Receiving Drug Therapy Research Articles

Insulinoma in Patients with Diabetes- A Systematic Review of Previously Reported Cases

Abstract Introduction: Paradoxical co-existence of insulinoma and diabetes is extremely rare. Although a few case reports addressed this association, a comprehensive study elucidating this relationship has been lacking. We performed a systematic review of published cases of insulinoma in diabetes. Methods: We conducted a literature search using PubMed and Google Scholar, employing various combinations of the following terms: ‘insulinoma’, ‘diabetes’, ‘nesidioblastosis’, ‘endogenous hyperinsulinism’, ‘hypoglycaemia’, and ‘hyperglycaemia’ (from January 1900 to January 30, 2024). Exclusion criteria included non-English publications, duplicate articles, reports lacking sufficient data, cases of endogenous hyperinsulinemic hypoglycaemia other than insulinoma, and inaccessible articles. Statistical analysis was performed using appropriate methods. Results: Sixty patients were considered for the final analysis. Mean age was 61 ± 15 years (range: 17–96 years) with a slight female preponderance; 88.3% had type-2 diabetes with a median duration of 8 years. The median delay in diagnosis of insulinoma was 6 months. Median blood glucose varied from 30.5 mg/dL to 235 mg/dL, with a mean HbA1c of 5.6 ± 1.3% (range: 2.9%–8.2%). Critical sampling data were available in 75% of cases. The median size of the insulinoma was 2 cm. Furthermore, 5.2% of insulinomas were extra-pancreatic. Among pancreatic insulinomas, 14.5% were multi-focal. One-third of cases were malignant. Surgical resection was done in 70.9% of cases, while 40% received drug therapy and 12.7% received both, with 20.7% overall mortality. Malignant insulinoma (P = 0.007), micro-angiopathic (P = 0.018) and macro-angiopathic complications (P = 0.039), and other co-morbidities (P = 0.009) were associated with unfavourable prognosis, while being overweight and obese (P = 0.020) at presentation was associated with favourable prognosis. Conclusion: This first systematic review provides insights into the uniqueness of insulinoma in diabetes.

HEALTH EXAMINATION AND EDUCATION ON THE USE OF CHOLESTEROL, URIC ACID, AND BLOOD SUGAR MEDICINE FOR THE COMMUNITY OF SUNGAI BAWANG VILLAGE, MUARA BADAK DISTRICT, KUTAI KARTANEGARA

Degenerative diseases that many people suffer from, including heart disease, stroke, hypertension, diabetes mellitus, cancer, and chronic kidney failure, have increased. In demographic data referring to the 2018 Riskesdas, for example, strokes increased to 10,9% from the previous 7%, and diabetes mellitus increased from 6.9% to 8.5% in 2018. Hypertension experienced the highest increase among diseases, from 25.8% to 34.1%. Management of degenerative diseases is through implementing community service activities carried out by lectures from the Study Program of Pharmacy undergraduate at STIKES Dirgahayu Samarinda to implement the tridharma obligations of higher education. The activity was held on Saturday, November 18, 2023, at Lamin Adat Sungai Bawang Village, Muara Badak District, Kutai Kartanegara. This activity aimed to conduct health checks for the community, from children to adults, and health education, especially controlling non-communicable diseases. The method used was education, free examination, and treatment for the community which consists of laboratory examinations, health consultations, pharmaceutical services, and health education, as well as evaluation when the activites have been completed. Based on the activities that have been carried out, it was known that one hundred and five residents came for an examination, then from screening for blood sugar, cholesterol, and uric acid tests, forty-seven people exceeded normal parameters, while ninety-eight received drug therapy.

Analysis of Beer's Criteria 2019 and Patient Characteristics of Potentially Inappropriate Medication in Elderly Patients with Diabetes Mellitus

Background: Elderly patients with type 2 diabetes mellitus with polypharmacy and various comorbidities often have problems with Potentially Inappropriate Medications (PIMs). One of the methods commonly used to detect this event is Beer's Criteria 2019.Objectives: This study aims to: (1) identify the characteristics of elderly hospitalized patients with type 2 DM; (2) analyze the incidence of PIM in patients; and (3) analyze the relationship between characteristics (age, gender, comorbidities, length of stay, and number of drugs given) with the incidence of PIMs.Methods: The research was conducted at two type C hospitals in the city of Bengkulu, with a total of 105 patients using the purposive sampling method. This research is a cross-sectional study with data collection techniques in the form of medical record data from patients for the period January – December 2022 who received drug therapy. Data analysis consists of comparing data with Beer'’s Criteria, quantitative descriptive and Fisher'’s test.Results: The research results showed that: (1) the largest age group in Hospitals ) had comorbidities, the highest number of drugs given was more than 10 types of drugs, and the majority of patients were hospitalized for less than five days; (2) There was an incidence of PIMs of 98.65% (73 patients) in Hospital (3) Statistical tests show that there is no relationship between age, gender, comorbidities, number of medications and length of stay with the incidence of PIMs.Conclusion: There is still inappropriate use of drugs given to elderly DM patients. It is hoped that further researchers will be able to find out the reasons for giving these drugs to elderly patients.

