IBRUTINIB IN THE MANAGEMENT OF NON-HODGKIN'S LYMPHOMA: A CASE REPORT

Non-Hodgkin's lymphoma (NHL) is a diverse group of lymphoid neoplasms, the prevalence of which has increased over the past few decades. NHL is diverse in the manner of presentation, response to various treatment and prognosis. The current case report describes a 40-year-old man who was diagnosed with small lymphocytic lymphoma/chronic lymphocytic leukemia in 2006. The patient had disease progression during the course of 10 years from the time of diagnosis for which he received multiple lines of chemotherapy (chlorambucil/prednisolone; rituximab/cyclophosphamide/ fludarabine; bendamustine/rituximab; and ofatumumab). However, in 2016, his disease again showed signs of progression, and hence he was started on ibrutinib 140 mg 3 times daily. After treatment with ibrutinib, there were no clinical nodes and hepatosplenomegaly, and all counts also normalized. Since the commencement of this agent, no disease progression was observed for almost 16 months. However, in July 2017, again disease progression occurred, and the patient was started on with cyclophosphamide, vincristine, and prednisone (COP) regimen. He received one cycle of COP regimen and continued on treatment with ibrutinib, and the treatment was well tolerated. In December 2017, he expired due to the progression of the disease. Ibrutinib, a Bruton's tyrosine kinase inhibitor, appears to be safe and effective in providing long-term disease control even in refractory cases of NHL

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe