836 Issues with Sleep Can Be Skin Deep: Management of Obstructive Sleep Apnea in Cutaneous Sarcoidosis

Introduction Introduction/Background: PAP Intolerance is a common initial complaint among new PAP users, with mask issues and difficulty with pressure level leading the list. In clinical practice, feelings of claustrophobia and anxiety are usually cited as the reason for PAP intolerance. Sometimes craniofacial impairments such as congenital malformations or change in facial architecture after a major accident or surgery may play a role. Our case describes our experience with a patient afflicted with severe sinonasal cutaneous Sarcoidosis. Report of case(s) Case Description: A 43 year old AAF with a PMH of morbid obesity, depression and cutaneous sinonasal Sarcoidosis was referred to Sleep Medicine by ENT in late May 2020 with complaints of snoring, witnessed apneas, excessive daytime sleepiness, fatigue, and non-restorative sleep for >20 years. The patient was first diagnosed with cutaneous Sarcoidosis limited to the internal sinonasal region around 2015 and managed by ENT until the lesions spread to her face. Due to this, the patient developed depression and became increasingly non-complaint with her medical regimens. As a result, her sarcoidosis and other co-morbidities worsened. Diagnostic Polysomnogram (PSG) in May 2020 showed presence of Hypopnea predominant Obstructive Sleep Apnea (OSA) with AHI 35.9 and O2 desaturation to 58%. Subsequently, the patient was placed on auto CPAP 6–20 cm H2O with a DreamWear FFM. At follow up in September 2020, her sarcoidosis had spread to her upper lip area, so she was prescribed a Fit Life mask to avoid this region. Follow up in December 2020 revealed improvement in Sarcoidosis and accompanying vast improvement in objective compliance though she reverted to using her DreamWear FFM due to “mask seal issues. An AirFit f20 mask was then given to help avoid the active lesions on her upper lip. Conclusion: Discussion/Conclusion In patients with compromised facial architecture, special attention must be paid to the type of mask interface used so it does not aggravate sensitive areas which may lead to poor compliance with PAP therapy. Instructions were given for her to alternate between her three masks—the Fit Life, the DreamWear FFM and the AirFit f20 FFM—in an effort to reduce irritation on her face over time. Support (if any):

Chemoprevention in Breast Cancer

Chemoprevention in breast cancer represents one of the most important therapeutic regimens in an effort to optimize survival and prevent breast cancer recurrence. The chapter aims to analyze below all potential medical regimens used in breast cancer chemoprevention, along with explaining the reasons why those are the ones selected: their characteristics, their mechanism of action, and their side effects. Among these, we may report tamoxifen, raloxifen, aromatase inhibitors, and new therapeutic regimens such as polyphenoles.

Integrating Care Work with Life

This chapter discusses what it's like for caregivers to work at home in contrast to work done by nurses in the hospital. Homes, by their very nature, lack the resources and support of a hospital, and often geography — the physical separation between the home and the hospital — places obstacles in the coordination of care. Unlike bureaucratic settings, which have standard work shifts, care work at home takes place over a twenty-four-hour period and caregivers' schedules are completely different from the schedules of the organizations they depend on for resources, such as delivery companies, vendors, or pharmacies. As is evident from contrasting the bustle of a busy hospital with the atmosphere in many homes, the division of labor and the people who do it are entirely different. In the hospital, nurses work in shifts to provide patient care. At home, there are far fewer people available, and they are in deeply embedded, preestablished familial roles and relationships, as well as existing patterns of housework and childcare. Because home is oriented toward relationships, “private” activities, and provisioning, rather than toward bureaucratic standards, compliance with medical regimens can also be more difficult. Whether or not caregivers received training in the hospital or rehabilitation, most said they were still very anxious, sometimes even overwhelmed and frightened, the first time they had to perform procedures by themselves at home. Caregivers dealt not only with the medical procedures, however, but also with their feelings about the care recipient's overall health and prognosis, and whether the recipient would be able to adapt to new regimens.

Medical Therapy of Acromegaly in Germany 2019 – Data from the German Acromegaly Registry

Context Acromegaly is a rare disease caused by excessive growth hormone (GH) secretion from pituitary adenomas in most cases. If neurosurgical therapy is contraindicated or not sufficient, medical therapy is the second line therapy. Objective To describe current medical therapy in acromegaly. Design & Methods Retrospective data analysis from 2732 patients treated in 69 centers of the German Acromegaly Registry. 749 patients were seen within the recent 18 months, of which 420 were on medical therapy (56.1%). Results 73% of medically treated acromegalic patients had normal/low IGF-1 levels. 57% of patients with non-normalized IGF-1 levels had an IGF-1 value between 1- and 1.25-fold above the upper limit of normal. Most patients (55%) received somatostatin analogs as monotherapy, 12% GH receptor monotherapy, and 9% dopamine agonist therapy. Doses of each medical therapy varied widely, with 120 mg lanreotide LAR every 4 weeks, 30 mg octreotide LAR every 4 weeks, 140 mg pegvisomant per week and 1mg cabergoline per week being the most frequent used regimens. A combination of different medical regimens was used in almost 25% of the patients. Conclusion The majority of German acromegalic patients receiving medical therapy are controlled according to normal IGF-1 levels.

Vilaprisan, a New Selective Progesterone Receptor Modulator in Uterine Fibroid Pharmacotherapy-Will it Really be a Breakthrough?

Background: Vilaprisan (VPR) is a new orally available selective progesterone receptor modulator (SPRM), with anti-proliferative activity against uterine fibroids (UFs). It definitively causes suppression of ovulation and inhibition of proliferation of endometrial, myometrial and UF cells. Purpose: This review aims to summarize current knowledge on VPR from all studies, including clinical trials, conducted to date and to contextualize the potential role of VPR in future medical regimens for the treatment of UFs. Methods: We performed a literature search in PubMed US National Library of Medicine and Google Scholar databases. Both databases were extensively searched for all original and review articles/book chapters as well as congress abstracts published in English until July 2019. The use of VPR for UF therapy was identified by using the keywords: “uterine fibroids” and “vilaprisan”. Results: In phase I and II clinical trials, VPR was shown to be effective in ameliorating UF-related clinical symptoms, especially abnormal or excessive uterine bleeding and in shrinking UFs. The tolerability of VPR is roughly similar to that of ulipristal acetate (UPA) and it tends to be more favorable than that of GnRH-agonists. Conclusion: Presently, all trials examining the utility of VPR for the treatment of UF are halted; likely, due to the recently reported cases of hepato-toxicity with UPA, in addition to non reassuring toxicology results from preclinical long-term testing on rodents, carried out in parallel with late stage testing on humans. An accurate summary of robust data related to the safety of VPR is urgently needed to draw definitive conclusions on the future clinical development of this drug for UF therapy.