Treatment Algorithm For Patients Research Articles

Intracardiac abscess in the clinical course of infective endocarditis complicated by acute heart failure

Background. Infective endocarditis (IE) remains a serious condition with a high incidence rate, ranging from 2.6 to 7 cases per 100,000 people, and has been increasing over recent decades. Intracardiac abscess (ICA) is one of the most severe complications of infective endocarditis, occurring in 30–40 % of cases involving native heart valves. Heart failure, the most common complication, is observed in 19–73 % of patients and often requires urgent surgical intervention. Objective: to determine the optimal diagnostic and treatment algorithm for patients with infective endocarditis complicated by acute heart failure (AHF) and intracardiac abscess. Materials and methods. From 2010 to 2023, at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, 473 surgeries were performed for active infectious endocarditis complicated by intracardiac abscesses, accounting for 15 % of all cases of IE. A comprehensive approach was used, including autopericardial patches, abscess debridement, reconstruction of the heart chambers, fibrous ring repair, valve replacement, and methods for preventing recurrences. Results. The patients were divided into two groups: ICA with AHF (N = 135, 28.5 %) and ICA without AHF (N = 338, 71.5 %). The average age of participants was 49.2 ± 1.2 years. In the overall group, procalcitonin and C-reactive protein levels were evaluated to characterize the inflammatory process. The inflammatory markers included leukocyte count, elevated erythrocyte sedimentation rate, and levels of C-reactive protein and procalcitonin. High levels of these markers indicate signs of persistent infection syndrome, immunosuppression, and catabolism. Increased blood lactate levels suggest tissue hypoxia and organ dysfunction. Acute heart failure was characterized by elevated levels of NT-proBNP, troponin, and creatine phosphokinase-MB. One hundred and thirty-five (28.5 %) infective endocarditis patients with ICA and signs of AHF at the preoperative stage of IV FC formed the study group. Conclusions. Successful treatment of IE depends on early surgical intervention and effective antibiotic therapy. Early detection of complications such as AHF and intracardiac abscesses is critically important. Autopericardial patches and modern surgical techniques significantly improve patient outcomes. Elevated markers such as NT-proBNP, troponin, C-reactive protein, procalcitonin, and lactate indicate the severity of the condition.

Neuromyelitis optica spectrum disorders, terminology and therapeutic issues: amended consensus opinion

In Russian Federation in 2022, the Expert Council adopted the main definitions and terms for neuromyelitis optica spectrum disorders (NMOSD) and proposed a treatment algorithm for patients with NMOSD with antibodies to aquaporin-4 (AQP4-IgG). The publication is intended to present the results of the work of the Russian Expert Council in September 2024. The experts agreed on clarifications of previously published terminology, new definitions, current issues in the therapy of NMOSD, proposed profiles of patients with NMOSD for ravulizumab and a monitoring plan during treatment with this drug, and agreed on an updated algorithm for prescribing medications that prevent exacerbations in patients with NMOSD with AQP4-IgG aged 18 years and older.

Five-year follow-up of idiopathic granulomatous mastitis.

Idiopathic granulomatous mastitis (IGM) is a benign and rare chronic inflammatory disease of the breast. Although there are various treatment modalities, an ideal treatment algorithm has not been defined. We designed this study to evaluate the clinical status, duration of remission, remission rates, and treatment algorithm in patients with IGM during a 5-year follow-up period after immunosuppressive therapy. This study was planned retrospectively in the rheumatology outpatient clinic including 63 patients with biopsy-proven IGM. Demographic characteristics, clinical findings, treatment options, and drug-free remission periods after treatment were obtained from the patient's records. The mean age of female patients with IGM was 36.4 ± 6.1years. Remission was achieved in all patients receiving immunosuppressive treatment and the median remission period was 13.9months. After 5years of follow-up, the median remission time without medication was 46.1months. There was a significant improvement in the laboratory parameters and clinical findings of the patients. The most preferred immunosuppressive agent in all patients was methotrexate, and the second was azathioprine. During the 5-year follow-up period, no recurrence after immunosuppressive therapy was detected in IGM patients. As seen in the treatment management chart, methotrexate provided remission in the majority of patients.

