Case Report: Combination of Olaparib With Chemotherapy in a Patient With ATM-Deficient Colorectal Cancer

Poly-ADP ribose polymerase (PARP) inhibitors are constantly increasing in their indications for use as anti-cancer treatment in various neoplasms, the majority of which are linked with BRCA deficiency. Preclinical data support the investigation of PARP inhibitors in other neoplasms exhibiting “BRCAness” or homologous recombination deficiency (HRD) as monotherapy as well as in combination with chemotherapy. With the current report we present the case of a heavily pretreated 55-year-old male patient diagnosed with stage IV ATM-deficient CRC, who was effectively treated with an off-label olaparib-irinotecan combination after exhaustion of all available treatment choices; furthermore, we discuss the existing data providing evidence for the use of PARP inhibitors in ATM-deficient CRC and encourage the implementation of next-generation sequencing (NGS) in patients with no other available treatment options.

Declining Trend in Use of Sleep Medications Among Older Adults in the United States

Recent initiatives to discourage over-prescription of sleep medications have increased awareness of their potential adverse effects in older adults; however, it is unknown whether these efforts translated into a decline in use of these medications in the United States. We assessed recent national trends in the use of medications for sleep disorders. Data came from the 2013-2018 National Health and Nutrition Examination Survey. At each of three waves of in-person assessments, participants presented prescription bottles for all medications used in the prior month. Interviewers recorded each medication and participants self-reported duration and indications for use. We identified all medications used for a sleep disorder and categorized medications into two groups: FDA-approved sleep medications, and medications used off-label (i.e., any other medication reported to be used for sleep disorders). We examined changes in the prevalence in use of these medications across the study period. The odds of using medications for sleep disorders decreased 31% between 2013 and 2018 (odds ratio [OR]=0.69, 95% confidence interval [CI]=0.51-0.92). This trend was driven by declines in use of FDA-approved sleep medications (OR=0.45, 95% CI=0.34, 0.59). Of note, among those age 80+ years, we observed an 86% decline (OR=0.14, 95% CI=0.05-0.36) in the odds of using FDA-approved sleep medications over the study period. Results suggest a possible effect of efforts to curb over-prescription and encourage judicious use of these agents. Future research needs to examine whether these changes have coincided with improved sleep health in the growing population of older adults.

The role of azithromycin in the antibacterial therapy of acute respiratory infections in children

Acute respiratory infections are the leading cause of morbidity and mortality in childhood. Antibacterial therapy for acute respiratory infections should be prescribed carefully and under strict indications. This review analyzes the etiological structure of diseases of the upper and lower respiratory tract, identifies modern views on the rational use of antibacterial agents in diseases such as acute tonsillopharyngitis, rhinosinusitis, bronchitis and pneumonia. Among the variety of antibacterial agents, macrolide drugs, in particular azithromycin, are most often used in pediatric practice. The pharmacological properties of azithromycin, mechanisms of its antimicrobial and immunomodulatory activity, indications for use in acute respiratory infections in children are considered in the article. No conflict of interest was declared by the authors. Key words: antibiotics, acute respiratory infection, macrolides, azithromycin, children.

Management of antithrombin III deficiency in pregnancy: a representative case and a literature review

The work is aimed at discussing pregnancy management for the most thrombogenic genetic thrombophilia - antithrombin III (AT-III) deficiency. A detailed analysis of the literature and clinical case of pregnancy management in a patient with AT-III deficiency, pulmonary embolism and habitual history of miscarriage has been performed and presented. Patients with AT-III deficiency are at high risk for developing thrombotic and obstetric complications even despite using therapeutic doses of anticoagulants. Indications for use and modes of administration of AT-III concentrate have not been currently defined clearly. Monitoring therapy with low molecular weight heparin is largely complicated because a test for determining anti-Xa activity is AT-III-dependent. In addition to standard methods for controlling antithrombotic therapy, we used tests characterizing the dynamic blood clot parameters: thromboelastography and thrombin generation test. The peak risk resulting in both thrombotic and hemorrhagic complications in such patients occurs during period of labor and the postpartum period, when a change in the regimen of anticoagulant therapy is required with its temporary withdrawal and additional administration of AT-III concentrate.

