Standard Short Course Research Articles

Reduced Corticosteroid Exposure Is Safe and Does Not Reduce Disease Control among Hodgkin Lymphoma Patients Treated with Escalated BEACOPP (eBEACOPP).

Background and Objectives: eBEACOPP is the most effective chemotherapy regimen for younger patients with early unfavorable (EU) and advanced-stage (AS) Hodgkin lymphoma (HL), albeit with significant toxicities. The 14-day/cycle prednisone course contributes to side effects, including osteoarticular events like avascular bone necrosis (AVN). Our center has been using eBEACOPP since 2009 for AS and 2014 for EU patients. In 2016, we reduced prednisone treatment to 7-10 days to lessen AVN risk. We analyzed the effects of this approach. Materials and Methods: We retrospectively collected data on patients who received at least two cycles of eBEACOPP for first-line HL treatment. Results: A total of 162 patients (33 EU, 129 AS) were included. Their median age was 31 (range 19-59 years), and 88 were males. A total of 94 patients received full corticosteroid courses, and 68 received reduced corticosteroid courses. The overall response rate (ORR) was 98%. Different corticosteroid dosings had no significant effect on ORR, febrile neutropenia episodes, or hospital admissions. After a median follow-up (mFU) of 58 months, the 5yPFS for the entire cohort was 98% vs. 95% for the standard course vs. the short corticosteroids course, respectively (p = 0.37), while the 5yOS was 98% vs. 99% for the standard course vs. short corticosteroids course, respectively (p = 0.87). In AS patients intended to be treated with six eBEACOPP cycles, 5yPFS and 5yOS were 100% vs. 97% and 100% vs. 99% for standard vs. short corticosteroid courses, respectively (p = 0.56 and p = 0.17). In EU patients, 5yPFS was 97% (standard) vs. 95% (short) (p = 0.98) and 5yOS 100% vs. 93.3% (p = 0.87). Osteoarticular events were numerically lower in patients receiving the shorter prednisone course, both in the whole cohort and in the subgroup of patients treated with six cycles of eBEACOPP, but this difference failed to reach statistical significance. Conclusions: eBEACOPP provides excellent and durable first-line disease control. Shortening the corticosteroid course does not compromise efficacy, potentially reducing toxicity. However, longer follow-ups and larger studies are needed for confirmation.

Architectural acoustics continuing education course—Presenter registration and reporting

The Technical Committee on Architectural Acoustics (TCAA) is a Registered Provider in the American Institute of Architects (AIA) Continuing Education System (CES). The TCAA has developed a standardized introductory short course for architects called “Architectural Acoustics,” for which attendees can earn one continuing education unit (CEU). This paper will cover the administrative requirements of the ASA/CES, to prepare potential presenters. These requirements include the proper handling of paperwork so that AIA members may receive credit for the course. The manner in which the course is given is also dictated by AIA requirements. TCAA membership and attendance at this workshop are required to qualify as an authorized presenter for this AIA/CES short course. Of course, anyone is free to register with the AIA to provide their own CEU program. However, the advantages of participating in this program are that the TCAA short course is already prepared, it is pre-approved by the AIA, and the registration fees are paid by the Acoustical Society of America.

Architectural acoustics short course presentation material

The Technical Committee on Architectural Acoustics (TCAA) is a Registered Provider in the American Institute of Architects (AIA) Continuing Education System (CES). The TCAA has developed a standardized introductory short course for architects called “Architectural Acoustics,” An architect can earn one continuing education unit (CEU) by attending this short course, if presented by a qualified member of TCAA. The course covers topics in sound isolation, mechanical system noise control, finish treatments, and implementation of quality acoustical spaces. This paper will cover the course material in order to prepare and qualify potential presenters. In order to qualify as an authorized presenter for this AIA/CES short course, attendance at this special session and membership in TCAA are required.

Impact of pyrazinamide usage on serious adverse events in elderly tuberculosis patients: A multicenter cohort study.

