Emtree Terms Research Articles

Adherence and Compliance with Oral Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

Introduction: Men who have sex with men (MSM), transgender people, sex workers, people who inject drugs, individuals in prisons and other closed settings have been considered key populations because they are at high risk of contracting HIV. The World Health Organization (WHO) has recommended Oral Pre-Exposure Prophylaxis (PrEP) because of its protective effect against HIV in this population. This study aims to analyze the factors that influence adherence and compliance with oral PrEP for HIV prevention. Methods: This systematic review was conducted the databases used were the PubMed, CINAHL Complete, and EMBASE. For search keywords, MeSH, CINAHL Subjects, and Emtree terms were combined with AND and OR Boolean operators. Studies selected encompassed quantitative, qualitative, mixed, and multimethod designs, between from 2015 to 2022, in English, Spanish, and Portuguese language. All references were imported and exported through EndNote for data collection. Methodological quality was evaluated using the MMAT checklist. We used deductive thematic analysis based on Taylor there are six categories that influence adherence and compliance to oral PrEP. Results: Out of 526 articles retrieved, 314 duplicates were eliminated and 26 were incorporated. Various factors affect adherence and compliance with oral PrEP. Conclusions: Based on the findings, PrEP's effectiveness and the perceived high risk of HIV infection served as motivators for PrEP utilization, while negative sentiments regarding PrEP, side effects, and stigma acted as hurdles to its use. Readiness facilitated PrEP adoption. Healthcare team support was viewed as an effective attribute for those administering oral PrEP.

Current trends and spatial-temporal dynamics of veterinary dentistry research: A scientometric study.

Understanding dental care in dogs has made remarkable progress in veterinary medicine. Therefore, this study aimed to analyze the academic literature published in veterinary dentistry from 1990 to 2023. A descriptive study was conducted using a scientometric approach and metadata from the Web of Science database. A search strategy adapted for this database was developed using MeSH and Emtree terms and the Boolean operators AND and OR. Using Bibliometrix, different metrics were evaluated to assess the scientific production of researchers and institutions and the impact of authors based on their publications. CiteSpace was also used for co-citation analysis and visualization of citation networks, trends, and patterns in this field of study over time. The bibliometric study analyzed 211 documents from 50 different sources from 1990 to 2023, with an annual growth rate of 6.5%, covering the period 1990-2023. A total of 474 authors were identified, with an average of 2.82 coauthors per paper and 11.85% international coauthorships. The average age of the papers was 12.4 years and 4.55 citations per paper. The most common types of documents were articles (154 documents). Research in veterinary dentistry has shown steady growth from 1990 to 2023. Although there have been fluctuations in article production over the years, there has been a steady growth in article production in veterinary dentistry in general. The annual average number of citations per article has varied over the years, reaching 45 in 2015. However, the average number of citations per article has decreased significantly from 2021 to 2023.

Comparing Medical Training Costs Internationally: A Systematic Review.

Acquiring a thorough understanding of the expenses linked to the education of health sciences students is crucial for effective university planning, budgeting, and overall preparedness. This systematic review aimed to identify and compare the per capita costs associated with educating medical and other health science students internationally-particularly emphasizing the context of Iran. A systematic review was conducted in 2023 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search covered the period from January 1, 2000, to November 11, 2022, using MeSH and EMTREE terms. Databases such as PubMed, Scopus, Web of Science, Embase, and Iranian databases were searched. Manual searches were performed using Google and Google Scholar. The study retrieved 1336 publications from bibliometric databases and, following thorough screening, included 8 relevant articles from 5 countries (Australia, Iran, United States, Thailand, and Vietnam). An additional 17 relevant articles from Iranian databases were also included. Based on USD purchasing power parity (PPP) 2019, the results show that the mean per capita cost of training a medical student for 1 academic year in Iran is $61,493.86 (range, $28,102-$133,603; standard deviation, $35,476.03). In comparison, the cost of training a medical student for 1 year is $263,305 in the United States and $44,674 in Australia. In Thailand and Vietnam, a 6-year medical program costs is $284,058 and $69,323, respectively. Moreover, according to most studies, training students in other health sciences in Iran for 1 academic year generally costs ˂$20,000 (PPP 2019). The study reveals that the costs associated with medical student education in Iran exceed that of most countries, second only to the United States. These findings highlight the importance of such data in improving the efficiency, sustainability, and informed resource allocation of global medical education programs for future planning and budgeting.

