Incomplete Treatment Research Articles

Assessment of Awareness and Approach Regarding Antibiotic Prescription and Resistance among Different Level of Dental Students in a Tertiary Care Dental College, Karachi

OBJECTIVE: To evaluate the awareness and approach of dental students regarding antibiotic prescription and its resistance due to irrational use of antibiotics. Antibiotic resistance is spreading alarmingly throughout the world, including developed countries. The common causes of antibiotic resistance include over prescription, incomplete treatment and inappropriate self medication.Among different causes of antimicrobial resistance, irrational use of antibiotic is the most prominent one. METHODOLOGY: After approved by the Institutional Ethics Committee of Ziauddin University this cross-sectional study was conducted from 1st April, 2020 to 30th July,2020 at Ziauddin University. Third and final year dental students as well as house officers were enrolled and the computed sample size was 133 to which 5% non-response rate was added, therefore total 139 dental students were approached. Non-probability convenience sampling technique was used. A self- designed, self administered questionnaire was prepared to collect the demographic data and information regarding the prescription pattern of antibiotics amongst study subjects. All questions in the questionnaire were close ended. The questionnaire comprised information pertaining to demographic characteristics, standard guideline for antibiotic prescriptions, antibiotic stewardship and resistance, improper prescription and its consequences. The dental students were briefed about the purpose of the study and the significance of participation and a written informed consent was obtained from them. The awareness of dental students regarding antibiotics was the outcome factor. The data was analyzed by using SPSS version 22. RESULTS: Out of total 139 dental students majority (79.1%)were familiar to standard antibiotic prescription guidelines .(87.8%) responded amoxicillin is beta lactam, for probability of antibiotic abuse and antibiotics aid in recovery of infections majority showed awareness (92.1% and 84.9% respectively). Almost equal students inquire recent antibiotic course prior to prescription (90.6%) as well as take extra caution prescribing antibiotic in immune compromised patients (89.9%). CONCLUSION: This study concluded that majority of the dental students had good awareness regarding antibiotics and factors related to it, as participants responded positively to the 70% of awareness - based questions. KEYWORDS: Awareness. Antibiotics, Resistance, Prescription, Dental Students

Identifying the Incidence, Predictors, Outcomes, and Prevention of Stent Thrombosis (ST) in Post-percutaneous Coronary Revascularization Patients With Drug-Eluting Stents (DES): A Systematic Review.

Stent thrombosis (ST) is a rare but catastrophic event to happen to a stented coronary artery. The incidence of ST has greatly been reduced after the advent of modern drug-eluting stent (DES) implants, which have become the most preferred treatment option in the stenting category for coronary artery disease (CAD). Although the risk reduction by newer category implant provides substantial benefits, the possibility of thrombosis still exists mostly during the early stage of DES implantation. The development of ST after percutaneous coronary intervention (PCI) can be predicted by multiple factors, but advancements in early diagnostic techniques and modified stent types have greatly reduced the occurrence of this complication. Mortality, which is one of the complications of ST, is primarily influenced by patient-related factors such as incomplete treatment duration of dual antiplatelet therapy (DAPT). The duration of DAPT after DES implantation in patients with acute coronary syndrome (ACS) is determined based on individual characteristics, mainly considered in view of bleeding or ischemia risk. Risk evaluation systems like DAPT/precise-DAPT scores help tailor and personalize the duration of DAPT for each individual patient. This systematic review contains pertinent articles extracted from the PubMed database. We retrieved articles from various study categories, encompassing publications from the period spanning 2014 to 2022. Our analysis highlighted results from studies investigating different aspects contributing to ST development. The most favorable prevention option was the use of customized DAPT intervention based on patient-specific predictable factors. Several complications associated with ST were identified, including recurrent ST, major adverse cardiovascular events (MACE) encompassing all-cause mortality (including cardiac and non-cardiac mortality), cerebrovascular accidents (CVA) or transient ischemic attacks (TIA), hospitalization due to heart failure, and myocardial infarction requiring revascularization. Mortality was also observed as a significant outcome. The umbrella term of ST includes multiple causative factors. Although DES has improved patient survival rates vastly with its usage, careful risk factor assessment and required follow-up, in each individual being stented, further guarantee a more promising reduction in late adverse outcomes.

