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Background: Breats cancer is a major health problem in elderly ( >= 70 years) women. Increase incidence with age and the progressive increase in life expectancy mean that the numbers in elderly breast cancer diagnosis are increasing. These patients do not always receive the proper treatment and despite this the survival of this population is not always depends on cancer, there are other competing causes of death typical of the aging population. Method(s): A retrospective observational analysis of women >= age 70 diagnosed with breast carcinoma in HUPHM between 2014 and 2020 was made. Clinical, pathological data and stages at diagnosis were analyzed. We checked our patients with the national death center (official national registry) thus obtaining an exact date of death and the cause of death. Data updated in January 2023 , ensuring a minimum follow-up of 24 months. We excluded deaths from Covid or of unknown cause to avoid bias. Result(s): A total of 421 patients were analyzed, mean age of 78.6 years and median follow-up of 48 months. 28% of patients had died at the time of analysis, 11% due to cancer and 17% from other causes. If we analyze the population deceased by cancer, no deaths are detected in patients diagnosed with carcinoma in situ (4% of the population), in stage I (30% of the population) the cumulative incidence of cancer death at 5 years is 3%, 7% In stage II (30% of the population), 15% in stage III (16%) and 70% in stage IV (12%). Death by other causes are more frequent in early breast cancer, the cumulative incidence at 5 years are 10% in stage I, 22% in stage II, 44% in satge III and just 10% in stage IV. The most frequent causes of death in this population were caridovascular events and infections. There are no differences in 5-year mortality according to histological subtypes 20%, 12%, 25% and 12% for triple negative, Rh+/HER2-, RH+/her2+ and RH-/HER2+ respectively. Conclusion(s): Although elderly patients do not receive optical treatments, mortality from cancer in early stages is incidental at 5 years, a different scenario is seen in metastatic disease in which the patient's prognosis depends mainly on the oncological disease, Therefore, an effort should be made in the treatment of these patients with metastatic breast cancer since adequate treatments can have a clearly positive impact on the survival of patients. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023
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Aim: There is limited literature on coronavirus disease-2019 (COVID-19) and tuberculosis (TB) coinfection, although high rates of coinfection between COVID-19 and other respiratory pathogens are expected. To the best of our knowledge, this is the first study to examine COVID-19 infection in patients diagnosed with active or previously treated TB in Turkey. In this study, the aim was to examine the frequency of COVID-19 and the factors affecting the frequency of COVID-19 in patients with active or previously treated TB. Method(s): The population of the retrospective cohort type study consisted of patients with TB enrolled in the Elazig Tuberculosis Dispensary between January 2015 and April 2021. The TB-related data of the patients was obtained from the Public Health Management System Tuberculosis System, and the COVID-19 information was obtained from the COVID-19 Case Tracking System. The status of being alive or dead and the date of death if they were dead were obtained from the Central Population Management System. Result(s): 23.92% (n=105) of 439 patients with TB were COVID-19 cases. Advanced age, having at least one comorbid disease, and the presence of chronic pulmonary disease, diabetes mellitus, and heart disease increased the risk of developing COVID-19 in active or previously treated patients with TB. Conclusion(s): COVID-19 was detected more frequently in active or previously treated TB patients than in the general population. Within the scope of public health services implemented to prevent the spread of COVID-19 infection, priority should be given to the TB patient group and older people, especially those with comorbid chronic pulmonary disease, diabetes mellitus, and heart disease in this group. Copyright © 2022 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.
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Background: FSGS is a histologic pattern of glomerular injury with numerous causes, frequently associated with kidney disease progression and kidney failure. Although CVD events are known to be associated with end stage kidney disease (ESKD), there is a paucity of research examining this relationship in the FSGS population. We assessed the impact of baseline proteinuria and eGFR decline to ESKD on CVD event incidence and all-cause mortality. Method(s): A descriptive, retrospective analysis using Optum de-identified Market Clarity and proprietary Natural Language Processed (NLP) Data (2007-2020). Inclusion criteria: Patients (>=18yo) with >=2 FSGS ICD-10 codes (N031, N041, N051, N061, N071) and/or >=2 FSGS NLP terms within 180 days and >=30 days apart without associated negation terms, >6mo pre-index activity (exclusion: COVID-19). Post-index CVD events included myocardial infarction (MI), ischemic stroke/transient ischemic attack (TIA), unstable angina, congestive heart failure (CHF), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). All-cause mortality included patients with a death date post-index. Result(s): Overall (n=7,974), 11.7% of patients with FSGS experienced a CVD event. Post-ESKD, and among patients with higher baseline proteinuria, CVD events and mortality were significantly elevated (p<.001;Table 1). Conclusion(s): A significant increase in CVD events and death was associated with elevated proteinuria and progression to ESKD in patients with FSGS. New therapies for FSGS that reduce proteinuria may reduce CVD events and improve overall survival. (Table Presented).
