Aim To evaluate the safety issues and adverse effects of using TCHP regimen (docetaxel, carboplatin, trastuzumab, and pertuzumab) versus TCP regimen (docetaxel, carboplatin, and trastuzumab) in older postmenopausal women with nonmetastatic HER2-positive breast cancer. HER2 overexpressed in 20–25% of breast cancer signals an aggressive form of breast cancer and is treated with trastuzumab and pertuzumab. Methods The patient record database was accessed to identify all postmenopausal women in the Punjab Care hospital who were above 65 years old, with stages 1–3 HER2-positive breast cancer and treated with neoadjuvant TCHP and neoadjuvant TCP from 2013 till 2016. Results In TCH-P group and TCH group, mild fatigue (34% versus 36%) and diarrhea (48% versus 49%) were most common toxicities. Fever in TCH-P group and TCH group (12% versus 13%) was common. Anorexia affected 21% and 16% of patients receiving TCH and TCHP regimen, respectively. Febrile neutropenia was higher in TCH-P group 13% (3/23) versus 4.5% (1/22) in TCH group. Also 27.2% (6/22) of TCH-P group was hospitalized for treatment related toxicities versus 21.7% (5/23) of TCH group. Conclusion Comparing neoadjuvant TCP and neoadjuvant TCH-P showed TCH-P regimen had an acceptable toxicity profile. Severe cardiac dysfunction was not observed. Using TCH-P regimen can be considered as relatively safe therapeutic option for elderly postmenopausal women with nonmetastatic HER2-positive breast cancer.
BACKGROUND Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious and well‐known complication of systemic lupus erythematosus (SLE). There are few studies on the population‐based estimates of the prevalence of NPSLE and its manifestations. Reliable prevalence estimates are needed to quantify the burden of the disease and to direct the attention of policy makers to magnitude of suffering associated with SLE. We aimed to quantify the prevalence of NPSLE in different population settings. METHODS We searched PubMed from January 2009 to June 2019 to identify studies relevant to this review. Databases searches combined terms from three themes: all age groups/general population, psychosis, neuropsychiatric impairment, mental disorders and delusions; and SLE, lupus, and systemic lupus erythematosus. Terms were searched as both keywords (title/abstract words) and subject headings as appropriate. We also searched original papers relevant to this review from the retrieved articles. For case classification and case ascertainment, NPSLE was classified according to the American College of Rheumatology guidelines. RESULT We excluded 79 from the initial 105 articles from the screening of titles and abstracts. The remaining 26 full text articles were reviewed and 9 were included in the review. The major neuropsychiatric comorbidities that were observed from the studies were major depression, headaches, seizures and cerebrovascular diseases. The prevalence estimates of neuropsychiatric disorders in NPSLE patients were as follows: major depression in patients (17%–52%) headaches (38.8%–60%), seizures (26.4%–63%), and cerebrovascular diseases (26%–38.8%). The overall prevalence estimates of NPSLE varies from 11% to 60% of all SLE patients. CONCLUSION This study confirms that the burden of neuropsychiatric manifestations of SLE, including major depression, seizures, cerebrovascular disease is high. Further studies are needed to elucidate the pathogenesis of neurological involvement in patients with SLE and to address the risk factors for NPSLE. Support or Funding Information American Association for Anatomists
IntroductionAtrial fibrillation (AF) increases the risk of potentially fatal or disabling ischaemic stroke, and a systematic review found <70% of eligible patients with AF are using oral anticoagulants (OACs).1MethodsMedical records of patients admitted with stroke/TIA associated with known or new diagnosis of AF from 1 st July 2016 to 30th June 2017 were reviewed. This data was to be compared to a similar audit conducted in 2009. Data collected included age, sex, history of AF, adequacy of anticoagulation (before and after admission) and vascular risk factors.Results49 patients (29 males, average age 76 years) were included in the study. Incidence of AF was found to be 27.9% in stroke and 8.4% among TIA admissions. Known AF occurred in 34 (82.9%) of the stroke admissions and 8 (100%) of the TIA admissions. Therefore, AF was diagnosed post-stroke in 17.1% of participants. Prior to stroke and TIA 61.9% of patients were receiving anticoagulants. Treatment prior to stroke or TIA consisted of 11 (26.2%) on DOACs, 15 (35.7%) on warfarin, 5 (11.9%) on anti-platelets, and 11 (26.2%) with no anti-thrombotics. Sub-therapeutic INRs (<2.0) upon admission were found in 60% of participants using warfarin. Among the 11 untreated patients, 1 patient was non-compliant, 1 had recent SAH, but no explanation was found for the remaining 9 participants. Anticoagulation rates improved on discharge with 40 (81.6%) patients prescribed either DOACs or warfarin.ConclusionAnticoagulation rates have improved since 2009 (61.9% vs 41%) in stroke/TIA admissions associated with AF. However, use of anticoagulants in this population remains inadequate. Furthermore, 60% of patients on warfarin had sub-therapeutic INRs upon admission. There is still a need for improved screening for AF, with only a slight decrease in rates of new diagnosis of AF compared to the 2009 audit (from 22% to 17.1%).Reference. Ogilvie IM, Newton N, Welner SA, Cowell W, Lip G. Underuse of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review. The American Journal of Medicine2009;124(7):11. https://doi.org/10.1016/j.amjmed.2009.11.025
Aim To improve an appropriate use of antithrombotic therapy in atrial fibrillation (AF) on the basis of the presence (or absence) of stroke risk factors (based on CHA2DS2VASc score) as per ESC guideline. Method This was a retrospective audit and data was obtained from the health record department on the total number of stroke admissions in 2012. A proforma based on the ECS guide was created and used to collect data from those that were coded as having a diagnosis of AF alongside the CVA. Results There were a total of 389 admissions with stroke in 2012 and 108 of these had a diagnosis of AF.29.9% of which were a new diagnosis AF at the time of admission. Of those who were known to have AF only 30.9% were anti-coagulated with Warfarin (W) despite all having a CHADS VASC score of 1 or more.46.8% of those had no documentation on the reason for the omission of anticoagulants.3 patients had a stroke while awaiting the initiation of W. Abstract 14 Figure 1 For those on W, 46.2% of those with an ischaemic stroke had a sub-therapeutic INR at the time of admission. The time in therapeutic range for the patients on W was calculated using the Rosendaal method. This demonstrated that 64.7%of all the patients on W had a TTR below 60%. Abstract 14 Figure 2 There were no patients on Novel Oral Anticoagulants (NOAC) in our audit. Conclusion The majority of patients with known AF were not on W despite > 95 % having a CHADS VASC score greater than 1. Those who were on W had poor INR control. 3 patients had a stroke while waiting for initiation of W. We believe that the risks of AF still needs to be highlighted and the use of NOACS in this cohort would have reduced stroke rate considerably.
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