Current Issue : October - December Volume : 2019 Issue Number : 4 Articles : 8 Articles
Background: Results from randomized phase III trials have shown that thrice-weekly docetaxel added to androgendeprivation\ntherapy (ADT) has a significant impact on the survival of patients with metastatic castration-naïve prostate\ncancer (mCNPC) and established early chemotherapy as part of the standard of care for high-risk disease. Controversy\nremains, however, because some patients experience critical toxicities related to docetaxel. The purpose of the current\nstudy was to evaluate the feasibility and adverse events of biweekly-administered docetaxel in patients with previouslyuntreated,\nhigh-risk mCNPC.\nMethods: The study included 35 consecutive patients with high-risk mCNPC who received ADT plus docetaxel 40 mg/\nM^2. Oral prednisone 5 mg twice daily was also given. Treatment was repeated every two weeks for up to 12 cycles or\nuntil disease progression or unacceptable toxicity occurred. High-risk was defined as bone metastases beyond axial\nskeleton and/or visceral disease.\nResults: The included patientsâ?? median age was 68 years (range: 31-86 years) and 17 (49%) had visceral metastases.\nBiweekly docetaxel was generally well-tolerated; the most commonly observed adverse events, considering those of all\ngrades, included alopecia (74%), nail changes (42%), and constipation (31%). Hematologic adverse events were\ninfrequent, and no patient received hematopoietic growth factors. One patient died after the fourth cycle due\nto respiratory failure, which occurred as a complication of pneumonia. Among the 35 patients, 28 completed\nthe planned 12 cycles of biweekly docetaxel. Prostate-specific antigen response (> 50% decrease from baseline)\nwas recorded in 33 patients (94%), and the radiologic response rate was 49%. Median progression-free survival was\n13.6 months (95% confidence interval: 6.7-20.4).\nConclusion: ADT plus biweekly-administered docetaxel appeared to be tolerated and effective in patients with\nhigh-risk mCNPC....
Background: Acute kidney injury (AKI) is strongly associated with high morbidity and mortality of critically ill\npatients. In the last years several different biological markers with higher sensitivity and specificity for the\noccurrence of renal impairment have been developed in order to promptly recognize and treat AKI. Nonetheless,\ntheir potential role in improving patientsâ?? outcome remains unclear since the effectiveness of an â??earlierâ? initiation\nof renal replacement therapy (RRT) is still debated. Since one large, high-quality randomized clinical trial has been\nrecently pubblished, we decided to perform a meta-analysis of all the RCTs ever performed on â??earlierâ? initiation of\nRRT versus standard RRT in critically ill patients with AKI to evaluate its effect on major outcomes.\nMethods: Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, and Cochrane Central\nRegister of clinical trials. The following inclusion criteria were used: random allocation to treatment (â??earlierâ? initiation of\nRRT versus later/standard initiation); critically ill patients.\nResults: Ten trials randomizing 2214 patients, 1073 to earlier initiation of RRT and 1141 to later initiation were included.\nNo difference in mortality (43.3% (465 of 1073) for those receiving early RRT and 40.8% (466 of 1141) for controls, p = 0.97)\nand survival without dependence on RRT (3.6% (34 of 931) for those receiving early RRT and 4.2% (40 of 939) for controls,\np = 0.51) were observed in the overall population. On the contrary, early initiation of RRT was associated with a significant\nreduction in hospital length of stay. No differences in occurrence of adverse events were observed.\nConclusions: Our study suggests that early initiation of RRT in critically ill patients with AKI does not provide a clinically\nrelevant advantage when compared with standard/late initiation....
