scholarly journals P066: Methotrexate in the management of suspected ectopic pregnancy

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S80-S80
Author(s):  
K. Hawrylyshyn ◽  
S. McLeod ◽  
J. Thomas ◽  
C. Varner
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Gestational Age ◽  
Tertiary Care ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Line Treatment ◽  
Success Rates ◽  
First Line ◽  
First Line Treatment

Introduction: Early detection of ectopic pregnancy and careful management is critical to prevent adverse clinical outcomes, including fallopian tube rupture and future decreased fertility, in patients presenting to the ED with symptoms suggestive of ectopic pregnancy. Methotrexate therapy is widely accepted as a first line treatment of ectopic pregnancy, with success rates greater than 90% if used according to published guidelines. This study aims to determine the outcomes of pregnant women who presented to the ED with suspected ectopic pregnancy whom received methotrexate as first line treatment. Methods: This was a retrospective chart review of pregnant (<12 week gestational age) women from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule out ectopic pregnancy, or pregnancy of unknown location (PUL) over a 7 year period. Results: Of 612 included patients, 30 (4.9%) were diagnosed with a ruptured ectopic pregnancy at the index ED visit. Of the remaining 582 patients, 256 (44.0%) were diagnosed with an ectopic pregnancy at the index ED visit, the Early Pregnancy Clinic, or a subsequent ED visit. Of these patients diagnosed with ectopic pregnancy, their initial treatments at time of discharge from the index ED visit were as follows: 102 (39.8%%) received methotrexate, 132 (51.6%) underwent expectant management, and 22 (8.6%) underwent surgical management. Of the 132 patients discharged with an expectant management plan, only 42 (31.8%) had a final outcome of expectant management; the others went on to be treated surgically or with methotrexate. Of the 165 patients treated with methotrexate at index visit or in follow-up, 30 (18.2%) went on to require surgical management with 17 (10.3%) documented as having ruptured on surgical evaluation. Clinical characteristics of patients treated with methotrexate include the following: mean age 32.8 years (SD 5.7), gestational age of 6.2 weeks (SD 1.2) and serum beta human chorionic gonadotropin level of 2702 mIU/mL (SD 8800). Conclusion: The proportion of patients receiving methotrexate as first-line treatment that resulted in rupture or required further surgical management is higher than reported literature at this institution. Further investigation is needed to determine if there was a relationship between methotrexate failure and non-adherence to recommended guidelines. Given the risk of a possible rupture, patient education of these risks is critical on discharge from the ED.

Methotrexate for the treatment of unruptured tubal ectopic pregnancy

CJEM ◽  
2018 ◽  
Vol 21 (3) ◽  
pp. 391-394
Author(s):  
K Hawrylyshyn ◽  
SL McLeod ◽  
J Thomas ◽  
Catherine Varner
Keyword(s):  
Ectopic Pregnancy ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Line Treatment ◽  
First Line ◽  
Tubal Ectopic Pregnancy ◽  
Surgical Evaluation ◽  
Ectopic Pregnancies ◽  
Recommended Guidelines ◽  
First Line Treatment

ABSTRACTObjectiveThe objective of this study was to determine the outcomes of women who presented to the emergency department (ED) with suspected ectopic pregnancy and received methotrexate as first-line treatment.MethodsThis was a retrospective chart review of pregnant (< 12 week’ gestational age) women from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule-out ectopic pregnancy, or pregnancy of unknown location over a 7-year period.ResultsOf 612 patients with a suspected ectopic pregnancy at initial ED presentation, 326 (53.3%) had non-ectopic pregnancy outcomes, 30 (4.9%) were diagnosed with a ruptured ectopic pregnancy at the index ED visit, and 18 (2.9%) were diagnosed and managed as non-tubal ectopic pregnancies and excluded from further analyses; 238 patients were diagnosed with a tubal ectopic pregnancy, and 152 (63.9%) were treated with methotrexate at the index ED visit or in follow-up. Of patients treated with methotrexate, 27 (17.8%) went on to require surgical management, with 17 (11.2%) documented as having ruptured on surgical evaluation.ConclusionThe proportion of patients failing methotrexate as first-line treatment was higher than previously reported. Further investigation is needed to determine whether methotrexate failure was due to non-adherence to recommended guidelines.

