Using clinical pathways to prospectively identify poor prognosis cancer patients: A preliminary analysis.

329 Background: Cancer patients in the last year of life may have different clinical needs and evolving goals of care. Helping clinicians consistently identify such patients in a systematic and prospective fashion, at a discrete moment in the care trajectory, is an important step towards optimizing the care of these patients. Methods: Physician medical directors for each clinical pathway at our institution were tasked with identifying nodes within their respective treatment pathways associated with poor prognosis, specifically a median overall survival of < 12 months. This information was embedded into the underlying data model of the pathways platform, allowing us to determine how often clinicians navigated through poor prognosis nodes. Results: Pathways medical directors identified 44 nodes associated with poor prognosis. Some of these nodes encompassed a broader set of patients (metastatic pancreatic cancer, any line), whereas others were more specific (metastatic non-small cell lung cancer, squamous cell histology, second line or beyond). For the period 3/11/20 – 5/31/21, clinicians navigated in the platform for 11,057 unique patients. Of these, 1,234 (11.1%) unique patients were associated with poor prognosis nodes. Such navigations were much more common in patients with solid tumors (table). Conclusions: A well-maintained clinical pathways program can be a mechanism for defining clinical settings associated with poor prognosis and for routinely identifying patients in these settings. By embedding this into the pathways data model, we can provide physicians with important reminders and resources related to goals of care conversations, supportive care resources, and appropriate treatment options and clinical trials.[Table: see text]

Treatment of severe thrombocytopenia with platelet biotherapic and Phosphorus

Background Thrombocytopenia is a decrease in the number of platelets in the blood resulting from disorders of production, distribution or destruction, leading to bleeding. The respective treatment of thrombocytopenia is usually based on corticotherapy and platelet transfusion. Aims Report the evolution of homeopathic treatment in a 12 years old Maltese canine cardiopathic patient with thrombocytopenia associated with the diagnosis of Ehrlichia canis. Methods Replacement of corticoid and transfusion by Platelet Biotherapic, to stimulate platelet production and high diluted Phosphorus to contain the bleeding. Results On 01/28/19, the patient presented thrombocytopenia of 5.000/mm³ with large platelets, petechials and suffusion hemorrhages in dorsal and ventral regions, extensive acute cervical hematoma due to blood collection; anisocytosis, polychromasia and Howell Jolly corpuscle in red series; and also reactive lymphocytes, monocytes active and toxic neutrophils in white series. On 01/30/19, initiated the administration of 3 globules of Platelet Biotherapic 12CH every 12 hours; 3 globules of Phosphorus 6CH every 24 hours, both oral; and topical phytotherapeutic use of Arnica montana once daily. Three days later, it was observed the complete absence of petechials and suffusion hemorrhages, with elevation of platelets count to 74.000/mm³ and mild leukocytosis with improvement in overall patient well-being. On 02/06/19, there was regression of hematoma and leukocytosis, in addition to the platelet count in 95.000/mm³. On 02/14/19, due to slight decrease in platelets to 92.000/mm³, the frequency of Phosphorus 6CH was changed every 12 hours. On 02/20/19, the new platelet count reached 126.000/mm³ with standardized morphology and no Howell Jolly record. Conclusion The homeopathies (High dilution medicine) have proven to be successful in the treatment of thrombocytopenia without causing side effects.

Brain Abscess Due To Asian Nocardia in a 63 Years-Old Patient with Adult Still´S Disease: A Rare Case Report and Literature Review

Cerebral nocardiosis is a rare and opportunistic pathology caused by a gram-positive, aerobic bacterium of the order of Actinomycetes called Nocardia spp. It appears in patients with immunodeficiencies affecting cellular immunity. Nocardia can affect an organ (lungs in 75% of cases) or manifest itself as a disseminated infection (central nervous system in 25% of cases). Here we present a rare case of 63-years-old patient immunocompromised by monoclonal biologic treatment for Adult-Onset Still disease (AOSD), who subsequently presents fever, signs of motor focality and resonance imaging findings which show supra and infratentorial lesions. The patient is managed in intensive therapy for sensory impairment, receiving standardized antibiotic scheme, getting through to complicated evolution. Cerebral nocardiosis is a rare infectious disease that requires an early diagnostic study and its respective treatment.