Abdominal Wall Abscess: An Infrequent Presentation of Colon Adenocarcinoma

Introduction: Colonic carcinoma has a variety of clinical presentations, however, invasion of the abdominal wall arising from the transverse colon is a rare one, as seen in this case report. Case report: 62-year-old patient with diffuse high intensity abdominal pain, fever, nausea, vomiting and an epigastric abscessed heterogeneous mass (8 x 7 x 7cm). A water-soluble contrast enema was performed, showing diverticula, absence of distal colon contrast transition and the apple core sign, compatible with transverse colon obstruction. A transverse colectomy was performed, with primary colo-colonic end-to-end anastomosis, including omentectomy and complete en-bloc resection of the affected abdominal wall area. The histopathological findings showed a transverse colon adenocarcinoma with abdominal wall invasion; all surgical margins were free of disease (R0), and 24 lymph nodes were retrieved. Patients’ recovery was successful. Discussion: Locally advanced colorectal cancers invade adjacent organs without distant metastases. They may result in abscess formation even in unusual locations like the abdominal wall, which is a rare complication (0.3 to 4%). Colon cancer diagnosis before surgery may not always be possible; and a flawed diagnosis can determine an incomplete treatment because the intraoperative macroscopic malignancy recognition is not always achievable. En-bloc resection is the gold standard treatment to accomplish a complete resection, with histologically negative margins and no residual tumor (R0). Conclusion: Colon adenocarcinoma may rarely present as an abdominal wall abscess. Image studies may include CT, radiography, etc. but the patient’s clinical status should always be prioritized; those who present abdominal obstruction with a high risk of sepsis and mortality should be offered immediate surgical treatment. En-bloc resection is the gold standard to accomplish histologically negative margins and no residual tumor.

Randomized Phase III Study Comparing Neoadjuvant Chemotherapy Followed by Surgery Versus Chemoradiation in Stage IB2-IIB Cervical Cancer: EORTC-55994.

This multicenter trial by the European Organisation for Research and Treatment of Cancer Gynecological Cancer Group was motivated by conflicting evidence on the value of neoadjuvant chemotherapy before surgery compared with concomitant chemoradiotherapy (CCRT) in stage IB2-IIB cervical carcinoma. Between May 2002 and January 2014, 626 patients with International Federation of Gynecology and Obstetrics stage IB2-IIb were randomly assigned between neoadjuvant chemotherapy followed by surgery (NACT-S; n = 314) and standard CCRT (n = 312). The primary end point was 5-year overall survival (OS) rate. Secondary end points were progression-free survival, OS, toxicity, and health-related quality of life (HRQOL). After a median follow-up of 8.7 years, 198 patients (31.6%) died. Age, stage, and cell type were balanced in both arms. Protocol treatment was completed in 223 of 314 (71%) patients in NACT-S and 257 of 312(82%) in CCRT arms. Main reasons for incomplete protocol treatment were toxicity (30 of 314; 9.6%) and progressive disease (21 of 314; 6.7%) in the NACT-S arm and toxicity (23 of 312; 7.4%) and patient refusal (13 of 312; 4.2%) in the CCRT arm. Additional radiotherapy after completed NACT-S was given to 107 patients (48%), and additional surgery to 20 patients (8%) after completed CCRT. Short-term adverse events (AEs) ≥grade 3 occurred more frequently with NACT-S (41% v 23%), and long-term AEs ≥grade 3 more often with CCRT (21% v 15%). The 5-year OS was not significantly different between NACT-S (72%; 95% CI, 66 to 77) and CCRT (76%; 95% CI, 70 to 80). This trial failed to demonstrate superiority in favor of the NACT-S arm but resulted in acceptable morbidity and HRQOL in both arms.

Synergistic lignin degradation between Phanerochaete chrysosporium and Fenton chemistry is mediated through iron cycling and ligninolytic enzyme induction.

