Factors Affecting Treatment Outcome Research Articles

Predictive factors of stone-free rate and complications in patients with proximal impacted ureteral stones undergoing percutaneous nephrolithotomy: based on a new scoring standard.

To evaluate the predictive factors affecting the stone-free rate (SFR) and complications of percutaneous nephrolithotomy (PCN) in the treatment of proximal impacted ureteral stones (PIUS) based on a new scoring standard. The data of 90 patients with PIUS were collected in this retrospective study between January 2015 and June 2023. Univariate and multivariate logistic regression analyses were used to determine factors affecting treatment outcome in terms of SFR and complications. The scoring standard for patients with PIUS was developed based on the univariate logistic regression analyses. In the univariate analysis, stone density (P = 0.015), and stone diameter (P = 0.032) significantly were associated with lower SFR. And degree of hydronephrosis (P = 0.014), Preoperative infection (P = 0.002), and history of lithotripsy (P = 0.045) were associated with occurrence of complications. Multivariate analysis indicated that stone density (P = 0.020), and stone diameter (P < 0.001) were associated with lower SFR; independent risk factors for development of complications were history of lithotripsy (P = 0.024), and preoperative infection (P < 0.001). Additionally, score ≥ 3 was the independent risk factor for both SFR (P < 0.001) and complication rate (P < 0.001). Subgroup analysis shown that there were statistically significant differences between the two groups in terms of stone-free rate (P = 0.032) and complications (P = 0.015). According to the findings of this study, the stone score ≥ 3 was determined as a critical predictive factor of SFR and complications in PIUS patients undergoing PCN based on a new scoring standard. Additionally, PCN has high initial SFR and low complications when dealing with score < 3 PIUS.

Autotransplantation in Pediatric Dentistry: Factors Affecting Treatment Outcomes

This research aimed to evaluate the outcomes of autotransplantation in both children and adolescents, with a focus on root growth, and determine the clinical and radiographic factors associated with the success rate. In this study, 73 teeth, autogenously transplanted in 63 patients, were examined over an observation period of 3.2 years on average. The mean age at the time of autotransplantation was 11.9 years. Based on the radiographic criteria, the success rate was 73.97% and the survival rate was 100%. Based on the radiographic criteria, the success rate was 73.97%, and the survival rate was 100%. A significant increase in root length was observed in the transplanted teeth with an open apex. An association was found between the success rate and use of bone graft and surgeon experience. In conclusion, greater clinical experience in autotransplantation (&gt; 36 cases) and prohibiting the use of bone grafts may improve the prognosis of the transplanted teeth in children and adolescents.

Factors Affecting Treatment Outcomes for Tuberculosis Patients: A Retrospective Cohort Study

Background: Tuberculosis (TB) is one of the ten leading causes of death globally. The present study aims to examine the treatment outcomes in TB patients and to determine the factors associated with unsuccessful treatment outcomes. Materials and Methods: This study was a retrospective registry-based cohort study conducted in Ordu pro-vince of Turkey between 2017-2021. Logistic regression analysis was used to explore the risk factors asso-ciated with unsuccessful outcomes. Results: A total of 400 TB patients were included in the analysis. The observed overall treatment success rate (TSR) (cured or treatment completed) was 87.7% (351). 49 patients (12.3%) had unsuccessful treatment results (death, failure or loss to follow-up). Age&amp;gt;65 years (odds ratio [OR] =12.2, 95% confidence intervals [CI] =4.03-36.85), male gender (OR = 2.2, 95% CI = 1.05-4.45) and being foreign-born (OR = 9.2, 95% CI = 1.16-73.72) were identified as risk factors associated with unsuccessful outcomes in patients (p&amp;lt;0.05). Conclusions: Age&amp;gt;65 years, male gender and foreign-born patients tend to have unsuccessful treatment outcomes. Careful monitoring of patients with any of these characteristics and taking special precautions for them may help to decrease unsuccessful treatment outcomes.

Exploring the Barriers and Facilitators in the Management of Childhood Trauma and Violence Exposure Intervention in the Vhembe District of the Limpopo Province, South Africa.