Initial Experiences with the MitraClip G4: Review of the Novel Device Features

Objective Percutaneous edge-to-edge mitral valve repair is an evolving procedure with increasing indications for use. The MitraClip™ G4 is the newest device with 4 device options, each with distinct characteristics. While the NTR and XTR clips have been in use, the G4 adds 2 new wider clips with additional features, the NTW and XTW. Methods We reviewed 26 cases employing the MitraClip G4 at our institution from November 2019 to March 2020. Results The NTR, XTR, NTW, and XTW clips were used in 3 (11.5%), 0 (0.0%), 16 (61.5%), and 11 (42.3%) cases, respectively. Median mitral regurgitation grade was reduced from 4+ to 1+, though 7 (27%) cases had 2+ residual mitral regurgitation. Conclusions The new G4 device includes simplified instructions for use, the option of a wider clip, controlled gripper actuation, and potential left atrial pressure monitoring. The newest MitraClip G4 device allows for potential improved treatment options for patients with mitral regurgitation.

Considerations about bisphosphonate therapy and patients using dental prosthesis: a literature review

Bisphosphonates are drugs used for treatment of many medical diseases; their prescription has increased over the years due to the various indications for use. They come in two distinct groups: containing nitrogen (alendronate, ibandronate, pamidronate, risedronate and zolendronate) and without nitrogen in their composition (etidronate and tiludronate). Despite being used in the treatment of several diseases, they can lead to the development of osteonecrosis in the patient's maxilla and/or mandible, when submitted to dental procedures, such as extractions, surgeries or traumas for non-adapted prostheses. It is recommended that patients who use bisphosphonates visit the dentist at least once a year, for better control and monitoring of oral health.

DIAGNOSTIC VALUE OF URETHRAL PROFILOMETRY IN CHILDREN: RECOMMENDATIONS FOR PRACTICAL USE

In pediatric neuro-urology, the method of urodynamic studies – urethra profirometry (UP) – is one of the main ones, but still inferior in frequency to cystometry and uropometry. The main indications for use of the UP method are stress urinary incontinence and a comprehensive examination of neurological patients. The long-term focus of the UP results has been on decreasing the closure function of the urethral sphincter. The article summarizes the material on the application of the UP method in children, describes the techniques, indications and possible results of the research on the practical significance of the reduction of intraurethral pressure, its high rates and instability.

Medicinal cannabis: knowledge, beliefs, and attitudes of Colombian psychiatrists

Background The use of cannabinoids in mental health has gained strength in recent years due to emerging scientific evidence and the lifting of prohibitionist laws that prevailed for years in many countries, including Colombia. This study describes the results of a survey of Colombian psychiatrists on some aspects of medicinal cannabis, such as attitudes towards its potential use, perceived knowledge, and beliefs surrounding its regulation and safety. Methods We conducted a cross-sectional survey of 145 psychiatrists in 14 territories of Colombia between November 2019 and July 2020. The survey consisted of 28 items on topics related to medicinal cannabis, including attitudes and clinical experience (4 items), perceived knowledge (4 items), indications for use in psychiatric pathologies (6 items), indications for use in nonpsychiatric pathologies (8 items), and concerns and awareness about safety and efficacy (6 items). The results were summarized using descriptive statistics. In addition, possible associations among variables were examined using Fisher’s exact test. Results Eighty-two percent of the psychiatrists agreed that medical cannabis should be available for different medical conditions, and 73.1% stated that they wanted to be able to prescribe it. However, 66.2% said they did not know how to help their patients legally access it, and only 25% understood the legal status of medicinal cannabis in the country. The mental health indications that received the highest approval levels for cannabis use were insomnia (35.2%), anxiety disorders (29%), and agitation in dementia (18.6%). The greatest disapproval of cannabis use was indicated for schizophrenia, with 66.9%. The most approved nonpsychiatric medical conditions were cancer-related chronic pain (87.6%), chemotherapy-related nausea and vomiting (78.6%), and chronic pain not associated with cancer (72.4%). Multinomial stepwise logistic regression analysis showed that female psychiatrists who did not agree with MC to treat psychiatric symptoms were more likely to agree with non-psychiatric use. Conclusions Our results showed that this sample of Colombian psychiatrists have a favorable attitude towards the prescription of medicinal cannabis; however, there is a serious lack of knowledge of the legal status of medicinal cannabis in the country and the methods through which patients can gain access to government-regulated products. Most of them approve the use of MC for nonpsychiatric conditions and, in general, disapprove of its use in mental illnesses. They generally consider medicinal cannabis as a safe treatment compared to other psychotropic drugs and medications with potential risk of dependence, such as opioids and/or benzodiazepines.