problem. Emerging evidence indicates the importance of the immune system in governing RT response. In support of this, immune checkpoint inhibitors (ICIs), which enhance immune activation, have demonstrated clinical therapeutic promise in combination with RT in certain advanced cancers. Irradiation (IR) combined with ICIs may prime the immune system to recognize and target recurrent cancer. Purpose: Investigate the therapeutic efficacy of ICIs in combination with RT for radiorecurrent PCa in a syngeneic pre-clinical model. Methods: TRAMP-C2 cells were treated with 10 Gy of radiation over 5 fractions (similar to clinical hypofractionated (HF) schedule) to generate TRAMP-C2 HF cells. Immune-competent mice were transplanted subcutaneously with TRAMP-C2 HF cells. Once tumors reached palpable size, mice were administered either ICIs (αPDL1 or αCTLA4) alone or in combination with RT. Tumor volume was monitored to determine the treatment effect. Correlative studies on excised tumors and secondary lymphoid organs included flow cytometry and NanoString gene expression panel to evaluate immunological mechanisms that contribute to anti-tumor effects[SL1]. Results: TRAMP-C2 HF cells were validated for radiation resistance and exhibited a more aggressive phenotype (reduction in senescence, increase in clonogenicity) similar to clinically recurrent PCa. Radiation resistance of TRAMP-C2 HF tumors was validated in vivo. Administration of αPDL1 and αCTLA4 as monotherapy or in combination did not achieve significant tumor growth delay compared to control. IR alone produced an observable tumor growth delay compared to ICIs alone. The combination of αPDL1 and IR did not yield additional growth delay compared to IR alone. Strikingly, significant tumor growth delay was seen with the combination of IR and αCTLA4 compared to IR alone, while also resulting in complete cure in a third of the mice. NanoString analysis of lymph nodes from mice treated with αCTLA4 and IR vs. IR alone demonstrated differential expression of genes regulating CD molecules, interleukins, and T-cell functions. Furthermore, enrichment of CD45 and CD8a RNA following αCTLA4 and IR was observed. Validation by flow cytometry is currently ongoing. Conclusion: We generated the first syngeneic radiorecurrent PCa model and demonstrated that combining αCTLA4 and IR results in synergistic tumor response. Combined therapy resulted in augmented immune response, most notably enhancement of CD8 T cell activity. Significance: These findings contribute to our understanding of immunological events associated with RT and ICIs in the context of radiorecurrent PCa and support new avenues for salvage therapy in clinical trials. Citation Format: Hanzhi Wang, Xiaoyong Huang, Stepahnie D White, Linsey Gong, Tera N Petchiny, Hans Chung, Emmanouil Fokas, Robert S Kerbel, Stanley K Liu. Combination of anti-CTLA4 and radiation induce synergistic tumor control in radiorecurrent prostate cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor Immunology and Immunotherapy; 2023 Oct 1-4; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Immunol Res 2023;11(12 Suppl):Abstract nr A025.

Radiation-induced bone loss in mice is ameliorated by inhibition of HIF-2α in skeletal progenitor cells.

Radiotherapy remains a common treatment modality for cancer despite skeletal complications. However, there are currently no effective treatments for radiation-induced bone loss, and the consequences of radiotherapy on skeletal progenitor cell (SPC) survival and function remain unclear. After radiation, leptin receptor-expressing cells, which include a population of SPCs, become localized to hypoxic regions of the bone and stabilize the transcription factor hypoxia-inducible factor-2α (HIF-2α), thus suggesting a role for HIF-2α in the skeletal response to radiation. Here, we conditionally knocked out HIF-2α in leptin receptor-expressing cells and their descendants in mice. Radiation therapy in littermate control mice reduced bone mass; however, HIF-2α conditional knockout mice maintained bone mass comparable to nonirradiated control animals. HIF-2α negatively regulated the number of SPCs, bone formation, and bone mineralization. To test whether blocking HIF-2α pharmacologically could reduce bone loss during radiation, we administered a selective HIF-2α inhibitor called PT2399 (a structural analog of which was recently FDA-approved) to wild-type mice before radiation exposure. Pharmacological inhibition of HIF-2α was sufficient to prevent radiation-induced bone loss in a single-limb irradiation mouse model. Given that ~90% of patients who receive a HIF-2α inhibitor develop anemia because of off-target effects, we developed a bone-targeting nanocarrier formulation to deliver the HIF-2α inhibitor to mouse bone, to increase on-target efficacy and reduce off-target toxicities. Nanocarrier-loaded PT2399 prevented radiation-induced bone loss in mice while reducing drug accumulation in the kidney. Targeted inhibition of HIF-2α may represent a therapeutic approach for protecting bone during radiation therapy.