Removal of recalcitrant lignin from wastewater remains a critical bottleneck in multiple aspects relating to microbial carbon cycling ranging from incomplete treatment of biosolids during wastewater treatment to limited conversion of biomass feedstock to biofuels. Based on previous studies showing that the white rot fungus Phanerochaete chrysosporium and Fenton chemistry synergistically degrade lignin, we sought to determine optimum levels of Fenton addition and the mechanisms underlying this synergy. We tested the extent of degradation of lignin under different ratios of Fenton reagents and found that relatively low levels of H2O2 and Fe(II) enhanced fungal lignin degradation, achieving 80.4 ± 1.61 % lignin degradation at 1.5 mM H2O2 and 0.3 mM Fe(II). Using a combination of whole-transcriptome sequencing and iron speciation assays, we determined that at these concentrations, Fenton chemistry induced the upregulation of 80 differentially expressed genes in P. ch including several oxidative enzymes. This study underlines the importance of non-canonical, auxiliary lignin-degrading pathways in the synergy between white rot fungi and Fenton chemistry in lignin degradation. We also found that, relative to the abiotic control, P. ch. increases the availability of Fe(II) for the production of hydroxyl radicals in the Fenton reaction by recycling Fe(III) (p < 0.001), decreasing the Fe(II) inputs necessary for lignin degradation via the Fenton reaction.

Surgical Management of Platysma Bands: A Narrative Review of Evolving Concepts and Changing Techniques for Neck Rejuvenation.

Platysmal bands are an unappealing feature of the aging face. Incomplete understanding of anatomy and physiology of platysmal bands has led to a long period of flawed or incomplete treatment. This review aims to elucidate the correct study of platysmal bands along with the most recent surgical treatments. To identify all articles related to the topic of surgical management of platysmal bands, an extensive search was performedon PubMed and Medline databases for all articles related to platysmal bands from 1990 to 2023. The articles were then reviewed by 2 independent reviewers, and all relevant articles were selected. The search was narrowed down to clinical trials and cohort studies. 6130 articleswere identified, of which 21 articles matched the inclusion criteria and were selected for the study totaling 2331 patients. Different surgical procedures were mentioned. Assessment of results was mostly subjective and done by the surgeon. Composite platysma-skin flap repositioning as opposed to wide skin undermining with or without submental incisions is being gradually accepted as a valid approach, with closed platysma myotomy and platysma denervation emerging as effective less invasive surgical modalities. Nevertheless, merits of more extensive procedures involving wide skin undermining and anterior platysma plication must not be lightly forgotten. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Racial Disparities in Breast Cancer Treatments and Adverse Events in the SEER-Medicare Data.

Despite lower incidence rates, African American (AA) patients have shorter survival from breast cancer (BC) than white (W) patients. Multiple factors contribute to decreased survival, including screening disparities, later presentation, and access to care. Disparities in adverse events (AEs) may contribute to delayed or incomplete treatment, earlier recurrence, and shortened survival. Here, we analyzed the SEER-Medicare dataset, which captures claims from a variety of venues, in order to determine whether the cancer care venues affect treatment and associated adverse events. We investigated a study population whose claims are included in the Outpatient files, consisting of hospital and healthcare facility venues, and a study population from the National Claims History (NCH) files, consisting of claims from physicians, office practices, and other non-institutional providers. We demonstrated statistically and substantively significant venue-specific differences in treatment rates, drugs administered, and AEs from treatments between AA and W patients. We showed that AA patients in the NCH dataset received lower rates of treatment, but patients in the Outpatient dataset received higher rates of treatment than W patients. The rates of recorded AEs per treatment were higher in the NCH setting than in the Outpatient setting in all patients. AEs were consistently higher in AA patients than in W patients. AA patients had higher comorbidity indices and were younger than W patients, but these variables did not appear to play roles in the AE differences. The frequency of specific anticancer drugs administered in cancer- and venue-specific circumstances and their associated AEs varied between AA and W patients. The higher AE rates were due to slightly higher frequencies in the administration of drugs with higher associated AE rates in AA patients than in W patients. Our investigations demonstrate significant differences in treatment rates and associated AEs between AA and W patients with BC, depending on the venues of care, likely contributing to differences in outcomes.