1382. The Lesser Known Treponemal Infections: A Review Of Non-Syphilitic Cases

Abstract Background Nonvenereal treponemal (NVT) infections (Bejel, Yaws, and Pinta) are historically a major health concern in developing countries1 (Figure 1), but they are increasingly ignored. NVTs can lead to severe complications. Our aim was to highlight disease characteristics, treatments, and outcomes, and to identify drug repurposing by curating all cases of NVTs in the literature in CURE ID4, a platform that catalogs real-world data on drug repurposing for difficult-to-treat infectious diseases. Geographical distribution of Contracted Nonvenereal Treponemal Infection Yaws caused by Treponema pallidum subsp pertenue was primarily prevalent in Southeast Asia, particularly Indonesia, and Papua New Guinea. In contrast, Treponema pallidum subsp endemicum, which causes Bejel, was commonly found in Japan. Treponema carateum, the causative agent of Pinta, was limited to Cuba. Geographical distribution of treated Nonvenereal Treponemal Infection Treponema Pallidum Subsp Pertenue (Yaws) was mainly treated in Southeast Asia, Indonesia, and Papua New Guinea, as well as in England following identification after migration. Treponema pallidum subsp endemicum (Bejel), was typically treated in Japan. Treponema Carateum (Pinta), was managed in South America. Methods We identified all case reports on NVTs from PubMed and Embase databases using relevant keywords, MeSH, and Emtree terms. Rayyan.ai3 was used to screen articles following a PRISMA protocol (Figure 3). All included articles were uploaded using the CURE ID case report form. De-identified, standardized data on NVTs from CURE ID was then analyzed. PRISMA protocol for Nonvenereal Treponemal Infections Out of 251 cases, identified on Pubmed and Embase, 53 cases met the inclusion criteria and were included in the analysis. We included cases published in English and those where antibiotics were used. All the case reports were added to CURE ID, organized, and analyzed. The CURE ID Home Page CURE ID captures treatment outcomes when drugs are used to treat new diseases or are used in other new ways. Through CURE ID’s ability to obtain and organize this information received directly from healthcare providers, patients, caregivers, electronic health records, and published case reports, promising new therapeutic uses can be identified for formal study by institutions involved in drug development, and unhelpful or harmful uses can potentially be avoided. Results 53 cases of NVTs were included: Yaws (37), Bejel (13), and Pinta (3). Most originated in developing countries (Figure 1), but many were treated in OECD countries (figure 2). Yaws predominantly occurred in children (1-10 years), while Bejel and Pinta were evenly distributed across age groups. Table 1 breaks down the NVTs according to gender and common sites of infection and Table 2 according to gender and symptoms. Diagnosis was often by clinical assessment (49/53) and serology (46/53) (Table 3). Penicillin was the most frequently used antibiotic, followed by azithromycin (Table 4). Common sites of infection caused by Nonvenereal Treponemal infections The presentations of Bejel and Yaws varied. In Bejel, men (4/10) primarily experienced genital involvement, and women (3/3) exhibited frequent facial involvement. In Yaws, both genders commonly experienced leg involvement. Meanwhile, Pinta usually presented with skin rashes/lesions all over the body in women and was not reported in men. Common symptoms caused by Nonvenereal Treponemal infections In the 37 cases of Yaws, skin rash/lesion (19/37) was the predominant presentation, followed by bone involvement (15/37) and ulcer (10/37). Bejel, on the other hand, commonly manifested with ulcers (7/13) and skin rash/lesion (6/13). In Pinta all three cases presented with skin rash/lesion. Investigations leading to the diagnosis Clinical assessment (49/53) and serology (46/53 cases) were commonly used diagnostic methods for Nonvenereal Treponemal infections. Conclusion Most cases originated in developing countries such as Indonesia (Figure 1), but many were only treated when patients emigrated to OECD countries (Figure 2). Interestingly, all cases of Bejel in females (3/3) had face or eye involvement, while symptoms were more varied for males (Table 2). This may be coincidental, but further investigation could identify gender-based differences in disease presentation. Most cases of NVT (52/53) either improved or were cured when treated (Table 5). Penicillin is FDA approved for NVTs and was the most often used drug (44/53). The successful use of azithromycin in some cases (7) indicates its potential as a second-line agent if resistance to penicillin arises. This project highlights the utility of CURE ID in using real-world data to identify signals of drug repurposing where traditional efficacy trials cannot be conducted. Antibiotics used to treat Nonvenereal Treponemal infections Penicillin was the most frequently used antibiotic class in 11/13 (84.61%), 30/37 (81.08%), and 3/3 (100%) of Bejel, Yaws, and Pinta respectively. Among other antibiotics, azithromycin was prescribed in 1/11 in Bejel and 6/37 in Yaws. Outcomes of Nonvenereal Treponemal infections The majority of Nonvenereal Treponemal infections (52/53) either showed improvement or were cured. Disclosures All Authors: No reported disclosures

Analysis of congenital heart disease research: Mapping impact, production and global collaboration