Clinicopathologic and survival analysis of patients with lung cancer treated at a tertiary care centre in India.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17505-e17505
Author(s):  
Vinod Raina ◽  
Prabhat Singh Malik ◽  
B. K Mohanti ◽  
Mehar C Sharma ◽  
Anant Mohan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Squamous Cell Carcinoma ◽  
Survival Analysis ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tertiary Care ◽  
Line Treatment ◽  
First Line ◽  
Tertiary Care Centre ◽  
First Line Treatment

e17505 Background: Lung cancer ranks among the most common and lethal malignancies worldwide and also in India. There are geographic and ethnic variations in incidences, clinical and pathological profile of lung cancer. There is paucity of data of changing trend of pathological and clinical profile from this part of the world. Methods: A total of 434 patients with lung cancer were analyzed who were registered at All India Institute of Medical Sciences, over a 3 year period, from July 2008 till June2011, based on information in hospital records. Survival analysis was performed on 310 patients who have received at least one modality of treatment. Results: Median age of the whole cohort was 55 years (23-84 years). There were 357 (82.26%) males and 77 (17.74%) females, 295(69.91%) smokers and 127 (30.09%) non smokers. 370 (85.25%) patients had NSCLC and 64 (14.74%) had SCLC. Among NSCLC, adenocarcinoma was the commonest histology (45.41%) followed by squamous cell carcinoma (29.46%) and unclassified NSCLC (20.54%). Majority (66.13%) of the diagnosis were based on biopsy (needle or bronchoscopic). Among NSCLC, 26.3% patients were of stage 1-3A and 73.7% were of stage 3B and 4. Among SCLC 25% patients were of limited stage and 75% patients were of extensive stage. 73.18% of NSCLC patients received chemotherapy, 19.15% received TKI and 5.75% received RT as first line treatment modality. Among SCLC 93.88% received chemotherapy and 6.12% received RT as first line treatment. Median PFS and OS of patients with NSCLC were 7.8 months and 13.2 months respectively while that of SCLC were 6.1 months and 9.2 months respectively. Conclusions: Pathological profile of lung cancer has changed in India. Adenocarcinoma has become the commonest histology, contrary to the older reports when squamous cell carcinoma was more common. Majority of the patients are diagnosed in advanced stage and survival of these patients remains poor.

Ectopic pregnancy outcomes in patients discharged from the emergency department

CJEM ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 71-74
Author(s):  
Krista Hawrylyshyn ◽  
Shelley L. McLeod ◽  
Jackie Thomas ◽  
Catherine Varner
Keyword(s):  
Emergency Department ◽  
Ectopic Pregnancy ◽  
Chart Review ◽  
Transvaginal Ultrasound ◽  
Tertiary Care ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Missed Abortion ◽  
Ectopic Pregnancies ◽  
Rule Out

AbstractObjectiveThe objective of this study was to determine the proportion of women who had a ruptured ectopic pregnancy after being discharged from the emergency department (ED) where ectopic pregnancy had not yet been excluded.MethodsThis was a retrospective chart review of pregnant (<12-week gestational age) women discharged home from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule-out ectopic pregnancy, or pregnancy of unknown location over a 7-year period.ResultsOf the 550 included patients, 83 (15.1%) had a viable pregnancy, 94 (17.1%) had a spontaneous or missed abortion, 230 (41.8%) had an ectopic pregnancy, 72 (13.1%) had unknown outcomes, and 71 (12.9%) had other outcomes that included therapeutic abortion, molar pregnancy, or resolution of βHCG with no location documented. Of the 230 ectopic pregnancies, 42 (7.6%) underwent expectant management, 131 (23.8%) were managed medically with methotrexate, 29 (5.3%) were managed with surgical intervention, and 28 (5.1%) patients had a ruptured ectopic pregnancy after their index ED visit. Of the 550 included patients, 221 (40.2%) did not have a transvaginal ultrasound during their index ED visit, and 73 (33.0%) were subsequently diagnosed with an ectopic pregnancy.ConclusionThese results may be useful for ED physicians counselling women with symptomatic early pregnancies about the risk of ectopic pregnancy after they are discharged from the ED.

