Early Treatment Initiation Improves Outcomes in Nevus of Ota: A 10-Year Retrospective Study

2020 ◽  
Author(s):  
Petchlada Achavanuntakul ◽  
Woraphong Manuskiatti ◽  
Rungsima Wanitphakdeedecha ◽  
Tatre Jantarakolica
Keyword(s):  
Retrospective Study ◽  
Early Treatment ◽  
Treatment Initiation ◽  
Nevus Of Ota

Early Treatment Initiation Improves Outcomes in Nevus of Ota: A 10-Year Retrospective Study

2021 ◽  
Author(s):  
Petchlada Achavanuntakul ◽  
Woraphong Manuskiatti ◽  
Rungsima Wanitphakdeedecha ◽  
Tatre Jantarakolica
Keyword(s):  
Retrospective Study ◽  
Early Treatment ◽  
Treatment Initiation ◽  
Nevus Of Ota

scholarly journals Adherence to antiretroviral therapy among HIV/AIDS patients in the context of early treatment initiation in Vietnam

2018 ◽  
Vol Volume 12 ◽  
pp. 2131-2137 ◽  
Author(s):  
Hue Thi Mai ◽  
Le Minh Giang ◽  
Bach Xuan Tran ◽  
Ha Do ◽  
Carl Latkin ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Early Treatment ◽  
Treatment Initiation ◽  
Aids Patients ◽  
Hiv Aids

Treatment of Nevus of Ota with 1064 nm Picosecond Nd: YAG Laser: A retrospective study

2021 ◽  
Author(s):  
Hedan Yang ◽  
Lifang Guo ◽  
Gaorong Jia ◽  
Xiangdong Gong ◽  
Qiuju Wu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Yag Laser ◽  
Nevus Of Ota

Outcome of Observation As Initial Strategy in Patients with Mantle Cell Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2699-2699 ◽  
Author(s):  
Pau Abrisqueta ◽  
Graham W Slack ◽  
David W Scott ◽  
Randy D. Gascoyne ◽  
Joseph M. Connors ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Early Treatment ◽  
Peripheral Blood ◽  
Research Funding ◽  
Treatment Initiation ◽  
Clinical Presentation ◽  
Cell Lymphoma ◽  
Performance Status ◽  
Ki 67 ◽  
Mantle Cell

