Related Adverse Effects Research Articles

Outcomes Among Hospitalized Patients with Relapsing Multiple Myeloma Utilizing Palliative Care: A United States Population-Based Cohort Study

Background Multiple myeloma has a limiting effect on quality of life, with pain being a commonly reported symptom secondary to lytic lesions. Palliative care plays an important role in both pain management as well as addressing individualized goals of care. Newer treatment options are often implemented in patients with relapsing multiple myeloma, and have the potential to cause further treatment related adverse effects. The role of palliative care in this subgroup needs further exploration. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified hospitalized patients who have relapsing multiple myeloma and subsequently had a palliative care encounter using appropriate ICD-10 CM codes. We stratified patients based on whether they had a palliative care encounter during the hospitalization or not. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of <0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among hospitalized patients with relapsing multiple myeloma with an in-patient palliative care encounter looking primarily at the in-hospital mortality, hospital LOS as well as total hospital charges. Results We identified a total of 16,726 hospitalized patients with relapsing multiple myeloma, of which 11.30% (1890/16,726) had an in-patient palliative care encounter. The overall in-hospital mortality among those with multiple myeloma was 9.86% (1040/16,726). Among those who had a palliative care encounter, the overall in-hospital mortality rate was significantly higher at 29.97% (566/1890) (p=<0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, the inpatient palliative care encounter among hospitalized multiple myeloma patients significantly increased the risk for in-hospital mortality (adjusted OR 11.99, 95% confidence interval [CI], 8.03-17.92; p=<0.001), longer hospital LOS (median LOS 7 days versus 5 days, p=<0.001) and higher total hospital charges (median total hospital charge 76131 vs 48855, p=0.002) Conclusion Our analysis revealed a statistically significant increased risk of in-hospital mortality, hospital LOS, and total hospital charges in hospitalized patients with relapsing multiple myeloma who had a palliative care encounter. Caution should be exercised in interpreting these results as they may reflect uncontrolled and more advanced disease in patients utilizing palliative care. Further prospective studies are needed to better understand short and long-term outcomes in this patient population.

Efficacy and safety of perioperative ketamine for the prevention of chronic postsurgical pain: A meta-analysis.

Assessment of the efficacy and safety of perioperative intravenous ketamine in reducing incidence and severity of chronic postsurgical pain. A systematic review and meta-analysis of randomized controlled trials (RCTs). The following data sources were systematically searched: MEDLINE, CENTRAL, and EMBASE (till 02/2021). Adult patients undergoing any surgery. Perioperative use of intravenous ketamine as an additive analgesic drug compared to placebo, no active control treatment, and other additive drugs. Primary outcomes were number of patients with chronic postsurgical pain after 6 months and ketamine related adverse effects. Secondary outcomes were chronic postsurgical pain incidence after 3 and 12 months, chronic postsurgical neuropathic pain incidence, chronic postsurgical moderate to severe pain incidence, intensity of chronic postsurgical pain at rest, and during movement, oral morphine consumption after 3, 6, and 12 months and incidence of opioid-related adverse effects. Thirty-six RCTs were included with a total of 3572 patients. Ketamine compared to placebo may result in no difference in the number of patients with chronic postsurgical pain after 6 months (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.71-1.05; I2 = 34%; 16 studies; low-certainty evidence). Ketamine may reduce the incidence of chronic postsurgical neuropathic pain after 3 months in comparison to placebo (RR 0.78, 95% CI 0.62-0.99, I2 = 31%, seven trials, low-certainty evidence). Ketamine compared to placebo may increase the risk for postoperative nystagmus (RR 9.04, 95% CI 1.15-70.90, I2 30%, two trials, low-certainty evidence) and postoperative visual disturbances (RR 2.29, 95% CI 1.05-4.99, I2 10%, seven trials, low-certainty evidence). There is low-certainty evidence that perioperative ketamine has no effect on chronic postsurgical pain in adult patients. Low-certainty evidence suggests that ketamine compared to placebo may reduce incidence of chronic postsurgical neuropathic pain after 3 months. Questions like ideal dosing, treatment duration and more patient-related outcome measures remain unanswered, which warrants further studies. Prospero CRD42021223625, 07.01.2021.

