Articles Related to Therapy

According to the UNAIDS 2022 report, 52% of the HIV positive children between 0-14 years were able to access treatment and of these 68% attain viral suppression. CCR5 promoter genotype specifically single nucleotide polymorphisms have been linked to modulate patient virological status. However, the few studies that have studied the association in infants have utilized allele-specific PCR a genotypic method limited to detecting already known SNPs. By using Sanger sequencing, we explored the association taking into account novel mutations.

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Immune-checkpoint inhibitors (ICI) have provided groundbreaking advancements for a variety of malignancies. It has been of recent interest to identify predictive indicators of response to improve cancer management using immunotherapy. The intestinal microbiome has been recognized as a potential predictor of ICI anti- tumor activity. Antibiotics reduce diversity the overall composition of the gut microbiota, with effects seen as quickly as in a single day. Post-antibiotic dysbiosis recovery varies depending on type and duration of exposure. Preclinical studies in mice with advanced cancer treated with broad spectrum antibiotics have been associated with resistance to ICI treatment.

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Introduction: The use of anti-retroviral drugs slows down disease progression in Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) and this has improved the quality of life and life expectancy of Persons Living with HIV/AIDS (PLWHA). However, optimum use of antiretroviral drugs (adherence) by PLWHA is the key to achieving viral load suppression and preventing drug resistance in them. Objective: This study determined the level of adherence to Anti-Retroviral Therapy (ART) among PLWHA in Ekiti State. Methodology: A cross-sectional study was conducted on 320 PLWHA in Ekiti State University Teaching Hospital, Ado-Ekiti and 300 PLWHA in Federal Teaching Hospital, Ido-Ekiti aged 18 years and above using ARV for at least six months prior to the study. Quantitative data were collected from the participants using a structured questionnaire while sixteen in-depth interviews were conducted among purposively selected PLWHA in both study centres to further elicit qualitative information on determinants of adherence. Quantitative data were analyzed with SPSS 22 using descriptive statistics while content analysis was used for qualitative data. Regression analysis was done to identify determinants of adherence at p value < 0.05. Results: About 60% of the PLWHA had high level of ART adherence while 18.9% had low adherence. Most of the respondents were female (66.0%), married (76.1%) and Christians (89.4%) and had post-secondary education (43.4%). Respondents’ age (X2=32.483), educational status (X2=2.473), marital status (X2=40.083), occupation (X2=57.951) and distance from the clinic (X2=13.181) significantly influenced the level of adherence. Patient factors such as forget timing of the medication, pill burden and feeling better, psychosocial factors like stigmatization, non-disclosure of status and depression; and healthcare factors such as long clinic waiting time and absence of support are some of the barriers to optimum ART adherence. Conclusion: Counseling on drug adherence and psycho-social support to PLWHA will further improve their level of adherence to medication.

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Background: Breast cancer is the most common cancer in women worldwide. Management of Breast cancer requires multidisciplinary team approach (viz, Surgery, Chemotherapy, Radiation therapy, Hormonal therapy & Targeted therapy). Radiotherapy reduces the risk of breast cancer mortality for women after breast conserving surgery and for women after mastectomy for node-positive disease. One of the organs at risk in breast cancer therapy is esophagus. As such, there is potential to expose greater volumes of esophagus to radiation. This may result in increased frequency and severity of acute radiation esophagitis during treatment. Aims and Objectives: To evaluate dosimetric parameters such as mean dose (Dmean) maximum dose (Dmax) which may influence the incidence and severity of esophagitis in breast cancer patients receiving radiotherapy. Material and Methods: Treatment plans of post mastectomy patients who had already received adjuvant RT of dose 50 Gy in 25 # over 5 weeks to the chest wall along with Supraclavicular field (SCF) using 3-Dimensional Conformal Radiation Therapy (3D CRT) and Intensity Modulated Radiation Therapy (IMRT) were selected. Mean dose (Dmean) and maximum dose (Dmax) to esophagus was assessed. Results: Dosimetric parameters assessed are Dmean and Dmax. Dmean assessed up to less than or equal to 11Gy and Dmax assessed upto less than or equal to 34Gy. The average of Dmean in this study is 8.34Gy which is within normal limits of prescribed dose. The mean Of Dmax in this study is 24.80Gy which is in limits of prescribed dose. Conclusion: Increased dose to esophagus in observed when IMRT is used especially when supraclavicular or internal mammary nodes are involved. Routine contouring of esophagus and planning accordingly may reduce oesophageal dose and acute oesophageal toxicity.

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Pediatric cancer overall survival has increased due to improvements in treatment. However, long-term adverse effects are a challenge for this population. Secondary myeloid neoplasm (MN) is one of the complications of solid tumor treatment. Therapy-related myeloid neoplasms (t-MN), therapy-related acute myeloid leukemia (t-AML), and therapy-related myelodysplastic syndrome (t-MDS) are the most common events. The aim of this study was to report a large pediatric sample and the relevance of t-MN after pediatric solid tumor therapy. We conducted a retrospective study between 2000-2016 in a cohort of pediatric patients treated for solid tumors who developed a secondary MN by medical records review and analysis. Seven from 2178 pediatric patients who were previously treated for solid tumors, were diagnosed with t-MN in a reference cancer center in Brazil. The median age at primary tumor diagnosis was 12.8 years old. Osteosarcoma, atypical primitive neuroectodermal tumor (PNET), Ewing sarcoma, and retinoblastoma were the most frequent solid tumors associated with t-MN. Three patients had a story of familiar cancer, and one patient with osteosarcoma had Li-Fraumeni syndrome confirmed. The median latency period to secondary MN was ten months and the prevalence rate was 0.32%. Two patients developed t-MDS and five, t-AML. All these patients received cytotoxic agents’ high doses that may have been associated with t-MN development. t-MN initial control, as well as unfavorable cytogenetic abnormalities, may have contributed to the poor outcome. We described the rarity of t-MN related to previous solid tumor therapy in a large pediatric sample in a Brazilian Cancer Center and their poor prognosis.