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Background: The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1-4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates. Aims: We aim to report our single-centre experience with complications arising from DPBSR. Methods: This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal >=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1). Results: 102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16-91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30-332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications. 72(70.6%) of patients had stents in-situ for >= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94-441). Stent removal >=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications. Conclusions: Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications.
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BACKGROUND AND AIMS: Patients with end-stage kidney disease (ESKD) face higher risk for severe outcomes from COVID-19 infection. Moreover, it is not well known to which extent potentially modifiable risk factors contribute to mortality risk. In this study, we investigated the incidence and risk factors for 30-day case-fatality of COVID-19 in haemodialysis patients treated in the European Fresenius Medical Care (FMC) Nephrocare network. METHOD: In this historical cohort study, we included unvaccinated adult dialysis patients with a first documented SARS-CoV-2 infection between 1 February 2020 and 31 March 2021 (study period) registered in the European Clinical Database (EuCliD ® ). The first SARS-CoV-2 suspicion date for all documented infections was considered the index date for the analysis. Patients were followed for up to 30 days. Follow-up time was defined from the index date until the date of death, end of follow-up period or lost to follow-up, whichever occurred first. We ascertained patients' characteristics in the 6-month period prior to index date. We used logistic regression and XGBoost to assess risk factors for 30-day mortality. RESULTS: We included 9211 patients meeting the inclusion criteria for the study (Table 1). Age was 65.4 ± 13.7 years, dialysis vintage was 4.2 ± 3.7 years. In the follow up period, 1912 patients died within 30 days (20.8%, 95% confidence interval: 19.9%- 21.6%). Correlates of COVID-19 related mortality are summarized in Table 2. Several potentially modifiable factors were associated with increased risk of death: patients on HD compared with online haemodiafiltration had shorter survival after presentation with COVID-19 as well as those who did not achieve the therapeutic targets for serum albumin, erythropoietin resistance index, protein catabolic rate, haemodynamic status, C-reactive protein, single-pool Kt/V, hydration status and serum sodium in the months before infection. The discrimination accuracy of prediction models developed with XGBoost was similar to that observed for main-effect logistic regression (AUC 0.69 and 0.71, respectively) suggesting that no major cross-interaction and non-linear effect could improve prediction accuracy. CONCLUSION: We observed high 30-day COVID-19 related mortality among unvaccinated dialysis patients. Older patients, men and those with greater.