Pyrazinamide (PZA) usage has been associated with adverse drug reactions, prompting its avoidance in treating elderly tuberculosis (TB) patients. This study aims to examine whether the administration of PZA is associated with poor outcomes during TB treatment among elderly individuals. A retrospective analysis was undertaken on data collected from a prospective cohort conducted between July 2019 and June 2023, which involved tuberculosis patients from 18 institutions across the Republic of Korea. The study aimed to assess the impact of PZA on the incidence of serious adverse events (SAEs), medication interruptions, and becoming loss to follow-up (LTFU) during standard short courses of TB treatment in elderly (≥65 years old) patients. PZA was administered to 356 of 390 elderly patients (91.3%), and 98 of the 390 (25.1%) experienced SAEs. Treatment success was significantly lower in patients not treated with PZA compared to those who received PZA (64.7% vs 89.9%, p < 0.001). The incidence of SAEs, medication interruption, or LTFU was higher in patients not given PZA compared those who received PZA (52.9% vs. 27.2%, p = 0.002). A multivariate logistic regression analysis, factoring in covariates such as age, comorbidities, and baseline laboratory data, revealed that PZA was not a risk factor for SAEs, medication interruption, or LTFU in TB treatment (odds ratio [OR] 0.457, 95% confidence interval [CI] 0.201-1.041). Treating elderly TB patients with PZA did not increase the incidence of SAEs, medication interruptions, or LTFU during the standard short course of TB treatment. Therefore, considering its potential advantages, incorporating PZA into the treatment regimen for elderly TB patients may be advisable.

Comparison of pathological response of standard chemoradiotherapy versus short course radiotherapy in rectal carcinoma: A pilot study

Comparison of pathological response of standard chemoradiotherapy versus short course radiotherapy in rectal carcinoma: A pilot study

Diagnostic and Management Guidelines of Thyroid Tuberculosis: Our Experience and Systematic Review.

Thyroid tuberculosis has non-specific clinical presentation, difficult diagnosis and specific medical management. The aim of this article is to present and share a review of the English-language literature on thyroid tuberculosis in order to gain a better understanding of diagnostic methods and provide guidelines for its management and to present our experience of three cases. The systematic search of the literature was performed on Pubmed and Medline from 1950 to 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We retrieved 13 manuscripts meeting our criteria from the search. There were 7 case series, and 6 manuscripts with review of the literature. Direct histopathological demonstration is the best diagnostic modality. FNAC is the study of choice and PCR assay increases its sensitivity. The standard short course ATT for 6months is recommended for isolated thyroid TB and for widespread disease, 12months therapy is recommended. Surgery is reserved for failure of medical therapy and abscess formation.

Analysis of Pathologic Complete Response Rates Between Different Neoadjuvant Radiation Treatment Regimens for Rectal Cancer

The standard of care for rectal cancer is either long or short course radiation followed by surgery with or without adjuvant chemotherapy. Recently, total neoadjuvant therapy, an approach consisting of giving all chemotherapy and radiotherapy prior to definitive surgery, has been a promising alternative. This study aims to assess the pathologic complete response (pCR) rates among different neoadjuvant treatment regimens and determine if neoadjuvant chemotherapy improves pCR rates.Electronic medical databases were queried to identify rectal cancer patients treated with neoadjuvant therapy at our institution from 2006-2019. Patients were grouped according to neoadjuvant therapy received: long-course chemoradiation (CRT), long-course chemoradiation with chemotherapy (CRT TNT), short-course radiation (SCRT), and short-course radiation with chemotherapy (SCRT TNT). Patients without follow-up data or surgical pathology reports were excluded. pCR was defined as no evidence of disease at surgery. pCR rates were determined and compared using Chi-square analysis.A total of 249 patients were analyzed. Table 1 shows treatment characteristics in each group. There were 200 (80.3%) patients who received CRT, 26 (10.4%) who received CRT TNT, 13 (5.2%) who received SCRT, and 10 (4%) who received SCRT TNT. Initial stage was different between groups, with metastatic patients more likely to receive SCRT TNT (P < 0.001). The median time to surgery were significantly different between groups (P < 0.001). Eleven (42.3%) and 6 (60%) patients received FOLFOX, and 13 (50%) and 4 (40%) of the patients received XELOX for CRT TNT and SCRT TNT, respectively. The remaining patients (7.7%) in the CRT TNT group received Capecitabine. For CRT, 53 (26.5%) patients achieved pCR, 3 (11.5%) in CRT TNT, 1 (7.7%) in SCRT, and 2 (20%) in SCRT TNT. None of these differences were statistically different (P = 0.19). On univariate analysis, age (P = 0.13), clinical T stage (P = 0.13), clinical N stage (P = 0.95), time to surgery (P = 0.82), and presence of chemotherapy in the neoadjuvant regimen (P = 0.22) were not significant predictors for pCR.Total neoadjuvant treatment for rectal cancer did not improve pCR rates over standard chemoradiation or short course radiation alone, which is contrary to what published series suggest. These results maybe be explained in part by the fact that chemotherapy was delivered first and the time from completing radiation to the time of surgery was not significantly different between groups. These data suggest that meaningful gains in pCR rates may be achieve by sequencing chemoradiation earlier in the TNT course. Future studies are needed to investigate this hypothesis.