Photocatalytic and adsorption performance of MXene@Ag/cryogel composites for sulfamethoxazole and mercury removal from water matrices

Water reuse is expected to grow with the increase of freshwater scarcity that is on the rise globally because of climate change. This research has addressed the preparation of an advanced material that can treat both inorganic and organic contaminants from water thanks to the synergy of its different components. Specifically, the advanced material is a novel hybrid filter media composed of a macroporous cryogel and single-layer Ti3C2Tx MXene nanosheets modified with silver nanoparticles (AgNPs). The cryogel was prepared using polyethylenimine and dimethylacrylamide below subfreezing temperatures. Single-layer MXenes produced via etching of Al from Ti3AlC 2 flakes were sorbed to the cryogel. AgNPs were prepared in-situ and deposited onto the MXenes. The composite was studied using SEM-EDS, TEM, XRD, XRF, FT-IR, zeta potential, DRS and it tested with two model substances that are global pollutants of distinct nature: the antibiotic sulfamethoxazole, that results from incomplete wastewater treatment, and Hg2+ from geogenic or industrial emissions. The composite acted as sorbent/photocatalyst and was highly effective towards the degradation of sulfamethoxazole under light irradiation together with adsorption of Hg2+ from waters, including river water. The photocatalytic activity of AgNP was enhanced by the MXene co-catalyst, while the cryogel served as scaffold for MXene@Ag and as Hg adsorbent. The effectiveness of composites reached 97% of degradation of sulfamethoxazole and around 98% of Hg2+ when working at concentrations greater than environmental levels. Hence, the combination of adsorption and photocatalytic properties in water filtration media consisting of MXene@Ag/cryogel composites and opportunity to explore for treating water.

A qPCR technology for direct quantification of methylation in untreated DNA

DNA methylation is important for gene expression and alterations in DNA methylation are involved in the development and progression of cancer and other major diseases. Analysis of DNA methylation patterns has until now been dependent on either a chemical or an enzymatic pre-treatment, which are both time consuming procedures and potentially biased due to incomplete treatment. We present a qPCR technology, EpiDirect®, that allows for direct PCR quantification of DNA methylations using untreated DNA. EpiDirect® is based on the ability of Intercalating Nucleic Acids (INA®) to differentiate between methylated and unmethylated cytosines in a special primer design. With this technology, we develop an assay to analyze the methylation status of a region of the MGMT promoter used in treatment selection and prognosis of glioblastoma patients. We compare the assay to two bisulfite-relying, methyl-specific PCR assays in a study involving 42 brain tumor FFPE samples, revealing high sensitivity, specificity, and the clinical utility of the method.

Determination of drug-related problems among type 2 diabetes outpatients in a hospital in Vietnam: A cross-sectional study.

Drug-related problems (DRPs) are common in clinical practice and occur at all stages of the medication process. The major factor contributing to DRPs is prescription, although patients' poor adherence to treatment is also a significant factor. This study evaluated type 2 diabetes outpatients in a hospital in Vietnam for drug-related problems (DRPs) and related variables. A cross-sectional descriptive study was conducted on 495 outpatients who met the criteria and 157 people agreed to participate in the interview. Medication order review and medication adherence review were used to identify DRPs. The types of DRP were based on the Pharmaceutical Care Network Europe (PCNE) categories version 9.0. The identification and assessment DRPs were carried out by clinical pharmacists and get agreed upon by physicians who had not directly prescribed patients who participated in the study. A total of 762 DRPs were identified via prescribing review process, the average number of DRP on each prescription was 1.54±1.07, while 412 DRPs were determined through patient interviewing. The most frequent DRPs were "ADR (Adverse Drug Reaction) occurring" (68.8%). The main causes were "patient is unable to understand instructions properly" or "patient is not properly instructed", "patient stores insulin inappropriately", "patient decides to use unnecessary drugs" and "patient intentionally uses/takes less drug than prescribed or does not take the drug at all for whatever reason" which accounted for 65.0%, 41.4%, 38.2%, and 28.7%, respectively. From the prescribing review, the most observed DRPs were "Inappropriate drug according to guidelines/formulary" and "No or incomplete drug treatment in spite of existing indication", accounting for 45.0% and 42.9%, respectively. There was a significant association between age (OR 3.38, 95% CI: 1.01-11.30), duration of diabetes (OR 3.61, 95%CI: 1.11-11.74), presence of comorbidity (OR 5.31, 95%CI: 1.97-14.30), polypharmacy (OR: 2.95, 95%CI: 1.01-8.72) and DRPs. In patients, poor knowledge of antidiabetic agents was the main reason to lack adherence and occurring ADR (OR 2.73, 95%CI: 1.32-5.66, p = 0.007 and OR 2.49, 95%CI: 1.54-4.03, p = 0.001 respectively). DRPs occurred in the prescribing stage and relating to patient's behavior of drug administration was high. Clear identification of DRPs and the associated factors are essential for building the intervention process to improve effectiveness and safety in the treatment of type 2 diabetes mellitus patients.

Areal roughness of the dorsal nail plate

Objective: Beau’s lines, onychorrhexis, and psoriatic lesions of the dorsal nail plate may be missed by photographic methods, indicating a need for surface texture measurement methods that are more quantitative, sensitive, and repeatable than visual inspection or imaging. We conducted this study to evaluate the utility of surface texture measurements of cadaveric nails that can be associated with histopathological studies in the future. Materials: The nail plates of four cadaveric right pollices and halluces were cleaned and molded, cast in clear epoxy, and scanned with a Sensofar S Neox optical profilometer. A one-way analysis of variance (ANOVA) was performed to determine statistical significance of findings. Results: Almost no differences were observed between the pollex and hallux scans, and between the distal and proximal regions. The greatest differences were found between individuals. Although lower magnification (5×) is less sensitive than higher magnification (20×), the lower magnification represented and characterized more of the dorsal nail plate. Conclusions: The dorsal nail plate areal roughness has a measurable range of values that may serve as a starting point for evaluating pathological findings, particularly Beau’s lines and psoriatic lesions. The sensitivity of these techniques may be especially valuable in the recognition of less severe states of these diseases that may enable the diagnosis of earlier stages of growth disruptions (Beau’s lines) or psoriasis. Such applications could be especially useful in investigations of the health of wildlife populations or vulnerable human populations with incomplete treatment records.

DESIGNING PROGRAMMABLE FERROMAGNETIC SOFT METASTRUCTURES FOR MINIMALLY INVASIVE ENDOVASCULAR THERAPY.

Minimally invasive endovascular therapy (MIET) is an innovative technique that utilizes percutaneous access and transcatheter implantation of medical devices to treat vascular diseases. However, conventional devices often face limitations such as incomplete or suboptimal treatment, leading to issues like recanalization in brain aneurysms, endoleaks in aortic aneurysms, and paravalvular leaks in cardiac valves. In this study, we introduce a new metastructure design for MIET employing re-entrant honeycomb structures with negative Poisson's ratio (NPR), which are initially designed through topology optimization and subsequently mapped onto a cylindrical surface. Using ferromagnetic soft materials, we developed structures with adjustable mechanical properties called magnetically activated structures (MAS). These magnetically activated structures can change shape under noninvasive magnetic fields, letting them fit against blood vessel walls to fix leaks or movement issues. The soft ferromagnetic materials allow the stent design to be remotely controlled, changed, and rearranged using external magnetic fields. This offers accurate control over stent placement and positioning inside blood vessels. We performed magneto-mechanical simulations to evaluate the proposed design's performance. Experimental tests were conducted on prototype beams to assess their bending and torsional responses to external magnetic fields. The simulation results were compared with experimental data to determine the accuracy of the magneto-mechanical simulation model for ferromagnetic soft materials. After validating the model, it was used to analyze the deformation behavior of the plane matrix and cylindrical structure designs of the Negative Poisson's Ratio (NPR) metamaterial. The results indicate that the plane matrix NPR metamaterial design exhibits concurrent vertical and horizontal expansion when subjected to an external magnetic field. In contrast, the cylindrical structure demonstrates simultaneous axial and radial expansion under the same conditions. The preliminary findings demonstrate the considerable potential and practicality of the proposed methodology in the development of magnetically activated MIET devices, which offer biocompatibility, a diminished risk of adverse reactions, and enhanced therapeutic outcomes. Integrating ferromagnetic soft materials into mechanical metastructures unlocks promising opportunities for designing stents with adjustable mechanical properties, propelling the field towards more sophisticated minimally invasive vascular interventions.

PCAT-DE: Reconstructing Pointlike and Diffuse Signals in Astronomical Images Using Spatial and Spectral Information

Observational data from astronomical imaging surveys contain information about a variety of source populations and environments, and their complexity will increase substantially as telescopes become more sensitive. Even for existing observations, measuring the correlations between pointlike and diffuse emission can be crucial to correctly inferring the properties of any individual component. For this task, information is typically lost, because of conservative data cuts, aggressive filtering, or incomplete treatment of contaminated data. We present the code PCAT-DE, an extension of probabilistic cataloging, designed to simultaneously model pointlike and diffuse signals. This work incorporates both explicit spatial templates and a set of nonparametric Fourier component templates into a forward model of astronomical images, reducing the number of processing steps applied to the observed data. Using synthetic Herschel-SPIRE multiband observations, we demonstrate that point-source and diffuse emission can be reliably separated and measured. We present two applications of this model. For the first, we perform point-source detection/photometry in the presence of galactic cirrus and demonstrate that cosmic infrared background galaxy counts can be recovered in cases of significant contamination. In the second, we show that the spatially extended thermal Sunyaev–Zel’dovich effect signal can be reliably measured even when it is subdominant to the pointlike emission from individual galaxies.

Biomarcadores pronósticos en el uso del radio-223 en pacientes con cáncer de próstata metastásico resistente a la castración

ObjectivesEstablish basal biomarkers in patients with bone metastatic castration-resistant prostate cancer (mCRPC) treated with Ra-223 that predicted a better overall survival (OS), assess hematology toxicity and treatment response. Materials and methodsRetrospective multicenter study in 151 patients with mCRPC between 2013 and 2020. OS was assessed according to basal hemoglobin (Hb), PSA, alkaline phosphatase (AP), WHO pain scale, Eastern Cooperative Oncology Group (ECOG), number of metastatic lesions on bone scan (BS), use of protective bone agents and received. Hematological toxicities were evaluated. Treatment response was based on changes in FA and pain. ResultsMedian OS was 24months (95%CI: 16.5-31). OS in 70% of patients who received complete Ra-223 treatment (5-6 doses) was 34.9m vs. 5.8m in patients with incomplete treatment (1-4 doses). OS was longer in patients with lower PSA and AP, Hb>13g/dL, lesser bone metastasis on GO and ECOG 0-1. 52/151 patients (34%) died during follow-up. Nearly 70% of patients experienced decrease in pain and 66% reduction on AP. Half of patients had mild hematological adverse effects and only 5% had severe. ConclusionsmCRPC patients treated with Ra-223 who had Hb>13g/mL, ECOG 0-1, low AP, PSA<20ng/ml and lesser bone metastasis on BS shown a better OS with adequate safety profile.

Role of verbal autopsy in cancer registration: A mixed-methods study from the population-based cancer registry of Northern India.