scholarly journals Clinical Outcomes with First-line Endocrine Therapy or Chemotherapy in Postmenopausal HR+/HER2-Metastatic Breast Cancer

2015 ◽  
Vol 9 ◽  
pp. BCBCR.S30771
Author(s):  
Yan Song ◽  
Yanni Hao ◽  
Alexander R. Macalalad ◽  
Peggy L. Lin ◽  
James E. Signorovitch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Treatment Options ◽  
Metastatic Breast ◽  
Retrospective Chart Review ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Objective To describe patient profiles and clinical outcomes associated with first-line endocrine monotherapy (ET) and chemotherapy (CT) for postmenopausal HR+/HER2– metastatic breast cancer (mBC) patients. Methods This is a retrospective chart review of 139 postmenopausal HR+/HER2– mBC patients initiating first-line ET monotherapy or CT. Overall survival (OS) was described using Kaplan–Meier curves. Exploratory comparative proportional hazards regression was conducted. Results Patients on first-line CT had significantly more frequent liver metastases than patients on first-line ET monotherapy at baseline. The median OS was 35.5 months [95% confidence interval (CI), 22.7–41.2 months] for patients on first-line ET monotherapy and 22.2 months (95% CI, 13.6–25.9 months) for those on first-line CT ( P = 0.021). Adjusting for baseline characteristics, the OS between first-line ET monotherapy and CT was not significantly different. Conclusions Patients who were prescribed CT as first-line treatment had evidence of more advanced disease at baseline and shorter OS than those who received ET monotherapy as first-line treatment, suggesting a need for additional safe and effective treatment options for these patients.

scholarly journals Hemorrhoidectomy versus rubber band ligation in treatment of second and third degree hemorrhoids: a comparative study

2019 ◽  
Vol 7 (6) ◽  
pp. 2394
Author(s):  
Nimesh B. Thakkar
Keyword(s):  
Tertiary Care ◽  
Rubber Band Ligation ◽  
Rubber Band ◽  
Low Grade ◽  
Care Hospital ◽  
Line Treatment ◽  
First Line ◽  
Band Ligation ◽  
First Line Treatment ◽  
Second Degree

Background: Optimum surgical intervention for low-grade haemorrhoids is unknown. Haemorrhoidal artery ligation (HAL) has been proposed as an efficacious, safe therapy while rubber band ligation (RBL) is a commonly used Out patient treatment.Methods: We compared recurrence after HAL versus RBL in patients with grade II-III haemorrhoids. The diagnosis of hemorrhoids is primarily based on the proctoscopic  examination. The study evaluates comparative results of rubber band ligation (RBL) and hemorrhoidectomy. This study was conducted over a period of 1 year from January 2017 to December 2017. It includes 50 patients having second- or third-degree primary hemorrhoids who attended surgical OPD of Tertiary Care Hospital in Gujarat. These 50 patients were selected randomly and divided into two groups of 25 patients each (hemorrhoidectomy group and RBL group). Patients of fissure, fistulae, and malignancy were excluded. All parameters were recorded and finally analysed.Results: Hemorrhoidectomy and RBL are equally effective especially in second-degree hemorrhoids. However, RBL should be considered the first-line treatment in second-degree hemorrhoids because being an outpatient procedure, it is cost effective for the patients, saves many hospital beds for more sick patients, and takes the pressure off the surgical waiting list. Although RBL is not as effective as hemorrhoidectomy in third-degree hemorrhoid, it does improve bleeding and prolapse and is highly recommended for patients who are unfit for surgery.Conclusions: RBL should be considered as the first-line treatment for second-degree hemorrhoid. However, in the third-degree hemorrhoids, hemorrhoidectomy achieves better results, and RBL is recommend as the first-line treatment for those patients in whom there is contraindication for surgery or anesthesia.