Drug Prescribing Evaluation to Foreign Travelers in Bali: A Study of Two Travel Clinics

Bali is one of the world's favorite travel destinations in developing countries. Most travelers who travel to developing countries seek medical assistance before, during and after travelling. Irrational prescribing is one of the causes of the higher medical cost. The objective was to evaluate drug prescriptions to foreign travelers in 2 travel clinics in Bali using the WHO prescribing indicators. This retrospective study used a cross-sectional method. Foreign travelers who took medication and received drug therapy at the travel clinics from January until December 2019 and had complete and legible medical record data were included in this study. Drug prescription were evaluated by following the WHO prescribing indicators, including the number of drugs per prescription sheet, the percentage of prescription drugs with generic names, the percentage of antibiotic prescriptions, the percentage of prescribed injections, and the percentage of drugs that were in accordance with the formulary. Drug use was said to berationalifall indicators were in accordance with WHO prescribing indicators where as it was said to be irrational if it did not meet the indicators set by WHO. We found a total number of prescriptions was 220 and the number of types of drugs in this study was 544. We found many poly pharmacy events, low prescriptions with generic names (14,2%), not all prescriptionsmetnationalformulary (64,8%), high prescriptions of antibiotic (50,0%) and injection (29,1%). Through this study, we concluded that there has been a phenomenon of irrational prescribing in those travel clinics.

Comparative assessment of patient’s quality of life under medical and surgical epilepsy treatment: an observational prospective study

Epilepsy has never been a purely medical problem; its social significance is well known. It is a global issue that affects people of all ages, races, and social classes in different countries and occurs in both men and women. Drug-resistant epilepsy is a form of the disease in which seizures persist despite appropriate therapy with two antiepileptic drugs, either as monotherapy or in combination. However, surgical treatment of drug-resistant epilepsy is still underutilized. The purpose of the study is to compare the level of quality of life in patients with drug-resistant epilepsy under medical treatment and 1 year after surgery in order to evaluate the dynamics in the areas of quality of life. The study design was a prospective case-control observation. The study included neurosurgical patients with a confirmed diagnosis of drug-resistant epilepsy divided into two groups: group 1 - patients in the preoperative phase receiving drug therapy with antiepileptic drugs, and group 2 - patients 1 year after surgical treatment of drug-resistant epilepsy. Demographic and clinical parameters were analyzed, and the Quality of Life in Epilepsy Inventory-31 survey was carried out before and 1 year after surgery. The first group consisted of 56 patients (55%), and the second group comprised 46 patients (45%). The overall mean quality of life score in group 1 was 53.5, and in group 2 – 59.9, which was statistically significantly different from group 1 (p=0.05). Of the 7 quality of life indicators, a statistically significant improvement was found in 2: general quality of life (p=0.01) and social functioning (p=0.01). 5 indicators showed no statistical differences between the groups: seizure worry (p=0.06), emotional well-being (p=0.9), energy/fatigue (p=0.5), cognitive function (p=0.7), and medication side effects (p=0.6). A comparative analysis of the quality of life of patients with pharmacoresistant epilepsy showed positive dynamics of quality of life from the first year after surgery in contrast to uncontrolled epilepsy against the background of medical treatment with antiepileptic drugs.

The fluoroquinolones may positively affect tendon healing after surgical repair.

This study aimed to evaluate the biomechanical and histological effects of fluoroquinolones on surgically repaired tendon healing. The Achilles tendons of 40 Wistar rats (mean weight: 213.5 g; range 201 to 242 g) were bilaterally surgically cut and repaired. The rats were randomly divided into four groups: the first and third groups were designated as control groups and did not receive drug therapy, whereas the second and fourth groups received 300 mg/kg ciprofloxacin for a week after the surgical procedure. The first and second groups had both tendons dissected at the end of the first week, while the third and fourth groups were dissected at the end of the third week. The left tendons were examined biomechanically, while the right tendons were examined histologically. Statistical analysis revealed that the mean maximum tensile forces of tendons in the first and second groups were 5.2±1.84 N (range, 2.9 to 8.5 N) and 11.1±2.65 N (range, 7.3 to 13.9 N), respectively, which was found to be statistically significant (p< 0.05). At the end of the third week, mean maximum tensile forces of the third and fourth groups were determined to be 20.7±5.0 N (range, 22.1 to 29.8 N) and 28.7±4.6 N (range, 22.1 to 36.8 N), respectively, which was also statistically significant (p< 0.05). Histologically, our results were compatible. This study demonstrated that ciprofloxacin did not exhibit the expected adverse effects on surgically repaired tendon healing in the early stages but likely contributed to healing in the short term by affecting the inflammatory phase.