Research has shown that barriers and facilitators in psychotherapy exhibit similarities. The authors of this study are of the view that to effectively address the difficulties encountered in psychotherapy for children and adolescents, it is crucial to consider the points of view of professionals who have firsthand encounters with children. The purpose of this study was to effectively explore barriers and facilitators in the treatment of children exposed to trauma and violence. Exploratory and descriptive methods, as components of a qualitative research design, were employed to investigate and articulate the barriers and facilitators involved in managing childhood trauma. An advertisement was used to recruit participants. It was developed and distributed to psychologists and social workers recommended by the Thohoyandou Victim Empowerment Programme. Seventeen professionals were individually interviewed using semi-structured interview schedules. The interviews were recorded, transcribed verbatim, and analysed using interpretative phenomenological analysis (IPA). The findings of the study indicated a lack of commitment from parents in honouring appointments, financial challenges, a fear of perpetrators associated with the poor reporting of incidences, professional boundaries, and referral route challenges. Familiar facilitators in the management of childhood trauma included continuous training and workshops for all people working with childhood trauma and violence, the employment of more victim advocates, and awareness campaigns. Additionally, the referral pathway for traumatised children presents logistical, psychological, and educational hurdles, underscoring the complex nature of meeting the needs of these vulnerable populations within the healthcare system. In conclusion, even while the currently available research supports the barriers and facilitators for this population, more investigation is required to examine how these factors affect treatment outcomes, particularly in community-based settings.

Factors affecting treatment outcomes of outpatient therapeutic program for treatment of severe acute malnutrition in under-fives: A review

This study aims to scrutinize the factors influencing treatment outcomes in Outpatient therapeutic programs (OTPs) targeting Severe Acute Malnutrition (SAM) in children under five. SAM in children under five is a pressing global health issue, necessitating effective treatment to mitigate its high mortality and morbidity risks. OTPs have been pivotal in addressing SAM in resource-constrained settings, offering ready-to-use therapeutic foods (RUTF) and medical care. However, the success of OTPs is dependent upon various factors, including the child's age and nutritional status and the quality of care provided. Understanding these factors and their influence on treatment outcomes is paramount for enhancing OTP effectiveness and alleviating the SAM burden among young children. A thorough search was conducted across Cochrane, Elsevier, and PubMed databases to identify relevant publications between 2016 to 2024. Twenty-four studies were initially retrieved, with thirteen meeting the inclusion criteria for data synthesis. Analysis of the selected studies revealed pivotal factors affecting treatment outcomes in OTPs for SAM. These factors include socio-demographic characteristics, clinical features and caregiver-related factors. Notably, factors such as age, nutritional status, comorbidities, program adherence and caregiver knowledge, emerged as significant determinants of treatment success. This review underscores the multifaceted nature of factors influencing treatment outcomes in OTPs for SAM among children under five. Understanding these determinants is crucial for optimizing program effectiveness and enhancing child health outcomes in resource-limited settings. Interventions addressing these factors will improve the impact of SAM treatment programs. Further research focusing on tailored interventions are recommended to refine SAM treatment strategies.

Difficult-to-treat depression: an integrative approach to therapeutic resistance.

Depression is a prevalent mental disorder that can have severe impacts. Despite medical efforts, some individuals develop treatment-resistant depression (TRD) or difficult-to-treat depression (DTD). TRD includes those unresponsive to standard treatments, whereas DTD encompasses a broader range of factors affecting treatment outcomes. This article examines the distinctions between TRD and DTD, highlighting the need for personalized multidisciplinary approaches. It discusses various therapeutic options, including pharmacological, psychological, and neurostimulation therapies, emphasizing the significance of considering psychosocial factors and individualized care. Raising awareness among the public, experts, and clinicians about the importance of psychosocial and multidisciplinary aspects in managing DTD can help reduce the stigma associated with depression and improve patient quality of life.