BackgroundCongenital heart disease (CHD) is a severe childhood health problem worldwide. This study analyzes the scientific production on CHD published in Scopus during the last decade. MethodsThis study assessed the research on CHD conducted during the 2011–2020 period. Indexed publications were identified using a list of keywords consisting of MeSH (Medical Subject Heading) and Emtree (EMBASE) terms for the category “Congenital Heart Defects.” The studies obtained were analyzed using the SciVal platform, and the production, impact, and collaboration indicators were considered. Additionally, an analysis of co-occurrence between countries and keywords was carried out with the VOSviewer software. ResultsThe study found 8934 articles on CHD. A growing trend was observed during the last decade. The distribution of the scientific production at the international level shows that most publications are from the United States, China, and the United Kingdom, whereas Latin American countries have the lowest production. The articles analyzed contain a total of 89,835 citations. Most studies are published in high-impact journals (Q1), with 3273 studies corresponding to 39.3% of the total production analyzed. In the keyword analysis, we found five areas investigated. ConclusionsScientific production has shown sustained growth in the past years. Increased scientific production in specific research areas may have helped decrease morbimortality due to CHD.

Benefit-risk assessment of incretin and other anti-diabetic agents in type 2 diabetes using a stochastic multicriteria acceptability analysis model.

Benefit-risk assessment of incretin and other anti-diabetic agents in type 2 diabetes using a stochastic multicriteria acceptability analysis model.

Clinical Indicators of Cardiovascular Risk in Adult Patients Undergoing Chemotherapy: A Protocol for Scoping Review

Heart disease and cancer are the main causes of morbidity and mortality worldwide. As the number of cancer survivors increases, cardiotoxicity associated with cancer treatment has become a major concern as it presents a substantial challenge in the follow-up of these patients. Here, we aimed to map the clinical indicators for cardiovascular risk in adult patients undergoing chemotherapy. A scoping review protocol adhering to the PRISMA-P statement and in accordance with the JBI guidelines will be conducted. Cochrane Library, MEDLINE/PubMed, Cochrane Library, EMBASE, Scopus, Web of Science, and PsycINFO as well as register sites such as ClinicalTrials.gov and WHO-ICTRP will be searched. Additional sources, including Google Scholar, The British Library, and medRXiv, will also be searched, with no date or idiom restrictions. A combination of subject headings, MeSH terms, Emtree terms, CINAHL Headings, and APA Thesaurus, using the Boolean terms AND/OR, will be performed. In addition, two independent researchers will conduct the overall steps of this review. The results will be presented via narrative summaries, considering the types of clinical indicators. To the best of our knowledge, this will be the first scoping review in the cardio-oncology field to map, via a rigorous review method, the clinical indicators for cardiovascular risk in adult cancer patients receiving chemotherapy.

Psoriatic arthritis of the temporomandibular joint: A systematic review.

Psoriasis is an inflammatory condition brought on by the immune system. This study aimed to perform a systematic review related to psoriatic arthritis (PsA) of the temporomandibular joint (TMJ). The search strategy was developed by a radiologist expert with more than 20 years of experience. The search was performed without time restrictions in five electronic databases: PubMed, Web of Science, Embase, Scopus and Ovid. The search strategy was based on MeSH and Emtree terms. The methodological quality of the studies was rated using the quality assessment tools from the National Heart Lung and Blood Institute (NHLBI). Twenty-three publications were included, 10 being case reports. One hundred-fifty-one patients with TMJ PsA were reported. Psoriasis evolution ranged from 1.5 years to 24 years. Clinical symptoms of TMJ involvement included: TMJ pain and sounds, limited range of jaw movements, preauricular swelling, malocclusion, headache, tinnitus, neck stiffness and altered dietary function. TMJ was evaluated by magnetic resonance imaging (six studies), computed tomography (eight articles) and by ultrasonography findings (two articles). For TMJ treatment, topical and systemic medication was reported in 11 studies. Five studies included patients needing surgical procedures for TMJ ankylosis. A relationship between TMD and psoriasis has been revealed. TMJ PsA has been investigated and debated, although the radiographic findings or clinical symptoms of PsA are not noticeably different from other forms of TMJ arthritis. Conservative therapy can lead to significant improvement of TMJ function.

Blastic Plasmacytoid Dendritic Cell Neoplasm

INTRODUCTION: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological disease. There is an incidence. We aimed to evaluate the scientometrics characteristics of the scientific production on BPDCN between 2011 and 2020. METHODOLOGY: A cross-sectional and retrospective bibliometric study was performed. The search was executed in the Scopus database. Data were extracted based on a formula developed using thesaurus MeSH (Medline) and Emtree (Embase) terms. The retrieved papers received 11.2 citations per paper. Four of the ten most productive authors were from the United States. The institution with the highest impact (1064 citations) and the highest scientific output (46 papers) was the University of Texas MD Anderson Cancer Center (United States). RESULTS: The journal “Movement Disorders” rated first with 18 articles and 643 citations in terms of productivity and impact, and articles published in Q1 journals surpassed the remaining quartiles. The most cited articles had national collaboration. Conclusion the number of papers on BPDCN has been rising, yet journals with a higher quality tend to keep the similar publication rates, although they have shown a slight increase in the recent years. CONCLUSIONS: High-income countries' international collaboration is crucial for increasing publications impact; hence, greater collaborations between researchers and institutions from countries around the world are needed to expand knowledge on this subject.