Treatment Selection and Clinical Outcomes in Lymphoplasmacytic Lymphoma/Waldenstrom Macroglobulinemia (LPL/WM) - a Single Center Analysis

Introduction: Lymphoplasmacytic lymphoma (LPL) is as an indolent neoplasm of B-lymphocytes with plasmacytic differentiation causing bone marrow infiltration along with variable involvement of lymph nodes/or spleen. Most common subtype of LPL, Waldenstrom Macroglobulinemia (WM) involves IgM monoclonal gammopathy of any concentration. Due to widespread availability of targeted therapy drugs (BTKi), the treatment landscape of LPL is changing. The aim of this study is to analyze disease characteristics, patterns of real-world treatment selection and its impact on clinical outcomes (Objective response rate (ORR), Progression free survival (PFS) and Overall survival (OS). Methods: A retrospective analysis of patients (age ≥18 years) with diagnosis of LPL/WM between January 1, 2003, to March 31, 2023, seen in consultation at Roswell Park Comprehensive Cancer Center was performed. ORR (CR, VGPR, PR and MR) was calculated according to response criteria at 6 th International Workshop for WM. Statistical analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC). OS and PFS were reported using standard Kaplan-Meier methods. Multivariate cox regression modeling was used to assess associations between first line regimen and survival outcomes (OS / PFS). Predictor variables, namely age at diagnosis, gender, Charlson Comorbidity Index (CCI) score, and rIPSS (revised International Prognostic Score System) were included in multivariable models. Results: A total of 127 patients were included in this study. The median age at diagnosis was 68 years (range 41 to 88), of which 75 (59.1%) were men. Majority of the population was White (n=112, 88.2%) and had ECOG of 0 (n=70, 67.3%). Monoclonal gammopathy of IgM subtype was present in 114 (94.2%), IgG in 3 (2.5%) and IgA in 1 (0.8%) patient. MYD88 mutation testing was positive in 69.8%, negative in 14% and unknown in 16.3% patients. Two out of 10 patients tested for CXCR4 mutation were positive. Sixteen (28.1%) patients had hyperviscosity symptoms and underwent plasmapheresis with first line treatment. These patients had a mean IgM level of 6249.5 mg/dL and mean M-spike of 4.53 g/dL. Of 121 patients with data on treatment strategy, 20 (16.5%) were monitored with observation alone. The most common treatment modality used in first line was chemo-immunotherapy (C-I) in 61 (50.4%) patients followed by Rituximab immunotherapy (R-I) in 20 (16.5%) patients and BTK inhibitors in 12 (9.9%) patients. ORR was highest 90.7% (39/43) in chemoimmunotherapy group, 87.5% (7/8) in BTKi group and 71.4% (10/14) in Immunotherapy group. Bendamustine-Rituximab was the most common used treatment regimen (n=42), with resultant CR in 20% and VGPR in 23.3% patients. At median follow-up duration of 36.9 months, median OS was 113.9 months in R-I, 159.8 months in C-I and not reached (NR) in BTKi group. The median PFS was 50.2 months in R-I, 61.2 in C-I and 23 months in BTKi group. Although Multivariate Cox Regression analysis failed to show statistically significant difference in PFS, there is tendency towards improved OS in C-I group (p=0.08) among all the groups when adjusted for age, sex, CCI. Conclusion: In our single center experience, chemoimmunotherapy combination with Bendamustine-Rituximab is the most used treatment choice in first line settings followed by single agent anti-CD20 therapy and BTKi. Although Multivariate Cox Regression analysis failed to show statistically significant difference in PFS, there is a tendency towards improved OS in the chemoimmunotherapy subgroup (p=0.08). The shorter PFS in BTKi group is likely due to toxicity of targeted therapy leading to treatment interruption and change of therapy.