Architectural acoustics short course presentation material

The Technical Committee on Architectural Acoustics (TCAA) is a Registered Provider in the American Institute of Architects (AIA) Continuing Education System (CES). The TCAA has developed a standardized introductory short course for architects called “Architectural Acoustics.” An architect can earn one continuing education unit (CEU) by attending this short course, if presented by a qualified member of TCAA. The course covers topics in sound isolation, mechanical system noise control, finish treatments, and implementation of quality acoustical spaces. This paper will cover the course material to prepare and qualify potential presenters. In order to qualify as an authorized presenter for this AIA/CES short course, attendance at this special session and membership in TCAA are required.

Architectural acoustics continuing education course—Presenter registration and reporting

The Technical Committee on Architectural Acoustics (TCAA) is a Registered Provider in the American Institute of Architects (AIA) Continuing Education System (CES). The TCAA has developed a standardized introductory short course for architects called “Architectural Acoustics,” for which attendees can earn one continuing education unit (CEU). This paper will cover the administrative requirements of the ASA/CES, to prepare potential presenters. These requirements include the proper handling of paperwork so that AIA members may receive credit for the course. The manner in which the course is given is also dictated by AIA requirements. TCAA membership and attendance at this workshop are required to qualify as an authorized presenter for this AIA/CES short course. Of course, anyone is free to register with the AIA to provide their own CEU program. However, the advantages of participating in this program are that the TCAA short course is already prepared, it is pre-approved by the AIA, and the registration fees are paid by the Acoustical Society of America.

Antibiotic Duration and Outcome Complications for Surgical Site Infection Prevention in Traumatic Mandible Fracture

BackgroundThe appropriate duration of antibiotic therapy for surgical site infection (SSI) prevention in traumatic mandibular fracture repair is unknown, and practices vary significantly. The objective of this study was to characterize antibiotic duration and outcomes after surgical repair of traumatic mandibular fracture. MethodsA single-center, retrospective analysis of all adult patients who underwent surgical fixation of a mandible fracture between January 2014 and December 2016 was performed. Operative service was categorized between otolaryngology (ear, nose, and throat surgery), plastic and reconstructive surgery, and oral and maxillofacial services. Primary outcomes were SSI and operative complications (including osteomyelitis, nonunion, malocclusion, and hardware infections). Differences in antibiotic prescription pattern were analyzed using analysis of variance test and Pearson chi-squared test. ResultsA total of 75 patients were included in the study with 33 (44.0%), 26 (34.7%), and 16 (21.3%) managed by plastic and reconstructive surgery, ear, nose, and throat surgery, and oral and maxillofacial services, respectively. Median age was 30.0 y. Median injury severity score was 4.0. There was no significant difference in hospital length of stay (P = 0.44), intensive care unit length of stay (P = 0.53), or postoperative complications (P = 0.15). None of our patients developed an SSI or postantibiotics complications. Although the total inpatient duration of antibiotics was not significantly different among services (P = 0.37), there were significant differences in outpatient duration of antibiotics (P = 0.007) and total duration of antibiotics (P = 0.003). ConclusionsDuration of antibiotics is not associated with postoperative SSI or antibiotics-related complications. The wide variation in prescribing practices and lack of any clear benefit for prolonged antibiotics provides an opportunity to explore the benefits of a standardized short course of antibiotics. Level of evidenceTherapeutic study, III.

Architectural acoustics continuing education course—Presenter registration and reporting requirements

The Technical Committee on Architectural Acoustics (TCAA) is a Registered Provider in the American Institute of Architects (AIA) Continuing Education System (CES). The TCAA has developed a standardized introductory short course for architects called “Architectural Acoustics,” for which attendees can earn one continuing education unit (CEU). This paper will cover the administrative requirements of the AIA/CES, to prepare potential presenters. These requirements include the proper handling of paperwork so that AIA members may receive credit for the course. The manner in which the course is given is also dictated by AIA requirements. TCAA membership and attendance at this workshop are required to qualify as an authorized presenter for this AIA/CES short course. Of course, anyone is free to register with the AIA to provide their own CEU program. However, the advantages of participating in this program are that the TCAA short course is already prepared, it is pre-approved by the AIA, and the registration fees are paid by the Acoustical Society of America.

