Medical Treatment Regimens Research Articles

Dental and temporomandibular joint alterations in rheumatoid arthritis patients and their association with salivary oxidative stress

Background/aim Rheumatoid arthritis (RA) is the most extensive inflammatory arthritis causing permanent deformities in the joint. Increasing evidence suggests that oxidative stress is a substantial factor in the pathogenesis of RA. This study aimed to examine the salivary oxidant-antioxidant status of RA and control groups and to compare these biomarkers by correlating them with disease activity, acute phase reactants, and clinical findings.Materials and methods Age and sex-matched 60 participants including 30 patients with RA and 30 control (50 females, 10 males; mean age: 42.62 ± 10.89 years) were evaluated. RA disease activity and severity were evaluated by the disease activity score 28-C reactive protein (DAS 28-CRP). Rheumatoid factor (RF) positivity, anticitrullinated protein antibodies (ACPA) positivity, erythrocyte sedimentation rate (ESR), CRP, tender and swollen joint counts, and medical treatment regimens of the patients (glucocorticoids, conventional or biologic disease-modifying antirheumatic drugs) were recorded. In the radiographic examination, dental findings, and bone alterations of the temporomandibular joint (TMJ) were recorded and compared for both groups. Saliva samples were obtained for analysis of total antioxidant status (TAS), total oxidant status (TOS), arylesterase (ARE), and oxidative stress index (OSI) levels. The data analysis was conducted by independent sample t-test and chi-square test.Results Condylar erosion was the most common radiographic change in TMJ of RA patients. Osteophyte formation was a prominent finding in the control group. Lower TAS and higher OSI levels were found in RA patients compared with controls (p = 0.013; p = 0.029, respectively). The effect of DAS 28-CRP score on the levels of oxidative stress biomarkers in RA patients was not significant. Conclusion Oxidative stress causes tissue damage in response to excessive mechanical loading, which in turn promotes TMD. However, disease activity has not a prominent impact on the salivary oxidative stress status of RA patients.

50. Development and Validation of the Reproductive Health Knowledge Index (RHKI)

<h3>Background</h3> Reproductive knowledge is important for promoting fertility, preventing pregnancy, and adhering to contraceptive and medical treatment regimens. To date there are no studies that broadly assess reproductive knowledge in females largely due to the absence of a validated tool. Extrapolating from studies in female adults utilizing several limited tools, it is likely that reproductive knowledge is low in all females, including adolescents. Thus, the objective of this study is to develop and validate a tool that reliably measures reproductive knowledge among female adolescents. <h3>Methods</h3> Development and validation of the reproductive health knowledge index (RHKI) was achieved as follows. 1. Instrument Development: Multiple answer questions were written at a fifth-grade reading level to assess: female pelvic anatomy and function, menstrual physiology, conception, gestation, and contraception. The multiple answer format was selected to undermine the advantage of the process of elimination and allow detection of partial knowledge. 2. Content Validity: The RHKI was reviewed by an expert panel (pediatricians, general and pediatric OB/GYNs, and OB/GYN residents) for comprehensiveness, accuracy, and length. IRB approval was obtained. The tool was reviewed by 10 female adolescents to ensure readability. A 20-item tool was finalized according to all suggestions. 3. Internal validity: Two groups with perceived differences in knowledge level, namely adolescents and medical students, were queried to investigate internal validity. Forty female adolescents age 13 to 19 awaiting an appointment at a pediatric gynecology clinic as well as 20 female medical students rotating at the same site were recruited to participate in the study. The REALM-TEEN tool was used to exclude adolescents reading below a fifth-grade reading level to limit confounding from poor comprehension. A Pearson correlation coefficient with p value was then calculated between age and performance with a goal metric of r = 0.7 supporting internal validity. <h3>Results</h3> Thus far, 26 adolescents and all 20 medical students have been surveyed. Preliminary analysis of performance by age yields a correlation coefficient of 0.82 with a p value of 0.0001. Overall, the content validity and internal validity support the ability of the RHKI to measure reproductive knowledge in female adolescents. <h3>Conclusions</h3> As noted, reproductive knowledge is important for many reasons. Further study in this area requires a valid tool, like the RHKI, capable of measuring said knowledge. Such a tool will allow us to identify factors influencing reproductive knowledge, inform sexual education courses, and educate adolescents with eventual impact on their overall well-being and health.