Post-Transfusion Purpura: A Literature Review

Introduction: Post-transfusion purpura (PTP) is a rare and occasionally life-threatening transfusion reaction characterized by severe thrombocytopenia usually within two weeks of blood transfusion. It is associated with the development of alloantibodies to human platelet antigens (HPAs). Due to its rarity, our knowledge of PTP is mostly based on reported cases or small cohorts. Methods: This is a systematic literature review of English language articles published in 2 large medical databases (Embase and Pubmed) using the search terms “post-transfusion purpura”, “posttransfusion purpura”, and “post transfusion purpura” between the years 1985 and 2023. Only articles reporting on patients older than 18 years were included. 684 articles were identified, 590 of them were excluded since they represented a combination of case reports of other conditions, laboratory, and epidemiological reports. The 94 articles left, represented case reports and case series of PTP encompassing 149 patients. 21 patients were removed since they represented duplicate cases. 17 patients were excluded due to missing information. 11 patients were excluded due to the presence of confounding clinical conditions. Results: A total of 100 cases were included in the study. The mean age was 56.7 years. 85% were female, 14% were male, and 1 was missing gender data. 62% of cases reported a baseline platelet count, ranging between 78,000 - 600,000 cells/µL. 65% of cases presented after a procedure- or surgery-related transfusion, of these 22 were related to cardiovascular procedures, while 16, 10, and 9 cases were related to gynecological, abdominal, and orthopedic surgeries respectively. A history of prior transfusions was only documented in 24% of cases. A prior pregnancy was reported in 63% of the cases. Red blood cell, fresh frozen plasma, and platelet transfusions were associated to 64%, 11%, and 9% of cases, respectively. The most common HPA antibody detected was HPA-1a (81%). HPA-1b, HPA-5b, and HPA-3a were the next most common antibodies, identified in 7%, 5%, and 5% cases, respectively. The median time from the first transfusion to the development of thrombocytopenia was 8 days, reaching a platelet nadir in 9 days. The platelet nadir ranged between 0 - 50,000 cells/ µL. Clinical presentation included post-transfusion fever (15%), petechial rash, epistaxis, and oral bleeding (65%, 17%, and 12, respectively), and bleeding from the genitourinary system, gastrointestinal tract, surgical incisions, lower respiratory tract, and central nervous system (38%, 28%, 6%, 6%, and 2% of cases, respectively). Death was reported in 9% of cases. The median time from PTP diagnosis to initiation of first treatment was 1 day. 83% of cases achieved an adequate response, defined as a platelet count &amp;gt; 100,000 cells/µL, after a mean/median time of 14.2/11.5 days (available in 68% of cases). Corticosteroids, intravenous immunoglobulin, and plasmapheresis were administered in 68%, 63%, and 27%, of cases, respectively. 6 patients received HPA 1a negative platelet transfusions. Conclusions: The majority of reported PTP cases were females with a history of pregnancy or blood transfusions consistent with existing literature. Over 60% of cases were linked to a surgical procedure, with cardiovascular cases constituting the largest portion. Anti-HPA-1a represented the most commonly detected antibody, followed by HPA-1b, HPA-5b, and HPA-3a. The most common sites of bleeding were the gastrointestinal and genitourinary tracts. 9% died from PTP. The majority of patients (83%) achieved an adequate response, with the most common treatment modalities being corticosteroids, IV immunoglobulins, and plasmapheresis.

Development and validation of a predictive models for predicting the cardiac events within one year for patients underwent percutaneous coronary intervention procedure at IJN

PurposePercutaneous coronary intervention (PCI) is a common treatment modality for coronary artery disease. Accurate prediction of patients at risk for complications and hospital readmission after PCI could improve the overall clinical management. We aimed to develop and validate predictive models to predict any cardiac event within a year post PCI procedure.MethodsThis is a retrospective cohort study utilizing data from the National Cardiovascular Disease (NCVD)-PCI registry. The data collected (N = 28,007) were split into training set (n = 24,409) and testing set (n = 3598). Four predictive models (logistic regression [LR], random forest method, support vector machine [SVM], and artificial neural network) were developed and validated. The outcome on risk prediction were compared.ResultsThe demographic and clinical features of patients in the training and testing cohorts were similar. Patients had mean age ± standard deviation of 58.15 ± 10.13 years at admission with a male majority (82.66%). In over half of the procedures (50.61%), patients had chronic stable angina. Within 1 year of follow up mortality, target vessel revascularization (TVR), and composite event of mortality and TVR were 3.92%, 9.48%, and 12.98% respectively. LR was the best model in predicting mortality event within 1-year post-PCI (AUC: 0.820). SVM had the highest discrimination power for both TVR event (AUC: 0.720) and composite event of mortality and TVR (AUC: 0.720).ConclusionsThis study successfully identified optimal prediction models with the good discriminatory ability for mortality outcome and good discrimination ability for TVR and composite event of mortality and TVR with a simple machine learning framework.

