Pembrolizumab for Unresectable or Metastatic Melanoma in Patients Older than 85 Years of Age

Dermatology ◽  
2019 ◽  
Vol 235 (3) ◽  
pp. 219-224 ◽  
Author(s):  
Johan Chanal ◽  
Nora Kramkimel ◽  
Carole Ratour ◽  
Selim Aractingi ◽  
Sarah Guégan ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Medical Records ◽  
Developed Countries ◽  
Advanced Melanoma ◽  
The Past ◽  
Potential Benefits ◽  
The Mean ◽  
Infusion Schedule ◽  
Grade 3 ◽  
Cell Death Protein

Background: Programmed cell death protein-1 (PD-1) inhibitors (pembrolizumab and nivolumab) have been approved for the treatment of advanced melanoma. Over the past decades, patients older than 85 years represent an expanding group of patients in developed countries. In France, 25% of melanomas are diagnosed in patients older than 75 years. Objective: To perform a monocentric retrospective study of patients older than 85 years and treated with pembrolizu­mab for unresectable or metastatic melanoma in order to evaluate tolerance and potential benefits of this immunotherapy. Methods: Medical records of patients treated with the PD-1 inhibitor pembrolizumab between January 2015 and January 2018 were reviewed. Results: Nine patients (6 women and 3 men) older than 85 years were included in the study. The mean age was 89.6 (85–97) years at inclusion. All patients were PS 0 or 1. The mean number of infusions was 4 (1–12). However, most patients were not able to tolerate the 4-infusion schedule. One patient refused the second infusion for personal reasons. Seven patients had grade 3 or 4 treatment-related adverse events. Conclusion: These results indicate that pembrolizumab treatment in patients older than 85 years may induce responses but is associated with a high risk of toxicity and impaired autonomy.

Local experience with ipilimumab and nivolumab in treatment of metastatic melanoma: From world standards to individualized approaches in real clinical practice.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e21023-e21023
Author(s):  
Georgy M. Manikhas ◽  
Rashida Orlova ◽  
Natalia V. Zhukova ◽  
Nina Antimonik ◽  
Svetlana I. Kutukova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Metastatic Melanoma ◽  
Performance Status ◽  
Advanced Melanoma ◽  
Medical Settings ◽  
Local Experience ◽  
Treatment Paradigm ◽  
Infusion Reactions ◽  
Grade 3 ◽  
The Moment

e21023 Background: Ipilimumab (Ipi) is the first agent in metastatic melanoma treatment that achieved long-term efficacy in selected patients. Nivolumab (Nivo) is one of agents, PD-1 inhibitors, that change treatment paradigm of advanced melanoma due to improving OS for lots of patients. There is still needed to evaluate efficacy of this drugs in regular medical settings. Methods: 43 patients with advanced melanoma were treated in SPb Clinical Oncology Dispensary from 2014 till now: 16 male and 27 female, median age is 58y.o. (from 39 to 84). 31 patients received Ipi, 12 patients received Nivo. Almost of patients are progressed after 1-4 lines of previous systemic therapy before starting treatment with Ipi or Nivo. Initial performance status (PS) assessed by ECOG scale was following; 1 patient had PS = 0 by ECOG, 37 patients – PS = 1 by ECOG and 5 patients had PS = 2 status by ECOG. Adverse events (AEs) are collected according to CTC AE v4.03. Results: At the time of analysis median FU is 25.75 month (95% CI: 6,6-35.9). The most frequently reported AEs are: pruritis 20%, fatigue 10%, diarrhea 7%, hepatitis 4%. 6% of AEs are grade 3/4. There are no any infusion reactions to Ipi and Nivo. Ipilimumab: median PFS is 6.0 month (95% CI: 4.9;7.1), 19% of patients (n = 6) have no PD at the moment. Median OS is 12.0 months (95% CI: 9.7;14.3), 29% of patients are still alive (n = 9). 6-months OS is 81%, 1-year OS is 35%. Nivolumab: Only 3 from 12 patients have PD after Nivo on the time of analysis. Median PFS and OS is not reached: 10 patients are still alive. 1-year OS is 83,33%. 52% of patients have reported AEs. Conclusions: Efficacy and tolerability of Ipi and Nivo in our clinical practice is similar to data from international clinical studies. The treatment with Ipi and Nivo is not associated with drug related infusion reactions and immediate AEs and doesn’t require supervision of patients at in-patient departments.Ipi and Nivo treatment is safe, could be used on out patients’ basis in regular medical settings.

Collaborative study of compliance in psychotic patients with risperidone long-acting injection (RLAI) in the last 5 years

2011 ◽  
Vol 26 (S2) ◽  
pp. 1263-1263
Author(s):  
R. Molina Ramos ◽  
H. Arnillas ◽  
J. Playà ◽  
M. Sánchez de Muniain ◽  
M. LLiteras ◽  
...  
Keyword(s):  
Medical Records ◽  
Collaborative Study ◽  
Outpatient Clinics ◽  
Psychotic Episode ◽  
Duration Of Treatment ◽  
Extrapyramidal Side Effect ◽  
The Past ◽  
Report Data ◽  
The Mean ◽  
Long Acting

IntroductionCompliance is essential to achieve the best results in serious mental illness like schizophrenia.ObjectivesIt was expected that the use of second-generation oral antipsychotics with less extrapyramidal side effect profile would improve the compliance, but the results do not support these expectations except in the case of risperidone long-acting injection.AimsThe aim of this study is to assess the degree of compliance in outpatients who were started treatment with RLAI while they were hospitalized for an acute psychotic episode in psychiatric unit.MethodsA retrospective study was conducted by reviewing medical records of hospitalized patients for psychotic episodes over the past 5 years in three hospitals in Mallorca (Balearic Islands, Spain) -Hospital de Manacor, Hospital son Llatzer and Hospital de Inca). Due to computerization of medical records, we knew the degree of compliance with treatment and outcome in outpatient clinics. We designed a case report data (CRD) to assess specific variables in our study that was completed for each patient.ResultsThe mean duration of treatment in patients who continue with RLAI was 38.8 months. Overall. 69.5% continued with the treatment after 5 years. The patients who continued treatment were rehospitalazed 20% less than the ones who discontinued.ConclusionsThe compliance with RLAI in outpatients was high even in patients with substances abuse. The patients who remain on treatment from hospital discharge have less readmissions. The most common dosis of RLAI is 50 mg. Lack of insight was the most frequent cause of discontinuation.

Vitamin A: dietologist’s position

2020 ◽  
pp. 49-57
Author(s):  
S. V. Orlova ◽  
E. A. Nikitina ◽  
L. I. Karushina ◽  
Yu. A. Pigaryova ◽  
O. E. Pronina
Keyword(s):  
Immune Response ◽  
Urinary Tract ◽  
Gastrointestinal Tract ◽  
Vitamin A ◽  
Developed Countries ◽  
Therapeutic Practice ◽  
The Past ◽  
Increased Risk ◽  
Mucous Membranes

Vitamin A (retinol) is one of the key elements for regulating the immune response and controls the division and differentiation of epithelial cells of the mucous membranes of the bronchopulmonary system, gastrointestinal tract, urinary tract, eyes, etc. Its significance in the context of the COVID‑19 pandemic is difficult to overestimate. However, a number of studies conducted in the past have associated the additional intake of vitamin A with an increased risk of developing cancer, as a result of which vitamin A was practically excluded from therapeutic practice in developed countries. Our review highlights the role of vitamin A in maintaining human health and the latest data on its effect on the development mechanisms of somatic pathology.

Evaluation of Low-Dose Gentamicin Once Daily Dosing Regimen at A General Hospital in Malaysia

2018 ◽  
Vol 9 (01) ◽  
Author(s):  
Ab Rahman A F ◽  
Md Sahak N. ◽  
Ali A. M.
Keyword(s):  
Medical Records ◽  
Public Hospital ◽  
Low Dose ◽  
Dosing Regimen ◽  
Once Daily ◽  
Neutropenic Sepsis ◽  
Wide Acceptance ◽  
The Mean ◽  
Initiation Of Therapy ◽  
Almost All

Objective: Once daily dosing (ODD) aminoglycoside is gaining wide acceptance as an alternative way of dosing. In our setting it is the regimen of choice whenever gentamicin is indicated. The objective of this study was to evaluate the practice of gentamicin ODD in a public hospital in Malaysia. Methods: We conducted a retrospective review of medical records of patients on gentamicin ODD who were admitted to Hospital Melaka during January 2002 until March 2010. All adult patients who were on ODD gentamicin with various level of renal function were included in the study. Patients on gentamicin less than 72 hours and pregnant women were excluded. Results: From 110 patients, 75 (68.2%) were male and 35 (31.8%) were female. Indications for ODD gentamicin included pneumonia, 34 (31.0%) neutropenic sepsis, 27 (24.5%) and sepsis, 11 (10.0%). The mean dose and duration of gentamicin was 3.2 mg/kg/day and 7 days, respectively. Almost all patients were on gentamicin combined with other antibiotics. Clinical cure based on fever resolution was found in 89.1% of patients treated with ODD. Resolution of fever took an average of 48 hours after initiation of therapy. The evaluation for bacteriologic cure could not be performed because of insufficient data on culture and sensitivity. Out of 38 patients with analyzable serum creatinine data, four patients might have developed nephrotoxicity. Conclusion: In our setting, lower dosages of ODD gentamicin when used in combination with other antibiotics seemed to be effective and safe in treating most gram negative infections.

Risk Factor Of Substitution ARV First Line People Living With HIV/AIDS In General Hospital Buleleng Bali

2020 ◽  
Vol 9 (1) ◽  
pp. 190-197
Author(s):  
Luh Putu Desy Puspaningrat ◽  
Gusti Putu Candra ◽  
Putu Dian Prima Kusuma Dewi ◽  
I Made Sundayana ◽  
Indrie Lutfiana
Keyword(s):  
Risk Factor ◽  
General Hospital ◽  
Medical Records ◽  
Secondary Data ◽  
District General Hospital ◽  
People Living With Hiv ◽  
First Line ◽  
The Past ◽  
Factor Substitution ◽  
Living With Hiv

Substitution is still a threat to the failure of ARV therapy so that no matter how small it must be noted and monitored in ARV therapy. The aims  was analysis risk factor substitution ARV first line in therapy ARV. This study was an analytic longitudinal study with retrospective secondary data analysis in a cohort of patients receiving ARV therapy at the District General Hospital of Buleleng District for the period of 2006-2015 and secondary data from medical records of PLHA patients receiving ART.  Result in this study that the percentage of first-line ARV substitution events is 9.88% (119/1204) who received ARV therapy for the past 11 years. Risk factors that increase the risk of substitution in ARV therapy patients are zidovudine (aOR 4.29 CI 1.31 -2.65 p 0.01), nevirapine (aOR1.86 CI 2.15 - 8.59 p 0.01) and functional working status (aOR 1.46 CI 1.13 - 1.98 p 0.01). 

Gamma knife radiosurgery for intracranial metastatic melanoma: a 6-year experience