Colposcopy in the Primary Health Care: A Scoping Review.

Low- and middle-income countries represent nearly 85% of all cervical cancer cases worldwide; thereby, it is extremely important to identify methods to improve the screening process. Therefore, this study aimed to summarize the primary characteristics of studies on accessibility, coverage, patient preferences, and factors associated with patient satisfaction or acceptance of colposcopy in primary healthcare. A search strategy, based on MeSH, Emtree, and free terms, was run through 5 databases (PubMed, Scopus, Embase, Ovid/Medline, and Web of Science). EndNote 20.1 © and Rayyan QCRI © were used for screening. A preset datasheet was used for data extraction. The systematic search retrieved 1127 references, and after removing duplicates, screening the titles and abstracts, and reviewing the full text, 7 studies were included. The interrater reliability was 77.73% (kappa statistic = 0.1842). Most studies estimated the proportion of women that sought for colposcopy after a previous screening test for human papilloma virus. One study identifies barriers to colposcopy examination in women at risk of developing cervical cancer. Three studies assessed the decentralization of colposcopy from a tertiary healthcare center to a primary care center. Pap smear was the most common first-line screening test, followed by liquid-based cytology sample and visual inspection with acetic acid. Only a few countries have investigated the use of colposcopy in primary care. Thus, barriers and the care structure for this implementation to be successful in reducing cervical cancer incidence and mortality should be identified.

Novel Therapies for De Novo or Relapsed/Refractory AML with TP53 Mutations : A Glimmer of Hope

Background: The prognosis of TP53 mutated acute myeloid leukemia (AML) is dismal. Due to their correlation with universally bad outcomes, TP53 mutations play a crucial role in risk assessment and treatment selection in 5-10% of AML cases. Traditional Therapies have shown limited response and poor overall survival (OS). With current therapy, the median OS of a patient with newly diagnosed TP53m-AML is 6-9 months, and only around 10% of patients survive three years after allogenic hematopoietic stem cell transplantation (alloHCT). We present the safety and efficacy of novel therapeutic agents that target specifically TP53 mutated AML. Materials & Method: A comprehensive literature search was performed on PubMed, Cochrane Library, Embase, and Web of Science. We used the following mesh terms and Emtree terms, "acute myeloid leukemia" OR "AML" AND "TP53 mutations" from the inception of literature till 06/01/2022. We screened 2300 articles and included articles citing novel therapies such as "Venetoclax" (VEN), "Hypomethylating agents (HMA), 5-azacytidine (5-AZA), "checkpoint inhibitors, and "MDM2 inhibitors". We extracted data for "complete response (CR), Overall Survival (OS), and Progression-free survival (PFS) and safety variables such as grade III-IV adverse events. We excluded case reports, case series, preclinical trials, single-arm studies, review articles, meta-analyses, and controlled. STATA version 14.2 was used. Results: A total of 1814 patients were included in three-phase III and eleven phase II trials. Bcl-2 inhibitors :For VEN in combination with two phase III trials incorporating 641 patients were evaluated; In both trials, encouraging remission rates were reported in de-nov or relapsed or refractory patients harboring TP53 mutations. However, the median OS was 14.7 vs 5.17 (mTP53 vs wTP53) months in the treatment group compared to 4.9 vs 9.6 (mTP53 vs wTp53) months in the control group respectively. For VEN +AZA combination group, CR rates in mTP53 patients was 55% versus 0% in AZA alone (p < 0.001). VEN with low-dose cytarabine (LDAC) had 27% CR, whereas LDAC alone had 7%. Checkpoint inhibitors such as nivolumab showed favorable responses, as in the phase II study of nivolumab in combination with azacitidine in relapsed/refractory (R/R) AML; it demonstrated acceptable toxicity and an overall response rate (ORR) of 33%. However, increased response rates were seen in HMA-naïve patients. HDAC inhibitors : In two phase II trials incorporating AZA vs AZA + entinostat, the CR was 46% vs 44% . The mOS achieved in AZA was 18 months vs. combination therapy with entinostat. In the study by Manero et al. , the combination therapy of Decitabine and valproic acid showed CR of 34% and mOS of 11.9 months. The results of other trials with respect to TP53 mutation is shown in table 1. APR-246 inhibitors: In two phase II trials combining Eprentapopt with AZA , 29 patients were enrolled and CR of 41% was achieved.Sallman et al. described a remission of 82% with a median OS of 14.7 months in Eprenetapopt + 5-AZA. The most common grade ≥ 3 hematological adverse events were anemia, neutropenia, thrombocytopenia, and leukopenia. MDM2 Inhibitors : In the MIRROS trial, a phase III trial incorporating idasanutlin + cytarabine + placebo + cytarabine in R/R AML;436 patients were enrolled. The CR was 20.3%vs 17.1%(odds ratio [OR], 1.23; 95%CI, 0.70-2.18). Common any-grade adverse events (≥ 10%incidence in any arm) were diarrhea (87.0%vs 32.9%), febrile neutropenia (52.8%vs 49.3%), and nausea (52.5%vs 31.5%). The grade ≥3 hematological and non-hematological adverse events have been reported in Table 1. Conclusion: Emerging therapies employ unique therapeutic pathways that have led to increased optimism regarding the therapeutic potential of TP53 mutations. Although the median OS remains approximately a year with these therapies, hypomethylating drugs in combination with VEN or as independent therapy demonstrated greater response rates than induction chemotherapy. Initial progress has resulted from eprenetapopt's direct targeting of mutant p53 protein, showing a favorable 82% complete response. Still a daunting challenge, a combination of these therapies may ultimately be necessary to obtain adequate and sustained responses. Participation in clinical trials for all newly diagnosed AML patients should be encouraged to promote the development of innovative therapeutics. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Link between COVID-19 vaccines and myocardial infarction.