Amiodarone induced thyroid dysfunction

Abstract Introduction Amiodarone causes hypothyroidism in 12-25% of treated patients, depending on the classification of hypothyroidism. Amiodarone induced thyrotoxicosis is seen in 1.2%-12%. It is recommended to taper thyroid supplementation after discontinuing amiodarone. Purpose To investigate the prevalence of amiodarone induced thyroid dysfunction in Iceland and the effects of dosage and treatment duration. Design The study population comprised of all patients that were subscribed amiodarone in Iceland during the calendar year of 2014, a total of 1054 patients. Ten patients that never took amiodarone were excluded and there was missing data in 22. Hypothyroidism had been diagnosed in 91 patients before starting amiodarone and 59 took amiodarone for less than 90 days and were excluded from further analysis, leaving 871 patients. Follow up data was obtained from the national health care records both retrospectively and prospectively for first prescription of amiodarone and signs of thyroid related problems. Amiodarone induced hypothyroidism was defined as a raised TSH more than 90 days after starting treatment and further classified into subclinical (with normal T4) and overt (low T4). Amiodarone induced thyrotoxicosis was defined as low TSH with an elevated T4. Results Amiodarone induced hypothyroidism was seen in 22.2% of patients at a mean age of 74 years. 10.7% had overt AIH and 11.6% had subclinical hypothyroidism. Hypothyroidism occurred on average after 3.3 ±0.4 years of treatment. The incidence increased with treatment duration and peaked at 41.8% after 15 years of treatment. The risk did not change with dosage. Only 4.6% on thyroid supplementation therapy had stopped treatment after a mean follow-up of 4.5 years after discontinuing amiodarone. Amiodarone induced thyrotoxicosis was seen in 10.0% with a mean age of 65.6 years. The mean duration of treatment at diagnosis of thyrotoxicosis was 3.9 ±0.6 years. The cumulative risk of thyrotoxicosis was highest (9.9%) during years 3 to 5 but persisted with ongoing treatment and peaked at 17.6% after 13 years of treatment. Higher dosage of amiodarone increased the risk in a dose dependent manner. It was 5% with <200 mg, 11.8% with 200 mg and 14.1% with >200mg (p<0.01). Hospital admission due to thyrotoxicosis was required in 35.3% of patients, 8.8% had thyroidectomies, 2.0% died and 26.5% had hypothyroidism following thyrotoxicosis. 48% were treated with carbimazole, of them 2.0% suffered agranulocytosis, 4.1% had hepatitis and 4.1% had pancreatitis. Conclusion In this nationwide study we found that long term users of amiodarone are at a higher risk of amiodarone induced hypothyroidism or thyrotoxicosis than previously described. Thyroid supplementation treatment is rarely stopped despite the pro-arrhythmic risk of overtreating hypothyroid patients. The high incidence of thyroid related adverse effects is a reminder of the serious side effects of amiodarone treatment.Amiodarone induced hypothyroidismAmiodarone induced Thyrotoxicosis

Impact of prophylactic dexamethasone on the efficacy of immune checkpoint inhibitors plus platinum-based chemotherapy in patients with advanced Non-Squamous Non-Small-Cell lung cancer

BackgroundBaseline corticosteroids exposure is associated with inferior clinical outcomes in patients with non-small-cell lung cancer (NSCLC) treated with programmed cell death-1 (PD-1) axis blockade. Dexamethasone is a potent corticosteroid used in the prevention of chemotherapy-associated adverse events (CAAEs). ObjectiveSince dexamethasone has immunosuppressive properties, this study attempted to elucidate its effects on the efficacy of immunotherapy plus chemotherapy in patients with non-squamous NSCLC. MethodsThe study retrospectively analyzed the medical records of 254 advanced non-squamous NSCLC patients who received front-line treatment with a PD-1 pathway inhibitor and platinum-based chemotherapy at three academic institutions. The average dosage of prophylactic dexamethasone per chemotherapy cycle was calculated. Patients were divided into three groups based on the dose of dexamethasone: High-d (≥24 mg), Moderate-d (12–24 mg), and Low-d (<12 mg). Spearman's rank correlation was used to assess the correlation between the dosage of dexamethasone and progression-free survival (PFS). Logistic regression was used to assess the correlation between dexamethasone dosage and the occurrence of immune related adverse effects (irAE). Univariate and multivariate Cox proportional hazards regression models were used to analyze the differences in survival among the different dexamethasone dosage groups. ResultThe dosage of prophylactic dexamethasone was not significantly correlated with PFS (Spearman’s rho = -0.103, P = 0.098). Results from the univariate [hazard ratio (HR)Low-d/High-d, 1.00; P = 0.997; HRModerate-d/High-d, 0.85; P = 0.438] and multivariate (HRLow-d/High-d, 0.71; P = 0.174; HRModerate-d/High-d, 0.87; P = 0.512) analyses showed no significant association between dexamethasone and PFS. Dexamethasone did not have significant effect on the objective response rate, disease control rate or overall survival. The toxicity profiles of irAE were similar across all three groups. ConclusionThe results of this study suggest that the use of prophylactic dexamethasone does not have an adverse effect on the clinical outcomes of non-squamous NSCLC patients treated with PD-1 blockade therapy and chemotherapy. Routine use of dexamethasone for preventing CAAEs should be recommended for patients undergoing combined immunotherapy and chemotherapy.