Factors in Predicting Short Term Mortality in ST Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Background: Percutaneous coronary angiography and intervention have been applied in the diagnosis and treatment of coronary artery disease at Gia Dinh People's Hospital since April 2009 until now with very positive results, contributing to improving the quality of diagnosis and treatment. Treating cardiovascular patients with high technology. However, there is currently no research to help evaluate performance as well as prognostic factors affecting treatment outcomes at this unit. Therefore, we conducted this study with the research question: Short-term mortality rate in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention at Gia Dinh People's Hospital. What is the year 2022 - 2023? What factors predict short-term mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Materials and methods: There were 163 patients at the Gia Dinh People's Hospital from November 2022 to September, 2023. This was a cohort study. Results: In-hospital and 30-day mortality rates after intervention were 4.29% and 4.91%, respectively. Short-term mortality prognostic factors include systolic blood pressure &lt; 100 mmHg, arrhythmia at admission, TIMI score &gt; 6, cardiogenic shock before the procedure, blood potassium concentration with mortality rate within 30 days after PCI, with p &lt; 0.05. Conclusion: In clinical practice, attention should be paid to factors predicting 30-day mortality in STEMI patients include systolic blood pressure &lt; 100 mmHg, arrhythmia at admission, TIMI score &gt; 6, cardiogenic shock before the procedure, blood potassium concentration with mortality rate within 30 days after PCI.

Factors affecting treatment outcomes of hospital injury patients in Korea.

To analyze the characteristics of hospital injured patients and the factors that affect treatment results. We used the data from the Korea National Hospital Discharge In-depth Injury Survey from 2019 to 2021 of the Korea Disease Control and Prevention Agency (KDCA), 18,037 people who experienced hospital injury accidents were analyzed. In a retrospective cross-sectional study, general characteristics and injury-related characteristics of patients with hospital-acquired injuries were collected. The data were analyzed using chi-square test and logistic regression analysis of complex sampling design. The significance of all statistical analyses was verified at the p-value (<0.05) level. Variables that significantly affected the death of patients with hospital injuries were gender, age, route of admission, type of hospital injury, principal diagnosis, and length of stay (p < 0.05). The risk of death was 3.174 times (95% confidence interval: 2.376-4.238) higher when neoplasm was the principal diagnosis compared to cases with principal diagnosis of other systems. It is necessary to do patient safety education to help medical personnel be more aware of groups of patients who had a high risk of death from hospital damage, such as male and elderly patients, patients who admitted through the emergency room, and patients whose principal diagnosis was neoplasm, circulatory system, or respiratory system disease.

Comparative effectiveness and cost evaluation of Risankizumab and Adalimumab in the management of psoriasis: a real-world study in Saudi Arabia

BackgroundPsoriasis, an immune-mediated chronic inflammatory disease primarily affecting skin and joints, has varying prevalence rates globally. It manifests in five types, with chronic plaque psoriasis being the most common. Treatment, which has no definitive cure, aims for complete resolution of skin symptoms and depends on disease extent, severity, and impact on patients’ lives. Biologics are an emerging treatment for psoriasis, targeting specific inflammatory pathways for potentially safer, more effective outcomes. However, these come with significant costs, necessitating more research to ensure value for money. This study aimed to compare the effectiveness of Risankizumab versus Adalimumab, the most commonly utilized biologic for managing psoriasis in Saudi Arabia.MethodsThis study retrospectively compared the effectiveness and direct medical cost of Risankizumab and Adalimumab in treating chronic plaque psoriasis in adults from two Saudi Arabian healthcare centers. The Psoriasis Area and Severity Index (PASI) and body surface area (BSA) were used to assess treatment effectiveness, with patient data sourced from electronic medical records. Multiple regression analysis was performed to examine various factors affecting treatment outcomes. An economic evaluation was conducted to examine the cost-effectiveness of the two drugs, considering four scenarios with varying dosage patterns and costs. Analysis was performed from the perspective of public healthcare payers and considered all utilized health services.ResultsThe data for 70 patients were analyzed, with comparable baseline characteristics between groups. While Risankizumab led to a greater reduction in PASI scores and BSA affected, these results were not statistically significant. The annual treatment cost for Risankizumab was higher than Adalimumab. Various scenarios were studied, considering real acquisition costs, double dosing for Adalimumab, and the use of biosimilars. A scenario assuming double dosing for Adalimumab and a 40% discount for Risankizumab demonstrated both cost and efficacy advantages in 71.25% of cases.ConclusionsThis study compared the effectiveness and cost of Risankizumab and Adalimumab for treating chronic plaque psoriasis in Saudi Arabian hospitals. Although Risankizumab showed a greater reduction in symptoms, the difference was not statistically significant. However, under certain scenarios, Risankizumab demonstrated cost and efficacy advantages. These findings may influence treatment decisions for psoriasis, but further research is needed.