Noradrenergic Modulation and a Treatment Algorithm for Behavioral Symptoms in Patients with Late Life Dementia

Introduction: Patients affected by neurodegeneration disorders (NDD) often experience difficult to treat disruptive neuropsychiatric symptoms (NPS) i.e. verbal disruption, aggression, psychomotor hyperactivity, sleep difficulties, hallucinations, delusions. The existing treatment algorithms include antipsychotics, gabapentin, trazodone, prazosin, memantine, cholinesterase inhibitors.1,2 Some NPS i.e. anxiety, agitation, aggression, disturbed sleep have been linked to overactivity of the brain noradrenergic system (NAS). The current report suggests a treatment algorithm which includes a method of noradrenergic modulation (NAM). Aims of the study: A. To evaluate a new treatment algorithm for patients with NPS and late life dementia. B. To evaluate the method of NAM in treatment of NPS. Participants and Methods: Nine elderly community dwelling patients (3 males and 6 females) with probable Alzheimer’s dementia and NPS. Age of the patients 71-104 years (86.9, SD 9.4), 4 patients with moderate and 5 patients with severe dementia. Treatment algorithm includes 5 steps and two pathways. Each step is evaluated on the clinical global impression of change (CGI-C) scale. The psychosis pathway (4 patients) begins with an antipsychotic, the alternative pathway (5 patients), with low dose gabapentin (GBP). The psychosis pathway, if ineffective, can switch to the alternative pathway with the add-on of GBP. The alternative pathway proceeds with addition of NAM which includes alpha-1 receptor antagonists (prazosin, doxazosin) and alpha-2 receptor agonists (transdermal clonidine, guanfacine). Results: Treatment was well tolerated. Substantial (7 patients) and moderate (2 patients) improvement in disruptive behaviors such as agitation, aggression, sleep was reflected on the CGI-C scale (score 1.2, SD 0.4), on the Cohen-Mansfeld Agitation Inventory (the score decreased from 52.6, SD 27.0 to 18.6, SD 7.9) and on the de novo introduced VAPS scale (from 8.7, SD 0.4 to 2.7, SD 0.8). The final step of the algorithm, method of NAM was the “game changer” in both psychosis and nonpsychosis alternative pathways. Conclusion: The case series provides preliminary evidence supporting the suggested approach to treatment of NPS in patients with late life dementia.

A New Method And An Algorithm For Non-Deflating Foley Catheter Balloons

Background: In rare cases, the catheter balloon cannot be deflated during catheter removal or repla-cement. In this study, we aimed to create a treatment algorithm for patients whose catheter balloon could not be deflated and to evaluate the effectiveness of a newly applied method. Materials and Methods: 55 male patients who applied to our clinic between January 2020 and July 2023 because the foley catheter could not be removed were evaluated. The methods applied in line with the algorithm we applied in our clinic were evaluated in terms of complications. However, a new met-hod that has not been described before in the literature was evaluated in terms of complications and effectiveness Results: A total of 55 patients were included in the study. The average age of the patients was 73.8 years. The average foley catheter stay was 14.9±8 days. When we examine the reasons for patients' catheterization; A catheter was placed in 5 patients, due to neurogenic bladder, 30 patients due to immobility, and 10 patients due to inability to urinate due to bladder outlet obstruction. All patients were successfully treated with the algorithm we applied. Conclusions: In rare cases, failure to deflate the foley catheter balloon is a very disturbing situation for patients. However, complications, mostly minor, may occur during treatment. We think that this met-hod and algorithm we have described is a method that can be used safely like other methods.

Gender differences in periodontal pocket microflora in patients with chronic generalized periodontitis