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The irreversible proteasome inhibitor Carfilzomib has a proven efficacy in doublet and triplet combinations for the treatment of patients with relapsed or refractory multiple myeloma (RRMM) as shown in the ENDEAVOR and ASPIRE trials. Here we retrospectively analyzed a series of RRMM patients treated with KRd regimen over 18 cycles to evaluate efficacy and tolerability of continuous treatment (Table 1). Data were elaborated using SPSS Statistics Version 26. Overall survival (OS) was calculated from the time of the beginning of treatment until the date of death for any cause or last follow-up visit. Progression free survival (PFS) was defined as the time from the beginning of treatment to documented progression. OS and PFS were analysed by the Kaplan-Meier test. The statistical significance level was set at the 95th percentile. 36 patients were enrolled at one Calabrian and three Sicilian centres on behalf of the Sicilian Myeloma Network from June 2016 to November 2021. 24 of them were on first relapse (66,6%). Median number of cycles was 31.5 (range 18-61). Overall response rate (ORR) at first response to KRd was 92%: 3 patients (8%) achieved a complete response (CR), 14 patients (39%) achieved a very good partial response (VGPR), 16 (45%) achieved PR, 2 (5%) a minimal response (MR) and 1 (3%) had a stable disease (SD). ORR at best response was 97% (56% CR, 30% VGPR, 4% PR), 1 patient (3%) had SD. At last follow up ORR was 53%: (36% CR, 8% VGPR, 8% PR), one (3%) had a SD. Progression disease (PD) occurred in 16 patients (44%), 15 of them were exposed to another treatment, among them 9 patients were exposed to at least two more treatments including novel agents (Daratumumab, Pomalidomide, Belantamab- Mafodotin). Median PFS was not reached and so was median OS calculated from the beginning of KRd. 9 patients (25%) reported grade 3-4 hematological AEs, 13 patients experienced (36%) grade 3-4 nonhematological AEs, only 3 (8%) cardiovascular AEs. Lenalidomide was reduced in 21 (58%), interrupted in 9 (25%) patients due to serious adverse events (SAEs). During Sars-Cov-2 pandemic waves, to reduce hospital admission, 8 patients who achieved at least VGPR continue halved Carfilzomib administration schedule (total dose 27 mg/m2 once every 2 weeks instead of twice) maintaining previous response except for 1 patient who experienced PD (at cycle 32, after one more year of KRD treatment). Real-world experiences often significantly diverge from randomized clinical trials for patients selection resulting into differences in terms of efficacy and tolerability. In our study KRd combination deepened response over time without relevant toxicity as showed also in a subgroup analysis of ASPIRE and ENDEAVOR. In addition, schedule modification during Sars-Cov-2 pandemic reduced the number of hospital admissions without losing quality of response, thus opening the question of which is the best administration regimen of Carfilzomib as maintenance. (Table Presented).
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Monoclonal gammopathy of unknown significance (MGUS) is a premalignant condition defined as the presence of a monoclonal protein with no evidence of plasma cell/B-cell-related malignancy. The risk of progression from MGUS to a related malignancy is approximately 1% per year. MGUS patients are closely monitored for signs of progression allowing for rapid initiation of treatment. In 2012, the International Kidney and Monoclonal Gammopathy Research Group (IKMG) introduced the term Monoclonal Gammopathy of Renal Significance (MGRS). MGRS is the clonal proliferation of a nephrotoxic monoclonal protein without meeting the criteria for any other plasma cell/B-cell malignancy. The diagnosis of MGRS allows for the initiation of urgent treatment required to prevent further deterioration in renal function. Updated diagnostic criteria from the IKMG made renal biopsy essential for diagnosis of MGRS. Consequently, the IKMG set out an algorithm to guide clinicians on when to consider a renal biopsy. The parameters measured to evaluate the need for a renal biopsy include urine albumin creatinine ratio (ACR). This audit was conducted in the Clatterbridge Cancer Centre Liverpool (CCC-L) a leading cancer centre in the Northwest of England. Urine ACR was chosen as the parameter to audit as it is a cheap, non-invasive, quantitative investigation. The primary outcome of this audit is to assess the number of MGUS patients who had an ACR measured at diagnosis in the Myeloma clinic from January 2014 to December 2020. Data were collected retrospectively from electronic clinic letters and notes. The date of diagnosis was defined as the date of clinic letter in which diagnosis was first confirmed. Patients were considered to have had an ACR performed at diagnosis if ACR was measured between 28 days prior to and post the date of diagnosis. ACR performed during disease was defined as any ACR measured from 28 days prior to date of diagnosis and date of death/data collection. Data from 503 patients (249 females, 254 males) were analysed. The median age at diagnosis was 73. Table 1 shows data for patients who had an ACR measurement performed at diagnosis and during disease. There is a trend towards greater compliance to measuring ACR at diagnosis in successive years from 2014 to 2019 (Table 1). This trend reverses in 2020 when only 40.0% of patients had an ACR measured at diagnosis. For all patients where ACR was performed during disease;56.8% ( n = 179) had the highest ACR measurement of <3.0 mg/mmol with only 14.0% ( n = 44) having the highest ACR measurement of >30.0 mg/mmol. If ACR was performed at diagnosis it was more commonly repeated if the value was higher;the frequencies with which ACR was repeated were 85.7% ( n = 12), 65.1% ( n = 28) and 28.4% ( n = 31) when ACR value at diagnosis was >30.0 mg/mmol, 3.0-30.0 mg/mmol and <3.0 mg/mmol respectively. This audit has shown an increased recognition for the importance of ACR measurement with increased compliance year on year. A likely hypothesis for the reduced measurements in 2020 is the need for remote clinic appointments during the Coronavirus 2019 (Covid-19) pandemic. Following IKMG guidelines 14.0% ( n = 44) of patients would be advised to have a renal biopsy due to their ACR measurement of >30.0 mg/ mmol. Further evaluation of this patient cohort is required to audit compliance with other parameters suggested by the IKMG. A diagnostic pathway to be used at the earliest opportunity for MGUS patients may then be developed..
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Background: The ongoing COVID-19 pandemic has had a profound impact on death rates in this country, specifically on marginalized populations. As a metropolitan safety net hospital during a pandemic, we questioned if this increase of death rates had any effect on the demographics of completed autopsies at our institution. We aim to determine if there has been any significant change in the demographics of autopsy with the onset of the COVID-19 pandemic and, if so, what those changes were. Design: A review of autopsy consent records from 2018-2021 was completed. Demographic data including gender, race, date of birth, and date of death was extracted from the medical record. Two cohorts were created: Pre-COVID-19, January 2018- February 2020 and During COVID-19, March 2020-September 2021. Data was collected and stored in Microsoft Excel. All analyses were performed in R (R-1.3.1056). P-values <0.05 were considered significant. Results: A total of 184 autopsy reports were reviewed, but analysis was limited to autopsies of adults who were also patients at this institution, a total of 157. A total of 62 autopsies were completed prior to the pandemic, while 95 were completed during COVID-19. Females accounted for 45.2% of pre-COVID autopsies and 46.3% of autopsies during COVID. The average age dropped from 62.8 to 60.9, however, neither age, race, nor gender was found to change significantly in the setting of the COVID-19 pandemic. Conclusions: The COVID-19 pandemic has not significantly impacted the demographics of patients undergoing autopsies at our institution. Of the adult autopsy consents reviewed, there was no significant demographic change between cohorts. The lasting effects of the pandemic on autopsies performed may be highlighted by a post-pandemic analysis.
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Introduction: The Swansea Hip interrogation Fracture Tool (SHiFT) was suggested combining the Clinical Frailty score and Nottingham hip fracture scores, and then using this combined score to aid clinical decision making during COVID 19 pandemic. The tool suggested three groups with suggested treatment decisions;scores 2 to 8 have surgery within 36 hours, scores 9 to 12 have surgery potentially delayed up to 7 days, scores 12 plus to be non-operative management. Swansea hospital treats approximately 500 to 600 hip fractures annually. Musgrove Park Hospital treats approximately 450 hip fractures annually therefore the aim of your study was to assess the reliability of this tool in our local population. Methods: A retrospective review of patients admitted with a hip fracture between January 2018 and December 2019. The date of discharge, the date of death if applicable, the clinical frailty score and Nottingham hip score, and the SHiFT score were recorded. The original study assessed mortality at 4 months therefore similar local data was collected. The local results were compared to the original SHiFT outcomes. Results: The original SHiFT study had 124 patients with an annual mortality rate of 26%. Our study had 103 patients with mortality rate of 26%. Our SHiFT scores ranged from 2 to 16, 25.2% had a score between 2 and 8, 50.5% had a score between 9 and 12, and 24.3% had a score of 13 to 16. The original SHiFT study scores range from 6 to 15 with respective percentage in each group of 34%, 56%, 10%. In our study 3.8% of patients with score between 2 and 8 died within 4 months, 9.6% of patients with scores 9 to 12, and 36% with scores 13 to 16. The percentage of deaths at 4 months within the same groups in the original study was 2%, 34%, and 58%. Conclusion: Whilst we recognise that clinical decision-making regarding resource allocation is difficult especially during a pandemic, we would not recommend using a tool such as SHiFT as this was not a reliable tool. Whilst our local population had a higher percentage of frailer patients with comorbidity this did not translate into higher mortality. Therefore, using this tool would have resulted in numerous patients being triage for inappropriate treatment decisions. We recognise that the main limitation in this study as well as the original study is the small patient numbers.