A Prospective Study on the Impact of Clinical Factors and Adjusted Triple D System for Success Rate of ESWL.

Objective: Our study aimed to evaluate the success rate of ESWL and identify relevant treatment-specific factors affecting treatment outcomes, as well as to assess the accuracy of the updated Triple D scoring system and compare it with older systems. Material and Methods: A prospective study of 71 patients who received ESWL treatment for renal stones that were 5-15 mm in size was completed. The patient having no residual stones or residual stones lesser than 4 mm after ESWL was identified as a treatment success. Univariate and multivariate logistic regression and ROC curves were used to identify important factors for treatment outcomes. Results: Successful treatment was achieved for 66.2% of patients. The stone volume (SV), mean stone density (MD), and delivered power to the stone volume unit ratio (SMLI/SV) were defined as the most critical factors influencing ESWL success. An updated Triple D score system with a, SMLI/SV ratio could be an alternative to older systems and reach an even higher accuracy. A limitation of this study is the limited sample size due to the COVID-19 pandemic. Conclusions: Our results show that the three factors that most influence the success of ESWL are the stone size, mean stone density, and SMLI/SV ratio. Based on this, we present a simple updated triple D score system to predict ESWL success, which could be implemented in future clinical practice.

Predictors of long-term remission in acromegaly – an updated review

Abstract Acromegaly is a rare chronic disorder due to growth hormone (GH) - secreting pituitary tumor. The first-line treatment of acromegaly is a transsphenoidal adenomectomy. Surgical remission rates range from 30-50% for macroadenomas to 70-90% for microadenomas. Thus in patients with active acromegaly after surgery, medical treatment is recommended. Treatment outcome on medical therapy differs a lot depending on medications. The aim of this paper is to summerize the current knowledge of factors predicting acromegaly remission after surgery and biochemical control on medical treatment. Factors affecting treatment outcome, not related to the patient and the tumor, are neurosurgeon’s experience and visualisation tools used during surgery. Younger patients, as well as women tend to achieve acromegaly remission after surgery less often. Patients with lower GH and insulin-like growth factor-1 (IGF-1) concentrations at diagnosis, in oral glucose tolerance test (OGTT) and postoperatively have a greater chance of surgical remission. However, some publications do not confirm that. Patients presenting with larger and more invasive tumors achieve surgical remisson less often. Hypointensive tumors on T2-weighted magnetic resonance imaging (MRI) scans are associated with better response to first-generation somatostatin receptor ligands (SRLs) and to pasireotide. Pathologic factors increasing the chance of acromegaly remission are densely granulated tumors, lower Ki-67 index, high expression of somatostatin receptors (SSTRs) and high expression of E-cadherin. A thorough analysis of the abovementioned factors predicting the treatment outcome in acromegaly may be helpful for selecting the best treatment option for each patient.

Factors influencing choice of treatment for proximal humeral fractures elaborated in a Delphi consensus process

