Errors Related to Medication Reconciliation: A Prospective Study in Patients Admitted to the Post CCU

Abstract Medication errors are one of the important factors that increase fatal injuries to the patients and burden significant economic costs to the health care. An appropriate medical history could reduce errors related to omission of the previous drugs at the time of hospitalization. The aim of this study, as first one in Iran, was evaluating the discrepancies between medication histories obtained by pharmacists and physicians/nurses and first order of physician. From September 2012 until March 2013, patients admitted to the post CCU of a 550 bed university hospital, were recruited in the study. As a part of medication reconciliation on admission, the physicians/nurses obtained medication history from all admitted patients. For patients included in the study, medication history was obtained by both physician/nurse and a pharmacy student (after training by a faculty clinical pharmacist) during the first 24 h of admission. 250 patients met inclusion criteria. The mean age of patients was 61.19 ± 14.41 years. Comparing pharmacy student drug history with medication lists obtained by nurses/physicians revealed 3036 discrepancies. On average, 12.14 discrepancies, ranged from 0 to 68, were identified per patient. Only in 20 patients (8%) there was 100 % agreement among medication lists obtained by pharmacist and physician/nurse. Comparing the medications by list of drugs ordered by physician at first visit showed 12.1 discrepancies on average ranging 0 to 72. According to the results, omission errors in our setting are higher than other countries. Pharmacybased medication reconciliation could be recommended to decrease this type of error

Outcome of Transphenoid Surgery for Corticotroph Pituitary Tumors

Background & Importance: The aim of this study was to demonstrate the result of transsphenoid microsurgery for Cushing disease in our center and comparing the results in details with other articles, to achieve the best decision for patients management in future. Case Presentation: Between 1991 to 2015, 50 patients suffering from Cushing disease were operated. Before operation, endocrine tests and neuroimaging examinations were done for all patients and all of them were operated via transsphenoid approach. They were followed up in clinic with endocrine tests and imaging in regular intervals. During this study, 50 Cushing cases including 47 primary and three secondary tumors were operated. Thirty four (68%) tumors were microadenoma and 16 (32%) macroadenoma. A patient died due to postoperative fulminant meningitis (mortality=2%). Mean of follow-up was five years. Overall, 40 (80%) patients had remission after operation and 9 (18%) patients achieved no remission, three of them had macroadenoma and six microadenoma. During follow-up period, three (6%) patients had recurrence which needed second operation. In secondary tumor and in macroadenoma with cavernous sinus involvement, the result was not good (33% and 0% remission, respectively). Conclusion: Transsphenoid surgery is a safe and effective first choice method to manage Cushing disease compared to other treatment modalities. In recurrent or resistant cases, other modalities could help to manage patients

Robotic-Assisted Partial Nephrectomy and Adrenalectomy: Case of a Pheochromocytoma Invading into Renal Parenchyma

Although upper pole renal masses and adrenal masses can usually be distinguished on cross-sectional imaging, large masses can obscure the boundaries between the kidney and adrenal gland. We describe a unique case of an adrenal pheochromocytoma in a 42-year-old female who was referred for robotic partial nephrectomy. During the procedure, the patient developed severe hypertension. The case was aborted, and the workup revealed pheochromocytoma. After appropriate pretreatment, the patient underwent a successful robotic adrenalectomy and partial nephrectomy. Therefore, we recommend screening patients with hypertension and large upper pole masses for pheochromocytoma to better direct preoperative management

Chemoresistance in prostate cancer cells is regulated by miRNAs and Hedgehog pathway.

Many prostate cancers relapse due to the generation of chemoresistance rendering first-line treatment drugs like paclitaxel (PTX) ineffective. The present study aims to determine the role of miRNAs and Hedgehog (Hh) pathway in chemoresistant prostate cancer and to evaluate the combination therapy using Hh inhibitor cyclopamine (CYA). Studies were conducted on PTX resistant DU145-TXR and PC3-TXR cell lines and clinical prostate tissues. Drug sensitivity and apoptosis assays showed significantly improved cytotoxicity with combination of PTX and CYA. To distinguish the presence of cancer stem cell like side populations (SP), Hoechst 33342 flow cytometry method was used. PTX resistant DU145 and PC3 cells, as well as human prostate cancer tissue possess a distinct SP fraction. Nearly 75% of the SP cells are in the G0/G1 phase compared to 62% for non-SP cells and have higher expression of stem cell markers as well. SP cell fraction was increased following PTX monotherapy and treatment with CYA or CYA plus PTX effectively reduced their numbers suggesting the effectiveness of combination therapy. SP fraction cells were allowed to differentiate and reanalyzed by Hoechst staining and gene expression analysis. Post differentiation, SP cells constitute 15.8% of total viable cells which decreases to 0.6% on treatment with CYA. The expression levels of P-gp efflux protein were also significantly decreased on treatment with PTX and CYA combination. MicroRNA profiling of DU145-TXR and PC3-TXR cells and prostate cancer tissue from the patients showed decreased expression of tumor suppressor miRNAs such as miR34a and miR200c. Treatment with PTX and CYA combination restored the expression of miR200c and 34a, confirming their role in modulating chemoresistance. We have shown that supplementing mitotic stabilizer drugs such as PTX with Hh-inhibitor CYA can reverse PTX chemoresistance and eliminate SP fraction in androgen independent, metastatic prostate cancer cell lines

Radiogenomics in Clear Cell Renal Cell Carcinoma: A Review of the Current Status and Future Directions

Radiogenomics is a field of translational radiology that aims to associate a disease’s radiologic phenotype with its underlying genotype, thus offering a novel class of non-invasive biomarkers with diagnostic, prognostic, and therapeutic potential. We herein review current radiogenomics literature in clear cell renal cell carcinoma (ccRCC), the most common renal malignancy. A literature review was performed by querying PubMed, Medline, Cochrane Library, Google Scholar, and Web of Science databases, identifying all relevant articles using the following search terms: “radiogenomics”, “renal cell carcinoma”, and “clear cell renal cell carcinoma”. Articles included were limited to the English language and published between 2009–2021. Of 141 retrieved articles, 16 fit our inclusion criteria. Most studies used computed tomography (CT) images from open-source and institutional databases to extract radiomic features that were then modeled against common genomic mutations in ccRCC using a variety of machine learning algorithms. In more recent studies, we noted a shift towards the prediction of transcriptomic and/or epigenetic disease profiles, as well as downstream clinical outcomes. Radiogenomics offers a platform for the development of non-invasive biomarkers for ccRCC, with promising results in small-scale retrospective studies. However, more research is needed to identify and validate robust radiogenomic biomarkers before integration into clinical practice

Prognostic factors and treatment impact on overall survival in patients with renal neuroendocrine tumour

Abstract Background Renal neuroendocrine neoplasms (R‐NEN) are exceptionally rare tumours characterized by high mortality rates. Objective The objective of this study is to analyse prognostic factors and treatment impact on overall survival in patients with R‐NEN. Design, setting and participants We identified all patients with R‐NEN in the National Cancer Database (NCDB) from 2004 to 2019 and identified prognostic factors for improved survival. Results and limitations Of 542 R‐NEN cases, 166 (31%) were neuroendocrine tumour grade 1 (NET‐G1), 14 (3%) were neuroendocrine tumour grade 2 (NET‐G2), 169 (31%) were neuroendocrine carcinoma (NEC‐NOS), 18 (3%) were large cell neuroendocrine carcinoma (LC‐NEC) and 175 (32%) were small cell neuroendocrine carcinoma (SC‐NEC). Median overall survival for all patients in the study was 44.88 months (SE, 4.265; 95% CI, 27.57–62.19). Median overall survival was 7.89 months (SE 0.67; 95% CI, 6.58–9.20) for patients without surgical intervention and 136.61 months (SE 16.44; 95% CI, 104.38–168.84, p < 0.001) for patients who underwent surgery. Increased age (HR, 1.05; 95% CI, 1.03–1.06; p < 0.001), T4 stage disease (HR, 3.17; 95% CI, 1.96–5.1; p < 0.001), NEC‐NOS histology (HR, 2.82; 95% CI, 1.64–4.86; p < 0.001), LC‐NEC histology (HR, 2.73; 95% CI, 1.04–7.17; p = 0.041) and SC‐NEC histology (HR, 5.17; 95% CI, 2.95–9.05; p < 0.001) were all positive predictors of worsening overall survival. The main limitation of the study is its retrospective design. Conclusion R‐NEN is an aggressive tumour characterized by high mortality rates. Surgery continues to be the mainstay of treatment and has shown to provide a survival benefit for most patients. Patient Summary R‐NEN is composed of several tumour histologies that differ based on their aggressiveness with NEC‐NOS and SC‐NEC being the most lethal. Surgery, predominantly through minimally invasive approaches, is the mainstay of treatment and has a clear survival benefit