Background: Periodontal disease, the primary cause of tooth loss, is a critical public health concern with a considerable impact on quality of life. It is of interest to explore gender differences in the course of inflammatory periodontal diseases, as well as the prospects of their personalized treatment and prevention in males and females. Aim: To assess the dental health and quantitative composition of periodontal pocket microflora in periodontitis patients, taking into account gender differences. Materials and Methods: The study included 39 patients with moderate chronic generalized periodontitis aged 40–60 years. The diagnosis was made using both primary and secondary dental diagnostic tools. The study had two groups: males (41%, n=16) and females (59%, n=23). The following parameters were assessed: oral hygiene index (OHI-S), severity of gingival inflammation (PMA), and quantitative composition of periodontal pocket microflora (DENTOSCREEN, “Lytech” Co. Ltd., Russia), taking into account gender differences. The study findings were statistically processed using Microsoft Office Excel 2016 with Data Analysis and AtteStat 12.0.5 add-ins. The Shapiro–Wilk test was used. The data are presented as median and interquartile range: Me [Q1; Q3]. The frequency of microorganisms is presented as percentage of the mean and standard error of the mean. The confidence interval was calculated using the Wald method, according to the formula for proportions and frequencies. For small values, the Wald method with Agresti–Coull correction was used. Samples were compared using the following tests: the Mann–Whitney U test was used for quantitative data and Fisher’s angular transformation (φ*emp) for frequency (nominal) attributes. Significant differences were defined as a probability 95% (p 0.05). Results: The quantitative composition of periodontal pocket microflora in patients with moderate periodontitis revealed significant gender differences, as demonstrated by an increase in the count of Fusobacterium nucleatum and Prevotella intermedia, as well as the frequency of Porphyromonas gingivalis, in males compared to females (φ*emp=1.736; p 0.05). Dental health indices confirmed the hypothesis of significant differences between males and females in terms of plaque index (OHI-S) and РМА. In males, poor oral hygiene was reported in 93.7% cases, which was significantly higher (φ*emp=2.04; p 0.05) than in females (69.6%). Moderate gingival inflammation was more prevalent in males, while mild gingival inflammation was more prevalent in females (p 0.05). Conclusion: The study findings emphasize the importance of oral hygiene in the prevention of chronic periodontitis and can be used to improve complex treatment algorithms for patients with periodontal diseases. This includes more frequent dental check-ups and professional oral care sessions, as well as oral hygiene training and monitoring, in males compared to females. Diagnosis by polymerase chain reaction allows for the identification and quantitative determination of DNA from periodontopathogenic bacteria at low concentrations, as well as the justification of treatment algorithms and prediction of treatment outcomes.

OGC SO21 - Role of Staging Laparoscopy on oesophageal and junctional cancer management

Abstract Background Staging laparoscopy and peritoneal cytology is currently recommended as a staging tool required for oesophageal and gastro-oesophageal junction (OGJ) adenocarcinomas. However, evidence is variable regarding the utility of this investigation, leading to heterogenous practice in the UK. With improved staging sensitivity of CT and PET imaging and inclusion of routine MDT discussion for upper GI cancer patients, staging laparoscopy may not be necessary for all patients with oesophago-gastric cancer, and in fact may delay their treatment. We thus aimed to assess the impact of staging laparoscopy on the treatment algorithm of patients with oesophago-gastric cancer. Method All staging laparoscopies undertaken between January 2022 and March 2024 were identified from our surgical database. Patients were included if they had oesophago-gastric adenocarcinoma, with a plan for curative treatment. Data collected included age, gender, location of primary tumour, CT/PET staging, laparoscopy findings, impact on treatment intention, neoadjuvant treatment, and final histology. Primary outcome was incidence of positive microscopic or macroscopic peritoneal disease for oesophageal and OGJ malignancy. Results 127 patients were identified - 69 (55%) oesophageal, 25 (20%) GOJ, and 32 (24.4%) gastric cancer. 1/70 (1.4%) patient diagnosed endoscopically with oesophageal cancer had positive peritoneal disease, which was suspected due to pre-operative imaging findings of ascites and suspicions of linitis plastica. Of patients diagnosed with GOJ cancer, 4/25 patients (16%) had peritoneal disease present. None of the 39 patients with oesophageal/junctional tumours with clinical T1-2 disease were found to have peritoneal disease on staging laparoscopy. 6/32 (19%) patients with gastric cancer were found to have unexpected peritoneal disease present. Conclusion This study found minimal impact staging laparoscopy has on the management of primary oesophageal cancers. Consideration can be made of limiting staging in oesophageal cancer to patients with suspicious findings on CT/PET imaging. For GOJ tumours, there may be a role for limiting staging laparoscopy for Siewert 1 tumours to T3/4 tumours based on CT/PET findings. Importantly, accurate identification on primary endoscopy of the location of the tumour in relation to the gastro-oesophageal junction is necessary to help guide ongoing management.