Interdigitating Dendritic Cell Sarcoma and Indeterminate Dendritic Cell Tumor: Patient Characteristics, Prognostic Factors, and Survival Outcomes for Rare Dendritic Cell Neoplasms

Background Dendritic cells are nonlymphoid, nonphagocytic, antigen-presenting cells present in lymphoid and nonlymphoid tissue. There are 4 types of dendritic cells: follicular, interdigitating, Langerhans, and fibroblastic cells. The WHO 2022 classification system groups dendritic cell and histiocytic neoplasms into 3 categories: plasmacytoid dendritic cell neoplasms, Langerhans cell and other dendritic cell neoplasms, and histiocytic neoplasms. The 2nd category is subdivided into “Langerhans cells neoplasms” and “other dendritic cell neoplasms”, which contains indeterminate dendritic cell tumor (IDCT) and interdigitating dendritic cell sarcoma (IDCS). The 2022 classification eliminated follicular dendritic cell sarcoma (FDCS) as it is no longer thought to be of hematopoietic origin. A prior Surveillance, Epidemiology, and End Results (SEER) review published in 2013 by Perkins and Shinohara grouped FDCS and IDCS and included 20 cases of IDCS diagnosed between 2001 and 2008. To our knowledge, this is the first update of epidemiologic and survival data for non-Langerhans cell and non-plasmacytoid dendritic cell neoplasms since the WHO reclassification. Methods We used the SEER 22 database, which collects data from cancer registries covering approximately 47.9% of the U.S. population. We selected all patients with cancers falling in the “other dendritic cell neoplasms” category according to the WHO 2022 classification from 2000-2020 using International Classification of Diseases for Oncology edition 3 (ICD-O-3) code of 9757/3, which codes for IDCS but also includes IDCT. The Kaplan-Meier method was used to display the survival curves. The Cox proportional hazards model was used to determine p values. Results A total of 72 cases of IDCS/IDCT were identified. Median follow up was 19 months and median OS for the entire cohort was 24 months (95% CI 10-92 months). Of these patients, 61.1% (n=44) were White, 16.7% (n=12) were Hispanic, 13.8% (n=10) were Black, 5.6% (n=4) were Asian or Pacific Islander, and 2 patients were of unknown race. IDCS/IDCT was more common in males than females with a ratio of 1.77. The most common primary sites of involvement were connective tissue in 40.2% (n=29), head and neck in 16.7% (n=12), lymph nodes in 11.1% (n=8), and bone marrow in 8.3% (n=6). Patients with bone marrow involvement had a trend towards worse OS (median OS of 5 months). IDCS/IDCT is more common in adults but does occur in children and adolescents. Only 6 cases were diagnosed in patients under the age of 20 years. Patients who were under the age of 60 years at diagnosis had a median OS of 155 months compared to a median OS of only 10 months for patients who were 60 years or older at diagnosis (Figure 1, p&amp;lt;0.001). Staging was unknown in 12 patients. Of patients with known staging, 56.7% (n=34) had localized disease and 43.3% (n=26) had metastatic disease. Patients with localized disease at diagnosis had a better prognosis with a median OS of 120 months compared to 5 months for patients with metastatic disease at diagnosis (Figure 2, p&amp;lt;0.001). Treatment modality was unknown in 29 of the patients. Of patients with known treatment, 34.9% (n=15) had surgery alone, 20.9% (n=9) had chemo alone, 16.3% (n=7) had radiation alone, and 27.9% (n=12) had combination treatment. Single modality treatment regimens were most popular in patients with localized disease with 48% (n=12) of the patients with known treatment modality getting surgery alone, followed by radiation alone at 24% (n=6).The most common cause of death in this cohort was IDCS/IDCT with 76% of deaths being attributed to the cancer (n=35, there were 46 total deaths). Conclusions Though cases of IDCS and IDCT have more than tripled since 2008, it still remains the rarest type of dendritic cell neoplasm. Connective tissue, head and neck, and lymph nodes were the most common sites involved. Surgical resection was the most common treatment modality followed by chemotherapy. Clinical presentation is rare in patients under the age of 20 years. Age 60 years and older and metastatic disease were associated with poor outcomes with a signal towards worse survival when bone marrow was involved. Our study updates current knowledge of IDCS/IDCT and highlights some of the unknowns in this type of neoplasm, particularly regarding other prognostic factors including treatment effect on survival.