BACKGROUNDVaccines for coronavirus disease 2019 (COVID-19) include ChAdOx1-SARS-COV-2 (AstraZeneca), Ad26.COV2.S (Janssen), mRNA-1273 (Moderna), BNT162b2 (Pfizer), BBIBP-CorV (Sinopharm), CoronaVac (Sinovac), and Bharat Biotech BBV152 (Covaxin).AIMTo find the association between COVID-19 vaccines and myocardial infarction (MI).METHODSThis is a systematic review that involved searching databases such as MEDLINE, EMBASE, and PakMediNet after making a search strategy using MeSH and Emtree terms. Eligibility criteria were set, and studies having no mention of MI as a complication of COVID-19 vaccination, protocols, genetic studies, and animal studies were excluded. Data was extracted using a predesigned extraction table, and 29 studies were selected after screening and applying the eligibility criteria.RESULTSThe majority of studies mentioned AstraZeneca (18 studies) followed by Pfizer (14 studies) and Moderna (9 studies) in subjects reporting MI after vaccination. Out of all the studies, 69% reported MI cases after the first COVID-19 vaccination dose and 14% after the second, 44% reported ST-segment elevation MI, and 26% reported non-ST-segment elevation MI. The mortality rate was 29% after MI.CONCLUSIONIn conclusion, many studies linked MI to COVID-19 vaccinations, but no definitive association could be found.

MM-082 Addition of Daratumumab to Drug Regimens in the Treatment of Multiple Myeloma: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Despite improvement in the treatment of multiple myeloma (MM), a significant number of patients do not respond to the existing drug regimens. In this meta-analysis, we will assess the efficacy of daratumumab in combination with other drug regimens used in the treatment of MM. Meta-analysis. A literature search was performed on PubMed, Embase, Web of Science, Cochrane, and clinicaltrials.gov with Mesh and Emtree terms, "daratumumab" and "multiple myeloma," from the inception of data to 27 March 2022. R software was used to conduct the meta-analysis. Daratumumab versus control. Pooled hazard ratio (HR) of progression-free survival (PFS), relative risk (RR) of overall response (OR), and RR of complete response (CR). A total of 4,564 articles were screened, and 9 randomized clinical trials (RCTs, N=4,725) were included. All patients were adults (>18 years). Daratumumab was given to 2,481 patients in combination with regimens including lenalidomide + dexamethasone (N=649), pomalidomide + dexamethasone (N=151), bortezomib + dexamethasone (N=377), bortezomib + melphalan + prednisone (N=350), bortezomib + thalidomide + dexamethasone (N=543), carfilzomib + dexamethasone (N=312), and lenalidomide + bortezomib + dexamethasone (N=99), whereas no daratumumab was given to 2,244 patients. In relapsed/refractory multiple myeloma (RRMM) patients (N=2,001), RR of OR was 1.25 (95% CI=1.17-1.32, I2=32%), CR was 2.46 (95% CI=2.02-3, I2=31%), and HR of PFS was 0.59 (95% CI=0.50-0.69, I2=70%), all in favor of daratumumab versus the control. In stem cell transplant (SCT)-eligible patients (N=1,281), RR of OR was 1.05 (95% CI=1-1.09, I2=33%), CR was 1.4 (95% CI=1.16-1.69, I2=32%), and HR of PFS was 0.58 (95% CI=0.49-0.69, I2=0%), all in favor of daratumumab versus the control as induction and consolidation therapy. In SCT-ineligible patients (N=1,443), RR of OR was 1.18 (95% CI=1.10-1.27, I2=61%), CR was 1.86 (95% CI=1.6-2.15, I2=0%), and HR of PFS was 0.59 (95% CI=0.52-0.68, I2=61%), all in favor of daratumumab versus the control as first therapy. The addition of daratumumab to current regimens significantly improved PFS and response rates in patients with RRMM, SCT-eligible MM, or SCT-ineligible MM. More RCTs are needed to confirm these results.