"Complimenting the Complement": Mechanistic Insights and Opportunities for Therapeutics in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and a leading cause of death in the US and worldwide. HCC remains a global health problem and is highly aggressive with unfavorable prognosis. Even with surgical interventions and newer medical treatment regimens, patients with HCC have poor survival rates. These limited therapeutic strategies and mechanistic understandings of HCC immunopathogenesis urgently warrant non-palliative treatment measures. Irrespective of the multitude etiologies, the liver microenvironment in HCC is intricately associated with chronic necroinflammation, progressive fibrosis, and cirrhosis as precedent events along with dysregulated innate and adaptive immune responses. Central to these immunological networks is the complement cascade (CC), a fundamental defense system inherent to the liver which tightly regulates humoral and cellular responses to noxious stimuli. Importantly, the liver is the primary source for biosynthesis of >80% of complement components and expresses a variety of complement receptors. Recent studies implicate the complement system in liver inflammation, abnormal regenerative responses, fibrosis, carcinogenesis, and development of HCC. Although complement activation differentially promotes immunosuppressive, stimulant, and angiogenic microenvironments conducive to HCC development, it remains under-investigated. Here, we review derangement of specific complement proteins in HCC in the context of altered complement regulatory factors, immune-activating components, and their implications in disease pathogenesis. We also summarize how complement molecules regulate cancer stem cells (CSCs), interact with complement-coagulation cascades, and provide therapeutic opportunities for targeted intervention in HCC.

PATIENTS WITH INFLAMMATORY BOWEL DISEASE PERSPECTIVE ON COVID-19 AND HEALTH CARE SERVICE DURING THE PANDEMIC

Patients with inflammatory bowel diseases (IBD) have experienced changes to the routine management of their conditions during the coronavirus disease (COVID-19) pandemic. The disease as well IBD treatment frequently require immunosuppressant medications, which could increase their risk of infection. The aim of this study was to determine patients’ experience of the health care service, including the restrictions of hospitals visits made in Norway from Mars 12th 2020. From June 18 to September 18 2020, all patients at the IBD outpatient clinic at Oslo University Hospital in Norway on biological therapy or other immunosuppressant’s were included. A questionnaire including patients concerns regarding their disease, medical therapy and COVID-19, as well as their health care service needs in follow-up during the COVID-19 pandemic. Altogether 506 IBD patients answered a paper-based questionnaire. The mean age was 40.78 (SD 14.71), 289/506 (57%) men, ulcerative colitis 199/506 (39%), Crohn’s disease 307/506 (61%). Sixty-three patients (12.5%) used biological therapy in combination with azathioprine or steroids. Ninety-one (18.2%) were in obligated quarantine with negative test. Five patients (4.9%) tested positive to SARS- CoV-2 of the 98 patients tested, (1.0% of the total sample). One third of the IBD patients perceived they had increased risk for being infected by SARS- CoV-2 because of the immunosuppressive drugs they used. Nonetheless, 496/506 (98.6%) of the patients adhered to continuing their medication. One-hundred and sixty-one (32.3%) voluntarily isolated, and 21/506 (4.2%) was in sick leave being afraid of being infected. Furthermore, 20/506 (4.0%) cancelled their consultation because they were afraid of being infected from SARS- CoV-2 at the hospital. The hospital changed physical consultation to telephone consultation for 75/506 (15.0%) of the patients. Thirty-eight patients (7.6%) reported that they were afraid of going to the hospital because of restrictions due to the COVID-19 pandemic, and 18/506 (3.6%) did not feel safe when at hospital. Approximately half of the IBD patients (219/506) were satisfied with the information provided by physician about medical treatment for IBD and Covid-19 while 398/506 (77.3%) were satisfied with the information from health-care providers about restrictions due to COVID-19. There were no statistical differences between Crohn’s disease and ulcerative colitis. IBD patients on biological treatment and immunosuppressives took precautions because of fear of being infected with SARS- CoV-2. At the same time, they adhere to medical treatment regimens and follow-up at the hospital. Most patients were satisfied with the information they received from physicians and other health-care workers. One percent tested positive to SARS-CoV-2.