Are people in the US getting cancer at a younger age?

e23321 Background: Advanced age is a well-known risk factor for the development of cancer. One-third of all cancer diagnoses occur in patients aged 75 or older1. In general, cancer incidence rates are very low in younger populations, with only 25 cases per 100,000 in those aged 20 years or younger and about 350 cases per 100,000 in those between the ages of 45 and 492. However, in recent years, studies have started to show an uncharacteristic rise in cancer diagnoses amongst young people in the United States. Methods: The Ipsos Oncology monitor is an online, multi-center medical chart review of oncology patients receiving drug therapy. Over 2,200 cancer treating physicians in the United States were screened for seniority and caseload and submitted data on 385,912 cancer patients (aggregate; all tumour types) between January 2018 to December 2023. Data captured included tumor type, patient age, whether the patient was newly diagnosed, follow-up or relapsed patient status and the treatment they received. Results: Reported patient age across all cancer types remained stable over time, recording an average age of 64.19 years in 2023. However, shifts in prevalence amongst younger age groups were recorded in select tumor indications. Within reported newly diagnosed breast cancer patients, the proportion of those aged 55 years or younger shifted significantly from 23% in December 2018, to 27% in December 2023. Over this same period, a similar trend was recorded in reported newly diagnosed colorectal cancer patients, with the proportion of those 55 years or younger rising from 17% to 22%. In contrast, sampled newly diagnosed melanoma and prostate patients reported decreased diagnoses in the 55 or younger age group. Conclusions: This demonstrates that the oncology patient cohort in this study remains mostly stable in age overall. However, the declining age of diagnosis in both reported breast and colorectal cancer may merit concern. These results outline the importance of robust screening efforts and suggest performance of routine screening at an earlier age may be beneficial. In addition, expansion of clinical trials and other oncology research to younger patient populations may be needed. Further investigation using comparator cohort is warranted. Age and cancer (2023) Cancer Research UK. Available at: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/age-and-cancer (Accessed: 31 January 2024). Risk factors: Age (no date) National Cancer Institute. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/age (Accessed: 31 January 2024). Ugai, T. et al. (2022) ‘Is early-onset cancer an emerging global epidemic? current evidence and future implications’, Nature Reviews Clinical Oncology, 19(10), pp. 656–673. doi:10.1038/s41571-022-00672-8.

Physician justification for anti-cancer treatment decisions in the evolving oncology market.

e23317 Background: Oncology is a rapidly expanding pharmaceutical space, driven by innovative research and clinical technology. Continued growth in anti-cancer therapy has generated an exceedingly competitive market. As treatment options increase, physicians must weigh a variety of factors to make individualized care decisions. Many elements are patient-specific, but physician biases may also impact selection. As the market evolves, it is unknown whether oncology providers will shift priorities to align with contemporary findings or continue to trust in historical experiences. Methods: The Ipsos Global Oncology Monitor is an online, multi-center medical chart review of oncology patients receiving drug therapy. Over 1,900 cancer-treating physicians in the United States were screened for seniority and caseload and submitted data on 253,051 cancer patients (aggregate; all tumor types) between January 2020 to December 2023. Upon record submission, physicians were prompted to select up to three responses most associated with the reason for prescribing the reported therapy. Responses were chosen from a finite list of closed-ended options. Results: Influence of “Approved Standard of Care” fell amongst sampled physicians, cited as a reason for selecting treatment in 61% of reported annual patients in 2023, declining by 2.94 percentage points since 2020. “Biomarker results” recorded increased influence on therapy selection, rising in association with 8% of reported patients in 2020 to 11% in 2023. Within tumor-specific cohorts, “Maintain/improve quality of life” was a notable reason for drug therapy decisions in both breast and colorectal cancer patient subsets in 2023 (10% and 19% respectively). Contrary to the overall patient cohort, drug therapy choice for reported prostate cancer patients has increasingly shown association with “Approved Standard of Care” (53% in 2020 to 60% in 2023). Conclusions: Results of this study highlight the evolution of factors influencing anti-cancer treatment decisions in sampled physicians. Sampled providers appear to be shifting away from universal treatments, as shown by lowered association with “Approved Standard of Care”. Sampled physicians seem to be opting for specific therapies, demonstrated by rising influence of “Biomarker results”. Discrepancies between tumors merit expansion of research in rarer indications and emphasize the importance of diagnostic testing to continue improving quality of care. Further investigation using comparator cohort is warranted.

