Bone health after RRBSO among BRCA1/2 mutation carriers: a population-based study / 부인종양

Objective@#Examine the risks of fractures and osteoporosis after risk-reducing bilateral salpingo-oophorectomy (RRBSO) among women with BRCA1/2 mutations. @*Methods@#In this retrospective population-based study in British Columbia, Canada, between 1996 to 2017, we compared risks of osteoporosis and fractures among women with BRCA1/2 mutations who underwent RRBSO before the age of 50 (n=329) with two age-matched groups without known mutations: 1) women who underwent bilateral oophorectomy (BO) (n=3,290); 2) women with intact ovaries who had hysterectomy or salpingectomy (n=3,290). Secondary outcomes were: having dual-energy X-ray absorptiometry (DEXA) scan, and bisphosphonates use. @*Results@#The mean age at RRBSO was 42.4 years (range, 26–49) and the median follow-up for women with BRCA1/2 mutations was 6.9 years (range, 1.1–19.9). There was no increased hazard of fractures for women with BRCA1/2 mutations (adjusted hazard ratio [aHR]=0.80; 95% confidence interval [CI]=0.56–1.14 compared to women who had BO; aHR=1.02; 95% CI=0.65–1.61 compared to women with intact ovaries). Among women who had DEXA-scan, those with BRCA1/2 mutations had higher risk of osteoporosis (aHR=1.60; 95% CI=1.00–2.54 compared to women who had BO; aHR=2.49; 95% CI=1.44–4.28 compared to women with intact ovaries). Women with BRCA1/2 mutations were more likely to get DEXA-scan than either control groups, but only 46% of them were screened. Of the women with BRCA1/2 mutations diagnosed with osteoporosis, 36% received bisphosphonates. @*Conclusion@#Women with BRCA1/2 mutations had higher risk of osteoporosis after RRBSO, but were not at increased risk of fractures during our follow-up. Low rates of DEXA-scan and bisphosphonates use indicate we can improve prevention of bone loss.

Incidence and attributable costs of ventilator-associated pneumonia [VAP] in a tertiary-level intensive care unit [ICU] in northern India

Ventilator-associated pneumonia [VAP] is the most common nosocomial infection acquired by patients in the intensive care unit [ICU]. However, the economic effects of such infections remain unclear particularly in developing countries. Patients who were mechanically ventilated for more than 48 h in the ICU were studied for the occurrence of VAP. Total drug costs and hospital costs were noted, and attributable costs were calculated after adjusting for potential confounders. Ninety-five [38%] patients who were ventilated for more than 48 h developed VAP, which resulted in an incidence of 40.1 VAP infections/1000 mechanical ventilation days. The patients with VAP experienced significantly longer hospital stay [21 [IQ = 14-33] days versus 11 [IQ = 6-18] days, P < 0.0001]] and incurred greater hospital costs [USD $6250.92 [IQ = 3525.39-9667.57] versus $2598.84 [IQ = 1644.33-4477.65], P < 0.0001]. Multiple regression analysis revealed that the cost-driving factors in our study population were the occurrence of VAP infections [P < 0.0001] and the duration of hospital stay [P < 0.0001]. The attributable cost of VAP infection was calculated to be USD $5200 [95% CI = 3245-7152]. We conclude that VAP significantly increases the costs of treatment in low-income developing countries. This study highlights the need to implement urgent measures to reduce the incidence of this disease in ICUs

Persistent Post-radiotherapy Pain and Locoregional Recurrence in Head and Neck Cancer-Is There a Hidden Link?

BACKGROUND: To explore the relationship between persistent post-radiotherapy pain and locoregional recurrence in head and neck cancer patients. METHODS: Five year retrospective data was reviewed of 86 patients of head and neck cancer treated with radiotherapy who continued to have pain at 6 weeks after completion of treatment. At follow-up after 3 months, these patients were stratified into: Group A (n = 39) constituted of patients whose pain subsided and Group B (n = 47) were patients who continued to have persistent pain. RESULTS: At median follow-up time of 25 months (range: 8-47), one patient (2.6%) and 18 (38.3%) patients in group A and group B had locoregional recurrence respectively (P < 0.0001). Furthermore, group B patients had higher mean pain score levels as compared to group A (P = 0.03). Patients in whom pain subsided within 3 months had statistically much greater disease-free survival in comparison to those with persistent pain (P < 0.0001). CONCLUSIONS: Pain in head and neck cancer is an important symptom and should be considered a poor prognostic factor. In the current study, the majority of the patients with persistent pain had recurrent disease as compared to those in whom pain subsided within 3 months of post-treatment. It is suggested that patients with persistent pain need more intense follow-up and should be investigated thoroughly to detect recurrence at an early stage to provide a better quality of life.