RTRB-14TREATMENT RECOMMENDATIONS FOR ELDERLY PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA LACK WORLDWIDE CONSENSUS

This study explored the current worldwide management strategies for elderly patients with newly diagnosed glioblastoma. A web-based survey was distributed to 168 radiation oncologists (RO), neuro-oncologists (NO) and neurosurgeons (NS) from the United Council for Neurologic Subspecialties and CNS subcommittees of international cancer groups. Questions addressed the influence of molecular information, age, and comorbidities on treatment recommendations to determine whether management consensus exists. Respondents were allowed to choose more than one response. There were 58 (39%) respondents (50% NO, 3.5% NS and 50% RO) with 73% having > 10 years experience. 90% were academicians and 55% reportedly saw >50 patients with GBM annually. The most important factors influencing treatment decisions were KPS (92%), MGMT methylation status (72%), and comorbidity index (31%). Only 42% of respondents factor in age with 60% defining elderly as > 70 years-old. The most common recommendations for MGMT-methylated elderly patients with KPS > 70 were standard chemoRT (58%), temozolomide alone (28%), and short course RT (28%). The most common recommendations for MGMT-unmethylated patients with KPS > 70 were standard chemoRT (45%), short course RT (45%), and short course chemoRT (20%). Recommendations for patients with KPS < 50 were short course RT (52%), supportive care (50%), or TMZ alone (22%). Novo-TTF is or will soon be available at 74% of institutions. The majority (85%) of institutions do not have a clinical trial specifically for elderly patients with GBM, although 94% expressed interest in participating in such a trial. 98% of respondents are willing to randomize MGMT-unmethylated elderly patients to an arm without TMZ. Over 90% of respondents are willing to use short course RT as the standard RT for elderly patients, irrespective of MGMT methylation status. This study highlights that worldwide treatment recommendations for elderly patients with newly diagnosed GBM vary widely. Further randomized studies are warranted to elucidate the optimal treatment strategy.

AIA/CES Provider registration and reporting requirements

The Technical Committee on Architectural Acoustics (TCAA) is a Registered Provider in the American Institute of Architects (AIA) Continuing Education System (CES). The TCAA has developed a standardized introductory short course for architects. The TCAA short course is called “Architectural Acoustics” and attendance at this one-hour long course can earn an architect one continuing education unit (CEU) with HSW Credit (Health Safety and Welfare). This paper will cover the administrative requirements of the AIA/CES, to prepare potential presenters. These requirements include the proper handling of paperwork, so that AIA members may receive credit for the course. Also, the manner in which the course is given is dictated by AIA requirements. TCAA membership and attendance at this workshop are required to qualify as an authorized presenter for this AIA/CES short course.

TCAA short course presentation material

The Technical Committee on Architectural Acoustics (TCAA) is a Registered Provider in the American Institute of Architects (AIA) Continuing Education System (CES). The TCAA has developed a standardized introductory short course for architects, called “Architectural Acoustics.” An architect can earn one continuing education unit (CEU) by attending this short course, if it is presented by a qualified member of TCAA. The course covers topics in sound isolation, mechanical system noise control, and finish treatments. This paper will cover the course material in order to prepare and qualify potential presenters. In order to qualify as an authorized presenter for this AIA/CES short course, attendance at this workshop and membership in TCAA are required.

Severe fludarabine neurotoxicity after reduced intensity conditioning regimen to allogeneic hematopoietic stem cell transplantation: a case report

Key Clinical MessageWe present a case of severe, irreversible neurotoxicity in a 55-year-old-patient with myelofibrosis undergoing hematopoietic stem cell transplantation following a reduced intensity conditioning including fludarabine. The patient developed progressive sensory-motor, visual and consciousness disturbances, eventually leading to death. MRI imaging pattern was unique and attributable to fludarabine neurotoxicity.

Treatment of Drug Susceptible Pulmonary Tuberculosis.

Tuberculosis (TB) remains a major global health problem, and the incidence of TB cases has not significantly decreased over the past decade in Korea. The standard short course regimen is highly effective against TB, but requires multiple TB-specific drugs and a long treatment duration. Recent studies using late-generation fluoroquinolones and/or high-dose rifapentine-containing regimens to shorten the duration of TB treatment showed negative results. Extending the treatment duration may be considered in patients with cavitation on the initial chest radiograph and positivity in sputum culture at 2 months of treatment for preventing TB relapse. Current evidence does not support the use of fixed-dose combinations compared to separate drugs for the purpose of improving treatment outcomes. All patients receiving TB treatment should be monitored regularly for response to therapy, facilitation of treatment completion, and management of adverse drug reactions. Mild adverse effects can be managed with symptomatic therapy and changing the timing of the drug administration, but severe adverse effects require a discontinuation of the offending drugs.

