A healthy man in his 40s presented with a 1-month history of haemoptysis and was unexpectedly found to have an elevated international normalised ratio (INR). He denied any known exposures to anticoagulants. Testing for the possible aetiologies of a high INR revealed coumarin poisoning with coumatetralyl as the cause. The approach to an elevated INR and management and diagnosis of suspected coumarin poisoning is reviewed.

The ability of monovalent IgG and F(ab')2 antivenoms to neutralize lethality, phospholipase A2, and coagulant activities induced by Daboia siamensis venom was studied. Both antivenoms were produced from the same batch of hyperimmune horse plasma and were adjusted to the same potency against the lethal effect of D. siamensis venom in experiments involving preincubation of venom and antivenom. Intact neutralization experiments involving independent injection of venom and antivenoms showed that the F(ab')2 antivenom was slightly more effective. Significant differences in favour of F(ab')2 antivenom were observed with respect to neutralization of phospholipase A2 and coagulant activities. Both IgG and F(ab')2 antivenoms were able to activate human complement in vitro. IgG antivenom had a significantly higher anticomplementary activity than F(ab')2 antivenom.

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54 Background: The majority of patients with non-small cell lung cancer (NSCLC) are diagnosed with incurable, metastatic disease. Immunotherapy (IO) agents have improved overall, long term survival. There is a need to better understand how these drugs are utilized and perform in the real world to further inform physicians and policymakers. Methods: In this retrospective study, we analyzed characteristics, treatment patterns, and outcomes of patients with metastatic NSCLC treated with checkpoint inhibitors nivolumab or pembrolizumab at five Canadian cancer centres, with a focus on patients who received these treatments in the 2nd (2L) or 3rd line (3L) setting. We excluded patients who were in blinded clinical trials, exposed to multiple IO drugs, or who had tumors with EGFR or ALK mutations. Primary endpoints were overall survival (OS) and progression free survival (PFS) from start of IO. Secondary endpoints included immune-related toxicities. Results: Across all sites, we screened 322 patients and included 230 who met criteria: 49 (21%) from Alberta; 60 (26%) from British Columbia; and 121 (53%) from Ontario. Patients were diagnosed with metastatic NSCLC from 2009 to 2018, but the majority were diagnosed after 2015. Median age at diagnosis was 66.6 years, 54% were female, and 86% were either current or former smokers and 67% had stage IV disease. About 88% received nivolumab; 87% (n=200) received IO in 2L (n=111) or 3L (n=89). The median OS from start of IO was 10.9 (8.7–15.6) months, and were similar for 2L vs 3L (9.3 vs 12.0 months, p = 0.2). Median PFS was 5.7 (4.4–8.1) months. Pneumonitis was the most frequently reported toxicity affecting 7% of patients. Thyroiditis was reported in 4%; colitis, while dermatitis and hepatitis were each reported in 3%, and nephritis in 1%. Conclusions: In the real world, IO for advanced NSCLC was well-tolerated and had outcomes that were comparable to landmark clinical trials.

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Pelvic organ prolapse, characterized by a descent of the vaginal walls or vaginal apex, can be treated surgically in symptomatic women who decline or have failed conservative management. Because prolapse can recur after surgery, mesh and biologic grafts have been developed to augment repairs. Use of transvaginal mesh materials quickly increased in the early twenty-first century; however, since the FDA warnings about potential serious complications from transvaginal mesh in 2008 and 2011, use has decreased dramatically, and many mesh products were removed from the market. Even through the peak of mesh use in prolapse surgery, native tissue repairs have remained the most common type of repair.

Abstract. The present retrospective chart review examined the overall survival (OS) of patients with pancreatic ductal adenocarcinoma based on the disease stage in a sample of 296 patients with pancreatic cancer. Secondary outcome measurements included OS in chemotherapy vs. supportive treatment groups among metastatic patients, OS based on response to chemotherapy among metastatic patients, and OS and disease free survival (DFS) in surgically resected disease with vs. without adjuvant therapy. Data were analyzed using Kaplan-Meier and multivariate cox-regression analyses based on a 95% confidence interval (CI) or an α-value of 0.05. OS was significantly different based on the disease stage, with 3.63 (95% CI, 2.84-4.43), 6.57 (95% CI, 4.06-9.08) and 15.57 (95% CI,