Audit of the workload in a maxillofacial and oral surgical unit in Johannesburg

Maxillofacial and oral surgical (MFOS) audits are able to provide data to both current and prospective patients regarding the quality of care an institution is capable of providing. The more frequently performed MFOS procedures can be determined and the allocation of funding and resources can therefore be achieved more appropriately. To conduct an audit to evaluate the workload and scopeof practice of the MFOS unit of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) for the year 2015 by quantifying MFOS conditions and the respective treatment modalities. The study was retrospective and cross-sectional. Data was retrieved from the patient logbook of the unit which was then entered into a Microsoft Excel Spreadsheet. Pie graphs and bar charts representing the data were then generated. A total of 1 750 patients were treated in the unit. The male to female ratio was 1.3:1 and the majority of these patients were in their 3rd and 4th age decade. Most patients required a tooth extraction mainly for an impacted 3rd molar. Dentoalveolar surgery was the most commonly performed procedure followed by the treatment of facial fractures. Pathological and other MFOS conditions were less commonly encountered. The CMJAH MFOS unit treats a high volume of patients according to comparisons with global studies.

N-Acetyl Cysteine Ameliorates Hepatotoxicity Associated with the Use of Methotrexate in Mice

Background: Liver is not only involved in maintaining homeostasis but also exhibits significant role in metabolism and detoxification of various drugs and toxins. Aim: To explore the hepato-protective role of N-acetylcysteine against methotrexate induced hepato-toxicity. Study design: Randomized controlled trial. Methodology: This study having mice (n=18) was carried out after ethical review committee’s (ERC) approval at Foundation university medical college in collaboration of National institute of health, Islamabad in 2017. Single intraperitoneal injection (20mg/kg) of methotrexate induced hepato-toxicity. Hepatoprotective effect was assessed by oral administration N-acetylcysteine (50mg/kg) alone with methotrexate. The extent of liver damage and effect of protective agents were determined by measuring serum ALT, AST, ALP after 24 hours of respective treatment. Liver samples were taken for histological analysis. One way ANOVA followed by Post Hoc Tukey test was applied for multiple comparisons of biochemical markers between the groups. Histopathological findings were analyzed by Chi Square test. p < 0.05 was considered significant. Results: Significant (p < 0.05) hepatotoxicity was seen with substantial elevation in serum ALT, AST and ALP with methotrexate. N-acetylcysteine attenuated the methotrexate induced hepatotoxicity significantly (p < 0.05). The histopathological examination showed mild steatosis along with focal pleomorphism in the liver of mice that received methotrexate in comparison to group treated with N-acetylcysteine and methotrexate though minimal inflammation was seen. Conclusion: We concluded that N-acetylcysteine ameliorates the methotrexate induced hepatotoxicity on when used concomitantly. Keywords: Hepatotoxicity, N-acetylcysteine and Methotrexate

N-Acetyl Cysteine Ameliorates Hepatotoxicity Associated with the Use of Methotrexate in Mice

Background: Liver is not only involved in maintaining homeostasis but also exhibits significant role in metabolism and detoxification of various drugs and toxins. Aim: To explore the hepato-protective role of N-acetylcysteine against methotrexate induced hepato-toxicity. Study design: Randomized controlled trial. Methodology: This study having mice (n=18) was carried out after ethical review committee’s (ERC) approval at Foundation university medical college in collaboration of National institute of health, Islamabad in 2017. Single intraperitoneal injection (20mg/kg) of methotrexate induced hepato-toxicity. Hepatoprotective effect was assessed by oral administration N-acetylcysteine (50mg/kg) alone with methotrexate. The extent of liver damage and effect of protective agents were determined by measuring serum ALT, AST, ALP after 24 hours of respective treatment. Liver samples were taken for histological analysis. One way ANOVA followed by Post Hoc Tukey test was applied for multiple comparisons of biochemical markers between the groups. Histopathological findings were analyzed by Chi Square test. p < 0.05 was considered significant. Results: Significant (p < 0.05) hepatotoxicity was seen with substantial elevation in serum ALT, AST and ALP with methotrexate. N-acetylcysteine attenuated the methotrexate induced hepatotoxicity significantly (p < 0.05). The histopathological examination showed mild steatosis along with focal pleomorphism in the liver of mice that received methotrexate in comparison to group treated with N-acetylcysteine and methotrexate though minimal inflammation was seen. Conclusion: We concluded that N-acetylcysteine ameliorates the methotrexate induced hepatotoxicity on when used concomitantly. Keywords: Hepatotoxicity, N-acetylcysteine and Methotrexate

A Constructive Fuzzy Representation Model for Heart Data Classification

The early detection of Heart Disease (HD) and the prediction of Heart Failure (HF) via telemonitoring and can contribute to the reduction of patients’ mortality and morbidity as well as to the reduction of respective treatment costs. In this study we propose a novel classification model based on fuzzy logic applied in the context of HD detection and HF prediction. The proposed model considers that data can be represented by fuzzy phrases constructed from fuzzy words, which are fuzzy sets derived from data. Advantages of this approach include the robustness of data classification, as well as an intuitive way for feature selection. The accuracy of the proposed model is investigated on real home telemonitoring data and a publicly available dataset from UCI.