Interventions based on environmental determinants for nutritional and physical activity behaviours in Colombia: a scoping review

ObjectiveTo identify, systematically, the interventions based on environmental determinants to improve the nutritional and physical activity (PA) habits available in Colombia.DesignA scoping review was performed according to the guidelines of...

Systematic Review of Comparisons Between Plastic and Silicone Dilators: Revealing a Knowledge Gap.

Vaginal stenosis is a distressing side effect of radiation therapy that can impair quality of life. Dilator therapy is an option for patients undergoing pelvic radiotherapy to mitigate vaginal stenosis. Currently, the dilators given to patients by most hospitals are made of plastic, compared to silicone dilators which are available on the market for purchase. We conducted a systematic literature review to find information to guide clinical recommendations to pelvic radiotherapy patients on potential differences regarding the use of plastic vs silicone dilators with regard to efficacy, cost, and patient preferences. A systematic literature review was conducted in Embase, MEDLINE, and PubMed using Emtree terms. To be included in the review, papers needed to: focus on female patients undergoing radiation therapy, assess a vaginal dilator, measure any dilator intervention outcome, and specifically compare plastic vs silicone dilators for any measured outcome (either qualitative or quantitative). The initial search yielded 195 articles. Two area experts, with a third expert for arbitration, read each article and found that none met all review inclusion criteria. No studies were found that compared silicone to plastic dilators with regard to efficacy in treating vaginal stenosis due to radiation therapy, no studies were found that compared cost or cost-effectiveness of the 2 dilator types, and no studies were found comparing patient preferences or experiences (eg, comfort, adherence, ease of use) between the 2 dilator types. The materials used to create dilators have never been rigorously compared in the context of radiotherapy-related vaginal stenosis. Institutions and patients have no data to guide their choice. Significantly more research at the patient and institutional level is needed to explore the potential long-term quality of life and cost benefits of improved adherence with silicone dilator use, and to guide shared decision-making regarding dilator choice.

Effectiveness of Telemedicine Compared with Standard Care for Patients with Rheumatic Diseases: A Systematic Review.

Objective: The aim of this study was to systematically review the evidence on the effectiveness of telemedicine compared to standard care for patients with rheumatic diseases. Methods: A search was performed in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews; for the gray literature, GREYNET databases and a snowball search were used. MeSH or Emtree terms. Three authors independently selected systematic reviews, randomized controlled trail (RCTs), or non-RCTs with patients with autoimmune or inflammatory rheumatic diseases, where telemedicine was compared with standard care. Effectiveness was measured in terms of disease activity, quality of life, and functional activity. The patients' satisfaction was also measured. The risk of bias was assessed by the Cochrane collaboration tool for RCTs and AMSTAR II for systematic reviews. Results: Four RCTs, one cross-out study, and five systematic reviews were included. The studies were conducted with rheumatoid arthritis patients, and one study involved patients with systematic lupus erythematosus. The interventions mainly involved teleconsultation and telemonitoring, with patient-reported outcomes (PROs) being compared with standard care. Four studies measured the effectiveness of telemedicine using PROs, in which three of the RCTs did not find differences in the clinical outcomes, and one found that telemedicine improved the remission of diseases, functional impairment, and radiographic joint damage progression. Two studies measured patient satisfaction with telemedicine and standard care without a significant difference between the groups. Conclusions: Despite heterogeneity between studies, the findings were remarkably consistent in demonstrating that there was no significant difference between the telemedicine group and the control group in terms of PROs and patient satisfaction. Patients should be offered the option of telemedicine to manage their diseases as part of health-care support. Further research is needed on the effectiveness of telemedicine in the long term for patients with rheumatic diseases.

A systematic literature review of real-world treatment outcomes of small cell lung cancer.

