Anal canal carcinoma treatment results: the experience of a single institution

<b>Background and Objectives:</b> Prior to the mid-1980s, the treatment of choice for anal cancer was abdominoperineal resection. Currently, combined chemoradiation is the standard of care. Or objective was to analyze results of treatment for anal canal carcinoma treated with combined chemoradiation. <b>Design and Setting:</b> 0Retrospective review of data in local cancer registry at King Faisal Specialist Hospital and Research Centre (KFSHRC) from a 12-year period (1993 to 2005). <b>Methods:</b> We identified patients with confirmed diagnosis of anal canal squamous cell carcinoma. <b>Results:</b> Of 40 patients identified, 33 were considered eligible for our analysis. All patients were treated by concurrent chemoradiation with mandatory treatment break (MTB) There were 10 (30&#x0025;) local recurrences. Five-year progression-free survival (PFS) was 50.9&#x0025;; overall survival (OS) at 5 years was 73.4&#x0025;. Patients with stage II disease had a median PFS period of 10 years, with no relapses until their last follow-up. There was no statistically significant difference in PFS between patients with stage IIIA disease and those with stage IIIB disease-44.7&#x0025; and 45&#x0025;, respectively (<i>P</i>=.8). Five-year PFS according to &#x2032;T&#x2032; stages was as follows: T1, 66&#x0025;; T2, 71&#x0025;; T3, 59&#x0025;; T4, 30&#x0025; (<i>P</i>&gt;.05). The 5-year colostomy-free survival (CFS) for all patients was 74&#x0025;. Distant metastases were observed in 4 patients. <b>Conclusion:</b> Combined chemoradiation in treatment of anal cancer is effective in terms of local control and sphincter preservation. Five-year estimates of PFS, OS, as well as CFS, in patients treated with a MTB were surprisingly comparable to those determined in most non-MTB series. However, we reported a higher local failure rate, for which we are reevaluating our treatment protocol

Simultaneous HPLC Determination of Clindamycin Phosphate, Tretinoin, and Preservatives in Gel Dosage Form Using a Novel Stability-Indicating Method

The most well-known, effective medicines for acne therapy are clindamycin phosphate and tretinoin. For the first time, we have developed and validated a reversed-phase HPLC stability-indicating technique for the detection of clindamycin phosphate (CLP), tretinoin (TRN), and two preservatives, methylparaben (MP) and imidazolidinyl urea (IU), simultaneously in this work. Most of the chromatographic conditions in the present study were optimized to achieve better separation. The best separation results were obtained using gradient elution on a C-18 (250 × 4.6 mm), 5 µm column, with a mobile phase consisting of solution A (1 mL/L ortho-phosphoric acid in water) and solution B (methanol), at a flow rate of 1.0 mL/min, with UV detection at wavelengths of 200 nm and 353 nm. Standard parameters such as system suitability, precision, accuracy, specificity, robustness, linearity, range, detection limit, quantification limit, and reagent stability were used to validate the developed technique. According to the standards of the International Council for Harmonization, all of the experimental parameters were found to be within allowable bounds (ICH). The simultaneous concentrations of clindamycin phosphate, tretinoin, methylparaben, and imidazolidinyl urea in pharmaceutical formulations were successfully determined using the suggested approach. The proposed RP-HPLC method detected no interfering peaks in the chromatogram. We may conclude from the data that the new RP-HPLC method can be utilized in pharmaceutical laboratories to simultaneously assess clindamycin phosphate, tretinoin, and two preservatives, methylparaben and imidazolidinyl urea, for both qualitative and quantitative analyses

Simultaneous HPLC Determination of Clindamycin Phosphate, Tretinoin, and Preservatives in Gel Dosage Form Using a Novel Stability-Indicating Method

The most well-known, effective medicines for acne therapy are clindamycin phosphate and tretinoin. For the first time, we have developed and validated a reversed-phase HPLC stability-indicating technique for the detection of clindamycin phosphate (CLP), tretinoin (TRN), and two preservatives, methylparaben (MP) and imidazolidinyl urea (IU), simultaneously in this work. Most of the chromatographic conditions in the present study were optimized to achieve better separation. The best separation results were obtained using gradient elution on a C-18 (250 &times; 4.6 mm), 5 &micro;m column, with a mobile phase consisting of solution A (1 mL/L ortho-phosphoric acid in water) and solution B (methanol), at a flow rate of 1.0 mL/min, with UV detection at wavelengths of 200 nm and 353 nm. Standard parameters such as system suitability, precision, accuracy, specificity, robustness, linearity, range, detection limit, quantification limit, and reagent stability were used to validate the developed technique. According to the standards of the International Council for Harmonization, all of the experimental parameters were found to be within allowable bounds (ICH). The simultaneous concentrations of clindamycin phosphate, tretinoin, methylparaben, and imidazolidinyl urea in pharmaceutical formulations were successfully determined using the suggested approach. The proposed RP-HPLC method detected no interfering peaks in the chromatogram. We may conclude from the data that the new RP-HPLC method can be utilized in pharmaceutical laboratories to simultaneously assess clindamycin phosphate, tretinoin, and two preservatives, methylparaben and imidazolidinyl urea, for both qualitative and quantitative analyses

Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia Region: A report from the Pediatric Oncology East and Mediterranean (POEM) Group

Background Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID-19) pandemic on access to care for children with cancer is likely but has not been evaluated. METHODS A 34-item survey focusing on barriers to pediatric oncology management during the COVID-19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID-19 cases and deaths were retrieved from the World Health Organization database. Results In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off-treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29\% to 44\% of centers, and 24\% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28\% of centers. Greater than 70\% of centers reported shortages in blood products, and 47\% to 62\% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in <30\% of centers, reflecting the low rates of COVID-19 hospitalizations in the corresponding countries at the time of the survey. Conclusions Mechanisms to approach childhood cancer treatment delivery during crises need to be re-evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

Objectives: To determine factors associated with COVID-19-related death in people with rheumatic diseases. Methods: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. Results: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. Conclusion: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants

Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study

Published by Elsevier Ltd.Background: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods: In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02-1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00-1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88-1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44-0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74-0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69-0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1-9·5]; p=0·14). Interpretation: Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities.MAG is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K01 AR070585 and K24 AR074534 [JY]). KDW is supported by the Department of Veterans Affairs and the Rheumatology Research Foundation Scientist Development award. JAS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253, and P30 AR072577), the Rheumatology Research Foundation (K Supplement Award and R Bridge Award), the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund. NJP is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258). AD-G is supported by grants from the Centers for Disease Control and Prevention and the Rheumatology Research Foundation. RH was supported by the Justus-Liebig University Giessen Clinician Scientist Program in Biomedical Research to work on this registry. JY is supported by grants from the National Institutes of Health (K24 AR074534 and P30 AR070155).info:eu-repo/semantics/publishedVersio