Catatonia in anti-NMDA receptor encephalitis: a case series and approach to improve outcomes with electroconvulsive therapy

BackgroundAnti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been recognised to present with the syndrome of catatonia. In severe cases dysautonomia is representative of malignant catatonia. The treatment with benzodiazepines (BZDs) and electroconvulsive...

Current Patient Management for Bacterial Meningitis Simultaneously Affected by Stroke.

Bacterial meningitis (BM) is a critical central nervous system infection characterized by increased risks of complications and potentially fatal outcomes. The chances of full recovery are significantly reduced in the presence of concomitant neurovascular complications such as ischemic and hemorrhagic strokes, intracerebral hemorrhage, and cerebral sinus thrombosis. Effective treatment of BM requires a targeted approach that simultaneously addresses the causative pathogen and manages the neurologically related complications. However, clinicians continue to face challenges in determining optimal pharmacotherapy for these patients.The presence of neurological complications is pivotal in determining patient outcomes, contributing to high disability and mortality rates. Early medical management is crucial and begins with essential stabilization followed by rapid diagnostic testing and the administration of empirical broad-spectrum antimicrobial therapy. The use of targeted antibiotics based on culture results is standard, with adjunct therapies such as dexamethasone and, in some cases, anticoagulants playing supportive roles. Despite the deployment of such comprehensive therapeutic strategies, the variability in treatment response and the high incidence of adverse outcomes necessitate ongoing research. This includes exploring novel therapeutic approaches and enhancing current clinical practices through retrospective studies and clinical trials to mitigate the high morbidity and mortality rates associated with BM and its complications. Strategic management is crucial for patient recovery, considering the substantial risk, a broad spectrum of complications, and fatal outcomes from this meningeal infection and stroke. The use of antimicrobial therapy with intravenous adjunct dexamethasone isthe current standard of care for patients with cerebrovascular complications and acute BM. In addition, other options that can provide benefits in complicated cases include anticoagulants and neurosurgery. Further investigation into treatment algorithms for patients with meningeal infection complicated by stroke and/or increased intracranial pressure is still needed.

Cardiac Sarcoidosis: Utilizing Cardiac MRI and PET-CT.

Cardiac sarcoidosis is an inflammatory condition that has been associated with deleterious cardiac manifestations. The diagnosis of cardiac sarcoidosis is challenging and can be guided by advanced cardiac imaging. Endomyocardial biopsy lacks sensitivity in confirming a diagnosis of cardiac sarcoidosis. Studies have shown that the use of cardiac magnetic resonance imaging (MRI) and cardiac Positron Emission Testing (PET) are associated with increased sensitivity and specificity in the diagnosis of cardiac sarcoidosis. Cardiac MRI and cardiac PET CT, although distinct entities, are complimentary in the diagnosis, prognostication of major cardiac events, and aid in the treatment algorithm in patients with cardiac sarcoidosis.

WHAT SCALES SHOULD THE CARDIOLOGIST USE IN PATIENTS WITH ATRIAL FIBRILLATION? WHAT IS NEW?

The current treatment algorithm for patients with non-valvular atrial fibrillation (AF) includes anticoagulation to prevent stroke and systemic embolism, improvement of AF symptom control by heart rate reduction or restoration and maintenance of sinus rhythm, and treatment of cardiovascular and other comorbidities. The evaluation of patients with AF should be structured and include assessment of stroke risk, symptom severity, severity of the AF burden (type of arrhythmia, number and duration of episodes, etc.) and predisposing condition. The use of the CHA2DS2-VASc (risk of stroke), HAS-BLED (risk of bleeding), EHRA (severity of AF symptoms), and 2MACE (risk of cardiovascular outcomes) scales is important to help assess the likelihood of adverse outcomes and select the optimal treatment to protect not only against stroke but also against cardiovascular events. It should be noted that the HAS-BLED scale is primarily necessary for identification of bleeding risk factors, the modification of which allows to increase the safety of anticoagulant therapy, and a high index value according to this scale can’t serve as a reason to refuse anticoagulation in a patient with AF. New scales of stroke and hemorrhagic complications risk assessment in patients with AF on the basis of clinical parameters and laboratory biomarkers have been proposed, but their possible advantages over the existing indices need to be confirmed in special studies

Coccygectomy for refractory coccydynia, old-fashioned but effective procedure: A retrospective analysis.