2002 ◽  
Vol 97 ◽  
pp. 494-498 ◽  
Author(s):  
Jorge Gonzalez-martinez ◽  
Laura Hernandez ◽  
Lucia Zamorano ◽  
Andrew Sloan ◽  
Kenneth Levin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Metastatic Melanoma ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Significant Difference ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to evaluate retrospectively the effectiveness of stereotactic radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to tumor control and survival that might be helpful in determining appropriate therapy. Methods. Twenty-four patients with intracranial metastases (115 lesions) metastatic from melanoma underwent radiosurgery. In 14 patients (58.3%) whole-brain radiotherapy (WBRT) was performed, and in 12 (50%) chemotherapy was conducted before radiosurgery. The median tumor volume was 4 cm3 (range 1–15 cm3). The mean dose was 16.4 Gy (range 13–20 Gy) prescribed to the 50% isodose at the tumor margin. All cases were categorized according to the Recursive Partitioning Analysis classification for brain metastases. Univariate and multivariate analyses of survival were performed to determine significant prognostic factors affecting survival. The mean survival was 5.5 months after radiosurgery. The analyses revealed no difference in terms of survival between patients who underwent WBRT or chemotherapy and those who did not. A significant difference (p < 0.05) in mean survival was observed between patients receiving immunotherapy or those with a Karnofsky Performance Scale (KPS) score of greater than 90. Conclusions. The treatment with systemic immunotherapy and a KPS score greater than 90 were factors associated with a better prognosis. Radiosurgery for melanoma-related brain metastases appears to be an effective treatment associated with few complications.

A summary of beach nourishment in China: The past decade of practices

Shore & Beach ◽  
2020 ◽  
pp. 65-73
Author(s):  
Gen Liu ◽  
Feng Cai ◽  
Hongshuai Qi ◽  
Jianhui Liu ◽  
Gang Lei ◽  
...  
Keyword(s):  
Beach Nourishment ◽  
Developed Countries ◽  
Ecological Design ◽  
Optimized Design ◽  
Limited Information ◽  
Personal Communications ◽  
Design Considerations ◽  
The Past ◽  
Technological Advances ◽  
Urban Beaches

Beach nourishment has been widely used for beach protection around the world. However, there is limited information about beach nourishment in China. This study offers an overview of beach nourishment practices, status and technological advances in China, based on the literature, reports, and personal communications. The results demonstrate that beach nourishment has been recognized as an effective and environmentally friendly measure to combat coastal erosion and has been increasingly adopted in China, especially in the past decade. The unique characteristics of coastal China resulted in a difference in beach nourishment between China and Western developed countries in terms of the types, objectives, and shapes of beach nourishment. For the types of nourishments in China, there were approximately the same number of restored beaches and newly constructed beaches. For fill sediment, homogeneous fill and heterogeneous fill comprised 51.1% and 48.9% of projects, respectively. The objective of beach nourishment was mainly to promote coastal tourism, and the shape of nourished beaches was dominated by headland bays. This study also indicated that China has achieved a number of technological advances in beach nourishment, including methods of beach nourishment on severely eroded coasts and muddy coasts, an optimized design of drain pipes involved in urban beaches, and ecological design considerations. From the past decade of practices, four aspects were proposed as considerations for future nourishment: sand sources, technique advances, ecological effects, and management of beach nourishments.

Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

2016 ◽  
Vol 5 (09) ◽  
pp. 4896
Author(s):  
Sripriya C.S.* ◽  
Shanthi B. ◽  
Arockia Doss S. ◽  
Antonie Raj I. ◽  
Mohana Priya
Keyword(s):  
Scrub Typhus ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
The Past ◽  
Igm Elisa ◽  
The Mean ◽  
Specific Symptoms ◽  
Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45. 

Rice tablet (Aluminum Phosphide) poisoning

2016 ◽  
Vol 5 (11) ◽  
pp. 5041
Author(s):  
Farkhondeh Jamshidi ◽  
Ahmad Ghorbani ◽  
Sina Darvishi*
Keyword(s):  
Medical Records ◽  
Statistical Tests ◽  
Patient Records ◽  
Demographic Information ◽  
Aluminum Phosphide ◽  
Men And Women ◽  
Significant Difference ◽  
The Mean ◽  
Aluminum Phosphide Poisoning ◽  
Commit Suicide