Needle-free electronically-controlled jet injector treatment with bleomycin and lidocaine is effective and well-tolerated in patients with recalcitrant keloids.

The treatment of recalcitrant keloids is challenging. Although intralesional bleomycin using conventional needle injectors (CNI) is effective, it has important drawbacks, such as the need for repetitive and painful injections. Therefore, we aimed to evaluate the effectiveness, tolerability and patient satisfaction of intralesional bleomycin with lidocaine administered with a needle-free electronically-controlled pneumatic jet-injector (EPI) in recalcitrant keloids. This retrospective study included patients with recalcitrant keloids who had received three intralesional EPI-assisted treatments with bleomycin and lidocaine. Effectiveness was assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline and four to six weeks after the third treatment. Additionally, treatment related pain scores numeric rating scale, adverse effects, patient satisfaction and Global Aesthetic Improvement Scale (GAIS) were assessed. Fifteen patients with a total of >148 recalcitrant keloids were included. The median total POSAS physician- and patient-scores were respectively 40 and 41 at baseline, and reduced with respectively 7 and 6-points at follow-up ( p < 0.001; p < 0.001). The median pain scores during EPI-assisted injections were significantly lower compared to CNI-assistant injections, (2.5 vs. 7.0, respectively ( p < 0.001)). Adverse effects were mild. Overall, patients were "satisfied" or "very satisfied" with the treatments (14/15, 93.3%). The GAIS was "very improved" in one patient, "improved" in nine patients and "unaltered" in four patients. EPI-assisted treatment with bleomycin and lidocaine is an effective, well tolerated, patient-friendly alternative for CNI in patients with recalcitrant keloid scars. Randomized controlled trials are warranted to confirm our findings and improve the clinical management of recalcitrant keloids.

Abstract 16756: Trends of Cardiovascular Deaths in Patients With Melanoma From 2005 to 2019: An Analysis Based on SEER Program Database

Introduction: Melanoma is the fifth most common cancer diagnosis in the United States. With recent advances in treatment modalities, including immune checkpoint inhibitors (ICIs), targeted therapies, there has been improvement in survival among melanoma patients. However, increasing resistance and treatment related adverse effects (TrAEs) are being reported including cardiovascular side effects. Objectives: To evaluate the trend of cardiovascular specific death rate among patients with melanoma. Methods: We used Surveillance, Epidemiology, and End Results (SEER) Program database 17 registries from 2000 to 2019 and SEER*Stat Version 8.4.1 software to analyze the data using the rate session. Joinpoint software, version 4.7.1.0 was used to create log-linear time trends annually. Results: Our study included 301,632 patients with melanoma from 2005 to 2019. The annual percentage change (APC) of melanoma was 0.46% (95% CI -1.45 to 1.07, p&gt;0.05) annually from 2005 to 2011 and 3.33% (95% CI 1.79 to 4.27, p&lt;0.05) annually from 2011 to 2014 and the incidence rate decreased by 0.06% (95% CI -1.44 to 0.5, p&gt;0.05) annually from 2014 to 2019. Melanoma specific mortality rate increased annually by 2.03 % (95% CI 0.78 to 3.94, P &lt;0.05) from 2005 to 2013 and decreased by 5.49% annually (95% CI -8.65 to -3.65, P &lt;0.05) from 2013 to 2019. Cardiovascular disease specific mortality rate increased by 7.08% annually (95% CI 4.66 to 9.64, P &lt;0.05) from 2005 to 2019. (Figure 1) Conclusion: Our study shows that there has been an annual increase in cardiovascular specific mortality rate from 2005 to 2019, while there was annual decrease in melanoma specific mortality rate from 2013 to 2019. Increase in cardiovascular specific death rates could be due to the direct toxicity of newer therapies and prolonged survival, which further could be due to advancement in diagnostics and newer therapies.