Anatomic Variations of Foramen Ovale as a Predictor of Successful Cannulation in Percutaneous Trigeminal Rhizotomies.

Percutaneous trigeminal rhizotomies are common treatment modalities for medically refractory trigeminal neuralgia (TN). Failure of these procedures is frequently due to surgical inability to cannulate the foramen ovale (FO) and is thought to be due to variations in anatomy. The purpose of this study is to characterize the relationships between anatomic features surrounding FO and investigate the association between anatomic morphology and successful cannulation of FO in patients undergoing percutaneous trigeminal rhizotomy. A retrospective analysis was conducted of all patients undergoing percutaneous trigeminal rhizotomy for TN at our academic center between January 1, 2010, and July 31, 2022. Preoperative 1-mm thin-cut computed tomography head imaging was accessed to perform measurements surrounding the FO, including inlet width, outlet width, interforaminal distance (a representation of the lateral extent of FO along the middle fossa), and sella-sphenoid angle (a representation of the coronal slope of FO). Mann-Whitney U tests assessed the difference in measurements for patients who succeeded and failed cannulation. Among 37 patients who met inclusion criteria, 34 (91.9%) successfully underwent cannulation. Successful cannulation was associated with larger inlet widths (median = 5.87 vs 3.67 mm, U = 6.0, P = .006), larger outlet widths (median = 7.13 vs 5.10 mm, U = 14.0, P = .040), and smaller sella-sphenoid angles (median = 52.00° vs 111.00°, U = 0.0, P < .001). Interforaminal distances were not associated with the ability to cannulate FO surgically. We have identified morphological characteristics associated with successful cannulation in percutaneous rhizotomies for TN. Preoperative imaging may optimize surgical technique and predict cannulation failure.

Earthquake disaster impact on health care of cancer patients: Single center experience

Background: The earthquakes in February 2023 in Turkey had a major impact on Turkey's health system, causing damage to hospitals and health centres in the affected areas. Cancer patients are one of the groups that are highly influenced by the disaster. The aim of this study was to evaluate some of the demographic and clinical characteristics of cancer patients who are getting health care in earthquake-affected areas.&#x0D; Material and Methods: Fifty cancer patients who lived in 11 cities of Turkey affected by the earthquake and were admitted to Gazi University Department of Medical Oncology after the earthquake between 15 February 2023 and 15 March 2023 were included in the study. Data such as demographic characteristics, cancer diagnosis, time of cancer treatment, and earthquake history were taken retrospectively from nationally-linked electronic records (E-nabız).&#x0D; Results: Breast cancer was the most common diagnosis of these patients. Most of the patients were taking active treatment (60%). Chemotherapy and hormonotherapy were the most common treatment modalities (20% and 18%, respectively). The median delay in the active treatment of 14 cancer patients was 24 days (2-60).&#x0D; Conclusions: The earthquake disaster has led to important impacts on cancer patients' care in most affected areas. The human, financial and medical resources should be improved. Especially if detailed nationally-linked electronic records are provided, cancer patients will not have difficulty seeking health care. This disaster should be an important stimulus for hospitals and healthcare systems to improve the care of patients during disasters.

Fifty years of hemodialysis in Ghana—current status, utilization and cost of dialysis services