Background: Adherence to phosphate binder treatment is important to prevent high serum phosphate level in\nchronic dialysis patients. We therefore wanted to investigate patient knowledge, beliefs about and adherence to\nphosphate binders among these patients and assess whether one-to-one pharmacist-led education and counselling\nenhance adherence and lead to changes in serum phosphate levels.\nMethods: A descriptive, interventional, single arm, pre-post study was performed at a hospital in Norway, including\nchronic dialysis patients aged 18 years or more using phosphate binders. The primary end-point was change in the\nproportion of patients with serum phosphate below 1.80 mmol/L and the secondary end-points included change in\nthe patientâ??s knowledge, beliefs and adherence after the intervention measured by completion of questionnaires\nâ??Patient Knowledgeâ??, Medication Adherence Report Scale (MARS- 5) and Beliefs about Medicines Questionnaire\n(BMQ). Data was collected both prior to and after one-to-one pharmacist-led education and counselling about their\nphosphate binders. Other medicines used by the patient was also registered.\nResults: A total of 69 patients were enrolled in the study. After intervention, the probability of serum phosphate\nbeing below the target threshold 1.80 mmol/L (5.58 mg/dL) increased, although no significant change in mean\nserum phosphate levels was seen. On the other hand, the knowledge regarding phosphate binder treatment and\nthe patientsâ?? beliefs about the necessity of the treatment increased, while the concerns decreased (BMQ). This effect\ndid not lead to increase in self-reported adherence measured by MARS-5. However the scores were high before the\nintervention.\nConclusions: Short term one-to-one individualized pharmacist-led education and counselling about phosphate\nbinders increased the probability of serum phosphate concentrations being below the target threshold level 1.80\nmmol/L (5.58 mg/dL), although not statistically significant. However, it did not decrease the mean serum phosphate\nlevel or increase the patientsâ?? self-reported adherence. The patients increased their knowledge about the phosphate\nbinder and their understanding of adherence, and were less concerned about the side effects of the medication....
Background: Unintentional renal artery occlusion after endovascular aneurysm repair (EVAR) for abdominal aortic\naneurysm remains one of the most unfavorable complications. Renal salvage options include percutaneous\ntransluminal renal artery angioplasty (PTRA) and open hepatosplenorenal bypass. However, the usefulness of kidney\nautotransplantation (AutoTx) remains unclear.\nCase presentation: A 76-year-old woman with a right solitary kidney attributable to a left renal thromboembolism\nhad previously undergone EVAR with a stent graft for an infrarenal aortic aneurysm, which led to ostial occlusion of\nthe right renal artery. In addition, she had undergone PTRA and stenting. Two days before admission, she\ndeveloped leg edema and hypertension, leading her to visit the hospital. Her serum creatinine level was 2.4\n(baseline, 1.0) mg/dL. Acute kidney injury due to renal artery in-stent restenosis was suspected; re-angioplasty was\nattempted on day 2 of hospitalization, but was unsuccessful. Her renal function did not improve and anuria\npersisted; thus, hemodialysis was initiated on the same day. The right kidney size (8.6 cm) was preserved relative to\nher body size, with only mild cortical atrophy. Doppler ultrasonography and mercaptoacetyltriglycine scintigraphy\nrevealed minimal but significant perfusion of the right kidney. Therefore, we considered that kidney perfusion was\nsustained and renal function could be reversed. On day 25 of hospitalization, right kidney AutoTx to the right iliac\nfossa was performed to reestablish adequate renal perfusion and reverse the need for dialysis. Soon after the\nprocedure, the patient started passing urine. Her renal function improved; her serum creatinine level decreased to\n1.0 mg/dL on day 33 of hospitalization. Hemodialysis was discontinued after the surgery. Zero-hour kidney biopsy\nshowed only mild tubular injury, with neither tubular necrosis nor glomerular abnormalities.\nConclusions: Kidney AutoTx can be performed for patients with renal artery in-stent occlusion after unsuccessful\nPTRA who previously underwent EVAR. Our case showed successful recovery of renal function nearly 1 month after\nrenal artery occlusion, indicating that revascularization should be considered even if it is delayed, as the kidney\nmight be perfused through collateral circulation....
Background: We aimed to compare the results of long-term use of two types of metal stent for chronic benign\nureteral strictures.\nMethods: Our study included 46 ureter units (UUs) that underwent metal stent placement from 2010 to 2017. We\nincluded benign ureteral strictures causes by variety reasons that could not be solved by other treatment and\nmalignant obstructions were excluded. Covered mesh stent (Uventaâ?¢) and a thermo-expandable stent (Memokath\n051â?¢) were used. Primary success was defined as maintaining patency without procedures and overall success was\ndefined as maintaining patency with additional procedures.\nResults: We placed covered mesh stents in 25 UUs and thermo-expandable stents in 21 UUs.................