Abstract PO5-26-01: Assessing the effect of multimodal therapy in massive fungating breast cancers without distant metastasis

Abstract Background: Massive fungating breast cancers (MFBCs), which comprise exudative, foul-smelling tumors, the size of a child’s head or involve extensive ulceration are classified as locally advanced breast cancers. The National Comprehensive Cancer Network guidelines recommend preoperative neoadjuvant chemotherapy in patients with locally advanced breast cancer without distant metastases. However, limited evidence is available regarding the successful treatment of fungating breast cancers. In clinical practice, many fungating breast cancer cases are treated as stage IV tumors. This study aimed to investigate whether multimodal therapy, including surgery for giant breast cancers, can improve survival rates and whether the survival rates are comparable to those of other stage III breast cancers. Subjects and methods: Out of 1480 cases of primary breast cancer diagnosed at our hospital between June 2012 and March 2020, 123 patients with clinical stages IIIA–IIIC were chosen for analysis. Furthermore, 29 of these patients with MFBC were selected. During multimodal therapy for selected patients with fungating breast cancer, difficulties were encountered in some patients with single-stage skin suturing and closure after standard neoadjuvant chemotherapy. These patients underwent surgery with an additional skin flap or skin grafting. Furthermore, radiation therapy was added as needed. We compared the survival rates of these patients with those of patients who received drug therapy only according to the therapeutic protocol for Stage IV. Survival rates of patients with MFBC and other stage III breast cancers were also compared. Statistical analyses were conducted using the Kaplan–Meier curve and the log-rank test. Results: Of the 29 patients with MFBC, 22 (75.9%) and seven (24.1%) were treated with multimodal and palliative therapies, respectively. The median age and follow-up period of the multimodal therapy group were 62 (range: 43–94) years and 67 (range, 32–131) months, respectively. The corresponding values for the palliative therapy group were 79 (range: 42–88) years and 31 (range: 2–96) months. All patients in the palliative treatment group were hormone receptor positive and HER2 negative, and treatment with hormone therapy was initiated. The 7-year survival rate was significantly higher in the multimodal therapy group than in the palliative treatment group (92.3% vs. 68.6%, p = 0.0317). Furthermore, the 5-year distant recurrence-free rate was higher in the multimodal treatment group (79.3% vs. 63.5%). Local recurrence did not occur in any patient in the multimodal treatment group. There was no significant difference in the 7-year survival rates between patients with MFBC and those with other stage III breast cancers (86.8% vs. 75.3%; p = 0.239). Triple-negative breast cancer accounted for 20.8% (20 96) of the other stage III breast cancers, but none of these were MFBCs. Conclusions: Clinically, MFBCs are often palliatively treated as stage IV tumors, even in the absence of distant metastasis. However, the survival rate was significantly higher in the multimodal therapy group than in the palliative treatment group. Furthermore, the survival and distant recurrence-free rates for MFBC were higher than those for other stage III breast cancers. Therefore, patients with MFBCs should be actively treated using curative treatments. Citation Format: Tamaki Tamanuki, Maki Namura, Tomoyoshi Aoyagi, Haruhito Sakata, Mika Iwai, Shinichirou Shimizu, Hiroshi Matsuzaki. Assessing the effect of multimodal therapy in massive fungating breast cancers without distant metastasis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-26-01.

Efficacy of total neoadjuvant chemotherapy in the FLOT regimen in patients with locally advanced gastric and gastroesophageal junction: results of a phase II study

Background. The established approach notably improving the therapeutic outcomes for locally advanced gastric cancer and gastroesophageal junction cancer, presently entails the amalgamation of perioperative chemotherapy aligned with the FLOT protocol and surgical intervention. However, this approach harbors limitations, as only half of the patient cohort successfully completes the entire prescribed course of drug therapy. The potential solution to this problem lies in the complete transfer of the chemotherapy volume to the preoperative period and the execution of total neoadjuvant chemotherapy with FLOT regimen.Aim. Aim is to conduct a comparative assessment of the efficacy and safety between total neoadjuvant and perioperative chemotherapy with FLOT regimen for patients with locally advanced gastric cancer and gastroesophageal junction cancer.Materials and methods. In a retrospective study we enrolled patients with histologically confirmed locally advanced gastric cancer and gastroesophageal junction cancer meeting clinical stage criteria T2–4 and N0–3, without of distant metastases, treated between 2014 and 2020 at Federal State Budgetary Institution “N. N. Blokhin National Medical Research Center of Oncology” оf the Ministry of Health of the Russian Federation and Moscow City Oncologic Hospital No. 62 Department of Healthcare of Moscow. Participants in the control group underwent 8 courses of perioperative chemotherapy (4 preoperatively and 4 postoperatively), while those in the experimental group received 8 courses of total neoadjuvant chemotherapy. Both groups received drug therapy according to the FLOT protocol: 5-fluorouracil 2600 mg/m2 , intravenous drip, over 24 hours, leucovorin 200 mg/m2 , intravenous drip, oxaliplatin 85 mg/m2 , intravenous drip, docetaxel 50 mg/m2 , intravenous drip, on day 1, with a 14-day intercourse interval. The primary endpoint was one-year progression-free survival.Results. In the study included 187 patients. Participants were divided into two groups: 95 in the total neoadjuvant chemotherapy group and 92 in the perioperative chemotherapy group. The one-year progression-free survival was higher in the total neoadjuvant chemotherapy group at 79 %, compared to 68 % in the perioperative chemotherapy group (HR 0.54, 95 % confidence interval 0.32–0.9, p = 0.02). Median disease-free survival was 27.2 and 19.5 months in the neoadjuvant and perioperative chemotherapy groups, respectively. The tolerability of the entire planned drug treatment regimen was superior in the total neoadjuvant chemotherapy group, reaching 88.4 %, as opposed to 57.6 % in the perioperative chemotherapy group (p = 0.0001).Conclusion. Among patients with locally advanced gastric cancer and gastroesophageal junction cancer, the application of total neoadjuvant chemotherapy according to the FLOT protocol, administered over 8 courses, demonstrated enhanced one-year progression-free survival and improved tolerability of the entire planned treatment regimen.