To describe utilisation of verbal autopsy as one of the data collection approaches in cancer registration in an Indian setting. We aimed to estimate the proportion and epidemiological characteristics of malignancies identified by the Varanasi population-based cancer registry (PBCR) using verbal autopsy between 2017 and 2019 and to develop a thematic network for implementing verbal autopsy. This was a cross-sectional mixed-methods study. Quantitative methods were applied to analyse information from PBCR proforma of the verbal autopsy-confirmed cancers; qualitative methods were applied to evaluate verbal autopsy conducted by field staff from key informants. In-depth interviews of field staff for the challenges and potential solutions during verbal autopsy were assessed. Of 6466 registered cancers, 1103 (17.1%) were verbal autopsy-confirmed cancers, which had no other source of information. The majority of verbal autopsy cases were from vulnerable populations who were aged >50 years (721, 65.4%), female (607, 55.1%), from rural backgrounds (853, 77.3%), illiterate or just able to read and write (636, 57.7%), and from lower and middle-income groups (823, 74.6%). Verbal autopsy helped provide information about symptoms and site of disease, diagnostic and treatment details, and disease status. Major challenges during verbal autopsy described by field staff were incomplete cancer treatment, destruction of medical records and non-cooperation by the community and lack of support from the local workforce as cancer is not notifiable. Verbal autopsy helped identify cancers that would have been missed during active case finding from available resources. The majority of verbal autopsy-confirmed patients belonged to vulnerable populations. Non-cooperation from community and local health systems was major challenge during verbal autopsy. Developing robust cancer awareness, patient navigation, and social support programmes will strengthen verbal autopsy. Integration of standardised and reproducible methods of verbal autopsy in cancer registry and digitalization of health information, especially in limited-resource settings with weak vital registration, will facilitate completeness in cancer registration.

Prognostic biomarkers in the use of radium-223 in patients with metastatic castration-resistent prostate cancer

ObjectivesThis study aimed to establish basal biomarkers in patients with bone metastatic castration-resistant prostate cancer (mCRPC) treated with 223Ra to predict better overall survival (OS), and assess hematologic toxicity and treatment response. Materials and methodsThis was a retrospective multicenter study including 151 patients with mCRPC between 2013 and 2020. OS was assessed according to basal hemoglobin (Hb), prostate-specific antigen (PSA), and alkaline phosphatase (AP) values, the World Health Organization pain scale, the Eastern Cooperative Oncology Group (ECOG) performance status scale, the number of metastatic lesions on bone scintigraphy (BS), and the use of protective bone agents and the dose received. The grade of hematological toxicities was evaluated as well as treatment response based on changes in AP and pre- and post-treatment pain. ResultsThe median OS was 24 months (95% confidence interval 16.5–31). The OS in 70% of patients who received complete (5–6 doses) versus incomplete (1–4 doses) 223Ra treatment was 34.9 vs. 5.8 months, respectively, being longer in patients with lower PSA and AP values, Hb >13 g/dl, lesser bone metastasis on bone scan and with an ECOG 0−1. 52/151 patients (34%) died during follow-up. Pain reduced in nearly 70% of patients and 66% presented a reduction in AP values. Half of the patients presented mild and 5 % severe hematological adverse effects. ConclusionsmCRPC patients treated with 223Ra with Hb values >13 g/mL, an ECOG 0−1, low AP values, PSA < 20 ng/mL and lesser bone metastasis on BS presented a better OS with an adequate safety profile.

Bedaquiline Efficacy in the Russian Federation: Meta-analysis with a Random Effects Model

The objective: to determine the rate of treatment success in MDR and XDR pulmonary tuberculosis patients when treated with chemotherapy regimens containing bedaquiline based on a meta-analysis using mathematical modeling.Subjects and Methods. We searched and analyzed published studies of bedaquiline conducted from 2014 to 2022 in the Russian Federation. A total of 41 publications were found, of which 15 were included in the meta-analysis since they contained data eligible for analysis. They presented treatment results of 1,356 TB patients, 886 (65,3%) patients had MDR TB, and 470 (34,7%) had XDR TB (according to the definition as of 2020). All of them received bedaquiline within the standard regimen for 24–26 weeks.Results. According to the meta-analysis results, when using treatment regimens containing bedaquiline in MDR/XDR TB patients, sputum conversion was achieved in 79,6% (95% CI 75,1–83,4) of cases, and effective treatment was observed in 82,0% (95% CI 78,6–84.9) of cases. Treatment default was noted in 8,7% (95% CI 5,7–13,1) of cases. At the same time, there is a statistically significant relationship (p&lt;0,01) between the proportion of patients with comorbidities and the proportion of patients with incomplete treatment. Lethal outcomes were recorded in 5,8% (95% CI 3,6–9,2), which were associated with the severe course of tuberculosis and concomitant pathology. Bedaquiline was canceled in 7,8% (95% CI 4,0–13,5) of cases. When analyzing the data of patients with MDR TB and XDR TB separately, treatment efficacy differed and amounted to 89,9% (95% CI 85,9–92,9) versus 71,9% (95% CI 66,3–76,8), respectively.