Coccydynia, characterized by persistent pain in the coccygeal region, significantly impacts patients' quality of life. While various treatment modalities exist, including conservative measures and surgical interventions like coccygectomy, optimal management remains unclear. This retrospective cohort study aimed to compare the clinical outcomes, functional improvements, and quality of life in patients with chronic coccydynia undergoing either infiltrative treatment or coccygectomy. Data from patients treated at our institution from January 2018 to December 2022 were analyzed. Participants meeting inclusion criteria were divided into two groups: Group A underwent coccygectomy, while Group B received conservative therapy. Clinical assessments, radiographic evaluations, and patient-reported outcomes were collected preoperatively and at follow-up intervals. Of the 223 initially examined patients, 55 met inclusion criteria. Group A (n = 21) underwent coccygectomy, while Group B (n = 34) received conservative therapy. Both groups showed significant pain reduction post-intervention, with sustained improvement in Group A. Functional outcomes favoured Group A, with significant improvements in disability and quality of life measures. Complications were minimal, with only one case of superficial wound infection in Group A. Our findings suggest that coccygectomy provides superior and lasting pain relief, functional improvement, and quality of life improvement compared to conservative therapy. While complications were minimal, further research with larger cohorts is warranted to validate these results and explore long-term outcomes. Despite its historical association with complications, advancements in surgical techniques and perioperative care have led to improved outcomes and reduced complication rates. Thus, coccygectomy should be considered in the treatment algorithm for patients with debilitating coccydynia.

Outcome of an Accelerated Treatment Algorithm for Patients Developing Diarrhea as a Complication of Ipilimumab-Based Cancer Immunotherapy in a Community Practice.

Immune-mediated diarrhea represents a serious complication of checkpoint inhibitor therapy, especially following ipilimumab-based treatment. Efficient diagnosis and control of diarrhea remains an ongoing challenge. We developed an accelerated management paradigm for patients with ipilimumab-induced diarrhea. Patients who developed significant diarrhea (>five loose stools/day) were presumed to be developing immune colitis. Therapy was interrupted and patients were treated with a methylprednisolone dose pack. If diarrhea was not completely resolved, high-dose steroids and infliximab were promptly added. Only non-responding patients underwent further evaluation for infection or other causes of diarrhea. A total of 242 patients were treated with ipilimumab-based regimens. Forty-six developed significant diarrhea (19%) and thirty-four (74.4%) had a rapid resolution of diarrhea following glucocorticosteroid and infliximab treatment. The median time to resolution of diarrhea was only 8.5 ± 16.4 days. Accelerated treatment for presumed immune-mediated diarrhea resulted in the rapid control of symptoms in the majority of patients. There were no intestinal complications or deaths. Immunosuppressive therapy for diarrhea did not appear to decrease the remission rate or survival. After the control of diarrhea, most patients were able to continue their planned immunotherapy. Further testing in 11/46 patients with unresponsive diarrhea revealed additional diagnoses, allowing their treatment to be adjusted.

Comparative efficacy of Bruton tyrosine kinase inhibitors in the treatment of relapsed/refractory chronic lymphocytic leukemia: A network meta-analysis (NMA).