Active Components of Pueraria lobata through the MAPK/ERK Signaling Pathway Alleviate Iron Overload in Alcoholic Liver Disease.

To delve into the primary active ingredients and mechanism of Pueraria lobata for alleviating iron overload in alcoholic liver disease. Pueraria lobata's potential targets and signaling pathways in treating alcohol-induced iron overloads were predicted using network pharmacology analysis. Then, animal experiments were used to validate the predictions of network pharmacology. The impact of puerarin or genistein on alcohol-induced iron accumulation, liver injury, oxidative stress, and apoptosis was assessed using morphological examination, biochemical index test, and immunofluorescence. Key proteins implicated in linked pathways were identified using RT-qPCR, western blot analysis, and immunohistochemistry. Network pharmacological predictions combined with animal experiments suggest that the model group compared to the control group, exhibited activation of the MAPK/ERK signaling pathway, suppression of hepcidin expression, and aggravated iron overload, liver damage, oxidative stress, and hepatocyte death. Puerarin and genistein, the active compounds in Pueraria lobata, effectively mitigated the aforementioned alcohol-induced effects. No statistically significant disparities were seen in the effects above between the two groups receiving drug therapy. This study preliminarily demonstrated that puerarin and genistein in Pueraria lobata may increase hepcidin production to alleviate alcohol-induced iron overload by inhibiting the MAPK/ERK signaling pathway.

Psychological Stress Analysis to Evaluate the Effects of Transcranial Magnetic Stimulation on Mood Regulation and Quality of Life in Patients with Bipolar Disorder.

To explore the impact of transcranial magnetic stimulation on emotion regulation and quality of life in patients with bipolar disorder (BD) and to evaluate the effectiveness of the mental stress analyzer. Patients with BD admitted to our hospital from August 2022 to August 2023 were retrospectively selected. For the present study, 60 patients who received drug therapy served as the control group, and the other 60 patients who received repeated transcranial stimulation on this basis served as the observation group. The heart rate variability (HRV) of the two groups of patients was detected by a mental stress analyzer/HRV analysis system. Hamilton Depression Rating Scale (HAMD), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) were used to evaluate the mental state of the two groups of patients. The quality of life of the two groups was assessed using the Comprehensive Quality of Life Questionnaire 74 (GQOLI-74). Clinical effectiveness global rating scale-illness severity (CGI-SI) was used to evaluate the clinical symptoms of the two groups of patients, and the incidence of adverse reactions was calculated. In comparison to the control group, the high-frequency power (HF) of the patients demonstrated an elevation in the observation group, and the low-frequency power (LF) and LF/HF were significantly reduced (p < 0.05). The standard deviation of NN intervals (SDNN), standard deviation of all five-minute NN intervals (SDANN), root mean square of successive differences (rMSSD), and percent RR intervals with a difference in duration higher than 50 ms (PNN50) of patients in the observation group showed a notable increase compared to the control group (p < 0.05). Compared with the control group, the HAMD, SAS, and SDS scores of the patients in the observation group demonstrated a substantial decline relative to the control group (p < 0.05). In contrast to the control group, there was a significant increase in the overall clinical effectiveness rate among patients in the observation group, and the incidence of adverse reactions was significantly reduced (p < 0.05). Repetitive transcranial magnetic stimulation (rTMS) has significant clinical effects in treating BD and can effectively improve patients' anxiety, suppress emotions, and regulate patients' emotions. At the same time, rTMS has high safety and little impact on the balance of patients' autonomic nervous function, reduces the incidence of adverse reactions, accelerates the patient's recovery process, and is suitable for clinical promotion.

Risk factors and a nomogram for predicting cognitive frailty in Chinese patients with lung cancer receiving drug therapy: A single-center cross-sectional study.