Abstract Background Patients with mantle cell lymphoma (MCL) follow a heterogeneous clinical course ranging from very indolent to very aggressive. While patients with MCL generally require treatment initiation shortly after diagnosis, it is unclear whether deferring treatment in patients with "indolent" MCL affects their overall outcome. Because it is difficult to identify such patients at the time of diagnosis, their course can only be retrospectively described as indolent after a prolonged period of observation. The aim of this study was to describe the subgroup of patients with MCL who underwent observation as their initial management, including their clinical and biological characteristics and outcomes. Methods Patients diagnosed with MCL from 1998-2015 who were initially observed for ≥3 months from the date of definitive diagnosis were identified in the BCCA Lymphoid Cancer and Pharmacy Databases. Pathology was centrally reviewed at the time of diagnosis, and only cases positive for CCND1 by immunohistochemistry and/or t(11;14) by FISH were included. During the study period, there were no predefined criteria guiding observation or active treatment. Eventual treatment indications included high tumor burden, disease associated symptoms or peripheral blood cytopenias. Clinical-biological features at diagnosis, treatment and outcomes, were analyzed. Results A total of 725 patients with MCL were initially identified, but 286 were excluded: missing data (n=179), treatment refusal (n=7), no treatment due to frailty (n=16), or absence of CCDN1 or t(11;14) confirmation (n=84). 365 (83%) patients received early treatment (ET) and 74 (17%) were observed >3 months (OBS), as shown in Table 1. In the OBS group, 52 (71%) patients had measurable lymph nodes at presentation, 16 (22%) a non-nodal presentation (defined as peripheral blood, bone marrow, and/or spleen only), and 5 (7%) only had gastro-intestinal involvement. Patients in the OBS group were older, with favorable presenting features including good performance status, less frequent B symptoms or increased LDH, and lower Ki67 (<30% vs ≥ 30%) than the ET group. However, MIPI scores were similar between both groups. The majority of patients received rituximab-containing chemotherapy (most commonly R-CHOP or R-bendamustine) at the time of initial treatment in both the ET group (70%) and the OBS group (72%). In the OBS cohort, with a median follow-up of 47 months (range 3.4 - 158 months) in living patients, the median time to treatment (TtT) was 35.5 months (range 5 - 79 months). 10 patients (14%) were observed for > 5 years without requiring treatment. Factors associated with longer TtT included clinical presentation (non-nodal vs nodal, median not reached vs 29 months; P=.005) and Ki-67 (<30% vs ≥ 30%, median 59 vs 20 months, P=.033). Median OS was significantly longer in the OBS group than in the ET group (66 vs 50 months, respectively, P=.024) reflecting the more favorable disease characteristics of the OBS group. Clinical presentation (ie, non-nodal vs nodal) was the only factor associated with OS (median 123 vs 47 months, P=.003) in the OBS group. Finally, the median OS from date of treatment initiation for patients eventually requiring therapy in the OBS group was 34.4 months. With a median age at treatment initiation of 71 yrs (range 40 - 91 yrs) in the OBS group, OS was not significantly different in comparison with the ET group when the analysis was adjusted by age at treatment. Conclusions A subgroup of patients with MCL may be safely observed at diagnosis of the disease without negatively impacting their outcomes, including not only those patients with non-nodal presentation but also asymptomatic patients with low burden nodal presentation, particularly those with a low proliferative rate. Table 1. Patients characteristics by treatment group Observation (n=74) Early treatment (N=365) p-value Median age, years (range) 68 (39 - 90) 66 (22 - 94) 0.05 Male sex 47/74 (64%) 262/365 (72%) 0.16 Performance status >1 7/71 (10%) 97/337 (29%) <.001 B symptoms 1/73 (1%) 116/353 (33%) <.001 Elevated LDH 5/66 (8%) 110/310 (36%) <.001 Ann Arbor Stage I/II 7/73 (10%) 40/357 (11%) 0.80 Ki-67 ≥30% 6/24 (25%) 89/151 (59%) 0.002 Blastoid morphology 0/74 (0) 44/365 (12%) <.001 Nodular pattern 30/58 (52%) 139/304 (46%) 0.40 MIPI 0.73 -   Low risk 20/64 (31%) 83/288 (29%) -   Intermediate risk 19/64 (30%) 77/288 (27%) -   High risk 25/64 (39%) 128/288 (44%) Disclosures Scott: Celgene: Consultancy, Honoraria; NanoString: Patents & Royalties: Inventor on a patent that NanoString has licensed. Connors:Roche: Research Funding; Seattle Genetics: Research Funding. Savage:Seattle Genetics: Honoraria, Speakers Bureau; BMS: Honoraria; Infinity: Honoraria; Roche: Other: Institutional research funding. Villa:Roche: Research Funding.

Quantitative PET-MRI for early treatment response assessment in pancreatic ductal adenocarcinoma.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 520-520
Author(s):  
Martin Valera Consunji ◽  
Spencer Behr ◽  
Andrew H. Ko ◽  
Margaret A. Tempero ◽  
Pelin Cinar ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Treatment Response ◽  
Early Treatment ◽  
Tumor Size ◽  
Treatment Initiation ◽  
Post Treatment ◽  
Ductal Adenocarcinoma ◽  
Imaging Biomarkers ◽  
Early Assessment ◽  
Early Treatment Response

520 Background: There is an unmet need for improved non-invasive markers to assess early treatment response in pancreatic ductal adenocarcinoma (PDAC). Assessing early treatment response using tumor size on anatomic imaging or serum carbohydrate antigen 19-9 (CA19-9) level is unreliable. In contrast, metabolic and functional imaging is a promising new tool that may differentiate responders from non-responders early on during therapy. Therefore, the objective of this pilot study was to explore the potential of integrated positron emission tomography-magnetic resonance imaging (PET-MRI) to provide imaging biomarkers of early (4 weeks post treatment initiation) response in patients with advanced PDAC. Methods: 13 patients with biopsy-proven locally advanced or metastatic PDAC underwent integrated 18F-fluorodeoxyglucose PET-MRI through the abdomen prior to, and again at 4 weeks post, treatment initiation. Patients also had computed tomography (CT) imaging of the chest, abdomen, and pelvis and serum CA19-9 levels measured, as per standard of care. Patients were classified as responders or non-responders according to RECIST (Response Evaluation Criteria In Solid Tumors) on delayed CT, at 8-12 weeks interval post treatment initiation. Changes in metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from PET, and apparent diffusion coefficient (ADC) from diffusion-weighted MRI at 4 weeks were compared between responders and non-responders. Results: Of the 13 patients, there were 7 responders (partial response by RECIST) and 6 non-responders (progressive or stable disease by RECIST). After 4 weeks of therapy, responders had a significantly greater decrease in MTV (p = 0.003) and TLG (p = 0.006) compared to non-responders. Responders also had a significantly greater increase in mean and minimum ADC (p = 0.004 and p = 0.024, respectively) compared to non-responders. Change in tumor size at 4 weeks was not significantly different between responders and non-responders (p = 0.11). Conclusions: Integrated PET-MRI can provide early assessment of treatment response in patients with advanced PDAC.