Incidence and treatment of checkpoint inhibitor induced immune related adverse events in the emergency department.

438 Background: Immune checkpoint inhibitors (ICPis) are currently indicated for the treatment of various types of cancers. Through inhibition of the cancer cell’s checkpoint mediated T-cell evasion, ICPis allow for sustained T-cell activation and proliferation, resulting in increased cancer cell death. However, due to increased activation and proliferation of cytotoxic T-cells, ICPis have been associated with a wide spectrum of adverse effects, known as immune related adverse effects (irAEs). Although recently updated, the 2018 NCCN and ASCO guidelines state that treatment is based on the location and severity of irAEs. In general, grade 3 toxicities warrant suspension of ICPis and initiation of high-dose corticosteroids. Corticosteroids should then be tapered over the course of at least 4-6 weeks. The diagnosis of an irAE is challenging, toxicities may be misdiagnosed as there is a diverse familiarity with ICPis and their associated irAEs. Subsequently, care may be delayed, and patients may not receive appropriate guideline directed care. Methods: This multi-center chart review included 7 hospitals within a large health system. Our electronic health record was utilized to compile a report of patients who had received ICPIs within 12 months of presentation to an ED within the health system between 9/1/2019 and 9/1/2022. Assessed outcomes included incidence and type of irAE, time between last ICPi dose and presentation to the ED, steroid used for treatment, time to steroid, treatment driver, and the action that deviated from the 2018 ASCO/NCCN guideline directed treatment if applicable. Results: Of the 241 patients receiving an ICPi, 26 (10.8%) experienced an irAE that prompted a visit to an ED within our health system. Guideline directed treatment of irAE(s) was followed 76.9% of the time, with the steroid dose being too low (15.4%) and the steroid taper occurring too quickly (7.7%) being the two reasons for discordant treatment. Treatment started a median of 1.1 after presentation to an ED, with colitis as the most prevalent irAE in 11 patients (42%) presenting. For all patients, there was an average of 20 days between the last ICPi dose and presentation to ED. The main steroid used was methylprednisolone (42%). Conclusions: The 10.8% of patients who experienced an irAE that prompted a visit to an ED within our health system is a lower rate than what has been described in the literature previously, where rates of presentation to an ED due to an irAE ranged from 25-37%. This could be due to previous data coming from before or shortly after the publication of ASCO and NCCN guidelines in 2018, or because our outpatient medical staff has become more aware of irAEs and their appropriate treatment. Limitations include this review was retrospective, no patients had an irAE that was refractory to steroids, and the study period being soon after national guidelines were published.

County-level artificial light at night (ALAN) in the contiguous US (2012-2019): spatial variations, temporal trends, and environmental justice analyses.

Artificial light at night (ALAN) is a growing environmental hazard with economic, ecological, and public health implications. Previous studies suggested a higher burden of light pollution and related adverse effects in disadvantaged communities. It is critical to characterize the geographic distribution and temporal trend of ALAN and identify associated demographic and socioeconomic factors at the population level to lay the foundation for environmental and public health monitoring and policy-making. We used satellite data from the Black Marble suite to characterize ALAN in all counties in contiguous US and reported considerable variations in ALAN spatiotemporal patterns between 2012 and 2019. As expected, ALAN levels were generally higher in metropolitan and coastal areas; however, several rural counties in Texas experienced remarkable increase in ALAN since 2012, while population-level ALAN burden also increased substantially in many metropolitan areas. Importantly, we found that during this period, although the overall ALAN levels in the USA declined modestly, the temporal trend of ALAN varied across areas with different racial/ethnic compositions: counties with a higher percentage of racial/ethnic minority groups, particularly Hispanic populations, exhibited significantly less decline. As a result, the differences in ALAN levels, as measured by the Black Marble product, across racial/ethnic groups became larger between 2012 and 2019. In conclusion, our study documented variations in ALAN spatiotemporal patterns across America and identified multiple population correlates of ALAN patterns that warrant further investigations. Future studies should identify underlying factors (e.g., economic development and decline, urban planning, and transition to newer lighting technologies such as light emitting diodes) that may have contributed to ALAN disparities in the USA.