To identify independent factors of cognitive frailty (CF) and construct a nomogram to predict cognitive frailty risk in patients with lung cancer receiving drug therapy. In this cross-sectional study, patients with lung cancer undergoing drug therapy from October 2022 to July 2023 were enrolled. The data collected includes general demographic characteristics, clinical data characteristics and assessment of tools for cognitive frailty and other factors. Logistic regression was harnessed to determine the influencing factors, R software was used to establish a nomogram model to predict the risk of cognitive frailty. The enhanced bootstrap method was employed for internal verification of the model. The performance of the nomogram was evaluated by using calibration curves, the area under the receiver operating characteristic curve, and decision curve analysis. A total of 372 patients were recruited, with a cognitive frailty prevalence of 56.2%. Age, education background, diabetes mellitus, insomnia, sarcopenia, and nutrition status were identified as independent factors. Then, a nomogram model was constructed and patients were classified into high- and low-risk groups with a cutoff value of 0.552. The internal validation results revealed good concordance, calibration and discrimination. The decision curve analysis presented prominent clinical utility. The prevalence of cognitive frailty was higher in lung cancer patients receiving drug therapy. The nomogram could identify the risk of cognitive frailty intuitively and simply in patients with lung cancer, so as to provide references for early screening and intervention for cognitive frailty at the early phases of drug treatment.

Quality of care in patients with hypertension: a retrospective cohort study of primary care routine data in Germany

BackgroundHypertension is a leading cause of morbidity and mortality if not properly managed. Primary care has a major impact on these outcomes if its strengths, such as continuity of care, are deployed wisely. The analysis aimed to evaluate the quality of care for newly diagnosed hypertension in routine primary care data.MethodsIn the retrospective cohort study, routine data (from 2016 to 2022) from eight primary care practices in Germany were exported in anonymized form directly from the electronic health record (EHR) systems and processed for this analysis. The analysis focused on five established quality indicators for the care of patients who have been recently diagnosed with hypertension.ResultsA total of 30,691 patients were treated in the participating practices, 2,507 of whom have recently been diagnosed with hypertension. Prior to the pandemic outbreak, 19% of hypertensive patients had blood pressure above 140/90 mmHg and 68% received drug therapy (n = 1,372). After the pandemic outbreak, the proportion of patients with measured blood pressure increased from 63 to 87%, while the other four indicators remained relatively stable. Up to 80% of the total variation of the quality indicators could be explained by individual practices.ConclusionFor the majority of patients, diagnostic procedures are not used to the extent recommended by guidelines. The analysis showed that quality indicators for outpatient care could be mapped onto the basis of routine data. The results could easily be reported to the practices in order to optimize the quality of care.

Optimisation of conservative treatment of patients with severe heart failure by using hemosorption

Background. Heart failure (HF) is a complex cardiac pathology that is the main cause of hospitalisation among adults and is characterised by a high mortality. Dilated cardiomyopathy (DCM) is the most common cause of HF, and it can be fatal within a few years after the first symptoms appear. Many patients with HF remain refractory to medical therapy, despite its constant development and improvement. The study aims to compare the effectiveness of conservative treatment of patients with severe HF that occurred on the background of DCM using drug therapy and its combination with a course of hemosorption (HS). Materials and methods. We analysed treatment outcomes in 30 patients with severe HF against DCM (New York Heart Association class III–V, left ventricular ejection fraction (LV EF) &lt; 30 %). Patients in group 1 (n = 13; N-terminal fragment of brain natriuretic peptide precursor (NT-pro BNP) 4,546.23 ± ± 3,265.01 pg/ml; LV EF 16.77 ± 2.92 %; LV end-diastolic volume (EDV) 261.31 ± 60.60 ml, LV end-systolic volume (ESV) 214.85 ± 49.44 ml) received drug therapy according to local protocols. In group 2 (n = 17; NT-pro BNP 3,974.49 ± 3,550.17 pg/ml; LV EF 18.18 ± 4.36 %; LV EDV 261.12 ± 79.96 ml, LV ESV 212.06 ± 71.67 ml), medical treatment was supplemented with a course of 3 HS procedures using granular deligandizing hemosorbent. Results. Patients in both study groups noted an improvement in well-being and a decrease in the severity of symptoms. The level of NT-pro BNP decreased to 2,609.92 ± 1,465.14 pg/ml (p &lt; 0.01) in group 1 and to 975.35 ± 511.55 pg/ml (p &lt; 0.05) in group 2. LV EF increased to 22.77 ± 4.69 % and 26.76 ± 5.02 %, respectively, in the groups (p &lt; 0.01). In patients of group 1, LV EDV and LV ESV changed to 262.22 ± 40.92 ml and 211.33 ± 35.22 ml, respectively. In group 2, there was a significant decrease in LV EDV to 228.94 ± 73.16 ml and LV ESV to 170.88 ± 60.28 ml (p &lt; 0.01). Conclusions. The use of HS in combination with drug therapy for severe HF on the background of DCM improves the clinical status of patients and LV systolic function.

