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Therapeutic drug monitoring for cytotoxic anticancer drugs: Principles and evidence-based practices.

Cytotoxic drugs are highly efficacious and also have low therapeutic index. A great degree of caution needs to be exercised in their usage. To optimize the efficacy these drugs need to be given at maximum tolerated dose which leads to significant amount of toxicity to the patient. The fine balance between efficacy and safety is the key to the success of cytotoxic chemotherapeutics. However, it is possibly more rewarding to obtain that balance for this class drugs as the frequency of drug related toxicities are higher compared to the other therapeutic class and are potentially life threatening

Surgical techniques for patients with cancer-related neuropathic pain.

In this manuscript, we discuss the use of neuromodulatory techniques such as intrathecal therapy (IT) and spinal cord stimulation (SCS) for cancer pain in neuro-oncology patients. Currently, cancer pain management relies on oral opioids, which have a number of systemic side effects particularly in a chronic setting. An escalation of pain therapy for pain relief, such as neuromodulation, is necessary to improve neuro-oncology patients' quality of life. The paper highlights the need for more comprehensive pain management for patients during and after receiving cancer therapies. IT allows analges

II Brazilian Consensus on the use of human immunoglobulin in patients with primary immunodeficiencies.

In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new know

Interventions for necrotizing soft tissue infections in adults.

BACKGROUND: Necrotizing soft tissue infections (NSTIs) are severe and rapidly spreading soft tissue infections of the subcutaneous tissue, fascia, or muscle, which are mostly caused by bacteria. Associated rates of mortality and morbidity are high, with the former estimated at around 23%, and disability, sequelae, and limb loss occurring in 15% of patients. Standard management includes intravenous empiric antimicrobial therapy, early surgical debridement of necrotic tissues, intensive care support, and adjuvant therapies such as intravenous immunoglobulin (IVIG). OBJECTIVES: To assess the eff

Астроцитизированный PTN уменьшает дефицит гиппокампального неврогенеза и когниции в моделях множественного склероза.

Множественный склероз (MS) — аутоиммунное воспалительное заболевание, которое приводит к моторным, сенсорным, когнитивным и эффективным расстройствам. Гиппокампальное обезвоживание, обычное явление в MS, связано с нарушенной когнитивной функцией и настроением. Несмотря на это, точные механизмы, лежащие в основе когнитивных нарушений в MS, по-прежнему остаются труднодостижимыми. Плейотропхин (PTN), скрытый нейронными стволовыми клетками и астроцитами, играет решающую роль в регулировании когниции. В этом исследовании изучается роль PTN на основе астроцитов. Мы обнаружили, что генетическое удале

Evaluation of adverse events and health-related quality of life in patients with colorectal cancer receiving ambulatory home-based chemotherapy in Thailand.

AimsTo compare adverse events and health-related quality of life in ambulatory home-based chemotherapy with those in inpatient.DesignProspective non-randomized observational study.MethodsParticipants were divided into two groups according to patients' preference receiving chemotherapy.ResultsSixty-four participants were enrolled in the inpatient, and 111 were in an ambulatory home-based chemotherapy. The frequency of anaemia, neutropenia and thrombocytopenia was significantly higher in inpatient group than in ambulatory home-based chemotherapy group (p < .001, <.001 and .002, respectively). Na

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… Participants in group B received oxaliplatin or irinotecan concurrent with leucovorin for a short infusion of 3–4 hr, followed by 5‐FU bolus injection and continuous infusion using an elastomeric infusion pump via the implanted port at the hospital ambulatory unit; patients then used the infusion pump … Disposable infusion pumps. American Journal of Health‐System Pharmacy, 63(13), 1260–1268. 10.2146/ajhp050408 Temiz, G. , & Durna, Z. (2020). Evaluation of quality of life and health care needs in cancer patients receiving chemotherapy. …

Health Risks from Microplastics in Intravenous Infusions: Evidence from Italy, Spain, and Ecuador.

The rising incidence of microplastics (MPs) is a possible health risk to humans. The present study aims to analyze the presence of MPs in intravenous (IV) infusions and compare MP concentrations from multiple brands. The IV solutions of 29 medical devices (IV-MDs) from seven brands commercialized in Ecuador, Spain, and Italy have been selected under specific consideration to carry out the study. The detection of MPs has been quite obvious in almost all of the samples from brands in the mentioned countries. MP concentrations ranged from 9 to 20 MPs/L in glass containers to 166-299 MPs/L in plas

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… It should be noted that the presence of linear stretch marks may be an indication of mechanical friction against internal system components (such as infusion pumps, filters, and tubulars) during administration or transportation due to the texture of the surfaces (i.e., soft, rough, microporosities, and … Mechanical stress and friction on the plastic may trigger the rate to increase from 0.90 MPs/mL to 1.57 MPs/mL under infusion pump scenarios [ 43 ]. Hydrolysis of plastic additives has been favoured in high RH scenarios. …

Therapies in Stiff-Person Syndrome: Advances and Future Prospects Based on Disease Pathophysiology.