The dark side of light at night: assessing breast cancer risk with a dose-response meta-analysis

Abstract Light at night (LAN) is a ubiquitous environmental issue resulting from exposure to artificial light during the night-time hours. The adverse effects of LAN include circadian disruption, melatonin suppression and altered clock gene expression. Very recent evidence suggests that LAN may increase risk of several diseases, including cancer. Breast cancer is the most common diagnosed cancer globally and the second leading cause of cancer-related mortality. Several environmental and life-style related risk factors have been linked to breast cancer onset. In this updated meta-analysis, we investigated how exposure to LAN may affect breast cancer risk. Using systematic online database searches (PubMed, Scopus, and Web of Science), we included 19 eligible studies (10 cohort and 9 case-control) investigating the association between LAN, either outdoor or indoor, and breast cancer risk. We first performed a meta-analysis comparing the highest versus lowest levels of exposure. Then, we performed a dose-response meta-analysis to investigate the shape of such relation. Overall, we found a positive association between LAN and breast cancer (risk ratio [RR] 1.08, 95% confidence interval-CI 1.03-1.13). In stratified analyses, the risk was more pronounced in premenopausal (RR 1.15, 95% CI 1.05-1.26) and normal-weighted (RR 1.17, 95% CI 1.00-1.36) women, while stratifying for outdoor/indoor exposure and for estrogen receptor status did not gave substantial differences in the risk estimates. The dose-response relation showed a linear risk increase up to 60 nW/cm2/sr after which the curve reached a plateau, especially among premenopausal women. These results strengthen the hypothesis that LAN is associated with breast cancer risk. Public health measures are warranted to minimize LAN exposure and reduce its related adverse effects on human health. Key messages • Light at night is positively associated with breast cancer risk. • The dose–response relation between light at night and breast cancer supports a positive association particularly in premenopausal women.

SAT340 Matters Of The HAART - Ritonavir Induced CYP3A4 Inhibition of Intranasal Fluticasone Leading To Cushing’s Syndrome

Abstract Disclosure: A. Ramachandran: None. S. Ghaith: None. A. Ramachandran: None. Background: Ritonavir, a potent inhibitor of the CYP3A4 enzyme, can lead to high systemic concentrations of even intranasal steroids causing Cushing’s syndrome. Case: A fifty-seven-year-old man with history of HIV on HAART presented with a 3-month history of fatigue, weight gain and easy bruising. History was negative for heat/cold intolerance, hair loss, constipation, erectile dysfunction. Medications included emtricitabine-tenofovir-alafenamide and ritonavir at stable doses for several years. He denied taking any oral or topical steroids, but reported using over the counter (OTC) fluticasone propionate (FP) for the past 6 months for seasonal allergies. Physical examination was significant for moon facies and abdominal striae. Labs were remarkable for low serum morning cortisol of 0.6 µg/dl (0.4-22.6 µg/dl), and low serum ACTH of &amp;lt;5 pg/ml (7-69 pg/ml). A diagnosis of exogenous steroid induced Cushing’s syndrome, as a result of ritonavir induced increase in FP levels was made. FP was gradually tapered and stopped. Serum cortisol and ACTH levels normalized at 15 µg/dl and 13 pg/ml respectively and his symptoms resolved completely after three months. Discussion: Ritonavir, a protease inhibitor (PI), is one of the strongest known inhibitors of CYP3A4 and is generally used to boost the plasma levels of other PIs. FP, a potent glucocorticoid, is generally used as monotherapy or as a combination inhaler in the treatment of asthma. It is rapidly metabolized by CYP3A4 and hence produces minimal side effects. However, its concurrent use with ritonavir results in increased serum concentration of FP leading to systemic adverse effects of glucocorticoids. Due to emerging awareness about this drug-drug interaction among physicians, prescription of inhalational steroids in patients on ritonavir is avoided. However, FP is an OTC intranasal glucocorticoid that is easily accessible, and its self-use is often times not reported by patients which makes it difficult for physicians to track on their patient’s medication list. A thorough review of OTC medications/supplements needs to be done when Cushing’s syndrome from exogenous steroids is suspected. It is also imperative that patients on ritonavir be counseled about the risks of taking any form of steroid formulations by any route. Conclusion: Educating patients on ritonavir about steroids being a component of many OTC medications/supplements, and a careful medication history and drug-drug interaction assessment is important in preventing steroid related adverse effects. Presentation: Saturday, June 17, 2023

Seroconversion and safety of Covid-19 vaccines in patients with chronic liver disease and liver transplant: A systematic review