scholarly journals A-DROP and Blood Urea Nitrogen-to-Serum Albumin Ratio are Useful in Assessing the Severity of Pneumocystis Pneumonia in Patients Without Human Immunodeficiency Virus Infection: A Retrospective Study

2020 ◽  
Author(s):  
Jumpei Akahane ◽  
Atsuhito Ushiki ◽  
Makoto Kosaka ◽  
Yuichi Ikuyama ◽  
Akemi Matsuo ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Prognostic Factors ◽  
Retrospective Study ◽  
Serum Albumin ◽  
Blood Urea Nitrogen ◽  
Treatment Initiation ◽  
Community Acquired Pneumonia ◽  
Urea Nitrogen ◽  
Albumin Ratio ◽  
Immunodeficiency Virus

Abstract Background: There is an increasing incidence of Pneumocystis pneumonia among individuals without the human immunodeficiency virus (HIV) infection (non-HIV Pneumocystis pneumonia). However, the prognostic factors for patients with non-HIV Pneumocystis pneumonia have not been identified. Moreover, A-DROP (for classifying the severity of community-acquired pneumonia) or the blood urea nitrogen-to-serum albumin ratio, which is reported to be predictor of mortality of community-acquired pneumonia, has not been established as an efficient prognostic factor in patients with non-HIV Pneumocystis pneumonia. In this study, we analyzed the prognostic factors for non-HIV Pneumocystis pneumonia and evaluated the effectiveness of A-DROP and the blood urea nitrogen-to-serum albumin ratio as prognostic factors.Methods: This retrospective study involved a chart review of the medical records of 102 patients diagnosed with non-HIV Pneumocystis pneumonia between January 2003 and May 2019 at five medical facilities. Prognostic factors associated with the 30-day mortality were assessed using multiple logistic regression analysis.Results: Among the 102 patients with non-HIV Pneumocystis pneumonia, 46 (45.1%) had autoimmune diseases, 19 (18.6%) had hematological malignancies, 18 (17.7%) had solid malignancies, and 19 (18.6%) had other diseases. The 30-day mortality rate for non-HIV Pneumocystis pneumonia was 20.5% in this study population. Compared with survivors, non-survivors had significantly lower serum albumin levels and a significantly higher age, corticosteroid dosage at the onset of Pneumocystis pneumonia, alveolar–arterial oxygen gradient, A-DROP score, lactate dehydrogenase levels, blood urea nitrogen levels, and blood urea nitrogen-to-serum albumin ratio. The results of multivariate analysis showed that a high A-DROP score and blood urea nitrogen-to-serum albumin ratio at treatment initiation were significantly associated with the 30-day mortality risk.Conclusions: A high A-DROP score and blood urea nitrogen-to-serum albumin ratio at treatment initiation are independent prognostic predictors of mortality risk in patients with non-HIV Pneumocystis pneumonia.

scholarly journals Delays and barriers to early treatment initiation for childhood tuberculosis in India

2019 ◽  
Vol 23 (10) ◽  
pp. 1090-1099 ◽  
Author(s):  
C. Valvi ◽  
A. Chandanwale ◽  
S. Khadse ◽  
R. Kulkarni ◽  
D. Kadam ◽  
...  
Keyword(s):  
Private Sector ◽  
Health Care Providers ◽  
Early Treatment ◽  
Treatment Initiation ◽  
Control Programme ◽  
Childhood Tuberculosis ◽  
Care Providers ◽  
Cross Sectional ◽  
Tb Treatment ◽  
Symptom Screening

BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27–86). Sixty-six (74%) children visited 1–8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10–75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.

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