Colon cancer-induced sarcopenia: clinical and radiological correlations

Background. The course of colon cancer (CC) is burdened in many patients with elderly and senile age, the presence of severe comorbidities, and complications of the malignancy. The complex treatment for advanced colon tumors also requires the search for predictors appropriate for routine clinical practice.&#x0D; Aim. To study the prevalence of sarcopenia (SP) in CC and assess the relationship of SP with the immediate treatment outcomes.&#x0D; Materials and methods. A retro-prospective assessment of cachexia and SP according to clinical and radiological criteria and their relationship to postoperative complications was performed in 679 patients. The mean age was 65±10.7 years. Group 1 included 181 patients who received drug therapy for common types of CC. Group 2 included 498 patients who underwent elective colon resections for cancer. The presence of SP was determined by threshold values for skeletal muscle area at the LIII level, averaged to the patient's height squared. To do this, the data from abdominal computed tomography performed for 1 month or less before the start of antitumor treatment were analyzed. The threshold criteria of Prado, Martin, and the European Working Group on Sarcopenia in Older People (EWGSOP2) were compared.&#x0D; Results. The SP prevalence was 64% according to the Prado criteria for stages I–II, 66% for stage III, and 73.4% for stage IV; according to the Martin criteria, 63.1%, 62.3%, and 68%, respectively, and according to the EWGSOP2 criteria 22.7%, 26.9%, and 32%, respectively. In general, SP was noted according to the Prado criteria in 70.2% of men and 61.4% of women, according to the Martin criteria in 55.8% of men and 71.9% of women, and according to the EWGSOP2 criteria in 27% of men and 22.9% of women. Sarcopenic obesity was identified in 10.1% of patients. In group 1, there was a statistically significant correlation (p0.001) between the presence of SP and poor overall survival of patients, with the Martin criteria showing the most significant correlation. In group 2, an equally strong correlation between the presence of SP according to the Prado criteria and postoperative mortality was found.&#x0D; Conclusion. In CC, SP is detected in more than half of patients before the start of antitumor treatment, being an unfavorable prognostic factor for overall survival and a predictor of death after surgical treatment. Timely diagnosis and treatment of SP can improve the CC therapy outcome.

Renal elasticity and perfusion changes on ultrasonography in an early-stage diabetic rat model.

Renal hemodynamic changes in early diabetes occur before the onset of significant structural abnormalities or clinical manifestations, and timely detection of these changes has clinical significance. This study aimed to evaluate renal elasticity and perfusion changes in an early-stage diabetic rat model by shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS), and to explore the potential correlations between renal elasticity and perfusion parameters. A total of 18 male Sprague-Dawley rats were randomly divided into three groups: a control group (group 1, n=6), a diabetic group (group 2, n=6), and a diabetic group receiving drug therapy (group 3, n=6). An intraperitoneal injection of streptozotocin (STZ) for 2 days combined with a high-fat diet (HFD) was used as the early-stage diabetic rat model. The diabetic rats in group 3 were treated with canagliflozin and losartan for 6 weeks, whereas the rats in groups 1 and 2 were given equal amounts of purified water. Renal stiffness on SWE and perfusion parameters on CEUS were measured and compared among the three groups, then the rats were sacrificed, and serum, urine, and renal histopathology were evaluated to confirm the development of early diabetes. The early-stage diabetic rats without significant pathological changes exhibited bigger kidneys and higher blood glucose (all P<0.05). Among the CEUS parameters, peak enhancement (PE), wash-in area under the curve (WiAUC), wash-in perfusion index (WiPI), wash-out AUC (WoAUC), wash-in and wash-out AUC (WiWoAUC), rise time (RT), and time to peak (TTP) of diabetic rats in group 2 were significantly increased (all P<0.05), and the hyperperfusion ameliorated significantly after drug treatment. The renal elasticity measured by SWE varied in accordance with certain perfusion parameters, and was strongly positively correlated with WiAUC (r=0.701, P<0.001), WoAUC (r=0.647, P<0.001), and WiWoAUC (r=0.655, P<0.001), and moderately positively correlated with PE (r=0.539, P=0.001), WiPI (r=0.555, P<0.001), RT (r=0.425, P=0.010), and TTP (r=0.439, P=0.007). Renal elasticity and perfusion changes in the early stage of diabetes, and renal elasticity was positively associated with delayed and increased perfusion.