Background and Aims: As part of the COVID-19 control strategy, a growing number of vaccine portfolios evolved and got fast-tracked through regulatory agencies, with a limited examination of their efficacy and safety in vulnerable populations, such as patients with chronic conditions and immunocompromised states. Patients with chronic liver disease (CLD), and cohorts post liver transplant (LT) in particular, were underrepresented in the determinant trials of vaccine development, hence the paucity of data on their efficacy and safety in published literature. This systematic review aims to examine the available evidence and ascertain the effectiveness and safety of Covid-19 vaccination in patients with CLD and those with LT. Methods: A systematic review of PubMed (Medline), Google Scholar, Cochrane Library, and ScienceDirect from inception until 1st March 2022 was conducted. We included observational studies and assessed vaccine efficacy regarding seroconversion or immunological rate, whereas serious or significant adverse effects have been considered safety outcomes when reported. Results: Studies comprised 45275 patients, performed in 11 different countries. Seroconversion or immunological rate after Covid-19 vaccination was mostly the primary endpoint, whereas other endpoints like covid-19 related adverse effects were also reported. Twenty-four of the final analyzed studies are prospective cohort studies, while four are retrospective cohort studies. Twenty-one studies included patients who underwent LT and received the Covid vaccine; nine included patients who had CLD due to various etiologies. The median age range of all included patients varied from 43–69 years. All patients with LT who received at least two doses of Covid vaccine had a seroconversion rate of around 60%. Patients with CLD had a seroconversion rate of about 92% post two doses of Covid vaccination. The average seroconversion rate in post-transplant recipients was around 45% after two doses of the significant Covid vaccines: Pfizer, AstraZeneca, Moderna, and Jansen. Only two studies have reported a higher seroconversion rate of 75% and 73% after the third dose of Covid vaccine. No significant adverse effects were reported in all studies; the most commonly reported negative effect was local injection site pain. Conclusion: The present systematic review, comprising real-world observational data studies, concludes that Covid-19 vaccination was associated with 92% and 60% seroconversion rates in patients with CLD and LT, respectively. No significant side effects were reported in all studies. This finding helps to resolve the uncertainty associated with Covid-19 vaccination in this cohort of patients.

Effects of Remote Ischemic Preconditioning on Delirium and Neurological Function in Patients Undergoing Cardiac Surgery: A Multicenter Randomized Controlled Trial.

Postoperative delirium (POD) and neurological dysfunction are very common following cardiac surgery and deteriorate the patient's prognosis and the outcome of surgical procedures. A clinically effective management strategy or drug is not yet available for POD. Additionally, it is unknown whether remote ischemic preconditioning (RIPC) has neuroprotective and anti-delirium benefits in patients who undergo cardiac surgery. This study examined whether RIPC can improve POD and neurological function in cardiac surgery patients. We screened 510 consecutive adult patients aged 18 and older who underwent cardiac surgery between January 2018 and December 2022. Then, 448 of these patients were recruited in the trial as the intention to treat (ITT) group, who were then randomly assigned to receive either a control (n = 223) or RIPC treatment (n = 225). The primary outcome measures were hospitalization postoperative delirium, six-month modified Rankins scale (mRS), hospital cerebral infarction, 30-day overall mortality, neuron-specific enolase (NSE) and S-100b levels, related adverse effects, hospital costs, and hospital stay. A statistically significant variation was not observed between the two groups in terms of the baseline clinical data. In contrast to the control group, the POD in the RIPC group was considerably alleviated. RIPC treatment also decreased the levels of NSE and S-100b, which alleviated nerve injury. The adverse impacts of RIPC-induced objective indicators of tissue or neurovascular damage were similar in both groups, showing no significant variations between the two. The hospital stays and hospitalization costs also decreased significantly in the RIPC-treated patients. The study findings suggested that RIPC may benefit cardiac surgery patients by reducing POD, alleviating injury, and lowering hospital expenditures and length of stay. Cardiac surgery patients can be treated with RIPC, which is an effective and safe technique.

Cause of hospitalization and its outcome in patient with chronic myeloid leukemia in Patan Hospital

Introduction: Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm characterized by dysregulated proliferation of granulocytes because of reciprocal translocation of chromosome 9 and 22. Despite the advances in treatment of CML, it still has a significant burden in patients’ life because of cost of medication, frequent hospitalization and effect on quality of life. The aim of this study is to find out the cause of hospitalization and its outcome in patient with CML. Method: It is a retrospective cross-sectional study conducted at Patan Hospital. The study included data of hospitalization of CML patients over a period of 3 years from April 2020 to April 2023 which was obtained from the record files and discharge notes of the patients. The data included information regarding age and sex of the patients, phase of disease, name of Tyrosine kinase inhibitor (TKI) used, cause of hospitalization and outcome of the hospitalization. Result: There were total of 102 admissions of which 82 admissions were analyzed. The mean age was 49 y, 56% were male, 70.7% were in chronic phase of disease and imatinib was the commonest TKI used (51.2 %). Disease related events were the most common cause of hospital admission (61%); 70 patients (85.4%) improved and were discharged whereas 12 patients (14.6 %) died during hospitalization. Conclusion: The commonest cause of hospitalization in CML patient was disease related events i.e., disease progression, drug related adverse effects and new diagnosis. Transformation to blast crisis had worst prognosis with increased mortality.