IntroductionHitherto, the decision-making process for treatment of proximal humerus fractures (PHF) remains controversial, with no established or commonly used treatment regimens. Identifying fracture- and patient-related factors that influence treatment decisions is crucial for the development of such treatment algorithms. The objective of this study was to define a Delphi consensus of clinically relevant fracture- and patient-related factors of PHF for clinical application and scientific research.MethodsAn online survey was conducted among an international panel of preselected experienced shoulder surgeons. An evidence-based list of fracture-related and patient-related factors affecting treatment outcome after PHF was generated and reviewed by the members of the committee through online surveys. The proposed factors were revised for definitions, and suggestions from the first round mentioned in the free text were included as possible factors in the second round of surveys. Consensus was defined as having at least a two-thirds majority agreement.ResultsThe Delphi consensus panel consisted of 18 shoulder surgeons who completed 2 rounds of online surveys. There was an agreement of more than two-thirds of the panel for three fracture-related factors affecting treatment decision in the case of PHF: head-split fracture, dislocated tuberosities, and fracture dislocation. Of all patient-related factors, a two-thirds consensus was reached for two factors: age and rotator cuff tear arthropathy.ConclusionThis study successfully conducted a Delphi consensus on factors influencing decision-making in the treatment of proximal humeral fractures. The documented factors will be useful for clinical evaluation and scientific validation in future studies.

Effect of knee arthroscopic debridement combined with peripatellar denervation on restoration of knee function in patients with knee osteoarthritis

BackgroundThis research examines knee osteoarthritis (OA), a prevalent orthopedic disease marked by cartilage degeneration and chronic synovitis, leading to pain, restricted mobility, and eventual loss of knee function. Notably, patellofemoral osteoarthritis constitutes a significant proportion of knee OA cases. Our study aims to assess the impact of knee arthroscopic debridement coupled with peripatellar denervation on restoring knee function in OA patients and analyze the risk factors affecting treatment outcomes. By doing so, we hope to contribute to the informed selection of clinical treatment plans, addressing a disease that, if untreated, significantly impairs patients’ quality of life.MethodsA total of 211 patients with knee osteoarthritis treated in our hospital from June 2020 to June 2022 were analyzed retrospectively. Among them, 116 patients received arthroscopic knee debridement treatment alone as the control group, and 95 in the observation group were combined with denervation treatment based on the control group. The clinical efficacy of the two groups of patients after treatment was evaluated, and patients’ pain was counted using the pain visual analogue score (VAS) method. The knee range of motion (ROM) was used to count the mobility of the patients and to compare the operative time, intraoperative perfusion volume, and length of stay between the two groups. According to the effectiveness after treatment, patients were divided into the improvement group (effective + markedly effective) and the non-improvement group, and the risk factors affecting the clinical efficacy of patients after treatment were analyzed by logistic regression.ResultsThe total treatment efficiency of patients in the control group was lower than that of those in the observation group (P < 0.05). There was no difference in intraoperative perfusion volume and length of stay between patients in both groups (P > 0.05). However, the operative time was shorter in the control group compared with that in the observation group (P < 0.001). The post-treatment VAS scores of patients in the observation group were lower than those in the control group, while the ROM scores were higher than those of the control group (P < 0.001). Age, BMI, and preoperative VAS score were found to be independent risk factors for patient outcome by logistic regression analysis (P < 0.05).Conclusionknee arthroscopic debridement combined with peripatellar denervation has a significant improvement in the restoration of knee function in patients with knee osteoarthritis and reduces their level of pain.

Factors Affecting Treatment Outcome of Metastatic Breast Cancer: Single Institution Study

BACKGROUND: Metastatic breast cancer (MBC) is an incurable disease. AIM: The goal of therapy is to prolong survival and amelioration of quality of life. However, the benefit of later systemic treatment lines is not clear. METHODS: This was a retrospective study of 345 MBC patient., assessment of progression free survival (PFS) survival with first line of treatment and second, third, fourth, fifth, and sixth lines of therapy, and analysis of different prognostic factors. RESULTS: The median overall survival (OS) was 31.7 month. The median PFS was 8.1 versus 3 month for first line of treatment and beyond. Where median PFS1, PFS 2, PFS 3, PFS 4, PFS 5, and PFS 6 were 8.1, 5.8, 3.8, 4.8, 3.4, and 2.6, respectively. PFS of first line was significantly prolonged in hormone positive luminal subtype, bone only metastasis, age above 35, ECOG I-II, and oligometastatic (p = 0.041, 0.038, 0.023, 0.034, 0.0001, and 0.001, respectively). Post-progression survival was 23.4 months and it was significantly prolonged in hormone positive luminal subtype, bone only metastasis, age above 35, ECOG I-II and PFS more than 6 months with first line. CONCLUSION: PFS is reduced with using more treatment lines in MBC. Patients with luminal subtype, bone only metastasis, age above 35, ECOG I-II, and PFS more than 6 months with first line may have the best benefit from later lines.