7048 Background: Next-generation Bruton’s tyrosine kinase inhibitors (BTKis) have led to changes in the treatment algorithm for patients with high-risk relapsed/refractory (R/R) CLL; defined based on the presence of genetic mutations and a high unmet need. Given the lack of head-to-head trials comparing these treatments in R/R CLL, a NMA was performed to estimate the relative efficacy of BTKis used to treat high-risk patients. Methods: Randomized controlled trials ALPINE (zanubrutinib vs. ibrutinib), ELEVATE-RR (acalabrutinib vs. ibrutinib), and ASCEND (acalabrutinib vs. bendamustine + rituximab/idelalisib + rituximab [BR/IR]) were included in the NMA. High-risk populations were defined based on the pre-specified subgroups within each trial, including patients with del17p and/or TP53 mutations in ALPINE (zanubrutinib: 75/327 and ibrutinib: 75/325), ASCEND (acalabrutinib: 44/155 and BR/IR: 42/155), and del17p/del11q in ELEVATE-RR (acalabrutinib: 268/268 and ibrutinib: 265/265). Bayesian NMAs were used to estimate hazard ratios (HRs) or odds ratios (ORs) with 95% credible intervals (CrIs), and probability better (PB) for zanubrutinib versus all other treatments. Outcomes analysed included investigator-assessed progression-free survival (PFS), overall survival (OS), overall response (ORR), and complete response (CR). Given the timing of the included trials in relation to the COVID-19 pandemic, ALPINE data were analyzed with and without adjustment for COVID-19 related deaths. Results: The NMA found a statistically significant improvement in PFS for zanubrutinib over acalabrutinib in high-risk patients and a trend towards improvement in OS, ORR, and CR (Table). Zanubrutinib led to statistically significant improvements in PFS versus ibrutinib (HR [95% CrI]: 0.49 [0.30, 0.78], PB: 99.9%) and BR/IR (0.12 [0.05, 0.26], PB: 100.0%). For OS, zanubrutinib showed a trend towards improvement versus ibrutinib (0.59 [0.31, 1.12] PB: 94.8%) and BR/IR (0.64 [0.24, 1.74] PB: 80.7%). Conclusions: This NMA found zanubrutinib to be the most efficacious BTKi for patients with high-risk R/R CLL, offering significantly delayed disease progression, and favourable survival and response vs. alternative BTKi treatments. [Table: see text]

Neurophysiological assessment of the condition of the masticatory muscle group in patients with occlusion disorders and chronic generalized periodontitis

Background. Recently, the interest of dentists and physiologists has been focused on the development of a set of informative computerized techniques for an objective analysis of the functional state of the dentofacial apparatus. Achieving certain successes in conducting functional diagnostic examinations contributes to the development of algorithms for complex treatment of patients with generalized periodontitis and premature occlusal contacts.Goal. Study of the functional state of the dentofacial apparatus according to the parameters of bioelectrical activity of muscles in patients with chronic generalized periodontitis and occlusal disorders in static and dynamic conditions of the lower jaw.Materials and methods. The study involved 37 people with clinically healthy periodontium, physiological occlusion, and absence of occlusal disorders (Group 1) and 45 patients with physiological types of occlusion, generalized chronic periodontitis and premature occlusal contacts (Group 2). Functional methods included electronic registration of occlusal relationships with the T-Scan® III computer occlusion analysis system and study of the bioelectrical activity of the masticatory muscles using the Bio-EMG® III electromyography using standard functional tests.Results. In patients of group 2, in comparison with patients of group 1, neuromuscular discoordination of the functional activity of the masticatory muscles was diagnosed. This condition is confirmed by the asymmetry and lack of muscle synergy when performing the “Maximum volitional compression” test, an improvement in the symmetry of the work of the muscles of the same name on the right and left sides and the synergy of the work of the muscles of the right and left masticatory groups, as well as a statistically significant increase in the values of biopotentials m. temporalis and m. masseter during the “Maximum volitional compression on rollers” test.Conclusions. Disturbances in the coordinated work of the muscles of the craniofacial region in patients with chronic generalized periodontitis and premature occlusal contacts are realized in a statistically significant increase in the biopotentials of the masticatory muscle group at rest, a decrease in biopotentials during functional loading, as well as a reduction in the values of symmetry and synergy in relation to similar values patients of group 1.

Abstract PO3-05-14: Practice patterns for sequential use of antibody-drug conjugate after antibody-drug conjugate in metastatic breast cancer: results from a physician survey

