Aripiprazole as a treatment option for delusional parasitosis: case series of 8 patients

OBJECTIVE: Delusional parasitosis (DP), also known as Ekbom's Syndrome, is a rare, generally monosymptomatic disorder that characterizes with the fixed belief of being infected by parasites without any evidence of medical or microbiological proof. These patients are examined in dermatology and infection clinics with symptoms and signs of pruritus, skin and subcutaneous scars secondary to itching. Primary DP is diagnosed when no etiological factor is detected while secondary DP arises from underlying physical or mental disorder. Formerly, pimozide was the commonly preferred choice of treatment with cases of DP. However, there is growing evidence that second-generation antipsychotics and antidepressants can be used in the treatment of DP. In this study, the usage of aripiprazole in the treatment of DP cases is presented. METHODS: 8 patients with the diagnosis of primary DP were evaluated in terms of demographic data, clinical variables and responses to treatment. A psychiatric diagnosis was made based on a clinical interview performed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) SCID-I. The patients were followed for six months. Three patients were female, five patients were male. The average age of the patients was 57.5. Four patients had essential hypertension as comorbidity. The duration of the symptoms ranged from 6 to 48 months with an average of 24.75 months. All of our 8 cases were consulted by the dermatology department. The patients were performed Hamilton Depression Scale (HDS) and Mini-Mental Status Examination (MMSE). Eight patients were treated with aripiprazole 10 or 15 mg/day, and no dose alteration was made. RESULTS: From the patients who were treated with aripiprazole, seven (87.5\%) patients had complete remission after three months, eight (100\%) patients achieved complete remission after six months. DISCUSSION: The earliest drug choice for patients with DP was pimozide, but because of the extrapyramidal side effects and cardiac side effects like QTc prolongation, second-generation antipsychotics are being investigated for treatment. Various researches are available related to the usage of second-generation antipsychotics like risperidone, olanzapine, paliperidone, ziprasidone, quetiapine, and aripiprazole in the cases with DP. This study shows that aripiprazole can be a successful treatment choice for DP, but further studies are needed for this topic

Kolorektal Kanser Riski ile Hipoksiyle İndüklenen Faktör-1 Alfa (HIF-1?) ve von Hippel-Lindau (VHL)

Colorectal cancers (CRC) are among the four most frequently seen cancers in humans and are the second leading cause of can-cer-related deaths. Hypoxia up regulates multiple genes involved in different steps of metastatic process, including angiogenesis, proliferation, migration, invasion, motility, adhesion and survival. Hypoxia Inducible Factor 1 (HIF-1) is a master regulator protein of cellular hypoxia-response and triggers the expression of above-mentioned metastatic-process genes. Von Hippel Lindau (VHL) is a protein that plays critical role in the response to hypoxia and product of a tumor suppressor gene. We studied three single nu-cleotide polymorphisms, rs11549465 (1772C T), rs11549467 (1790G A) in HIF-1? and rs779805 (5’UTR A G) in VHL, and assessed their associations with CRC risk, clinicopathologic and demographic features and lifestyle, and tumor stage and grade of CRC patients and/or healthy controls. ARMS-PCR technique for genotyping of rs11549465 C T and rs11549467 GA and PCR-RFLP technique for genotyping of rs779805 AG were used. CT/TT genotypes of HIF-1? 1772C T polymorphism were found to increase the risk of colorectal cancer in patients (OR 1.96, 95% CI 1.02-3.77, p 0.05). Additionally, it was demon-strated via statistical analyses that higher age, male gender, cancer history in family, co-existing diseases, and exposure to white soil stands to be risk factors of colorectal cancer (p 0.05). No significant relation was found between patient’s TNM stages and distributions of genotype (p 0.05). The findings from our study demonstrates that, in addition to risk factors for colorectal can-cer, scanning CT/TT genotypes of HIF-1? C1772T polymorphism can be advantageous in early-diagnosis of colorectal cancer.Kolorektal kanser insanda sık görülen dört kanser türü arasında yer alır ve ölüme götüren kanserler içerisinde ikinci sıradadır. Hipoksi, anjiogenez, proliferasyon, migrasyon, invazyon, adhezyon ve sağkalımı içeren metastatik süreçte rol alan pek çok geni kontrol eder. Birçok kanser türünün gelişmesinde etkili olduğu düşünülen HIF-1? gen proteini hücrenin hipoksiye cevabının anahtar regülatörüdür. VHL proteini tümör baskılayıcı bir genin ürünü olup, hipoksiye cevap yolağında önemli rol alır. Biz bu çalışmada, HIF-1? geninin rs11549465 (1772C T), rs11549467 (1790G A) polimorfizmleri ile VHL geninin rs779805 (5’UTR A G) polimorfizmini ve ayrıca yaş, cinsiyet, ailede kanser öyküsü, sistemik hastalıklar, beyaz toprak maruziyeti, sigara ve alkol tüketimi ile CRC riski arasındaki ilişkiyi araştırdık. Çalışmaya, histolojik olarak teyit edilen CRC tanısı almış 92 hasta ile kontrol grubu olarak 101 birey katıldı. DNA izolasyonu için periferal kan kullanıldı. HIF-1? genindeki rs11549465 C T ve rs11549467 GA polimorfizm değişimlerini genotiplemek için ARMS-PZR; VHL rs779805 A G polimorfizm değişimini genotiplemek için PZR-RFLP moleküler tanı yöntemleri kullanıldı. Hasta grubunda, HIF-1?1772C T polimorfizminin CT/TT genotipleri CRC riski ile istatistiksel anlamda ilişkili bulundu (OR 1.96, 95% CI 1.02-3.77, p 0.05). Ayrıca kanser öyküsü, ileri yaş, erkek cinsiyet, eşlik eden hastalıklar ve beyaz toprak maruziyetinin kolorektal kanser için birer risk faktörü olduğu istatistiksel analizlerle belirlendi (p 0.05). Hastaların TNM evreleri ile genotip dağılımları arasında belirgin bir ilişkiye rastlanmadı (p 0.05). Sonuç olarak, HIF-1? C1772T polimorfizminin CT/TT genotipleri, ailede kanser öyküsü ve beyaz toprak maruziyeti CRC için birer risk faktörüdür ve CT/TT genotipi kolorektal kanserin erken tanısında avantaj sağlayabilir bir risk belirteci olarak kullanılabilecekti

Survival for patients with invasive cutaneous melanoma among ethnic groups: the effects of socioeconomic status and treatment.

Although uncommon, melanoma is associated with poor survival characteristics among African Americans and Hispanics compared with non-Hispanic whites (NHWs). Low socioeconomic status (SES) is also associated with poor survival among patients with melanoma, but it is not known whether this is because of SES itself or because of treatment disparities. We set out to determine this by using the large, population-based California Cancer Registry (CCR) database as a model.We conducted a case-only analysis of CCR data (1993 to 2003), including a descriptive analysis of relevant clinical variables and SES. The SES variable used has been derived from principle component analysis of census block-level CCR data that was linked to census data to address seven indicators of SES. Univariate analyses of overall survival (OS) were conducted using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazard ratios (HRs).A total of 39,049 incident patient cases of cutaneous melanoma, including 36,694 in NHWs; 127 in African Americans; 1,996 in Hispanics; and 262 in Asian-Americans, were analyzed. Higher SES was associated with an early stage at presentation (P < .0001), with treatment with surgery (P = .0005), and with prolonged survival (P < .0001). After adjustments for age, sex, histology, American Joint Committee on Cancer stage, anatomic site, treatment, and SES, a statistically significant increased risk of death was observed for African Americans compared with NHWs (HR, 1.60; 95% CI, 1.17 to 2.18); no survival differences were noted for Asians or Hispanics compared with NHWs in the adjusted analysis.Low SES independently predicts poor outcome among patients with cutaneous melanoma. However, the poor OS observed for African American patients with melanoma is not explained by differences in treatment or SES

Phase I prospective trial of TAS-102 (trifluridine and tipiracil) and radioembolization with 90Y resin microspheres for chemo-refractory colorectal liver metastases

BackgroundExtrahepatic disease progression limits clinical efficacy of Yttrium-90 (90Y) radioembolization (TARE) for patients with chemotherapy-refractory metastatic colorectal cancer (mCRC). Trifluridine and tipiracil (TAS-102) has overall survival benefit for patients with refractory mCRC and may be a radiosensitizer.MethodsSequential lobar TARE using 90Y resin microspheres in combination with TAS-102 in 28-day cycles were used to treat adult patients with bilobar liver-dominant chemo-refractory mCRC according to 3 + 3 dose escalation design with a 12-patient dose expansion cohort. Study objectives were to establish safety and determine maximum tolerated dose (MTD) of TAS-102 in combination with TARE.ResultsA total of 21 patients (14 women, 7 men) with median age of 60 years were enrolled. No dose limiting toxicities were observed. Treatment related severe adverse events included cytopenias (10 patients, 48%) and radioembolization-induced liver disease (2 patients, 10%). Disease control rate in the liver lobes treated with TARE was 100%. Best observed radiographic responses were partial response for 4 patients (19%) and stable disease for 12 patients (57%).ConclusionsThe combination of TAS-102 and TARE for patients with liver-dominant mCRC is safe and consistently achieves disease control within the liver.Trial registrationClinicalTrials.gov identifier NCT02602327 (first posted 11/11/2015)

A step towards equitable clinical trial recruitment: a protocol for the development and preliminary testing of an online prostate cancer health information and clinical trial matching tool

BackgroundRecruitment of a diverse participant pool to cancer clinical trials is an essential component of clinical research as it improves the generalizability of findings. Investigating and piloting novel recruitment strategies that take advantage of ubiquitous digital technologies has become an important component of facilitating broad recruitment and addressing inequities in clinical trial participation. Equitable and inclusive recruitment improves generalizability of clinical trial outcomes, benefiting patients, clinicians, and the research community. The increasing prevalence of online connectivity in the USA and use of the Internet as a resource for medical information provides an opportunity for digital recruitment strategies in cancer clinical trials. This study aims to measure the acceptability, preliminary estimates of efficacy, and feasibility of the Trial Library intervention, an Internet-based cancer clinical trial matching tool. This study will also examine the extent to which the Trial Library website, designed to address the linguistic and literacy needs of broader patient populations, influences patient-initiated conversations with physicians about clinical trial participation.MethodsThis is a study protocol for a non-randomized, single-arm pilot study. This is a mixed methods study design that utilizes the statistical analysis of quantitative survey data and the qualitative analysis of interview data to assess the participant experience with the Trial Library intervention. This study will examine (1) acceptability as a measure of participant satisfaction with this intervention, (2) preliminary measure of efficacy as a measure of proportion of participants with documented clinical trial discussion in the electronic medical record, and (3) feasibility of the intervention as a measure of duration of clinical visit.DiscussionThe principles that informed the design of the Trial Library intervention aim to be generalizable to clinical trials across many disease contexts. From the ground up, this intervention is built to be inclusive of the linguistic, literacy, and technological needs of underrepresented patient populations. This study will collect essential preliminary data prior to a multi-site randomized clinical trial of the Trial Library intervention.Trial registrationThis study has received institutional approval from the Committee of Human Subjects Research at the University of California, San Francisco

sj-docx-1-opp-10.1177_10781552241229024 - Supplemental material for Rechallenges without desensitization following platinum-based chemotherapy reactions

Supplemental material, sj-docx-1-opp-10.1177_10781552241229024 for Rechallenges without desensitization following platinum-based chemotherapy reactions by Fernanda D Young, Sidney Aung, Monica Tang, Karen M Anstey, Michael C Lee, Emely Alfaro, Pelin Cinar, Hansen Ho and Iris M Otani in Journal of Oncology Pharmacy Practice</p