Among the glutamic acid decarboxylase (GAD)-antibody-spectrum disorders, the most common phenotypic subset is the stiff-person syndrome (SPS), caused by impaired GABAergic inhibitory neurotransmission and autoimmunity characterized by very high titers of GAD antibodies and increased GAD-IgG intrathecal synthesis. If not properly treated or untreated because of delayed diagnosis, SPS progresses leading to disability; it is therefore fundamental to apply the best therapeutic schemes from the outset. This article is focused on the rationale of specific therapeutic strategies based on the SPS path

HIV-1 matrix protein p17 misfolding forms toxic amyloidogenic assemblies that induce neurocognitive disorders.

Human immunodeficiency virus type-1 (HIV-1)-associated neurocognitive disorder (HAND) remains an important neurological manifestation that adversely affects a patient's quality of life. HIV-1 matrix protein p17 (p17) has been detected in autoptic brain tissue of HAND individuals who presented early with severe AIDS encephalopathy. We hypothesised that the ability of p17 to misfold may result in the generation of toxic assemblies in the brain and may be relevant for HAND pathogenesis. A multidisciplinary integrated approach has been applied to determine the ability of p17 to form soluble amyloi

Practical strategies to manage cancer patients during the COVID-19 pandemic: Saudi Oncology Pharmacy Assembly Experts recommendations.

PurposeDuring COVID-19 pandemic, cancer patients are considered one of the most vulnerable to infection since they tend to have advanced age, multiple comorbidities, and are often immunosuppressed by their cancer or therapy. Hence, the Saudi Oncology Pharmacy Assembly has issued recommendations to reduce the frequency of cancer patients' visits to oncology centers during the pandemic while maintaining the access to cancer therapy and minimize the risk of exposure to coronavirus disease.Materials and methodsA qualitative methodological approach was conducted in April 2020 using a virtual panel

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… pumps when needed. ○ Oral antiemetics. ○ Growth factors and oral antibiotics can be used for patients receiving high-risk chemotherapy as primary prophylaxis for FN and empiric oral antibiotics in clinically stable patients with FN. ○ Oral sodium bicarbonate with or without acetazolamide if needed, … Examples include: IV hydration can be given orally with proper patient education or intravenously at home through elastomeric infusion pumps when continuous hydration is needed. Oral antiemetics, rather than injectable ones, should be given to all patients when feasible. …

Cost minimization analysis of subcutaneous and intravenous immunoglobulin treatment in Italy.

IntroductionHuman immunoglobulins are the standard of care for patients with immunodeficiencies and represent a first-line treatment for chronic inflammatory demyelinating polyneuropathy (CIDP). This study aimed to evaluate costs associated with facilitated subcutaneous (fSCIG), conventional subcutaneous (cSCIG), and intravenous (IVIG) administration of immunoglobulin in patients with primary or secondary immunodeficiency (PID and SID, respectively) and in patients with CIDP in Italy.MethodsA cost-minimization analysis from a societal perspective was developed, considering a one-year follow-up

Early Interventional Treatments for Patients with Cancer Pain: A Narrative Review.

Between 10% and 20% of patients with cancer-related pain cannot achieve adequate control following the three-step ladder guidelines by the World Health Organization. Therefore, a "fourth step", including interventional approaches, has been suggested for those cases. Systematic reviews support the early use of interventional procedures to treat refractory cancer pain, control symptoms and prevent opioid dose escalation. There is strong evidence of the efficacy of celiac plexus or splanchnic neurolysis, vertebroplasty, kyphoplasty and intrathecal drug delivery. Those procedures have been found t

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… Articles were identified by the following key words: “Cancer Pain”; “Intractable Pain”; “Nerve Block”; “Radiofrequency Ablation”; “Spinal Injections”; “Implantable Infusion Pumps”; “Vertebroplasty” or “Kyphoplasty”. …

Investigation and management of osteoporosis in aged trauma patients: a treatment algorithm adapted to the German guidelines for osteoporosis.