scholarly journals Outcomes of patients with metastatic gastrointestinal stromal tumors (GIST) treated with multi-kinase inhibitors other than imatinib as first-line treatment

ESMO Open ◽  
2020 ◽  
Vol 5 (6) ◽  
pp. e001082
Author(s):  
Alice Boilève ◽  
Armelle Dufresne ◽  
Ali Chamseddine ◽  
Elise Nassif ◽  
Sarah Dumont ◽  
...  
Keyword(s):  
Median Time ◽  
Phase Ii ◽  
Kinase Inhibitors ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Subsequent Treatment ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
First Line Treatment

BackgroundImatinib is the standard first-line therapy in metastatic gastrointestinal stromal tumours (GIST). Investigational multi-kinase inhibitors (MKIs) such as nilotinib, dasatinib or masitinib have been tested as first-line therapies in phase II/III studies. This might theoretically result either in increased survival or in early emergence of resistance to approved MKIs.MethodsTo assess whether using MKIs other than imatinib in first line decreases imatinib efficacy in second line for patients with GIST, a retrospective chart review was performed from 2005 to 2011 in two French tertiary centres of patients with GIST who received investigational MKIs (in phase II/III trials) as first-line treatment, followed by imatinib as second line.ResultsOf 46 patients, (55% women, median age 55 years (range 24–81)), 22 (47%) had a KIT exon 11 mutation, 1 a KIT exon 9 mutation (2%), 1 a PDGFRA D842V mutation (2%). Out of 46 patients, 21 (46%) received masitinib, 17 (37%) received dasatinib and 8 (17%) received nilotinib as first-line treatment with a median progression-free survival of 18.0 months (95% CI: 8.5 to 25.5). Median time to imatinib failure was 19.7 months (95% CI: 13.5 to 29.0). Median time to second relapse was 48.7 months (95% CI: 31.2 to 72.0). Median overall survival from time of initial metastasis diagnosis was 5.7 years (95% CI: 4.5 to 7.4).ConclusionsPatients with GIST who received investigational MKIs as first-line treatment and imatinib as second line had a time to second relapse longer than that observed historically with imatinib in first line, suggesting that using MKIs other than imatinib in first line does not decrease the efficacy of subsequent treatment lines.

scholarly journals 0527 The Uptake of a Free Digital CBTi Programme in a Large Commercial Organisation

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A201-A202
Author(s):  
A Gardiner ◽  
N Stanley
Keyword(s):  
Success Rate ◽  
Perceived Barriers ◽  
Line Treatment ◽  
Success Rates ◽  
First Line ◽  
Face To Face ◽  
The Uk ◽  
Human Support ◽  
Large Organisation ◽  
First Line Treatment

Abstract Introduction CBTi is effective in the treatment of insomnia and is now recommended as the first-line treatment. However, despite the desirability of CBTi, access to therapy is restricted due to the lack of sufficient appropriately trained and experienced therapists. Because of the lack of therapists and the financial and time costs associated with face to face therapy a number of programmes that offer CBTi digitally have been developed, which have been shown to have similar success rates to receiving therapy in person. Methods The uptake of Sleepstation www.sleepstation.org.uk, a clinically proven CBTi platform with additional human support, was investigated when it was offered free to the members of a large organisation in the UK. The availability of the programme was promoted via the organisation’s website for 3 months. Results 1173 people registered an interest in the programme of which 880 were assessed for suitability (73% female, median age 45yrs). 411 where offered treatment due to symptoms indicative of insomnia. 188 initiated treatment. 137 complete the programme or reached recovery. 112 showed an improvement in their sleep. Conclusion Simply reporting the success rate of CBTi only tells part of the story. Simply improving access to CBTi, whether face to face or digitally, does not necessarily improve the initiation, retention, and completion of CBTi therapy. Further research is needed to fully understand the real and perceived barriers to the use of CBTi. Support This study was facilitated by Sleepstation

scholarly journals Antibiotic Use and Treatment Outcomes among Children with Community-Acquired Pneumonia Admitted to a Tertiary Care Public Hospital in Nepal