Effectiveness of Credelio® Plus, a novel chewable tablet containing milbemycin oxime and lotilaner for the treatment of larval and immature adult stages of Toxocara canis in experimentally infected dogs

Background The ascarid, Toxocara canis, is a common and important zoonotic intestinal nematode parasite that infects dogs globally. An effective treatment that kills any pre-patent stages of immature T. canis could additionally reduce or eliminate the development of patent infections that can result in clinical disease in infected dogs and would further reduce environmental contamination of eggs. Two randomized, blinded, GCP-compliant, pivotal laboratory dose confirmation studies were conducted to assess the effectiveness and safety of a new novel combination of lotilaner and milbemycin oxime tablets (Credelio Plus) administered orally to dogs that were experimentally infected with immature (L4 or immature adult [L5]) stages of T. canis. Methods The commercial tablet formulation of Credelio Plus® was administered in a time frame relative to inoculation with infective eggs. This allowed for effectiveness to be assessed against each specific immature stage of T. canis. In each study, dogs were randomized and allocated to one of four treatment groups. Each treatment group contained ten dogs that had been experimentally inoculated on Day 0 with infective T. canis eggs and then were dosed once on Day 14 or Day 24 using either placebo tablets or Credelio Plus tablets (IP) to provide minimum dosages of 0.75 mg/kg of milbemycin oxime and 20 mg/kg of lotilaner. All dogs were necropsied 5 or 6 days after their respective treatment. At necropsy, all nematodes recovered from the gastrointestinal tract were counted by species and stage. Results In both dose confirmation studies using geometric mean worm counts, effectiveness of Credelio Plus was ≥ 98.6% and ≥ 96.8% against L4 larval stage T. canis and immature adult [L5] T. canis in both studies, respectively. Conclusions These studies demonstrated that the Credelio Plus combination tablet administered orally to dogs was highly efficacious against experimental infections with L4 and immature adult [L5] stages of T. canis.

OP33 Oral ritlecitinib and brepocitinib in patients with Moderate to Severe Active Ulcerative Colitis: Data from the VIBRATO umbrella study

Background The efficacy and safety of oral ritlecitinib (JAK3/TEC inhibitor) and brepocitinib (TYK2/JAK1 inhibitor) were assessed in a 32-week Phase 2b induction-maintenance umbrella study (VIBRATO) in participants with moderate to severe active ulcerative colitis who had inadequate or loss of response, or intolerance to corticosteroids, immunosuppressants, or biologic therapies. We report efficacy and safety results from the 8-week induction period of the VIBRATO study. Methods Adult participants with Total Mayo Score ≥6 and centrally-read Mayo endoscopic subscore ≥1 were randomised to receive oral ritlecitinib 20, 70, or 200 mg; brepocitinib 10, 30, or 60 mg; or placebo once-daily (QD) for 8 weeks. Participants then continued in their respective treatment cohorts to receive ritlecitinib 50 mg or brepocitinib 30 mg QD for 24 weeks. The proportions of patients who achieved remission (Total Mayo Score ≤2; no individual subscore &gt;1; rectal bleeding subscore 0), modified remission (Modified Mayo Score: Total Mayo without Physician’s Global Assessment; stool frequency subscore ≤1; rectal bleeding subscore 0; endoscopic subscore ≤1), or endoscopic improvement (Mayo endoscopic subscore ≤1) were analysed. Results 319 participants were randomised: baseline mean (standard deviation [SD]) age 40.3 (13.8) years; mean (SD) Total Mayo Score 9.0 (1.5); and median (range) disease duration 4.8 (0.24, 36.5) years. Ritlecitinib and brepocitinib were generally safe and well tolerated. At Week 8, a dose–response relationship was observed across all efficacy endpoints for ritlecitinib and brepocitinib. The proportions of participants achieving remission were significantly higher (P&lt;0.05) with ritlecitinib 70 and 200 mg and brepocitinib 30 and 60 mg vs placebo (Figure 1). The proportions of participants achieving endoscopic improvement and modified remission were significantly higher in all ritlecitinib and brepocitinib groups vs placebo (Figures 2 and 3). Conclusion Ritlecitinib 70 and 200 mg QD and brepocitinib 30 and 60 mg QD demonstrated significant improvement in remission, modified remission, and endoscopic improvement in participants with moderate to severe active ulcerative colitis.