Survival Analysis and Factors Affecting Treatment Outcome in Glioblastoma Multiforme: A Cohort Study

Introduction: High-grade gliomas, especially Glioblastoma Multiforme (GBM), are the most prevalent primary brain tumours in adults. Treating GBM is challenging due to resistant tumour cells, resulting in a dismal prognosis. While GBM often develops spontaneously, familial gliomas have also been identified in 1% of cases. Primary and secondary glioblastoma are the subtypes that affect patients of varying ages and develop via different paths. Aim: To estimate the two year survival and to assess factors affecting survival in patients diagnosed with GBM and to evaluate the “ability for self-care” following treatment. Materials and Methods: The cohort study investigated treatment outcomes in GBM using a sample of 65 patients from the Department of Radiation Oncology at Government Medical College Thrissur, a tertiary care centre in Kerala, India. The patients were diagnosed between January 2018 and December 2019. Survival and the factors determining survival were explored through case records and telephonic interviews with primary caregivers. Median survival and two year survival rates were calculated. The study examined possible associations of survival with patient-related, tumourrelated, and treatment-related factors. Patient-related factors assessed were age, gender, and Eastern Cooperative Oncology Group (ECOG) performance status at diagnosis. Tumour-related factors assessed included tumour location, laterality, and volume based on pretreatment Magnetic Resonance Imaging (MRI). Treatment-related factors such as extent of surgery, postoperative radiotherapy, and chemotherapy were also assessed. Data analysis was performed using the Statistical Package for Social Sciences (SPSS version 21.0). Qualitative variables were expressed in percentage and compared using the Chi-square test or Fisher’sexact test. Quantitative variables were expressed as mean and standard deviation and compared using unpaired t-tests. Telephonic interviews with primary caregivers were conducted to assess the “ability for self-care” following treatment. Results: The study included a total of 65 cases, with a mean patient age of 54 years. Out of the patients, 45 (68%) patients were male, while 20 (32%) patients were female. The median survival for GBM was found to be eight months. The one year and two year survival rates were 18.46% (12 patients) and 10.8% (7 patients), respectively. The survivors had a mean age of 48 years. There were no statistically significant differences in survival based on sex (p-value=0.527), tumour location (p-value=0.765), and laterality (p-value=0.596). Survival was found to be related to ECOG performance status at diagnosis (p-value=0.001) and tumour volume (p-value=0.002). Among the patients, 37 (58%) patients were able to perform self-care after treatment, while 28 (42%) patients were unable to do so. Conclusion: The survival of patients with GBM is related to ECOG performance status at diagnosis and the pretreatment volume of the tumour. The evidence was insufficient to establish a relationship between survival and the administration of postoperative radiotherapy and chemotherapy. Despite multimodality treatment protocols, the survival of patients with GBM remains dismal. A tailored treatment protocol that weighing morbidity of treatment and cost effectiveness on one side and survival on the other side is the need of the hour.

Second-Line Antiretroviral Treatment Outcome in HIV-Infected Patients Coinfected with Tuberculosis in Pakistan.

Tuberculosis (TB) coinfection in human immunodeficiency virus- (HIV-) infected patients is considered a risk of antiretroviral therapy (ART) failure. Coadministration of antitubercular therapy (ATT) with ART is another challenge for TB management. The study was aimed at investigating contributing factors affecting treatment outcomes in HIV-/TB-coinfected patients. Cross-sectional. Setting. Samples were collected from the Pakistan Institute of Medical Sciences Hospital Islamabad. Subject and Methods. Clinicodemographic and immunovirological factors between the two groups were compared. The Student t-test and chi-square test were applied to compare outcome variables, and logistic regression was applied to determine the effect of TB on virological failure (VF). Main Outcome Measures. TB coinfection did not increase VF even in univariate (p = 0.974) and multivariate analysis at 6 and 12 months of 2nd-line ART start. ARV switching was significant (p = 0.033) in TB-coinfected patients. VF was significantly high in ATT-coadministered patients along with a viral load of ≥1000 (p = 0.000). Sample Size and Characteristics. We recruited seventy-four HIV patients on 2nd-line ART; 33 coinfected with TB were followed for at least 12 months. In HIV-/TB-coinfected patients, CD4 count, CD4 gain, and VF remained comparable to HIV patients with no TB infection. ATT significantly affects the treatment outcome, suggesting drug-to-drug interactions. These factors are important to revisit the therapeutic guidelines to maximize the benefit of dual therapy in resource-limited settings.