2021 ◽  
Vol 6 (2) ◽  
pp. 55
Author(s):  
Bhishma Pokhrel ◽  
Tapendra Koirala ◽  
Dipendra Gautam ◽  
Ajay Kumar ◽  
Bienvenu Salim Camara ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Public Hospital ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Line Treatment ◽  
Hospital Data ◽  
First Line ◽  
Cross Sectional ◽  
First Line Treatment

In the era of growing antimicrobial resistance, there is a concern about the effectiveness of first-line antibiotics such as ampicillin in children hospitalized with community-acquired pneumonia. In this study, we describe antibiotic use and treatment outcomes among under-five children with community-acquired pneumonia admitted to a tertiary care public hospital in Nepal from 2017 to 2019. In this cross-sectional study involving secondary analysis of hospital data, there were 659 patients and 30% of them had a history of prehospital antibiotic use. Irrespective of prehospital antibiotic use, ampicillin monotherapy (70%) was the most common first-line treatment provided during hospitalization followed by ceftriaxone monotherapy (12%). The remaining children (18%) were treated with various other antibiotics alone or in combination as first-line treatment. Broad-spectrum antibiotics such as linezolid, vancomycin, and meropenem were used in less than 1% of patients. Overall, 66 (10%) children were required to switch to second-line treatment and only 7 (1%) children were required to switch to third-line treatment. Almost all (99%) children recovered without any sequelae. This study highlights the effectiveness of ampicillin monotherapy in the treatment of community-acquired pneumonia in hospitalized children in a non-intensive care unit setting.

scholarly journals P067: Ectopic pregnancy outcomes in patients discharged from the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S80-S81
Author(s):  
K. Hawrylyshyn ◽  
S. McLeod ◽  
J. Thomas ◽  
C. Varner
Keyword(s):  
Ectopic Pregnancy ◽  
Chart Review ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Missed Abortion ◽  
Ectopic Pregnancies ◽  
Pregnancy Of Unknown Location ◽  
Rule Out

Introduction: The objective of this study was to determine the proportion of women who had a ruptured ectopic pregnancy after being discharged from the ED where ectopic pregnancy had not yet been excluded. Methods: This was a retrospective chart review of pregnant (<12 week gestational age) women discharged home from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule out ectopic pregnancy, or pregnancy of unknown location (PUL) over a 7 year period. Results: Of the 550 included patients, 83 (15.1%) had a viable pregnancy, 94 (17.1%) had a spontaneous or missed abortion, 230 (41.8%) had an ectopic pregnancy, 72 (13.1%) had unknown outcomes and 71 (12.9%) had other outcomes which included therapeutic abortion, molar pregnancy or resolution of HCG with no location documented. Of the 230 ectopic pregnancies, 42 (7.6%) underwent expectant management, 131 (23.8%) were managed medically with methotrexate, 29 (5.3%) were managed with surgical intervention, and 28 (5.1%) patients had a ruptured ectopic pregnancy after their index ED visit. Of the 550 included patients, 221 (40.2%) did not have a transvaginal US during their index ED visit, 73 (33.0%) were subsequently diagnosed with an ectopic pregnancy. Conclusion: These results may be useful for ED physicians counselling women with symptomatic early pregnancies about the risk of ectopic pregnancy after they are discharged from the ED.

Sign in / Sign up

Export Citation Format

Share Document