BACKGROUND: Osteoporosis-associated fractures are of increasing importance in trauma surgery. Systematic diagnostics and treatment of osteoporosis during a hospital stay, however, remain inadequate. Therefore, a specific algorithm for diagnosing and treating osteoporosis in trauma surgery patients was developed based on the DVO (German Osteology Society) guideline for osteoporosis from 2014. METHODS: In a first step, the individuals' age and risk profile for osteoporosis is identified considering specific fractures indicating osteoporosis and risk factors assessed by a specific questionnaire.

Pseudomonas aeruginosa Infections in Cancer Patients.

Pseudomonas aeruginosa (P. aeruginosa) is one of the most frequent opportunistic microorganisms causing infections in oncological patients, especially those with neutropenia. Through its ability to adapt to difficult environmental conditions and high intrinsic resistance to antibiotics, it successfully adapts and survives in the hospital environment, causing sporadic infections and outbreaks. It produces a variety of virulence factors that damage host cells, evade host immune responses, and permit colonization and infections of hospitalized patients, who usually develop blood stream, respirato

Diagnosis and treatment of type 1 diabetes at the dawn of the personalized medicine era.

Type 1 diabetes affects millions of people globally and requires careful management to avoid serious long-term complications, including heart and kidney disease, stroke, and loss of sight. The type 1 diabetes patient cohort is highly heterogeneous, with individuals presenting with disease at different stages and severities, arising from distinct etiologies, and overlaying varied genetic backgrounds. At present, the "one-size-fits-all" treatment for type 1 diabetes is exogenic insulin substitution therapy, but this approach fails to achieve optimal blood glucose control in many individuals. Wit

The use of interventional procedures for cancer pain. A brief review.

ContextPain is a common experience in people living with cancer. Concerns around opioid prescribing have seen a move toward a multi-modality management approach, which includes interventional pain procedures.PurposeIn this paper we discuss the interventional pain procedures used to treat cancer pain at two major tertiary centers in Australia.Methods and resultsThis expert review provides practical insights on cancer pain management from healthcare providers in different specialties. These insights can be used to guide the management of a wide range of cancer pain types.ConclusionsFurthermore,

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… The drug/s may be delivered through a single bolus injection, through external infusion pump, or a fully implantable device. The choice of delivery method depends largely on the clinical situation and local nursing expertise and availability. … External infusion pumps are usually considered for patients with a limited prognosis measured in weeks, whereas fully implantable devices are more appropriate for patients with a life expectancy greater than 6 months [ 28 , 29 ]. …

Should treatment of hypogammaglobulinemia with immunoglobulin replacement therapy (IgRT) become standard of care in patients with chronic lymphocytic leukemia?

Hypogammaglobulinemia (HGG) is a frequent finding in patients with hematological malignancies, and is commonly described in chronic lymphocytic leukemia (CLL) before or after treatment. We reviewed published literature available online in the last thirty years through Medline search of indexed articles focusing on the main differences and advantages of the products now available on the market, namely intravenous Ig (IVIg) and subcutaneous Ig (SCIg) preparations. IgRT is effective and safe in the prophylaxis of infections in a selected group of patients with CLL and hypogammaglobulinemia and is

Insights into Facilitated Subcutaneous Immunoglobulin Use in Patients with Secondary Immunodeficiency Diseases: A FIGARO Subgroup Analysis.

The Facilitated Immunoglobulin Administration Registry And Outcomes (FIGARO) Study was a European, multicenter, prospective, observational study conducted across Europe designed to provide insights on the clinical use and tolerability of facilitated subcutaneous immunoglobulin (fSCIG). Data herein are reported for the cohort of patients with secondary immunodeficiency (SID), with a subgroup analysis by age. The SID cohort included 31 patients: 1 pediatric, 15 adult, and 15 older adult patients. Over the 36-month observation period, the median monthly dose of fSCIG (30 g) and median monthly inf

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society.

Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but

The Missing Link: Integrating Interventional Pain Management in the Era of Multimodal Oncology.

Cancer-related pain (CrP) is one of the most frequent and debilitating issues that affect the quality of life of patients with cancer. Systemic analgesics, particularly opioids, have been the cornerstone of pain management. However, the following shortcomings of the mentioned therapies, such as side effects, tolerance, and inadequate relief in refractory cases, make implementing a more complete, multimodal treatment plan necessary. Interventional pain management (IPM) uses specific invasive procedures, with different degree of invasiveness, such as nerve blocks, neurolysis, neuromodulation, an