DRUG INDUCED HEPATITIS

Aims and Objectives: We evaluated whether HBV +ve and HCV +ve patients areat high risk for developing drug induced hepatitis than control subjects during treatment fortuberculosis with standard short course regimens. Study design: Observational cohort study.Place and duration: This study was conducted at Department of Medicine, Liaquat University ofMedical and Health Sciences Jamshoro from May 2008 to May 2011. Material and Methods: Allnewly diagnosed active tuberculosis patients were included in the study population and theywere further screened for hepatitis B surface antigen and HCV antibodies. All patients weredivided into three groups. One having no co-infection with hepatitis B and Hepatitis C and wastaken as control group, second group was co-infected with hepatitis B and third was co-infectedwith hepatitis C. short course anti tuberculous regimen was started and patients were followed forsix months. Results: One hundred and twenty eight tuberculous patients were divided into threegroups. 92 in control groups without any co-infection with hepatitis B and C, 10 were HBV +veand 26 were HCV +ve. During follow up 24 developed drug induced hepatitis, 8(38.33%, n = 24)in control group, 2(8.33%, n = 24) in hepatitis B group and 14(58.33%, n = 24) in hepatitis Cgroup. Conclusions: These findings suggest that treatment for tuberculosis in HCV seropositivepatients is a risk factor for the development of hepatitis exacerbation and HBV seropositivepatients shows no any increased risk of hepatitis exacerbation.

Butterfly pattern hypopigmentation with antitubercular treatment

Standard short course chemotherapy is the key element of the DOTS strategy and these drugs cause different kinds of cutaneous adverse drug reactions that usually occur within 2 months of initiation of treatment in around 97% of the patients. We hereby report a case of a 16-year-old female patient who developed butterfly pattern hypopigmented rashes after 3 months of starting on category 1 antitubercular treatment (ATT). Other causes with similar picture were ruled out with additional investigations and the case was confirmed as ATT induced hypopigmented rash. WHO-UMC causality assessment showed a probable association.

The design and rationale for the Acute Medically Ill Venous Thromboembolism Prevention with Extended Duration Betrixaban (APEX) study

Randomized clinical trials have identified a population of acute medically ill patients who remain at risk for venous thromboembolism (VTE) beyond the standard duration of therapy and hospital discharge. The aim of the APEX study is to determine whether extended administration of oral betrixaban (35-42 days) is superior to a standard short course of prophylaxis with subcutaneous enoxaparin (10 ± 4 days followed by placebo) in patients with known risk factors for post-discharge VTE. Patients initially are randomized to receive either betrixaban or enoxaparin (and matching placebo) in a double dummy design. Following a standard duration period of enoxaparin treatment (with placebo tablets) or betrixaban (with placebo injections), patients receive only betrixaban (or alternative matching placebo). Patients are considered for enrollment if they are older than 40 years, have a specified medical illness, and restricted mobility. They must also meet the APEX criteria for increased VTE risk (aged ≥75 years, baseline D-Dimer ≥2× upper the limit of "normal", or 2 additional ancillary risk factors for VTE). The primary efficacy end point is the composite of asymptomatic proximal deep venous thrombosis, symptomatic deep venous thrombosis, non-fatal (pulmonary embolus) pulmonary embolism, or VTE-related death through day 35. The primary safety outcome is the occurrence of major bleeding. We hypothesize that extended duration betrixaban VTE prophylaxis will be safe and more effective than standard short duration enoxaparin in preventing VTE in acute medically ill patients with known risk factors for post hospital discharge VTE.

Architectural acoustics continuing education course—Presenter registration and reporting requirements

The Technical Committee on Architectural Acoustics (TCAA) is a Registered Provider in the American Institute of Architects (AIA) Continuing Education System (CES). The TCAA has developed a standardized introductory short course for architects called “Architectural Acoustics,” for which attendees can earn one continuing education unit (CEU). This paper will cover the administrative requirements of the AIA/CES, to prepare potential presenters. These requirements include the proper handling of paperwork so that AIA members may receive credit for the course. The manner in which the course is given is also dictated by AIA requirements. TCAA membership and attendance at this workshop are required to qualify as an authorized presenter for this AIA/CES short course. Of course, anyone is free to register with the AIA to provide their own CEU program. However, the advantages of participating in this program are that the TCAA short course is already prepared, it is pre-approved by the AIA, and the registration fees are paid by the Acoustical Society of America.