BackgroundKidney failure is common in Ghana. Haemodialysis (HD) is the most common treatment modality for survival. Although, HD has been available in Ghana for 50 years, the majority of patients who develop kidney failure cannot access it. We describe the state of HD, dialysis prevalence, its utilization and cost of HD after fifty years of dialysis initiation in Ghana.MethodsA situational assessment of HDs centres in Ghana was conducted by surveying nephrologists, doctors, nurses and other health care professionals in HD centres from August to October 2022. We assessed the density of HD centres, number of HD machines, prevalence of nephrologists, number of patients receiving HD treatment and the cost of dialysis in private and government facilities in Ghana.ResultsThere are 51 HD centres located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning, as 11 had shut down or are yet to operate. Of the functioning centres most (n = 26, 65%) are in the Greater Accra region serving 17.7% of the population and 7(17.5%) in the Ashanti region serving 17.5% of the population in Ghana. The rest of the seven regions have one centre each. The private sector has twice as many HD centers (n = 27, 67.5%) as the public sector (n = 13,32.5%). There are 299 HD machines yielding 9.7 HD machines per million population (pmp) with a median of 6 (IQR 4–10) machines per centre. Ghana has 0.44 nephrologists pmp. Currently, 1195 patients receive HD, giving a prevalence of 38.8 patients pmp with 609(50.9%) in the private sector. The mean cost of HD session is US $53.9 ± 8.8 in Ghana.ConclusionThere are gross inequities in the regional distribution of HD centres in Ghana, with a low HD prevalence and nephrology workforce despite a high burden of CKD. The cost of haemodialysis remains prohibitive and mainly paid out-of-pocket limiting its utilization.

P057 Exploring the ‘Pharmacist Role’ in Insomnia Management and Care Provision: A Scoping Review

Abstract Background Insomnia is a highly burdensome sleep disorder, with a global prevalence of approximately thirty percent in adults. Given its impact on daily functioning and the role it plays in the development/progression of comorbid mental/physical disease, appropriate and timely management is essential. Pharmacists are at the forefront of the primary care workforce and given their expanding roles in healthcare, could aid in alleviating the burden of insomnia in the community by delivering adequate care. Objectives To describe the current and potential roles of pharmacists in insomnia care. Methods An extensive search of five databases (MEDLINE, EMBASE, SCOPUS, IPA, CINAHL) was conducted. Titles, abstracts, and full text articles were screened to identify relevant studies for review inclusion. Articles were reviewed and data extracted, analysed, and grouped categorically based on nature of care provided. Results Thirty studies met inclusion criteria. Insomnia management provision across these studies was divided categorically into 1) Screening/Assessment, 2) Pharmacological and non-pharmacological management provision, and 3) Deprescribing services. Regarding treatment provision, it was evident that pharmacological approaches remain the most common treatment modality adopted despite guidelines recommending behavioural therapy as first line. Overall, the results highlighted that provided with the adequate training and education, pharmacists have the potential to engage in insomnia screening, behavioural therapy and deprescribing services, improving overall insomnia management in primary care. Conclusion The outcomes of this review highlight a current gap in insomnia management practices carried out by pharmacists and provide evidence for improved roles when pharmacists are upskilled with specialised insomnia management education/training.

Intraocular Lymphoma and Metastatic Tumors of the Retina

Intraocular lymphomas (IOLs) are a rare, heterogeneous group of malignancies often misdiagnosed and underrecognized. These tumors are often non-Hodgkin's and B-cell type when they occur. Primary IOLs are classified into two groups: primary uveal lymphomas (PULs) and primary vitreoretinal lymphomas (PVRLs). PULs are small cells, low-to-moderately aggressive, relatively benign, and rarely associated with central nervous system (CNS) involvement. PVRLs often diffuse large B-cells, are highly aggressive, and are related to malignant primary CNS lymphoma. Secondary IOLs that metastasize to intraocular structures other than the CNS constitute the last group of IOLs. Secondary IOLs typically metastasize to the choroid and have a poor prognosis due to associated systemic disease. All IOLs are challenging to diagnose, leading to treatment delays. Metastatic tumors are the most common intraocular malignancies. However, metastases mainly occur in the choroid. Retinal metastases are much rarer. Primary tumor sites are the most common skin, gastrointestinal tract, lung, and breast cancers. A biopsy is helpful to confirm the diagnosis and may help locate the primary tumor. Radiotherapy is the most common treatment modality. A multidisciplinary approach is essential in treatment management. Despite successful treatment of retinal metastases, patients have a poor prognosis for survival of primary tumors. This review aims to increase awareness and share diagnostic clues and treatment strategies in these critical and insidious malignancies in light of current literature. IOLs and metastatic tumors of the retina will be evaluated separately under the headings.

Assessment of frailty and quality of life and their correlation in the haemodialysis population at Palmerston North Hospital, New Zealand.