Abstract Introduction: Antibody-drug conjugates (ADCs) have become a key part of metastatic breast cancer (MBC) treatment. Trastuzumab deruxtecan (T-DXd), and Sacituzumab Govitecan (SG) are approved ADCs available for the treatment of MBC. Completed trials that led to the approval of these ADCs did not include patients who had received the other ADC as prior therapy. Little is known about the optimal sequencing of these agents and how clinicians are incorporating ADC sequencing decisions at bedside. Methods: An online survey regarding the use of sequential ADCs was distributed electronically from April 2023 to July 2023 among US clinicians who treat patients with breast cancer. The survey included eight questions assessing clinician practice settings and the use of ADC sequencing and five case-based scenarios (table 1). Descriptive statistics were used to assess survey responses. Results: 107 survey responses were received, out of which 72% were female responders and 93% were medical oncologists. The majority of responders practiced in an academic setting (83%) and reported being involved in clinical research (82%). 58% of responders have been in practice for >10 years and 68% treat >20 breast cancer patients per week. 87% had prescribed an ADC post-ADC for MBC. 46% of responders thought that the degree of benefit for an ADC post-ADC would be similar to the benefit noted in the pivotal ADC trials, and 54% thought that the degree of benefit with sequencing would be lower than in the pivotal trials. Regarding the case-based questions for patients with triple-negative breast cancer and HER2 low disease who had disease progression on first-line metastatic therapy, 64-71% of clinicians opted to give SG as the first ADC followed by T-DXd as the second ADC in sequence, regardless of age, PDL1 status and prior metastatic therapies. For a patient with hormone-positive (HR+), HER2 low MBC, who had received capecitabine as the first metastatic chemotherapy, 50% opted to give T-DXd as the first ADC followed by SG as the second ADC, and 40% opted to give weekly paclitaxel followed by SG as the first ADC. For a patient with HR+, HER2 low MBC who had received two prior chemotherapies for metastatic disease, 77% opted for T-DXd as the first ADC, followed by SG as the second sequential ADC. When grade 1 pneumonitis was added as a comorbidity to the case, only 16% opted to give T-DXd as the first ADC choice. Conclusion: Almost 90% of clinicians report prescribing sequential ADCs for MBC, yet there is little uniformity in how these ADCs are sequenced. More than 50% felt that the benefit of the second ADC in the sequence will be lower than the registration trials that led to the approval of the ADC in a setting of no prior ADC treatment. The optimal sequencing of ADCs remains an area of unmet need and further studies are needed to guide optimal medical decisions regarding sequential ADC-based treatment algorithms for patients with MBC. Table 1. Case-based scenarios for ADC sequencing Citation Format: Yara Abdou, Prarthna Bhardwaj, Rachel Abelman, Laura Spring, Aditya Bardia, Lisa Carey, Priyanka Sharma. Practice patterns for sequential use of antibody-drug conjugate after antibody-drug conjugate in metastatic breast cancer: results from a physician survey [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 PO3-05-14.

Assessment of the dalargin effect on the level of vitamin D and melatonin in blood serum in patients with malignant bone tumors and polymorbidity

Background. Involved in many cascades of biological regulatory reactions, calcium, vitamin D and melatonin create a single metabolic pattern, maintaining the dynamic balance of bone tissue homeostasis. Nevertheless, these regulatory molecules, as structural and functional elements of bone tissue, play a crucial role in various cellular processes associated with oncogenesis and tumor progression. Synthetic peptide dalargin has wound healing, reparative, anti-inflammatory, antioxidant, immunomodulatory, anticarcinogenic, antitumor, and antimetastatic effects. The purpose of the study was to investigate the synthetic neuropeptide dalargin influence on the dynamics of vitamin D and melatonin blood serum le­vels as part of the treatment algorithm of patients with bone malignant tumors of the lower extremities and pelvis with polymorbidity and endoprosthetics. Materials and methods. The study inclu­ded a control (first) group and a main (second) group of clinical observation of patients with malignant bone lesions. The serum melatonin content was measured by enzyme immunoassay using reagent kits (No. RE54021) from IBL-Hamburg GmbH (Germany). Serum levels of 25-hydroxycalciferol (25(OH)D) were determined by the immunochemiluminescent method on an ARCHITECT 25-OH Vitamin D Controls automatic analyzer. Results. In patients who received dalargin, more pronounced positive dynamics were established in the normalization of 25(ОН)D and melatonin levels, and there was no exacerbation of concomitant diseases. In contrast to the data of patients who did not receive dalargin, in the group where it was used, there were no relapses or metastases of the tumor du­ring 14 months. A comparison of the 25(ОН)D and melatonin le­vels in patients 6–7 months and 12–14 months after treatment shows a tendency to recovery of indicators only in patients who were additionally treated with dalargin (p < 0.01). Conclusions. The study showed the possibility of using the neuropeptide dalargin to increase the effectiveness of the treatment of patients with primary malignant tumors with the burden of polymorbidity by influencing the levels of vitamin D and melatonin in the blood serum.