PATIENTS WITH INFLAMMATORY BOWEL DISEASE PERSPECTIVE ON COVID-19 AND HEALTH CARE SERVICE DURING THE PANDEMIC

BackgroundPatients with inflammatory bowel diseases (IBD) have experienced changes to the routine management of their conditions during the coronavirus disease (COVID-19) pandemic. The disease as well IBD treatment frequently require immunosuppressant medications, which could increase their risk of infection. The aim of this study was to determine patients’ experience of the health care service, including the restrictions of hospitals visits made in Norway from Mars 12th 2020.MethodFrom June 18 to September 18 2020, all patients at the IBD outpatient clinic at Oslo University Hospital in Norway on biological therapy or other immunosuppressant’s were included. A questionnaire including patients concerns regarding their disease, medical therapy and COVID-19, as well as their health care service needs in follow-up during the COVID-19 pandemic.ResultsAltogether 506 IBD patients answered a paper-based questionnaire. The mean age was 40.78 (SD 14.71), 289/506 (57%) men, ulcerative colitis 199/506 (39%), Crohn’s disease 307/506 (61%). Sixty-three patients (12.5%) used biological therapy in combination with azathioprine or steroids. Ninety-one (18.2%) were in obligated quarantine with negative test. Five patients (4.9%) tested positive to SARS- CoV-2 of the 98 patients tested, (1.0% of the total sample). One third of the IBD patients perceived they had increased risk for being infected by SARS- CoV-2 because of the immunosuppressive drugs they used. Nonetheless, 496/506 (98.6%) of the patients adhered to continuing their medication. One-hundred and sixty-one (32.3%) voluntarily isolated, and 21/506 (4.2%) was in sick leave being afraid of being infected. Furthermore, 20/506 (4.0%) cancelled their consultation because they were afraid of being infected from SARS- CoV-2 at the hospital. The hospital changed physical consultation to telephone consultation for 75/506 (15.0%) of the patients. Thirty-eight patients (7.6%) reported that they were afraid of going to the hospital because of restrictions due to the COVID-19 pandemic, and 18/506 (3.6%) did not feel safe when at hospital. Approximately half of the IBD patients (219/506) were satisfied with the information provided by physician about medical treatment for IBD and Covid-19 while 398/506 (77.3%) were satisfied with the information from health-care providers about restrictions due to COVID-19. There were no statistical differences between Crohn’s disease and ulcerative colitis.ConclusionIBD patients on biological treatment and immunosuppressives took precautions because of fear of being infected with SARS- CoV-2. At the same time, they adhere to medical treatment regimens and follow-up at the hospital. Most patients were satisfied with the information they received from physicians and other health-care workers. One percent tested positive to SARS-CoV-2.

Comparison of fasting and post prandial lipid profile in patients of IHD

Background: Despite recent advancements in medical services and treatment regimens, ischemic heart disease (IHD) is still the leading cause of death in both developed and developing countries. While hypercholesterolemia and hypertriglyceridemia are considered separate risk factors, most recent research in this area have focused at fasting lipids and lipoproteins. Aims and Objectives: To compare the fasting and post prandial lipid profile in patients of IHD.Materials and Method: Upon receiving informed consent, 50 patients with IHD who were reporting to the Department of Medicine were enrolled in the current study. A previous history of myocardial infarction, ECG data, echocardiography, coronary artery bypass grafting surgery, or a coronary angiogram is used to diagnose CHD. For at least six months prior to the study, all of these patients had been free of some clinical incident. Both of the enrolled patients were given a thorough clinical review, with the results being entered into a prestructured proforma. After a twelve-hour overnight fast and two hours after a mixed diet, each subject's venous blood was obtained aseptically. Fasting samples and postprandial (PP) samples were analyzed for lipid profile and blood sugar; blood sugar was measured in 2 hour PP samples and lipids in 4 hour PP samples. Results: Tobacco chewing (30%) was the most common risk factor observed followed by smoking and hypertension (20%). It was observed that mean fasting sugar level of the study subjects was 85.40±21.25mg/dl while post prandial sugar level was 112.60±24.50mg/dl. It was observed that mean fasting triglycerides was 210.02±63.9mg/dl and mean post prandial triglycerides 275.65±48.0mg/dl and the difference was statistically significant. Fall in post prandial total cholesterol (229.72±53.9mg/dl) was observed as compared to fasting level (245.87±64.5mg/dl) but the difference observed was not statistically significant. Mean fasting HDL was 42.71±4.9mg/dl while mean post prandial HDL was 40.65±3.6mg/dl. It was seen that mean fasting LDL was 156.45±23.9mg/dl and mean post prandial LDL was 145.76±31.5mg/dl. It was observed that post prandial VLDL levels (41.76±28.55) were raised as compared to fasting VLDL levels (37.90±17.6) but the difference was not statistically significant. Conclusion: Except for TG, which was statistically significant higher post-prandially, there was no significant clinical disparity between fasting and nonfasting levels of total cholesterol, HDL, or LDL.

Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at a STI Clinic in Guangzhou, China, 2016-2018

BackgroundAntimicrobial resistance in M. genitalium is a growing clinical problem. We investigated the mutations associated with macrolide and fluoroquinolone resistance, two commonly used medical regimens for treatment in China. Our aim is to analyze the prevalence and diversity of mutations among M. genitalium-positive clinical specimens in Guangzhou, south China.MethodsA total of 154 stored M. genitalium positive specimens from men and women attending a STI clinic were tested for macrolide and fluoroquinolone mutations. M. genitalium was detected via TaqMan MGB real-time PCR. Mutations associated with macrolide resistance were detected using primers targeting region V of the 23S rRNA gene. Fluoroquinolone resistant mutations were screened via primers targeting topoisomerase IV (parC) and DNA gyrase (gyrA).Results98.7% (152/154), 95.5% (147/154) and 90.3% (139/154) of M. genitalium positive samples produced sufficient amplicon for detecting resistance mutations in 23S rRNA, gyrA and parC genes, respectively. 66.4% (101/152), 0.7% (1/147) and 77.7% (108/139) samples manifested mutations in 23S rRNA, gyrA and parC genes, respectively. A2072G (59/101, 58.4%) and S83I (79/108, 73.1%) were highly predominating in 23S rRNA and parC genes, respectively. Two samples had amino acid substitutions in gyrA (M95I and A96T, respectively). Two samples had two amino acid substitutions in parC (S83I + D87Y). 48.6% (67/138) of samples harbored both macrolide and fluoroquinolone resistance-associated mutations. The most common combination of mutations was A2072G (23S rRNA) and S83I (parC) (40/67, 59.7%). One sample had three amino acid changes in 23S rRNA, gyrA and parC genes (A2072G + A96T + S83I).ConclusionsThe high antimicrobial resistance rate of M. genitalium in Guangzhou is a very worrying problem and suggests that antimicrobial resistance testing and the development of new antibiotic regimens are crucially needed.

Fertility issue in early stage endometrial cancer patients.

Endometrial cancer (EC) is the most common cancer of the female reproductive system in developed countries. The incidence of EC has been increasing in young women. Approximately 4% of cases are aged <40 years. These young women may wish to delay therapy until after they have children. Common complaints in patients with EC include irregular vaginal bleeding, pelvic pain, and enlarged uterus. Imaging techniques such as transvaginal ultrasound (TVUS) or magnetic resonance imaging (MRI) can be utilized in detecting EC. Although the recommended treatment of EC is hysterectomy and bilateral salpingo-oophorectomy with or without systemic lymph node dissection, loss of reproductive function is the primary limiting factor of this surgical approach. Some studies have reported favorable results with high-dose oral progestins or levonorgestrel-releasing intrauterine system or hysteroscopic tumor resection followed by treatment with high-dose oral progestins. The most widely utilized medical treatment regimens are medroxyprogesterone acetate (MPA) 250–600 mg/day or megestrol acetate (MA) 160–480 mg/day. However, there is still a lack of evidence to establish the optimal dose and duration of progestin treatment. Patients with complete remission (CR) who wish to conceive must be encouraged, and referral to a fertility clinic should be offered as soon as possible. The key aspect of fertility-sparing management in women with EC appears to be the selection of appropriate candidates. Owing to the rarity of this condition, management may often be suboptimal. The aim of this review is to assess the current approaches to management of young women with EC who wish to preserve their fertility.

Short-Term Medical Cannabis Treatment Regimens Produced Beneficial Effects among Palliative Cancer Patients.

In the last decade the use of medical cannabis (MC) for palliative cancer treatment has risen. However, the choice between products is arbitrary and most patients are using Tetrahydrocannabinol (THC)-dominant cannabis products. In this study, we aimed to assess the short-term outcomes of MC treatment prescribed by oncologists in relation to the type of cannabis they receive. A comparative analysis was used to assess the differences in treatment effectiveness and safety between THC-dominant (n = 56, 52%), cannabidiol (CBD)-dominant (n = 19, 18%), and mixed (n = 33, 30%) MC treatments. Oncology patients (n = 108) reported on multiple symptoms in baseline questionnaires, initiated MC treatment, and completed a one-month follow-up. Most parameters improved significantly from baseline, including pain intensity, affective and sensory pain, sleep quality and duration, cancer distress, and both physical and psychological symptom burden. There was no significant difference between the three MC treatments in the MC-related safety profile. Generally, there were no differences between the three MC treatments in pain intensity and in most secondary outcomes. Unexpectedly, CBD-dominant oil treatments were similar to THC-dominant treatments in their beneficial effects for most secondary outcomes. THC-dominant treatments showed significant superiority in their beneficial effect only in sleep duration compared to CBD-dominant treatments. This work provides evidence that, though patients usually consume THC-dominant products, caregivers should also consider CBD-dominant products as a useful treatment for cancer-related symptoms.