End-stage kidney disease (ESKD) is increasingly becoming a healthcare concern in New Zealand and haemodialysis remains the most common modality of treatment. Frailty and health-related quality of life (HRQOL) are established predictors of prognosis and have already been shown to be poor in the dialyzing population. Existing data show correlation between these measures in the ESKD population, however there is little evidence for those on haemodialysis specifically. Our study aimed to assess for a correlation between frailty and HRQOL in the haemodialysis population at Palmerston North Hospital, and to assess for any differences in frailty and HRQOL scores between indigenous Māori and non-Māori subgroups. A cross-sectional study was conducted involving 93 in-centre haemodialysis patients from Palmerston North Hospital, New Zealand. Baseline demographic data was measured alongside frailty and HRQOL scores, which were measured using the Kidney Disease Quality of Life tool (KDQOL-36) and the Edmonton Frail Scale. A statistically significant negative correlation was observed between frailty and all aspects of HRQOL (p < .05), with the strongest correlation observed between frailty and the physical component (r = -.64, p = <.001). Independent samples t-test showed no statistically significant difference between scores for Māori and non-Māori in frailty (M = 7.4, SD = 3.3 vs. M = 6.8, SD = 3.2; t (91) = -0.92, p = .80), or HRQOL (p values > .05 in all components). A negative correlation was observed between frailty and HRQOL. This information can be beneficial in guiding discussions around treatment modality and for future patients and useful in enabling better predictions of prognosis. No statistically significant differences in frailty and HRQOL scores were observed between Māori and non-Māori groups, however the generalizability of this finding is limited due to the insufficient size of the study population.

Head and Neck Cancer Online Support Groups: Disparities in Participation and Impact on Patients.

To characterize the users of the head and neck cancer (HNC) online support group (OSG) and describe the perceived benefits of membership. Cross-sectional. Online. An administered survey with questions asking about demographics, cancer history, treatment choices, and feelings about OSGs was posted on the 5 largest HNC OSGs on Facebook. A total of 97 participants completed the survey. Mean age was 57.8 years old (standard deviation = 10.7 years). Most participants were female (50.5%) and Caucasian (92.8%). This cohort was well educated with 65.5% holding at least a college degree. Annual income was high with 41.8% reporting annual income of $100,000 or greater. The most common treatment modality was radiation (88.7%). The most common surgery was neck dissection (46.4%). Most participants preferred OSGs (70.8%) over other support group types. OSGs were heavily utilized with our cohort reporting using the OSG at least several times a week (80.0%). The top reasons for joining the OSG were sharing one's experience of HNC (76.3%) and gaining support from others with HNC (85.6%). OSGs were ranked as the #3 source of medical information for HNC behind otolaryngologists and oncologists. Membership in a HNC OSG had a minimal impact on decision-making. HNC OSGs appear to provide a beneficial community for HNC patients. Otolaryngologists should consider incorporating HNC OSG as a possible supplemental resource for their HNC patients.

Role of Intravenous Tranexamic Acid in Prevention of Seroma Formation after Umbilical and Para Umbilical Hernioplasty

Umbilical and paraumbilical hernias are common conditions affecting a significant portion of the global population, with surgical intervention being a common treatment modality. Seroma formation is a common complication after hernioplasty. Tranexamic acid (TXA) has emerged as a promising prophylactic agent for seroma prevention, as it inhibits fibrin breakdown, reducing blood loss and blood transfusions. Objective: To evaluate the role of intravenous tranexamic acid in the prevention of seroma formation after umbilical and paraumbilical hernioplasty. Methods: It was a cohort study conducted at the department of surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan from Oct 2022 to Apr 2022. Patients aged 18 years or above who underwent umbilical and paraumbilical hernioplasty of either gender were involved in the study. The individuals were then categorized into two groups: the exposed group, consisting of patients who received intravenous tranexamic acid (IVTXA), and the unexposed group, comprising of patients who did not receive IVTXA. Both groups were monitored for a duration of three months to assess the incidence of seroma formation. Results: Out of 30 patients in each group, 4 patients (13.3%) in the IVTXA group developed seroma, while 26 patients (86.7%) in the Without TXA group developed seroma. This difference was statistically significant with p-value=0.0021. The risk of seroma formation is 0.22 times lesser in patients with intravenous tranexamic acid as compared to patients without tranexamic acid (RR=0.22, 95% CI: 0.12-0.91). Conclusions: IVTXA may be effective in preventing seroma formation after umbilical and paraumbilical hernioplasty.