The abuse of some pesticides especially to suicide is one of the current problems of pesticides. Aluminum phosphide induced poisoning usually happens to suicide and sometimes it is due to accidental occupational exposure and in a few cases it has some criminal intensions. This study is conducted to evaluate patients poisoned with aluminum phosphide. In the present study the medical records of cases of poisoning with rice tablets (aluminum phosphide) hospitalized in Ahvaz Razi hospital is studied. Accordingly, a checklist is prepared that included demographic information of patients (age, gender) and information on patient records (information on poisoning) are completed using the patients’ medical records. The analysis of data is done by SPSS V22. 18 patients poisoned with rice tablet (aluminum phosphide) are studied. Results of the study show that 11 patients are male and seven are female. The mean patient age is 27.06 ±8.04 years that is 28 ±9 and 25 ±6.02 in men and women respectively. Statistical tests show no statistically significant difference in mean age in both genders (P> 0.05). Among patients, 11 subjects took aluminum phosphide to attempt suicide and 3 cases took it unintentionally and of course the reason is not mentioned in four cases. Among the patients who tried to commit suicide by taking aluminum phosphide, 6 cases are male and 5 cases are female that no statistically significant difference is observed between the genders in this respect (P> 0.05). In addition to the study of the complications caused by this poisoning and its mortality, it is recommended to responsible authorities to provide the necessary educations and treatments to prevent this type of poisoning.

Assessing single nucleotide polymorphism selection methods for the development of a low-density panel optimized for imputation in South African Drakensberger beef cattle

2021 ◽  
Author(s):  
Simon F Lashmar ◽  
Donagh P Berry ◽  
Rian Pierneef ◽  
Farai C Muchadeyi ◽  
Carina Visser
Keyword(s):  
South African ◽  
Clustering Algorithm ◽  
Imputation Accuracy ◽  
Developed Countries ◽  
Genotype Imputation ◽  
Selection Strategy ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Single Nucleotide Polymorphism Selection ◽  
The Mean

Abstract A major obstacle in applying genomic selection (GS) to uniquely adapted local breeds in less-developed countries has been the cost of genotyping at high densities of single nucleotide polymorphisms (SNP). Cost reduction can be achieved by imputing genotypes from lower to higher densities. Locally adapted breeds tend to be admixed and exhibit a high degree of genomic heterogeneity thus necessitating the optimization of SNP selection for downstream imputation. The aim of this study was to quantify the achievable imputation accuracy for a sample of 1,135 South African (SA) Drakensberger using several custom-derived lower-density panels varying in both SNP density and how the SNP were selected. From a pool of 120,608 genotyped SNP, subsets of SNP were chosen 1) at random, 2) with even genomic dispersion, 3) by maximizing the mean minor allele frequency (MAF), 4) using a combined score of MAF and linkage disequilibrium (LD), 5) using a partitioning-around-medoids (PAM) algorithm, and finally 6) using a hierarchical LD-based clustering algorithm. Imputation accuracy to higher density improved as SNP density increased; animal-wise imputation accuracy defined as the within-animal correlation between the imputed and actual alleles ranged from 0.625 to 0.990 when 2,500 randomly selected SNP were chosen versus a range of 0.918 to 0.999 when 50,000 randomly selected SNP were used. At a panel density of 10,000 SNP, the mean (standard deviation) animal-wise allele concordance rate was 0.976 (0.018) versus 0.982 (0.014) when the worst (i.e., random) as opposed to the best (i.e., combination of MAF and LD) SNP selection strategy was employed. A difference of 0.071 units was observed between the mean correlation-based accuracy of imputed SNP categorized as low (0.01&lt;MAF≤0.1) versus high MAF (0.4&lt;MAF≤0.5). Greater mean imputation accuracy was achieved for SNP located on autosomal extremes when these regions were populated with more SNP. The presented results suggested that genotype imputation can be a practical cost-saving strategy for indigenous breeds such as the South African Drakensberger. Based on the results, a genotyping panel consisting of approximately 10,000 SNP selected based on a combination of MAF and LD would suffice in achieving a less than 3% imputation error rate for a breed characterized by genomic admixture on the condition that these SNP are selected based on breed-specific selection criteria.

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