Background Ayurveda is an ancient medicine practice that is emerging in the United States as a complementary and alternative treatment for chronic illness. Type 2 diabetes is a chronic illness that has major long-term implications for individuals suffering from the disease as well as the health-care system as a whole. Modifications in diet, exercise, and lifestyle are all important factors in successful treatment of type 2 diabetes and are incorporated into the ancient Indian medicinal practice of Ayurveda. Review Summary: This review summarizes the available evidence for the use of Ayurvedic therapies in the treatment of type 2 diabetes. For the treatment of type 2 diabetes, Ayurvedic practices primarily emphasizes the use of herbal supplements; however, exercise, weight management, and various supplemental procedures are included in Ayurvedic practices. The goal of Ayurvedic practices on the treatment of type 2 diabetes like in Western medicine focuses on bringing the hemoglobin A1c (HbA1c) value into a therapeutic range. Where Ayurveda differs is that it looks at the functionality of a person in the context of striking a balance between the life forces or doshas that each individual possesses. Finally, this article includes a case study received from AyurVAID clinic in Bangalore, India that details the specific Ayurvedic intervention used in a patient, bringing his HbA1c from a level of 11.2 to 5.7 over the course of 9 months. Conclusion Patients with type 2 diabetes may inquire about current complementary and alternative therapies available for the treatment of their disease. Awareness of such modalities is necessary for effective patient counseling and care. The benefits of offering a wide array of treatment options include possible reduction of HbA1c and of comorbidities with adjunct use of supplements and mind–body practices.
Immune checkpoint inhibitors (ICI) target the PD-1/PD-L1 and CTLA-4 pathways and allows the immune system to deliver antitumor effects. However, it is also associated with well-documented immune-related cutaneous adverse events (ircAEs), affecting up to 70–90% of patients on ICI. In this study, we describe the characteristics of and patient outcomes with ICI-associated steroid-refractory or steroid-dependent ircAEs treated with dupilumab. Patients with ircAEs treated with dupilumab between March 28, 2017, and October 1, 2021, at Memorial Sloan Kettering Cancer Center were included in this retrospective study, which assessed the rate of clinical response of the ircAE to dupilumab and any associated adverse events (AEs). Laboratory values were compared before and after dupilumab. All available biopsies of the ircAEs were reviewed by a dermatopathologist. Thirty-four of 39 patients (87%, 95% CI: 73% to 96%) responded to dupilumab. Among these 34 responders, 15 (44.1%) were complete responders with total ircAE resolution and 19 (55.9%) were partial responders with significant clinical improvement or reduction in severity. Only 1 patient (2.6%) discontinued therapy due to AEs, specifically, injection site reaction. Average eosinophil counts decreased by 0.2 K/mcL (p=0.0086). Relative eosinophils decreased by a mean of 2.6% (p=0.0152). Total serum immunoglobulin E levels decreased by an average of 372.1 kU/L (p=0.0728). The most common primary inflammatory patterns identified on histopathological examination were spongiotic dermatitis (n=13, 33.3%) and interface dermatitis (n=5, 12.8%). Dupilumab is a promising option for steroid-refractory or steroid-dependent immune-related cutaneous adverse events, particularly those that are eczematous, maculopapular, or pruritic. Among this cohort, dupilumab was well-tolerated with a high overall response rate. Nonetheless, prospective, randomized, controlled trials are warranted to confirm these observations and confirm its long-term safety.
Background Cutaneous metastases in pancreatic cancer (PC) are rare. Herein, we evaluate the clinical, genomic, and other descriptors of patients with PC and cutaneous metastases. Methods Institutional databases were queried, and clinical history, demographics, PC cutaneous metastasis details, and overall survival (OS) from cutaneous metastasis diagnosis were abstracted. OS was estimated using Kaplan–Meier methods. Results Forty patients were identified, and median age (Q1–Q3, IQR) of PC diagnosis was 66.0 (59.3–72.3, 12.9) years. Most patients had Stage IV disease at diagnosis ( n = 26, 65%). The most common location of the primary tumor was the tail of the pancreas ( n = 17, 43%). The most common cutaneous metastasis site was the abdomen ( n = 31, 78%), with umbilical lesions occurring in 74% ( n = 23) of abdominal lesions. The median OS (95% CI) was 11.4 months (7.0, 20.4). Twenty‐three patients had umbilical metastases (58%), and 17 patients had non‐umbilical metastases (43%). The median OS (95% CI) was 13.7 (7.0, 28.7) months in patients with umbilical metastases and 8.9 (4.1, Not reached) months in patients with non‐umbilical metastases ( p = 0.1). Sixteen of 40 (40%) patients underwent somatic testing, and findings were consistent with known profiles. Germline testing in 12 (30%) patients identified pathogenic variants in patients: CHEK2 , BRCA1, and ATM. Conclusion Cutaneous metastases from PC most frequently arise from a pancreas tail primary site and most frequently occur in the umbilicus. Cutaneous metastases may generally be categorized as umbilical or non‐umbilical metastases.
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