Variations in Incidence of Trigger Finger and Response to Corticosteroid Injection after Aromatase Inhibitor Therapy for Breast Cancer.

Aromatase inhibitors (AIs), such as letrozole and anastrozole, have been demonstrated to have significant musculoskeletal symptoms in patients. The purpose of this study was to evaluate the effect of specific AI medications on the incidence of trigger finger and independent factors affecting treatment outcomes within this population. A retrospective chart review was performed at the authors' institution between the years 2014 and 2018 in patients with the diagnosis of breast cancer. This cohort was then sorted based on receiving medication regimens, trigger finger diagnosis, steroid injections, and need for surgical release of trigger finger. A total of 15,144 patients were included for initial review. The overall rate of trigger finger diagnosis was 2.75% in the entire breast cancer population and 4.5% for patients receiving AI therapy. Patients taking letrozole and anastrozole had an increased odds ratio of 2.0 and 1.7, respectively, for developing trigger finger. Patients who switched between letrozole and anastrozole during treatment had a higher rate of failed steroid injection treatment (45.2% versus 23.5%; P = 0.021). Among patients receiving AI treatment diagnosed with trigger finger, diabetes and hemoglobin A1c level greater than 6.5 were associated with significantly increased rates of failed steroid therapy. Patients receiving AI therapy have an increased incidence of trigger finger. The outcomes of treatment are equivalent between AI and non-AI trigger finger populations. However, steroid therapy is more likely to fail in patients who require switching of regimens because of significant musculoskeletal symptoms. Poorly controlled diabetes was also an independent factor for compromised steroid treatment of trigger finger. Therapeutic, III.

Management of Displaced Maxillary Canines by Extraction of the Primary Canine: Factors Affecting Treatment Outcome

The purpose of this study was to evaluate the effect of interceptive primary canine extraction in palatally and buccally displaced maxillary permanent canines, and to analyze the clinical and radiographic factors affecting the treatment outcome. 97 maxillary permanent canines from 86 patients whose maxillary permanent canine were in the mesio-occlusal directions and overlapped with the roots of the adjacent teeth were analyzed. In 64 of 97 (66.0%) maxillary permanent canines, the displaced crown was completely deviated from the adjacent lateral incisor root only by extraction of the primary canine. Not only the characteristics of maxillary permanent canines such as bucco-palatal displacement direction, horizontal and vertical position of the crown tip, and presence of apical closure, but also periapical rarefaction on the primary canine and peg-shaped adjacent lateral incisor significantly affected the treatment outcome.

Factors affecting treatment outcome in patients with Acute Mesenteric Ischemia

Factors affecting treatment outcome in patients with Acute Mesenteric Ischemia

Single Centre, Retrospective Analysis of Treatment Outcomes and Prognostic Factors in Blastic Phase Chronic Myeloid Leukemia (CML-BP) Following Systemic Therapy