Comparative Characteristics of the Reaction of Cellular Elements of Human Venous Blood on Contact with Carbon Hemosorbent and Chitosan Fibers in vitro

The aim of the work was a comparative description of the reaction of cellular elements of venous blood of a person in vitro upon contact with the carbon sorbent used in the small-volume hemoperfusion (SVH) procedure and chitosan fibers. The formation of chitosan fibers was carried out from a 4% solution of chitosan in a 2% solution of acetic acid in a laboratory setup using the coagulation method. Within 60 min of the experiment in samples of blood in contact with hemosorbents in a rotational mode, 26 parameters were recorded on a SySmex XT 1800i hematology analyzer. The optical density was recorded on a UNICO 280 (S) spectrophotometer at wavelengths corresponding to the absorption maxima of the hemoglobin molecule (414 and 540 nm). An analysis of the results showed that chitosan fibers have greater hemocompatibility and the ability to modify the surface of the fibers with selective agents. Based on the data obtained, it can be concluded that chitosan fibers can be used in the SVH procedure both independently and as a neutral matrix for constructing specific hemoactivators for the practical use of this biopolymer in effective medical treatment regimens.

Neuroform Atlas stent-assisted coiling of ruptured intracranial aneurysms: A multicenter study

PurposeTo assess efficacy, safety and to discuss optimal medical therapy of stent-assisted coiling of ruptured intracranial aneurysms. MethodsRuptured intracranial aneurysms treated with stent-assisted coiling in eight different institutions were retrospectively reviewed. Medical treatment regimens varied among the centers, mainly regarding heparin administration and post-procedural single or double antiplatelet therapy. Clinical and angiographic results, including complications and outcomes were analyzed and related to the different therapies. ResultsSixty-one consecutive patients (male/female 23/38), aged 59.1 years (36–86) underwent stent-assisted coiling for ruptured intracranial aneurysm without antiplatelet pre-medication. Intravenous acetylsalicylic acid (ASA) 500mg was administered to all patients immediately after stent deployment. At the same time heparin was given as bolus in 15 patients (24.6%) as part of local protocol. Intravenous glycoprotein 2b/3a inhibitors (antiGP2b3a) were used as bail-out therapy for stent thrombosis. Stent thrombosis occurred in 22 patients (36.1%), of which 4 (6.5%) lead to incomplete and 18 (29.6) to complete occlusion of the stent. Heparin administration had no effect on thrombosis rate. Thrombosis resolution occurred in all cases with intravenous antiGP2b3a (7 tirofiban, 15 abciximab), without increasing overall complication rate. Single antiplatelet therapy with ASA (28 patients, 45.9%) or double antiplatelet therapy including ASA and clopidogrel (33 patients, 54.1%) were administered after procedure, depending on local protocols and on neurointerventionists’ experience. Overall complication rate, including ischemia and hemorrhage was higher in patients in which only ASA was administered (21.4% vs. 12.1%). No late stent thrombosis was seen, regardless of whether a single or double antiplatelet regimen was used. Nevertheless, the small sample size suggests caution in interpreting these results. Moreover, a possible bias may arise from the decision whether to modify the maintenance therapy or not depending on the severity of the intracranial hemorrhage in a case-by-case assessment. At three months, 34 out of 38 patients with HH grade 1-2 (89.4%), and 11 out of 23 with Hunt-Hess grade of 3-4 (47.8%) were independent (Modified Ranking Scale 0-2). ConclusionStent assisted coiling of ruptured intracranial aneurysms is a feasible option when simple coiling is not possible. Optimal medical treatment is still controversial because balance between hemorrhagic and ischemic risks is difficult to evaluate. In our series, heparin bolus had no effect on subsequent stent thrombosis. In all cases peri-operative stent thrombosis was successfully managed using bail-out intravenous antiGP2b3a, which did not increase post-procedural hemorrhage rates. A non-significant trend towards increased complications rate was noticed in patients treated with single antiplatelet therapy versus double antiplatelet therapy.

Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol

BackgroundSelf-regulation (SR), or the capacity to control one’s thoughts, emotions, and behaviors in order to achieve a desired goal, shapes health outcomes through many pathways, including supporting adherence to medical treatment regimens. Type 1 Diabetes (T1D) is one specific condition that requires SR to ensure adherence to daily treatment regimens that can be arduous and effortful (e.g., monitoring blood glucose). Adolescents, in particular, have poor adherence to T1D treatment regimens, yet it is essential that they assume increased responsibility for managing their T1D as they approach young adulthood. Adolescence is also a time of rapid changes in SR capacity and thus a compelling period for intervention. Promoting SR among adolescents with T1D may thus be a novel method to improve treatment regimen adherence. The current study tests a behavioral intervention to enhance SR among adolescents with T1D. SR and T1D medical regimen adherence will be examined as primary and secondary outcomes, respectively.MethodsWe will use a randomized control trial design to test the impact of a behavioral intervention on three SR targets: Executive Functioning (EF), Emotion Regulation (ER), and Future Orientation (FO); and T1D medical regimen adherence. Adolescents with T1D (n = 94) will be recruited from pediatric endocrinology clinics and randomly assigned to treatment or control group. The behavioral intervention consists of working memory training (to enhance EF), biofeedback and relaxation training (to enhance ER), and episodic future thinking training (to enhance FO) across an 8-week period. SR and treatment regimen adherence will be assessed at pre- and post-test using multiple methods (behavioral tasks, diabetes device downloads, self- and parent-report). We will use an intent-to-treat framework using generalized linear mixed models to test our hypotheses that: 1) the treatment group will demonstrate greater improvements in SR than the control group, and 2) the treatment group will demonstrate better treatment regimen adherence outcomes than the control group.DiscussionIf successful, SR-focused behavioral interventions could improve health outcomes among adolescents with T1D and have transdiagnostic implications across multiple chronic conditions requiring treatment regimen adherence.Trial registrationClinicalTrials.gov: NCT03688919; registered September 28, 2018.

Concordance of Treatment Recommendations for Metastatic Non-Small-Cell Lung Cancer Between Watson for Oncology System and Medical Team.

ObjectiveThe disease complexity of metastatic non-small-cell lung cancer (mNSCLC) makes it difficult for physicians to make clinical decisions efficiently and accurately. The Watson for Oncology (WFO) system of artificial intelligence might help physicians by providing fast and precise treatment regimens. This study measured the concordance of the medical treatment regimens of the WFO system and actual clinical regimens, with the aim of determining the suitability of WFO recommendations for Chinese patients with mNSCLC.MethodsRetrospective data of mNSCLC patients were input to the WFO, which generated a treatment regimen (WFO regimen). The actual regimen was made by physicians in a medical team for patients (medical-team regimen). The factors influencing the consistency of the two treatment options were analyzed by univariate and multivariate analyses.ResultsThe concordance rate was 85.16% between the WFO and medical-team regimens for mNSCLC patients. Logistic regression showed that the concordance differed significantly for various pathological types and gene mutations in two treatment regimens. Patients with adenocarcinoma had a lower rate of “recommended” regimen than those with squamous cell carcinoma. There was a statistically significant difference in EGFR-mutant patients for “not recommended” regimens with inconsistency rate of 18.75%. In conclusion, the WFO regimen has 85.16% consistency rate with medical-team regimen in our treatment center. The different pathological type and different gene mutation markedly influenced the agreement rate of the two treatment regimens.ConclusionWFO recommendations have high applicability to mNSCLC patients in our hospital. This study demonstrates that the valuable WFO system may assist the doctors better to determine the accurate and effective treatment regimens for mNSCLC patients in the Chinese medical setting.

A case of diffuse endobronchial metastasis of rectum carcinoma presenting with symptoms of diffuse airway obstruction and respiratory failure

Endobronchial metastases of extra pulmonary tumors are rare. This report presents a case with diffuse endobronchial metastases with rectum carcinoma. A 63-year-old non-smoker female was admitted to our outpatient clinic with dyspnea and dry cough for two months. She had a history of rectum carcinoma and resection surgery eight months ago. On physical examination, wheezing was remarkable. There was patchy consolidation in both lung fields on chest x-ray. PET-CT revealed widespread nodules in pulmonary parenchyma which were consistent with rectal cancer metastasis. Bronchoscopy was performed and revealed extensive mucosal infiltration and multiple various sizes of polypoid lesions in the distal trachea and both main lobar bronchus. The histopathological evaluation reported as metastasis of rectum carcinoma. The oncological medical treatment regimen and radiotherapy was also planned. She admitted to emergency department with chest pain and progressive dyspnea 2 months after the diagnosis. Thorax CT demonstrated that increased metastatic peribronchial infiltrates, septal thickening and endobronchial polypoid lesions which was consisted with lymphangitic carsinomatosis and endobronchial metastasis. There was hypercapnic respiratory failure according to arterial blood gases analysis. She was intubated and admitted to the intensive care unit (ICU) and died in ICU on 7th day of admission. This case indicates that the possibility of endobronchial metastasis should be considered in a patient with underlying malignancy. If available bronchoscopic intervention should be planned not to let misdiagnosis.