Background: Post-radical prostatectomy urinary incontinence (PPI) negatively affects the quality of life of patients.\nAccurate identification of the problem by physicians is essential for adequate postoperative management. In this\nstudy we sought to access whether there is, for urinary incontinence, any discrepancy between medical reports and\nthe perception of patients.\nMethods: We performed a retrospective analysis of medical records of 337 patients subjected to radical retropubic\nprostatectomy (RRP) between 2005 and 2010. Sociodemographic variables were collected, as well as continence\nstatus over the course of treatment. Next, we contacted patients by phone to determine continence status at\npresent and at time of their last appointment, as well as to apply ICIQ â?? SF questionnaire. Poisson regression model\nwith robust variance was used to estimate the factors associated with discrepancy, using the stepwise backward\nstrategy. Software used was Stata® (StataCorp, LC) version 11.0.\nResults: There is discrepancy between medical reports and patientsâ?? perceptions in 42.2% of cases. This discrepancy\nwas found in 56% of elderly patients and 52% of men with low schooling, with statistical significance in these\ngroups (p = 0.069 and 0.0001, respectively), whereas in multivariate regression analysis the discrepancy rate was\nsignificantly higher in black men (discrepancy rate of 52.6%) with low schooling (p = 0.004 and 0.043, respectively).\nConclusion: There is discrepancy between medical reports and the perception of black men with low schooling in\nrespect to post-radical prostatectomy urinary incontinence and a need for more thorough investigation of this\ncondition in patients that fit this risk profile....
Background: Urosepsis is a catastrophic complication, which can easily develop into septic shock and lead to death if\nnot diagnosed early and effectively treated in time. However, there is a lack of evidence on the risk factors and\noutcomes in calculous pyonephrosis patients. Therefore, this study was conducted to identify risk factors and\noutcomes of intra- and postoperative urosepsis in this particular population.\nMethods: Clinical data of 287 patients with calculous pyonephrosis were collected. In the univariate and\nmultivariate analysis, all patients were divided into urosepsis group and non-urosepsis group. The diagnosis\nof urosepsis was mainly on the basis of the criteria of American College of Chest Physicians (ACCP)/Society\nof Critical Care Medicine (SCCM). Patient characteristics and outcomes data were analyzed, and risk factors\nwere assessed by binary logistic regression analysis.\nResults: Of 287 patients, 41 (14.3%) acquired urosepsis. Univariate analysis showed that white blood cell (WBC\n> 10*10^9/L) before surgery (P = 0.027), surgery types (P = 0.009), hypotension during surgery (P < 0.001) and urgent\nsurgery (P < 0.001) were associated with intra- and postoperative urosepsis for calculous pyonephrosis patients. In\nmultivariate analysis, hypotension during surgery and urgent surgery were closely related to intra- and postoperative\nurosepsis. Outcome analysis suggested that patients developing urosepsis had a longer intensive care unit (ICU) stay\nand postoperative hospital stay and higher mortality.\nConclusions: Hypotension during surgery and urgent surgery were risk factors of intra- and postoperative urosepsis for\ncalculous pyonephrosis patients, which may lead to a prolonged ICU stay, postoperative hospital stay and higher\nmortality....
Background: A classification tree model (CT-PIRP) was developed in 2013 to predict the annual renal function\ndecline of patients with chronic kidney disease (CKD) participating in the PIRP (Progetto Insufficienza Renale\nProgressiva) project, which involves thirteen Nephrology Hospital Units in Emilia-Romagna (Italy). This model\nidentified seven subgroups with specific combinations of baseline characteristics that were associated with a\ndifferential estimated glomerular filtration rate (eGFR) annual decline, but the modelâ??s ability to predict mortality\nand renal replacement therapy (RRT) has not been established yet.\nMethods: Survival analysis was used to determine whether CT-PIRP subgroups identified in the derivation cohort\n(n = 2265) had different mortality and RRT risks. Temporal validation was performed in a matched cohort (n = 2051)\nof subsequently enrolled PIRP patients, in which discrimination and calibration were assessed using Kaplan-Meier\nsurvival curves, Cox regression and Fine & Gray competing risk modeling.\nResults: In both cohorts mortality risk was higher for subgroups 3 (proteinuric, low eGFR, high serum phosphate) and\nlower for subgroups 1 (proteinuric, high eGFR), 4 (non-proteinuric, younger, non-diabetic) and 5 (non-proteinuric,\nyounger, diabetic). Risk of RRT was higher for subgroups 3 and 2 (proteinuric, low eGFR, low serum phosphate), while\nsubgroups 1, 6 (non-proteinuric, old females) and 7 (non-proteinuric, old males) showed lower risk. Calibration was\nexcellent for mortality in all subgroups while for RRT it was overall good except in subgroups 4 and 5.\nConclusions: The CT-PIRP model is a temporally validated prediction tool for mortality and RRT, based on variables\nroutinely collected, that could assist decision-making regarding the treatment of incident CKD patients. External\nvalidation in other CKD populations is needed to determine its generalizability....
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