DOACs for stroke prevention in patients with AF and cancer

Stroke prophylaxis in atrial fibrillation is an important consideration in patients with cancer. However, there is little consensus on the choice of anticoagulation, due to the numerous difficulties associated with active cancer. Direct oral anticoagulants (DOACs) have been shown to be a promising option. Here, we conduct a simple cross-sectional analysis of 29 cancer patients receiving DOACs for stroke prophylaxis in atrial fibrillation at a tertiary-care institution in London. Our study demonstrates an encouraging efficacy and safety profile of DOACs used in this setting. We conclude by suggesting that, while DOACs may be useful, anticoagulation in cancer patients should continue to be individualised

Study of obstetric and perinatal outcome of twin pregnancy

Background: Multifetal pregnancy constitutes a significant portion of high-risk pregnancies. This is due to the increasing obstetric and perinatal morbidity and mortality rates associated with it. Maternal and perinatal outcome of twin pregnancies has been evaluated in this study.Methods: Total 30 patients with twin pregnancy and having gestational age more than 28 weeks were included in this observational study.Results: Incidence of twins in the study was found to be 2%. Twin pregnancies were more common in multiparous women aged between 20 and 30 years. Most common foetal presentation was vertex- vertex presentation. Most common maternal complication was preterm labour seen in 67% women, followed by anaemia seen in 50% women. Most of the women were delivered by caesarean section (63.3%). Most common perinatal complication was birth hypoxia (41.6%). Other perinatal complications were jaundice, septicemia, intrauterine growth restriction. 71% of the neonates had birth weight less than 2.5 kg. Perinatal mortality was found to be 11.6%.Conclusions: Twin pregnancies are high risk pregnancies associated with higher obstetric and perinatal morbidity. Perinatal morbidity was more common for the second coming twin. Regular antenatal visits, planned delivery and better NICU facilities can help combat these complications. A team of skilled obstetricians and pediatricians along with a multidisciplinary approach is essential for the effective management of twin pregnancies

Are we using the relevant questionnaires to assess health related quality of life in multiple myeloma patients in the era of new generation targeted and novel immunotherapies?

  Therapeutic advances have significantly improved the survival of multiple myeloma (MM) patients. Clinicians and researchers should ensure that patients with this incurable cancer are not only living longer, but also living better. Several validated questionnaires are available and frequently used to assess health related quality of life (HRQOL). However, they were developed >20 years ago before the era of new generation treatments, which have unique toxicity profiles. Introduction of new treatment combinations and maintenance therapies also means that these questionnaires may not be able to fully capture all HRQOL aspects. To better understand which of these aspects are truly important, we asked MM patients and healthcare professionals (HCP) from a single centre to indicate the level of relevance of each item in 9 HRQOL questionnaires. Our results revealed that patients ranked items related to social functioning, receiving information about MM and involvement in their management as most relevant. In contrast, HCPs placed highest relevance to items corresponding to symptoms from MM or treatment toxicities. Subgroup analysis of patients revealed additional topics that were deemed relevant: those ≤70 y.o. were more concerned about disease progression whereas those >70 y.o. prioritised items related to physical function; patients with renal impairment and bone disease found having energy and pain more relevant than in the general MM cohort. These findings can contribute to guiding the content development of new HRQOL tools relevant to both MM patients as a whole, as well as specific subgroups receiving newer treatments. </p