COVID 19 Diagnostic Tests: A Study of 12,270 Patients to Determine Which Test Offers the Most Beneficial Results

COVID 19 has caused capitulation from healthcare entities all over the world. First described in Hubei, China, the virus has spread to 185 countries, showing little signs of eradication or eradication. There does not exist a medical treatment regimen or a vaccine to address COVID 19 definitively. The best response, to date, has been early diagnosis and immediate isolation or quarantine of the patient, with supportive care. As medical institutions all around the world struggle to keep up with this pandemic, there is not a consensus amongst medical professionals in the rapid diagnosis of this disease entity. Purpose: The purpose of our study was to review the literature and establish a test, or tests, that would aid the clinician in attaining a swift, yet accurate diagnosis. Methods: We searched PubMed and Google scholar and reviewed 32 articles. Keyword searches consisted of COVID 19, pandemic, diagnoses, diagnostic testing, pandemic amongst others. We compared the data obtained from these studies in an effort to find the best diagnostic test. Results: There were a total of 12,270 patients that were in our study [1]-[32]. This is the largest study to date in the literature addressing diagnosis of COVID 19. Fever, cough and fatigue, in that respective order were the most common clinical symptoms. Laboratory findings consisted of leukopenia, elevated erythrocyte sedimentation (ESR) and elevated C-reactive protein, CRP. The gold standard test described in multiple studies was the RT-PCR. Serum assays of IgM and IgG were also drawn and found to be accurate in 93% of the time. CT Chest was both sensitive and specific, 90% and 86%. This diagnostic imaging was even more successful when coupled with clinical symptoms and approaching days 7 - 12 since the onset of clinical symptoms. Discussion: This is the largest study compiled to address diagnostic testing in COVID 19 patients. The patient population is spread vastly around the world, with access to many reported tests limited in certain countries. Given the significant sensitivity and specificity of diagnostic imaging, in the setting of clinical symptoms, we recommend patient undergo CT Chest in the face of COVID 19 exposure and clinical symptoms. While RT-PCR, IgM-IgG assays are beneficial, isolation, treatment, and possible quarantine of presumptive positive COVID 19 patients (based upon clinical symptoms and imaging) should not be delayed, for fear of increased infectivity and further risk to society at large.

Hurricanes and healthcare: a case report on the influences of Hurricane Maria and managed Medicare in treating a Puerto Rican resident

BackgroundWhile Medicare is a federal health insurance program, managed Medicare limits access to healthcare services to networks within states or territories. However, if a natural disaster requires evacuation, displaced patients are at risk of losing coverage for their benefits. Previous literature has discussed the quality of managed Medicare plans within Puerto Rico but has not addressed the adequacy of this coverage if residents are displaced to the continental United States. We explore Hurricane Maria’s impact on a resident of Puerto Rico with chronic health problems, and the challenges he faces seeking healthcare in New York.Case presentationA 59-year-old male with a history of diabetes mellitus type II, coronary artery disease, peripheral vascular disease status post right foot amputation, and end-stage kidney disease on hemodialysis was admitted in October of 2017 for chest pain and swelling of legs for 5 days. The patient had missed his last three dialysis sessions after Hurricane Maria forced him to leave Puerto Rico. In examining this patient’s treatment, we observe the effect of Hurricane Maria on the medical management of Puerto Rican residents and identify challenges managed Medicare may pose to patients who cross state or territory lines.ConclusionsWe employ this patient’s narrative to frame a larger discussion of Puerto Rican managed Medicare and provide additional recommendations for healthcare providers. Moreover, we consider this case in the context of disaster-related continuity of care for patients with complex medical conditions or treatment regimens. To address the gaps in the care of these patients, this article proposes (1) developing system-based approaches for screening displaced patients, (2) increasing the awareness of Special Enrollment Periods related to Medicare among healthcare providers, and (3) creating policy solutions to assure access to care for patients with complex medical conditions.

Factors affecting compliance of drug therapy in outpatient children

Background: Adherence to a medical treatment regimen is an essential determinant of clinical success and professional success of doctor as well. Compared with the thousands of trials for individual drugs and treatments, there are few relatively rigorous trials of adherence interventions. Our study is a small effort towards understanding reasons for poor compliance among paediatric patients.Methods: The 256 cases that were selected for study had various clinical conditions. Compliance definition was applied only for those who received antibiotics. For other cases who received drugs other than antibiotics, we asked number of skipped doses. Data collected by paediatrician during follow-up or next visit because of some other illness and by telephone call to parents by assistant. Parents and kids were asked about the reasons for skipping the doses and also about their personal preferences towards medicines.Results: Out of 256 children 93 were prescribed antibiotics, 37.63% had good compliance and 62.36% had poor compliance.7% never skipped any medicine, 62% skipped less often (≤5 times) and 31% skipped. Very often (≥6 times), taste (67%), quantity (52%), apparent recovery (62%), school (65%), sleeping (56%), timing with food (47%) and bottle getting finished (49%) were the most common reasons for missing the dose of any medicine. Adherence was better when less number of doses were given less often. Chocolate flavor was liked by most kids.Conclusions: Prescribing medications should involve parents, children and practitioners in an open discussion around the most suitable, palatable formulations for successful treatment outcomes.

Evaluation of risk factors predicting surgical treatment in tuboovarian abscess cases

Objective: The main outcome measure of the present study was to find out the predictive factors affecting the need for surgery in patients diagnosed with tuboovarian abscess (TOA). We also examined the success of different medical treatment regimens in those patients.&#x0D; Material and Methods: This was a retrospective clinical study performed on 96 TOA patients who were treated in the current hospital between August 2015 and August 2019. All patients underwent physical examination and ultrasonographic imaging with some laboratory tests to investigate the presence of TOA. Two different medical treatment regimens were administered as recommended by the international guidelines after the initial diagnoses. Patients with worsening clinical and/or laboratory findings and/or who did not respond to medical treatment were taken to surgery. Predictive factors for surgical intervention and success rates of medical treatment regimens were evaluated.&#x0D; Results: White blood cell (WBC) levels≥ 16000 and abscess size≥ 7 cm was strongly correlated with the requirement for surgery. The 94 patients received the Regimen 1. Six patients underwent surgery urgently when they were under medical treatment. Regimen 1 failed in 21 (22.34 %) patients out of 94, Regimen 2 was shifted to. Six patients (28.5%) out of 21 underwent surgery because of treatment failure with Regimen 2. Recovery was achieved in the remaining 15 (71.4%) patients.&#x0D; Conclusion: The success of medical TOA treatment was found to be high. Therefore, medical treatment can be applied first, except in case of acute abdomen. It was found that WBC and abscess diameter in patients with TOA in admission were the most important factors affecting the need for surgery. The factors affecting the duration of medical treatment were found to be age, WBC count, CRP (C-Reactive Protein), ESR (Erythrocyte Sedimentation Rate) and NLR (Neutrophil/Lymphocyte Ratio) levels.

Medication adherence in patients with myasthenia gravis in Brazil: a cross-sectional study.

Advances in the treatment of MG have allowed most patients to effectively treat their disorder with oral medications. In parallel, non-adherence to medication treatment regimens is a worldwide health problem. Other chronic neurological disorders have already been associated with low adherence to treatment. However, the literature regarding adherence among patients with MG is definitely poor. The purpose of this study was to capture the prevalence and the associated factors of non-adherence to pharmacological treatment in patients with MG. We carried out a cross-sectional cohort study with 58 consecutive patients with MG from a university-affiliated referral hospital in São Paulo, Brazil. We registered clinical and sociodemographic data and patients were classified according to the MGFA classification. Clinical severity was assessed with myasthenia gravis composite (MGC) scale. Neuropsychiatric symptoms were evaluated with the Hospital Anxiety and Depression Scale (HADS) and quality of life with the 15-Item Quality Of Life Instrument for myasthenia gravis scale (MG-QOL15). Adherence to pharmacological treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8). There were 26 (44.8%) patients adherent to treatment. Low adherence was associated with poor educational attainment, longer time of disease and greater daily number of pills (p < 0.05). Patients with poor compliance to treatment presented worse quality of life and increased neuropsychiatric symptoms (p < 0.05). Adherence can be relatively challenging in patients with MG. Medical approach should recognize that therapeutic success in the treatment of MG goes through adherence to treatment.

Modeling the Choice Between Risperidone Long-Acting Injectable and Generic Risperidone from the Perspective of a Japanese Hospital.

IntroductionThe Japanese government’s current policy is to encourage hospitals to discharge hospital patients with schizophrenia earlier and provide them with community care. This study aims to analyze clinical and economic outcomes of different discharge strategies in psychiatric hospitals in Japan.MethodsA simulation was conducted to compare patient relapse and hospital revenues for different discharge plans. We constructed a decision tree where each tree consists of a different Markov chain that models hospital revenue for four different discharge plans: discharge of the patient after 1, 2, or 3 months, or 4 months or more. The simulation also included variations in the medical treatment regimen in an outpatient setting as part of the discharge strategy. In particular, we looked at the choice between risperidone long-acting injectable (RLAI) and generic risperidone (RIS GE).ResultsThe use of RLAI in an outpatient setting reduced the number of rehospitalizations compared to generic risperidone use under all discharge plans. Different discharge plans were associated with differences in economic outcomes as well. One of the key revenue drivers for the hospital was the continuation of treatment in the outpatient setting after discharge.ConclusionThe use of RLAI in an outpatient setting could help to prevent rehospitalization, thereby contributing to better community care.FundingThe Rapid Service Fee was funded by Janssen KK.