Background:Robust evidence from real-world studies is needed to aid decision-makers and other stakeholders in choosing the best treatment options for patients. The objective of this work was to assess real-world outcomes of treatment strategies for limited- and extensive-stage small cell lung cancer (SCLC) prior to the global introduction of immunotherapies for this disease.Methods:Searches were conducted in MEDLINE and Embase to identify articles published in English from October 1, 2015, through May 20, 2020. Searches were designed using a combination of Medical Subject Heading (Medline), Emtree (Embase subject headings), and free-text terms such as SCLC. Observational studies reporting data on outcomes of initial treatment strategies in patients with limited- and extensive-stage SCLC were included. Studies with limited sample sizes (<100 patients), enrolled all patients prior to 2010, or did not report outcomes for limited- and extensive-stage SCLC separately were excluded. Data were extracted into a predesigned template by a single researcher. All extractions were validated by a second researcher, with disagreements resolved via consensus.Results:Forty articles were included in this review. Most enrolled patients from the United States (n = 18 articles) or China (n = 12 articles). Most examined limited-stage (n = 27 articles) SCLC. All studies examined overall survival as the primary outcome. Articles investigating limited-stage SCLC reported outcomes for surgery, chemotherapy and/or radiotherapy, and adjuvant prophylactic cranial irradiation. In studies examining multiple treatment strategies, chemoradiotherapy was the most commonly utilized therapy (56%–82%), with chemotherapy used in 18% to 44% of patients. Across studies, median overall survival was generally higher for chemoradiotherapy (15–45 months) compared with chemotherapy alone (6.0–15.6 months). Studies of extensive-stage SCLC primarily reported on chemotherapy alone, consolidative thoracic radiotherapy, and radiotherapy for patients presenting with brain metastases. Overall survival was generally lower for patients receiving chemotherapy alone (median: 6.4–16.5 months; 3 years, 5%–14.9%) compared with chemotherapy in combination with consolidative thoracic radiotherapy (median: 12.1–18.0 months; 3 years, 15.0%–18.1%). Studies examining whole-brain radiotherapy for brain metastases reported lower median overall survival (5.6–8.7 months) compared with stereotactic radiosurgery (10.0–14.5 months).Conclusions:Under current standard of care, which has remained relatively unchanged over the past few decades, prognosis remains poor for patients with SCLC.

Two checkpoint inhibitor combinations in patients with cutaneous melanoma: A systematic review of clinical trials.

e21530 Background: Melanoma is a cancer of melanocytes and has the potential to metastasize to distant organs. Immune checkpoint inhibitors (ICI) enhance the immune response against cancer cells. Programmed cell death protein-1 (PD-1), PD-ligand-1 (PD-L1), cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), and lymphocyte-activation gene (LAG-3) are the common targets of ICI. Blocking two pathways can have an additive/synergistic effect. This systematic review will assess the efficacy of two ICI combinations in cutaneous melanoma. Methods: A search was performed on PubMed, Embase, and clinicaltrials.gov. We used the following mesh and Emtree terms, “Melanoma” AND “Immune checkpoint inhibitors,” from the inception of literature till 01/15/2022. We screened 11,287 articles and included 4 randomized clinical trials (N = 1,948) and 6 single-arm clinical trials (N = 438) in this review. We excluded preclinical trials, case reports, case series, review articles, observational studies, meta-analysis, and irrelevant clinical trials. Results: In 10 clinical studies (N = 2,386), two ICI combinations were assessed in adult patients with melanoma. Nivolumab (nivo) + ipilimumab (ipi), relatlimab (rela) + nivo, pembrolizumab (pemb) + ipi, lag525 + spartalizumab (spa), fianlimab (fian) + cemiplimab (cem) and single drug/placebo were used to treat 560, 365, 223, 42, 48, and 1,148 patients, respectively. 2,119, 70, and 197 patients had advanced untreated, PD-1/L1 refractory, and resectable stage III/IV melanoma. The response rates (RR) and survival rates are given in table. Conclusions: Two ICI combinations of nivo, ipi, and rela were more effective than monotherapy in patients with untreated advanced melanoma. In early phase trials, combinations of ipi, nivo, pemb, lag525, spa, fian, and cem were effective in advanced melanoma. Nivo, ipi, and rela were effective in patients with resectable melanoma. Pemb+ipi was effective in patients with PD-1/L1 refractory melanoma. More randomized double-blinded clinical trials are needed to confirm these results.[Table: see text]

Efficacy and safety of selpercatinib in RET-altered tumors: A systematic review and meta-analysis.