Advancements in the Management of Follicular Lymphoma: A Comprehensive Review

Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma in Western countries. While FL is generally incurable, standard initial therapies are associated with high response rates and durable remissions for most patients. In addition, novel targeted agents and immunotherapies are changing the treatment algorithm for patients with relapsed or refractory disease. This review discusses the initial staging, prognosis, and treatment options for newly diagnosed and relapsed/refractory FL. Initial treatment options for FL include active surveillance, radiotherapy, rituximab monotherapy, and chemoimmunotherapy. Staging with positron emission tomography/computed tomography and bone marrow biopsy is crucial for identifying early-stage patients. Most patients with FL will receive chemoimmunotherapy as the initial treatment with options including rituximab or obinutuzumab plus cyclophosphamide, vincristine, and prednisone; cyclophosphamide, doxorubicin, vincristine, and prednisone; bendamustine; or lenalidomide. No significant differences in overall survival have been observed in randomized studies comparing these regimens. Maintenance therapy with rituximab or obinutuzumab in responders to initial chemoimmunotherapy improves progression-free survival. For relapsed/refractory FL, treatment options include chemoimmunotherapy, lenalidomide-based regimens, tazemetostat, chimeric antigen receptor (CAR)-T cell therapy (axicabtagene ciloleucel and tisagenlecleucel), and CD3/CD20 bispecific antibodies (BsAbs). Given the encouraging outcomes obtained with CAR-T cell therapy and BsAbs, multiple trials are testing these highly active agents in earlier lines of therapy and among high-risk patients with early relapse after frontline chemoimmunotherapy. Additional studies and follow-up are needed to understand how these novel agents may further change treatment algorithms for FL.

Current aspects of surgical methods for removal of bladder stones in patients with bladder outlet obstruction

The prevalence of bladder stones is quite high, which represents a significant medical and social problem. Despite significant progress in the field of medicine, there are currently no generally accepted standards for the treatment of patients with cystolithiasis. This review presents an analysis of literature sources using the PubMed, Google Scholar, Scopus, eLibrary, Cyberleninka databases, dedicated to modern aspects of the treatment of patients with bladder stones and bladder outlet obstruction. The features, advantages and disadvantages of various surgical methods for treating such patients are described in detail. It has been shown that despite the fact that transurethral cystolithotripsy with litholapaxy is the most common surgical option, modern medicine offers alternative methods of surgical treatment. It is emphasized that to achieve the greatest effectiveness of treatment, the correct choice of surgical method is necessary, based on the individual characteristics of the patient. It was noted that there is a need to optimize the treatment algorithm for patients with bladder stones and bladder outlet obstruction.

Standardizing the Treatment for Pediatric Status Epilepticus: A Quality Improvement Study

AbstractApproximately 30 to 40% of children with generalized convulsive status epilepticus remain refractory to benzodiazepines. Due to inconsistences in our approach for these patients in the emergency department, we initiated a quality improvement project to standardize the treatment process.A plan, do, study, act (PDSA) format was used for the project that involved creating a treatment algorithm based on the American Epilepsy Society (AES) guidelines, educating the staff on the treatment recommendations, and then collecting clinical data. We selected time to second-line anticonvulsant therapy as our primary outcome measure. Following the implementation of the treatment algorithm and order set, we performed comparative analyses of the pre- and post-implementation cohorts.A total of 21 pre- and 36 post-implementation patients were identified. Baseline data demonstrated no difference in age or gender. Post-implementation patients received second-line therapy sooner (24 vs. 39 minutes, p = 0.001) and more post patients received second-line therapy within the AES guideline's time frame (83 vs. 52%, p = 0.012) compared with the pre-implementation patients. In a multivariable analysis, post-implementation patients had a higher likelihood of receiving second-line therapy within the AES-recommended time frame (odds ratio [OR] = 5.78; 95% confidence interval [CI]: 1.49–22.48; p = 0.011). Age, gender, intubation status, anticonvulsants given prior to emergency department (ED), and treatment by a pediatric ED specialist were not associated with increased odds of provider adherence to AES guidelines.In conclusion, a standardized approach utilizing a treatment algorithm for patients with pediatric benzodiazepine refractory status epilepticus was associated with reduced time to administration of second-line anticonvulsant therapy and better compliance with AES guidelines in a mixed pediatric and adult ED setting.