Turn down the emotion, not the volume: Emotion regulation in Black and Afro‐Caribbean youth

Black youth face marginalization at multiple levels, which can have deleterious developmental consequences. An important focus is the misrepresentation of Black emotional expression at the intersection of structural racism and clinical psychology. As efforts to incorporate anti‐racism in psychological care continue, there is a need to increase specificity to improve clinical efforts. The white hegemony for both boys and girls leads to the dehumanization of Black teens, which often leads to misdiagnosis and incomplete treatment plans.

Socio-economic, education, and insurance-related factors associated with the treatment completion rates in patients with nonmetastatic urinary bladder cancer: A Retrospective cohort study.

Among urological malignancies, the diagnosis and treatment of urinary bladder cancer (UBC) incurs the highest cost per patient. Our objective was to broaden the current understanding of how demographic, socioeconomic, education, and insurance-related factors influence UBC management. Between January 2017 and December 2019, all patients with nonmetastatic bladder cancer were included. The demographic, treatment, and follow-up details were retrieved from a prospectively maintained database, and the Modified Kuppuswamy Index was used to evaluate the patients' socioeconomic level. Patients were divided into the completed treatment group, or the incomplete treatment group based on adherence to the initially intended treatment plan. Patients who presented with benign disease or metastases were not included. Eighty-nine patients did not complete the initially intended course of treatment out of 132 patients who needed additional management after the initial transurethral resection. Comparable risk factors and demographic profiles existed in both groups. Patients with intermediate-risk disease are more likely to fail to adhere to the initial intended treatment (odds ratio [OR] = 0.09; 95% confidence interval [CI]: 0.02-0.30). On logistic regression analysis, upper socioeconomic status (OR = 6.8; 95% CI: 0.35-132.1) patients and patients with higher educational status of graduation or above (OR = 3.62; 95% CI: 0.75-17.43) had higher chances of treatment completion. Education status significantly impacted treatment completion on multivariate analysis (P = 0.01). Patients who utilized employer-funded insurance had better treatment compliance (OR = 4.1; 95% CI: 0.90-18.7). The compliance was unaffected by smoking, occupation, or other demographic factors. Patients with low economic status, low levels of education, and who need adjuvant intravesical therapy had considerably greater treatment dropout rates.

Anti –Inflammatory Effect of Methanolic and Aqueous Extracts of Urtica pilulifera L. Seed in Rats

Wide range of acute and chronic inflammatory ailments, side effects of their available therapies and incomplete treatment of such patients push the researches to find new and more effective drugs. To reach this aim, in the current study, we evaluate Urtica pilulifera L. (family Urticaceae) as an introduced traditional herb for treatment of inflammation in Persian Medicine (PM). In an animal study, Anti-inflammatory effects of U. pilulifera were assessed in formalin-induced hind paw edema in rats. Sodium salicylate (300 mg/kg, i.p., SS) injection was used as a positive control drug and compared with methanolic extract of U. pilulifera (20 mg/kg; i.p.) (MUP), three different doses of aqueous extract of U. pilulifera (20, 40 and 80 mg/kg; i.p.) (AUP) and a group of distilled water (6 mL/kg; i.p.). As acute anti-inflammatory effect, AUP in doses 40 and 80 mg/kg decreased edema significantly (p&lt;0.05). In chronic anti-inflammatory response, results indicated that all AUP doses had anti-inflammatory effects (p &lt;0.05) with no significant difference with SS group. In conclusion, AUP had anti-inflammatory effects on both acute and chronic edema; while MUP was only effective in chronic inflammation.