Introduction: Despite the introduction of BCR-ABL1 tyrosine kinase inhibitors (TKI), the prognosis of blastic phase chronic myeloid leukemia (CML-BP) remains dismal. Due to its low incidence, prospective evaluation of outcomes of CML-BP following systemic treatment is challenging. Thus, we aimed to evaluate the outcomes of CML-BP following systemic therapy, and to analyze prognostic factors affecting treatment outcomes. Methods: We retrospectively identified 55 patients with CML-BP per the European LeukaemiaNet 2013 criteria who treated at the Princess Margaret Cancer Centre in Toronto, Canada between 2000 and 2022. Patient and disease characteristics at the time of CML-BP diagnosis are presented in Table 1. Multiparametric flow cytometry data are described below, with percentages reflecting the proportion of positive antigen expression in evaluable patients. Treatment outcomes measured included: complete response (CR), leukaemia-free survival (LFS) and overall survival (OS). Prognostic factors evaluated include: age, transformation from chronic/accelerated phase (CP/AP), clonal evolution (CE), additional cytogenetic abnormalities (ACA), ABL1 KD mutation, extramedullary disease, blast immunophenotype, systemic treatment modality (intensive chemotherapy (IC) +/- TKI vs TKI monotherapy) and allogeneic haematopoietic stem cell transplantation (HCT). Results: Among the 55 patients, the median age at time of CML-BP diagnosis was 45 years (17 - 68) and included 35 (64%) cases of CML in myeloid BP (MBP) and 20 (36%) cases of lymphoid BP (LBP). 40 (72%) patients had transformed from a previous CP/AP with a median time of 2.4 years (0.1 - 19.3) from initial diagnosis to transformation. Extramedullary disease was present in 18/53 (34%) patients. The blast immunophenotype of MBP patients (n=31) was: CD34+ (84%), CD117+ (52%), HLA-DR+ (68%), CD13+ (87%), CD33+ (97%), MPO+ (40%), CD38+ (100%) and CD123+ (50%). Nine MBP patients (36%) had aberrant CD7 expression. Among 17 evaluable LBP patients, the immunophenotypic profile was: CD34+ (94%), HLA-DR+ (76%), CD19+ (94%), CD20+ (41%), CD10+ (94%), TdT (88%), CD38+ (100%) and CD7+ (18%). Nine patients (53%) had aberrant CD13 expression and five (29%) displayed aberrant CD33 expression. At CML-BP diagnosis, 21/42 (50%) had an ACA, of which 11 (26%) patients had high risk ACA, defined as −7/7q, 11q23 or 3q26.2 aberrations, or complex karyotype. Among transformed patients, CE was present in 16/43 (37%) patients. In 18 patients evaluated with Sanger sequencing at time of BP transformation, 9 patients (50%) had an ABL1-KD mutation. 54/55 received systemic therapy: 31 (57%) intensive chemotherapy (IC) + TKI, 7 (13%) IC alone, and 16 (30%) TKI monotherapy. Two patients died before response assessment, one after IC and one after TKI monotherapy. Among 46 patients with available post-treatment bone marrow assessments, CR/CRi rates were similar in those treated with IC+ TKI (29/31; 94%), IC only (5/6; 83%) or TKI only (7/9; 78%). Overall, 40/54 (74%) patients proceeded to allogeneic HCT after achieving CR/CRi or second CP. After a median follow-up of 39 months, the 3-year LFS and OS rates of all patients were 34.9% (20.7-49.6%) and 44.9% (95% CI, 30.4-58.4%), respectively. Patients with CML-LBP had a significantly higher OS compared to those with CML-MBP (p=0.0463), however, no significant difference in LFS was seen (p= 0.0913). Median duration of LFS and OS was 1.56 and 2.51 years, respectively. The following variables were found to be independently prognostic for OS: Transformation from CP/AP (p=0.0489, HR 4.328 [1.007, 18.60]), CD117 expression at time of CML-BP (p=0.0291, HR 2.809 [1.111, 7.102]), and IC + TKI (vs TKI monotherapy) (p=0.0068, HR 0.268 [0.104, 0.689]). CE at BP, transformation from CP/AP and IC +TKI (vs TKI monotherapy) were prognostic for LFS by univariate analysis, however, none was identified as independent risk factors. Conclusion The prognosis of CML-BP remains poor despite systemic therapy. Transformation from CP/AP, CD117 positivity at diagnosis of CML-BP and TKI monotherapy were identified as independent, adverse prognostic risk factors for OS. However, treatment with IC + TKI appeared to improve survival outcomes compared with TKI therapy alone. Therefore, combination therapy with IC + TKI should be considered the optimal strategy in treatment patients with CML-BP. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal