22 research outputs found
Detection of pathogenic variants in breast cancer susceptibility genes in bilateral breast cancer
Differential involvement of germline pathogenic variants in breast cancer genes between DCIS and low-grade invasive cancers
Impact of timing of stem cell return following high dose melphalan in multiple myeloma patients with renal impairment: a single center experience
High dose melphalan (HDM) followed by autologous stem cell transplantation (ASCT) remains the standard consolidation in transplant eligible multiple myeloma (MM) patients. The timing between HDM administration and hematopoietic stem cell return (HSCR) varies among institutions, with a 'rest period' of 48 hours (h) employed by some for patients with renal impairment (RI). We investigated the differences in hematopoietic recovery and HDM toxicity between MM patients with RI who had HSCR after 24 vs 48 h from HDM. Fifty MM patients with RI (48 h group; n = 31 and 24 h group; n = 19) were included. No statistically significant differences were noted in surrogates for hematopoietic recovery and HDM toxicity between both groups. Only one death occurred in the 24 h group. No patients required renal replacement therapy. Therefore, a 24 h period between HDM and AHSC infusion appears safe for MM patients with RI
High-resolution CT phenotypes in pulmonary sarcoidosis: a multinational Delphi consensus study
One view of sarcoidosis is that the term covers many different diseases. However, no classification framework exists for the future exploration of pathogenetic pathways, genetic or trigger predilections, patterns of lung function impairment, or treatment separations, or for the development of diagnostic algorithms or relevant outcome measures. We aimed to establish agreement on high-resolution CT (HRCT) phenotypic separations in sarcoidosis to anchor future CT research through a multinational two-round Delphi consensus process. Delphi participants included members of the Fleischner Society and the World Association of Sarcoidosis and other Granulomatous Disorders, as well as members' nominees. 146 individuals (98 chest physicians, 48 thoracic radiologists) from 28 countries took part, 144 of whom completed both Delphi rounds. After rating of 35 Delphi statements on a five-point Likert scale, consensus was achieved for 22 (63%) statements. There was 97% agreement on the existence of distinct HRCT phenotypes, with seven HRCT phenotypes that were categorised by participants as non-fibrotic or likely to be fibrotic. The international consensus reached in this Delphi exercise justifies the formulation of a CT classification as a basis for the possible definition of separate diseases. Further refinement of phenotypes with rapidly achievable CT studies is now needed to underpin the development of a formal classification of sarcoidosis
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial
Background
Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.
Methods
In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.
Findings
Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group.
Interpretation
Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.
Funding
London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation
Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study
Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown
Prevalence of three-rooted primary mandibular first molars in Karnataka (South Indian) population
Background: The occurrence of an extra distal root in primary mandibular first molars is relevant clinically for the delivery of optimal care. However, there have been no studies conducted for establishing the prevalence of same in the South Indian population.Aim: The aim of this study is to evaluate the prevalence of three-rooted primary mandibular first molars in children of Davangere, Karnataka.Materials and Methods: Children aged 3–10 years, who reported to the Department of Pedodontics and Preventive Dentistry were included in the study. Intraoral periapical radiographs of bilateral primary mandibular first molars, obtained from 77 patients, were investigated for the presence of additional root. A total of 154 primary mandibular first molars were examined.Statistical Analysis: Data were analyzed using descriptive analysis.Results: The total occurrence of three-rooted primary mandibular first molar among the study participants was 1.3%. There was noted an equal distribution among boys and girls (1:1). Both the three-rooted primary first molar occurred on the right side with no bilateral occurrence noted.Conclusion: Primary mandibular first molar can display several anatomical variations, most frequently supernumerary root located distolingually. Hence, pedodontists should be alert in the identification of additional roots and to make necessary treatment modifications
Efficacy of a multimodal intervention strategy in improving hand hygiene compliance in a tertiary level intensive care unit
Context: The role of hand hygiene in preventing health care associated
infections (HCAIs) has been clearly established. However, compliance
rates remain poor among health care personnel. Aims: a) To investigate
the health care workers\u2032 hand hygiene compliance rates in the
intensive care unit (ICU), b) to assess reasons for non-compliance and
c) to study the efficacy of a multimodal intervention strategy at
improving compliance. Settings: A mixed medical-surgical ICU of a
tertiary level hospital. Design: A before-after prospective,
observational, intervention study. Materials and Methods: All health
care personnel who came in contact with patients in the ICU were
observed for their hand hygiene compliance before and after a
multimodal intervention strategy (education, posters, verbal reminders
and easy availability of products). A self-report questionnaire was
also circulated to assess perceptions regarding compliance. Statistical
analysis was done using c2 test or Fisher exact test (Epi info
software). Results: Hand hygiene compliance among medical personnel
working in the ICU was 26% and the most common reason cited for
non-compliance was lack of time (37%). The overall compliance improved
significantly following the intervention to 57.36% (P<0.000). All
health care worker groups showed significant improvements: staff nurses
(21.48-61.59%, P<0.0000), nursing students (9.86-33.33%,
P<0.0000), resident trainees (21.62-60.71%, P<0.0000), visiting
consultants (22-57.14%, P=0.0001), physiotherapists (70-75.95%,
P=0.413) and paramedical staff (10.71-55.45%, P< 0.0000).
Conclusions: Hand hygiene compliance among health care workers in the
ICU is poor; however, intervention strategies, such as the one used,
can be useful in improving the compliance rates significantly
Efficacy of a multimodal intervention strategy in improving hand hygiene compliance in a tertiary level intensive care unit
Context: The role of hand hygiene in preventing health care associated
infections (HCAIs) has been clearly established. However, compliance
rates remain poor among health care personnel. Aims: a) To investigate
the health care workers′ hand hygiene compliance rates in the
intensive care unit (ICU), b) to assess reasons for non-compliance and
c) to study the efficacy of a multimodal intervention strategy at
improving compliance. Settings: A mixed medical-surgical ICU of a
tertiary level hospital. Design: A before-after prospective,
observational, intervention study. Materials and Methods: All health
care personnel who came in contact with patients in the ICU were
observed for their hand hygiene compliance before and after a
multimodal intervention strategy (education, posters, verbal reminders
and easy availability of products). A self-report questionnaire was
also circulated to assess perceptions regarding compliance. Statistical
analysis was done using c2 test or Fisher exact test (Epi info
software). Results: Hand hygiene compliance among medical personnel
working in the ICU was 26% and the most common reason cited for
non-compliance was lack of time (37%). The overall compliance improved
significantly following the intervention to 57.36% (P<0.000). All
health care worker groups showed significant improvements: staff nurses
(21.48-61.59%, P<0.0000), nursing students (9.86-33.33%,
P<0.0000), resident trainees (21.62-60.71%, P<0.0000), visiting
consultants (22-57.14%, P=0.0001), physiotherapists (70-75.95%,
P=0.413) and paramedical staff (10.71-55.45%, P< 0.0000).
Conclusions: Hand hygiene compliance among health care workers in the
ICU is poor; however, intervention strategies, such as the one used,
can be useful in improving the compliance rates significantly