Adjunctive dexamethasone palmitate use for intercostal nerve block after video-assisted thoracoscopic surgery: A prospective, randomized control trial

ObjectivesThe efficacy of dexamethasone palmitate in extending durations of local anesthetic blocks is uncertain. In a randomized, double-blind study of patients undergoing video-assisted thoracoscopic surgery, we tested whether intravenous or perineural dexamethasone palmitate caused prolonged analgesia after intercostal nerve block. MethodsA total of 90 patients subjected to video-assisted thoracoscopic surgery between May and December 2022 were randomly assigned to one of three intercostal nerve blocks study arms (n = 30 each), requiring the addition of 0.5% ropivacaine (23 ml) as follows: controls (C group), 2 ml saline; IV-DXP group, 2 ml saline + 2 ml (8 mg) intravenous dexamethasone palmitate; and PN-DXP group, 2 ml (8 mg) perineural dexamethasone palmitate. Time to first postoperative remedial analgesia served as primary outcome measure. Secondary endpoints included postoperative opioid consumption, pain scores by Visual Analog Scale, analgesia satisfaction, and related adverse effects. ResultsCompared with controls or the IV-DXP group, time to first postoperative remedial analgesia was longer and postoperative opioid consumption for rescue analgesia was lower in the PN-DXP group (p < 0.01). Similarly, the Visual Analog Scale scores in patients at 8, 12, 18, and 24 h postoperatively were lower in the PN-DXP group than in controls and the IV-DXP group (p < 0.01). Patient satisfaction was statistically lower in the PN-DXP group, compared with either the control or IV-DXP group (p < 0.05). Clinically, the three groups did not differ significantly in occurrences of adverse effects during the 48-h postoperative monitoring period (p > 0.05). ConclusionsPerineural dexamethasone palmitate is a promising adjunct to ropivacaine intercostal nerve block by prolonging analgesia with almost no related adverse effects.

Natural Compounds Derived from Plants on Prevention and Treatment of Renal Cell Carcinoma: A Literature Review.

Renal cell carcinoma (RCC) accounts for roughly 85% of all malignant kidney cancer. Therapeutic options for RCC have expanded rapidly over the past decade. Targeted therapy and immunotherapy have ushered in a new era of the treatment of RCC, which has facilitated the outcomes of RCC. However, the related adverse effects and drug resistance remain an urgent issue. Natural compounds are optional strategies to reduce mobility. Natural compounds are favored by clinicians and researchers due to their good tolerance and low economic burden. Many studies have explored the anti-RCC activity of natural products and revealed relevant mechanisms. In this article, the chemoprevention and therapeutic potential of natural compounds is reviewed and the mechanisms regarding natural compounds are explored.

Assessment of Changes in Tumor Volume Following Chemotherapy For Nodular Sclerosıng Hodgkin Lymphoma (NSHL)

Objective: Hodgkin lymphoma is a critical malignancy which may be seen during childhood and adolescence. Since it may be observed in younger patients, treatment strategies should be considered thoroughly to achieve optimal results in terms of local control and treatment related adverse effects. Systemic therapy plays a critical role in treatment of Hodgkin lymphoma. In this study, we evaluated changes in tumor volume following chemotherapy for nodular sclerosing Hodgkin lymphoma (NSHL).

Can brain stimulation enhance cognition in clinical populations? A critical review.

Many psychiatric and neurological conditions are associated with cognitive impairment for which there are very limited treatment options. Brain stimulation methodologies show promise as novel therapeutics and have cognitive effects. Electroconvulsive therapy (ECT), known more for its related transient adverse cognitive effects, can produce significant cognitive improvement in the weeks following acute treatment. Transcranial magnetic stimulation (TMS) is increasingly used as a treatment for major depression and has acute cognitive effects. Emerging research from controlled studies suggests that repeated TMS treatments may additionally have cognitive benefit. ECT and TMS treatment cause neurotrophic changes, although whether these are associated with cognitive effects remains unclear. Transcranial electrical stimulation methods including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) are in development as novel treatments for multiple psychiatric conditions. These treatments may also produce cognitive enhancement particularly when stimulation occurs concurrently with a cognitive task. This review summarizes the current clinical evidence for these brain stimulation treatments as therapeutics for enhancing cognition. Acute, or short-lasting, effects as well as longer-term effects from repeated treatments are reviewed, together with potential putative neural mechanisms. Areas of future research are highlighted to assist with optimization of these approaches for enhancing cognition.

Increased risk for incisional hernia following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

The incidence of incisional hernias (IH) after midline laparotomy varies from 11% to 20%. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is potentially prone to hernias because a Xiphoid to pubis laparotomy incision performed on patients who have undergone previous abdominal surgeries with the addition of chemotherapy and its related adverse effects. We performed a retrospective analysis on a prospectively maintained single institution database from March 2015 to July 2020. The inclusion criteria were patients who underwent CRS-HIPEC and had at least 6 months postoperative follow-up with post-operative cross-sectional imaging study. Two hundred and one patients were included in the study. All patients underwent CRS-HIPEC with resection of previous scar and umbilectomy. Fifty-four patients were diagnosed with IH (26.9%). The major risk factors for IH in multivariate analysis were higher American society of Anesthesiologists score (ASA) (OR 3.9, P = 0.012), increasing age (OR 1.06, P = 0.004) and increasing BMI (OR 1.1, P = 0.006). Most of the hernia sites were median (n = 43, 79.6%). Eleven (20.4%) patients had lateral hernias due to stoma incisions or drain sites. Most of the median hernias were at the level of the resected umbilicus 58.9% (n = 23). Five (9.3%) of the patients with IH necessitated an urgent surgical repair. We have demonstrated that more than a quarter of the patients after CRS-HIPEC suffer from IH and up to 10% of them may require surgical intervention. More research is needed to find the appropriate intraoperative interventions to minimize this sequela.

Struggling with COVID-19 in Adult Inborn Errors of Immunity Patients: A Case Series of Combination Therapy and Multiple Lines of Therapy for Selected Patients.

The SARS-CoV-2 infection is now a part of the everyday lives of immunocompromised patients, but the choice of treatment and the time of viral clearance can often be complex, exposing patients to possible complications. The role of the available antiviral and monoclonal therapies is a matter of debate, as are their effectiveness and potential related adverse effects. To date, in the literature, the amount of data on the use of combination therapies and on the multiple lines of anti-SARS-CoV-2 therapy available to the general population and especially to inborn error of immunity (IEI) patients is small. Here, we report a case series of five adult IEI patients managed as inpatients at three Italian IEI referral centers (Rome, Treviso, and Cagliari) treated with combination therapy or multiple therapeutic lines for SARS-CoV-2 infection, such as monoclonal antibodies (mAbs), antivirals, convalescent plasma (CP), mAbs plus antiviral, and CP combined with antiviral. This study may support the use of combination therapy against SARS-CoV-2 in complicated IEI patients with predominant antibody deficiency and impaired vaccine response.

Exploring the feelings of being at risk of vaccine related adverse effects: A cross-sectional survey in France

ObjectivesThe literature on vaccine hesitancy has widely commented on the various factors leading some to feel particularly at risk of disease infection while others do not. But little attention has been paid to whether we also see such differences regarding people's assessment of their personal vulnerability towards vaccine adverse events (AEs). MethodsWe designed two cross-sectional online surveys among representative samples of the French mainland population (n = 2015 and 3087). We asked participants if they felt, more than others, at risk of severe vaccine related side effects and to explain why. We performed two separate mixed effect binomial regressions models: 1) to explore the link between the feeling of being particularly at risk of severe vaccine related AEs and socio-demographic characteristics, source of information, trust in health agencies and partisan orientation; 2) to explore the link between the fear of side effects and vaccine hesitancy. ResultsWe found that 15% of respondents felt to be, more than others, at risk of severe vaccine-related adverse events and that this feeling was associated to negative attitudes to vaccines. This feeling was particularly prevalent among women, those with a lower income, lower educational attainment and lower trust in public health institutions. The vast majority of the reasons given by responders are unrelated to genuine risk factors of vaccine related adverse events. ConclusionsThese findings suggest that vaccine hesitancy is at least partly grounded in a feeling of vulnerability towards vaccine adverse events.