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Objective: To determine the prevalence of minority drug resistance variants in the protease and Gag regions among patients failing a protease inhibitor (PI) based regimen with or without a susceptible genotype based on Sanger sequencing technology. Methods: Samples were obtained from patients who were failing on a protease inhibitor-based regimen (n = 500). Sanger based sequencing was performed as part of the standard of care. Mutation analysis was performed using the Stanford HIV drug Resistance database. A subset of these patient samples was grouped into two categories: those failing a PI based with mutations in the protease region (n = 100) and those failing on a PI based regimen without mutations in the protease region (n = 128). These samples were then analyzed in the protease and Gag regions using Next Generation Sequencing (NGS) technology and analysis of the drug resistance mutations was performed at the 20% and 1% cutoffs. Results: An initial analysis of the protease region for patients failing with drug resistance mutations revealed that most patients harbored mutations that confer resistance to Lopinavir and Atazanavir, but these mutations had little effect on Darunavir. Furthermore, NGS revealed that in patients failing with and without drug resistance mutations, minority drug resistance mutations were present at each of the drug resistance codons and at codons that confer multi-drug resistance to protease inhibitors. Further analysis of the Gag gene revealed more genetic diversity among patients failing with no mutations in the protease as evidenced by the proportion of polymorphisms at each codon. Conclusion: Based on Sanger sequencing, a proportion of patients fail a PI based regimen with a susceptible genotype. However, these patients harbor minority variants in the protease and numerous polymorphisms in the Gag region which when combined these could explain their poor response to therapy. Therefore, in order to improve patient care in low resource settings, there is need to adapt NGS as the standard genotyping technique so that minority variants are captured much earlier. In addition, since mutations in the Gag region also play a role in response to PIs, this region should be included in the routine monitoring for response to therapy in patients on a PI based regimen.

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HIV-1 infection treatment has greatly improved with the availability of combined antiretroviral therapy (cART). Unlike Tenofovir Disoproxil Fumarate, Tenofovir Alafenamide has a more favourable renal profile, even if proximal tubulopathy and electrolyte disturbances have been reported. As earlier as 4000 years ago, liquorice root was used for some medical treatments. Excessive liquorice intake is described to cause a state of mineralocorticoid excess. However, liquorice-induced hypokalaemia usually occurs with mild clinical manifestations and a severe presentation is rare.

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A total of 2090 cases of acute myocardial infarction and 63 cases of acute myocardial infarction combined with ventricular septal perforation were collected from Fuwai Huazhong Cardiovascular Hospital from September 2017 to January 2021. 189 cases of type 1 acute myocardial infarction were randomly selected according to the ratio of 1:3 as a control group, the patients collected and analyzed clinical data, the risk factors of AMI and VSR.

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In spite of recommendation for antiplatelet therapy following drug eluting stent (DES) implantation, the prescription for antiplatelet therapy in real world clinical practice varies from centre to centre as per physician discretion. The study was intended to assess the cardiovascular outcomes and bleeding complications of dual antiplatelet therapy (DAPT) beyond 12 months following DES implantation.

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Desirable treatment options for inoperable esophageal cancer considering not only overall survival (OS) but also quality of life (QOL) during the entire clinical course remain unclear. We evaluated OS and QOL during the clinical course of patients with inoperable esophageal cancer undergoing chemoradiation or radiation. Forty-four patients with inoperable esophageal cancer between 2015 and 2020 were included in this retrospective study.

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Snoring is a concomitant of sleeping. This phenomenon is not only considered annoying, but also often taboo because it affects the privacy of those affected. In addition, however, snoring can be the cause of sometimes life-threatening diseases, such as hypertension, stroke and myocardial infarction.

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Diarrhoea is a common and diverse aetiology problem in HIV infected patients that can cause deterioration in the quality of life, malnutrition and failure of antiretroviral therapy (ART). Ibalizumab (IBA), a humanized monoclonal antibody that binds to domain 2 of CD4 T lymphocytes receptor, has been recently approved for treating adults infected with multidrug-resistant HIV-1 infection for whom it is otherwise not possible to construct a suppressive antiviral regimen.

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Glioblastoma is the most common and most deadly type of primary brain malignant tumors. despite applying the best trimodal treatment consisting of surgery chemoterapy and radiotherapy, there are few patients who survive decades after treatment.

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Temozolomide is an orally administered chemotherapeutic drug used concurrently with radiation for the treatment of newly diagnosed glioblastoma. Although the addition of Temozolomide has shown to improve overall survival, it is commonly associated with haematological complications. Eltrombopag is an oral thrombopoietin (TPO) receptor agonist that is also used off-label for temozolomide-induced aplastic anaemia.

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Multiple sclerosis (MS) is a chronic inflammatory condition not commonly associated with cancer. Although since 1993 with the introduction of disease modifying therapies (DMTs), changing the natural history of the disease, cancer risk appears associated with some of these new therapies. We present the most common risks associated with each DMTs.

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