6091 Background: RET proto-oncogene encodes receptor tyrosine kinase. Selpercatinib was the first RET-specific tyrosine kinase inhibitor approved by FDA in RET-altered tumors (pralsetinib was approved afterward). This systematic review and meta-analysis will assess the efficacy and safety of selpercatinib in RET-altered tumors. Methods: A search was performed on PubMed, Embase, Cochrane, WOS, and clinicaltrials.gov. We used the following mesh and Emtree terms, “selpercatinib” AND “proto oncogene proteins c ret,” from the inception of literature till 10/15/2021. We screened 187 articles and included 2 phase I/II clinical trials (N = 309) in this meta-analysis. We excluded preclinical trials, case reports, case series, review articles, observational studies, meta-analysis, and clinical trials not providing any information about the efficacy of selpercatinib in RET-altered tumors. The quantitative analysis was performed using the R programming language. Results: In 2 clinical studies (N = 309), 144 patients had RET-altered advanced non-small cell lung cancer (NSCLC) and 162 had thyroid cancer. RET mutations were reported in 143 patients and RET-fusion in 163 tumors. 179 patients were previously treated with systemic therapy while 127 patients were treatment naïve. Pooled overall response (OR), complete response (CR), partial response (PR), progressive disease (PD), and stable disease (SD) were 72% (95% CI = 0.64-0.78, I2= 40%), 6% (95% CI = 0.03-0.13, I2= 49%), 66% (95% CI = 0.57-0.74, I2= 50%), 3% (95% CI = 0.01-0.06, I2= 0), and 24% (95% CI = 0.18-0.30, I2= 22%), respectively, in RET-altered thyroid/NSCLC patients. Pooled OR was 67% (95% CI = 0.60-0.73, I2= 0), 78% (95% CI = 0.64-0.87, I2= 51%), 75% (95% CI = 0.58-0.87, I2= 68%), and 71% (95% CI = 0.63-0.78, I2= 0%) in previously treated, treatment naïve, RET-fusion tumor, and RET-mutation tumor patients, respectively. Pooled incidence of ≥grade 3 any adverse event, rise in ALT, rise in AST, diarrhea, hypertension, and QT abnormalities were reported in 58% (95% CI = 0.43-0.72, I2= 85%), 10% (95% CI = 0.08-0.14, I2= 0), 11% (95% CI = 0.07-0.15, I2= 17), 5% (95% CI = 0.03-0.08, I2= 0), 17% (95% CI = 0.11-0.26, I2= 62%), and 4% (95% CI = 0.02-0.07, I2= 18%) of the participants, respectively. Conclusions: Selpercatinib was safe and effective in patients with RET-altered NSCLC and thyroid cancer regardless of prior treatment status and type of RET alteration. On indirect comparison, the safety profile with selpercatinib was better than previously used non-specific RET-inhibitors. Randomized clinical trials (RCTs) NCT04211337 and NCT04194944 are in progress to compare selpercatinib with non-specific RET inhibitors and chemotherapy/PD-1 inhibitor. More RCTs are needed to assess the combinations of selpercatinib with other drugs.

Acute and sub-acute ocular manifestations in pediatric patients with COVID-19: A systematic review.

The coronavirus disease 2019 (COVID-19) pandemic has been the most challenging health problem in the last 2 years. Post-COVID-19 multisystem inflammatory syndrome of children (MIS-C) is a severe post-COVID-19 complication in pediatric patients. Ocular manifestations may be the first presentation of MIS-C, wherein prompt treatment may improve outcomes. In this systematic review, we aimed to summarize the acute and sub-acute ocular manifestations in pediatric patients with laboratory-confirmed COVID-19. We included all online primary studies, with no language restriction and published between January 1, 2019 and November 18, 2020, reporting any acute or sub-acute ocular manifestations in children with laboratory-confirmed COVID-19. PubMed/MEDLINE was searched using the following MeSH and Emtree terms: "eye," "ophthalmologic," "ocular," "vision," "conjunctivitis," "severe acute respiratory syndrome coronavirus 2," "SARS-CoV-2," "corona," "2019-nCoV," "COVID19," and "COVID." The eligibility and quality of the selected records were assessed by two independent reviewers as per the Cochrane Handbook for Systematic Review. A total of 1,192 records were identified electronically. Seven papers were extracted from the reference lists of the eligible records. Thirty-six papers met the inclusion criteria and were categorized into two subgroups according to acute or sub-acute presentation of ocular manifestations. Among 463 pediatric patients with COVID-19, 72 (15.5%) had acute ocular manifestations. There was one patient with central retinal vein occlusion and another with photophobia and diplopia associated with meningoencephalitis. Among 895 pediatric patients with post-COVID-19 MIS-C, 469 (52.4%) had ocular manifestations, which only included non-purulent conjunctivitis. Ocular manifestations have been reported in less than one-fifth of pediatric patients with acute COVID-19. Furthermore, conjunctivitis was the only ocular manifestation reported in half of the patients with MIS-C, and it may be missed easily due to its non-purulent nature. During the COVID-19 pandemic, pediatricians and health workers must remain vigilant for early detection of signs of this potentially fatal post-COVID-19 inflammatory syndrome.