The ratio of women who received complete dose of steroids for suspected PTB compared to the number of patients who actually deliver prematurely is high raising doubts about the methods employed to diagnose PTB.
Background: Microsatellite instability-high (MSI-H) is shown to predict response to the immune checkpoint inhibitors (ICPi). Recently, the FDA granted an accelerated approval for the use of pembrolizumab in any solid tumor and nivolumab in metastatic colorectal cancer in patients with MSI-H. However, the immune-related adverse events (irAEs) exhibit a unique heterogeneous spectrum than conventional chemotherapy adverse drug reactions (ADRs). Underestimating the irAEs could be potentially lethal. Objectives: To evaluate the irAEs; their management, and outcome in MSI-H patients treated with ICPi at the National Center for Cancer Care and Research (NCCCR) in Qatar. Methods: All patients with MSI-H and treated with ICPi at the NCCCR between January 2015 and June 2018 were reviewed retrospectively. Radiologic assessment of irAEs and Naranjo score were used to estimate and confirm the probability of ADRs. Patient demographics, immunotherapy treatment, reported irAEs, and their management were collected. Results: Of the total cohort of patients receiving ICPIs; 9 patients with MSI-H were identified; all received pembrolizumab. 45% (n=4) of the patients were still actively on treatment; 22% (n=2) received only 1 dose then passed away; 22 % (n=2) discontinued because of disease progression; and 11% (n=1) of the patients received 2 cycles as neoadjuvant treatment. To the best of our knowledge, this is the biggest cohort of cancer patients with MSI-H in the Middle East. Calculated Naranjo score was 7 in 45% of the patients (n=4) and 5 in 22 % of patient (n=2), which indicates a probable ADR. 34% of the patients (n=3) did not experience ADRs till the date of data cutoff. 8 irAEs were seen in 67% (n=6) of the patients (Table 1). Based on laboratory or radiologic confirmation, 87.5% (n=7) were irAEs and 12.5% (n=1) was not related to pembrolizumab. Laboratory findings confirmed 25% of the ADRs and radiologic findings confirmed 75% of the ADRs. Of those who developed irARs, 3 patients required a hold of treatment, 1 needed monitoring, and 2 required pharmacologic interventions. There was one patient who received empirical pharmacologic intervention at which evaluation showed no relation to immunotherapy. Conclusion: irAEs can sometimes be unpredictable, rare, and often missed. Frequent monitoring and early management of these suspected or confirmed adverse effects is life saving and should be done in a multidisciplinary approach.
Objective: Ectopic pregnancy case fatalities have decreased dramatically, although incidence has remained steady over years. Advancement in early diagnosis methods and intro duction of methotrexate (MTX) in the management has led to such improve ment. Different protocols, such as single, two dose and multiple doses of MTX has been indorsed by the American congress of obstetrics and gynecology. Here at Women's Hospital in Qatar we use single dose pro tocol. However, there no previous report on the outcome of MTX in term success rate in Qatar. Methods:A retrospective study on patients diagnosed with tubal ectopic pregnancy between Jan 2008 and Dec 2010 were conducted. Institutional review board of Hamad Medical Corporation, Qatar, approved this study. Statistical analysis were done using SPSS Inc. Ver 20, Chicago, IL. Results:Two hundred and forty-eight file met the study inclusion and exclusion criteria, but only 196 completed their follow up until beta-human chorionic gonadotropin (β-hCG) less than 15 IU/L. Methotrexate prescribing has increased three times over the study period. The success rate for MTX was 89% and it was positively correlated with lower initial b-hCG levels. However, six out six patients with in b-hCG levels more than 10,000 IU/L were successfully treated with MTX. Conclusion:Methotrexate is effective method of treatment in stable patients. Further studies are required to investigate role of MTX in patients with high b-hCG levels (> 10,000 IU/L).
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