The effectiveness of medical penile rehabilitation after radical prostatectomy

Background. Among the drug methods of penile rehabilitation in patients after nerve-sparing prostatectomy, the use of phosphodiesterase-5 (PDE-5) inhibitors is proposed as the first line of therapy, which have shown high efficiency, ease of use, good tolerability and safety, improving the quality of life of patients.Aim. To evaluate the effectiveness of drug-induced penile rehabilitation after nerve-sparing prostatectomy in the restoration of erectile function (EF) with an analysis of the factors influencing it.Materials and methods. The study included 108 patients with localized prostate cancer who underwent nerve-sparing prostatectomy. All patients were randomized into two groups. In Group 1 patients did not receive drug therapy for the prevention and treatment of erectile dysfunction. In Group 2 patients in the postoperative period received daily PDE-5 inhibitors (tadalafil) at a minimum dosage of 5 mg for 12 months as a drug therapy. Initially and at the annual stage of the study, the state of EF, erectile rigidity, night penile test, and quality of life were assessed. An analysis was also made of the factors affecting the preservation of EF one year after nerve-sparing radical prostatectomy.Results. The best reliable results in terms of maintaining EF at the annual stage of the study were obtained in the group whose patients received postoperative drug therapy with PDE-5 inhibitors. It was possible to identify the most significant factors influencing the state of EF in the postoperative period after radical prostatectomy: the type of operation – bilateral nerve sparing, taking PDE-5 inhibitors, the patient’s age, the presence/absence of diabetes mellitus, the state of EF (International Index of Erectile Function-5 value) before the operation.Conclusion. Daily intake of PDE-5 inhibitors at a low dose of 5 mg is indicated for patients after nerve-sparing prostatectomy as an effective means of penile rehabilitation in order to preserve EF, as it provides better results compared to no drug therapy. Patients who meet criteria such as young age, no diabetes, high preoperative International Index of Erectile Function-5 levels may benefit most from nerve-sparing surgical techniques and early postoperative participation in a penile rehabilitation program for erectile dysfunction.

PECULIARITIES OF HEMODYNAMICS IN PATIENTS WITH CHRONIC HEART FAILURE CONSIDERING SEX DIMORPHISM

Introduction. Heart failure is an important factor in the development of pathological processes and pathophysiological manifestations; it can be modified at all stages of its development, regardless of sex and age, and be accompanied by arterial hypertension, heart ischemia, tachycardia, bradycardia, etc. The purpose of this study is to investigate the peculiarities of central hemodynamics in cases of chronic heart failure considering sex dimorphism. Materials and methods. The research comprised 149 individuals, aged between 18 and 75, with long-term heart failure, who received inpatient treatment at the Heart Failure Department of the National Centre of Cardiology "Acad. M.D. Strazhesko Institute of Cardiology” of the National Academy of Sciences of Ukraine for 2020 – 2022. Objective criteria such as heart rate, systolic and diastolic blood pressure, pulse pressure, systolic blood volume, and minute blood volume were used to assess the state of the cardiovascular system. All patients underwent an echocardiogram in M- and B-modes to assess the structural and functional state of the heart and to establish an accurate diagnosis. Results. Analyzing the obtained results, it should be noted that there is a certain sexual dimorphism in the indicators of central hemodynamics in patients with chronic heart failure: for instance, women with chronic heart failure demonstrates significantly higher values of blood pressure and pulse pressure than men with the same diagnosis. The values of minute blood volume in patients with chronic heart failure of both sexes were within the reference values. More pronounced changes in central hemodynamic parameters under chronic heart failure were observed in women compared to men. It should be noted that all investigations were conducted while individuals were receiving medical therapy for heart failure. It is note worthy that the results of the echocardiographic examination indicate profound changes in the heart structure in the patients with chronic heart failure. In particular, the set of the evaluated indicators point out left ventricle hypertrophy. The degree of hypertrophy provides unquestionable predictive value. Remodelling of the myocardium is a possible occurrence linked to arterial hypertension. Conclusion. Central hemodynamic indicators reveal sex dimorphism, with greater distinction observed in the patients with chronic heart failure, particularly among women. Despite this, the main indicators of hemodynamics in patients with chronic heart failure were within the reference values, which can be explained by the fact that the patients received drug therapy. However, the analysis of indicators obtained by echocardiographic study indicates profound changes in the heart structure in patients with chronic heart failure, which are more pronounced in male patients compared to their female counterparts.

Potentially Inappropriate Medication Inpatient Elderly with DM Type 2 at RSUD M. Yunus Bengkulu based on Beer's Criteria 2019

This study aims to determine the incidence of PIMs and the factors that influence PIMs in geriatric patients with type 2 DM. This study was a non-experimental study with a cross-sectional method. The data collection technique uses medical record data of Type 2 DM patients without or with comorbidities who are elderly in the period of January-December 2022 who are receiving drug therapy. Sampling was done by purposive sampling of 42 patients and data were analyzed using Fisher's statistical test. The results showed that the use of PIMs at RSUD M. Yunus was 92.86% (39 patients). The incidence of PIMs for Type 2 DM drugs were insulin sliding scale (1 patient) and glimepiride (4 patients). For drugs other than Type 2 DM, PPI class drugs are 43.82%. Fisher's test showed that only the number of drugs had a significant relationship with the incidence of PIMs (p=0.019), while other characteristics such as age, gender, comorbidities and length of stay had no effect on PIMs.