Abstract Background Light-chain amyloidosis (AL) with cardiac involvement carries a poor prognosis; median untreated survival is <6 months. Three-drug therapy with bortezomib, dexamethasone, and an ...alkylating agent (BDex+AA) is associated with improved biomarker response rates in AL amyloidosis. Objectives This study sought to evaluate the effect of BDex+AA as a first-line treatment strategy on mortality in patients with symptomatic heart failure from AL cardiac amyloidosis. Methods Patients newly diagnosed with symptomatic New York Heart Association (NYHA) functional class ≥II heart failure due to AL amyloidosis were retrospectively studied. Initial treatment strategy was adjudicated and propensity score analysis was used to adjust for the nonrandomized allocation of treatments. Survival was assessed using a Cox proportional hazards model after adjusting for the propensity score for receiving treatment, age, NYHA functional class, and ejection fraction. Results Among 106 treated patients (age 64.6 ± 11.3 years, 63% male, 76% lambda subtype), 40 received the 3-drug regimen and 66 received other regimens. Mortality was 65% overall, 48% in the BDex+AA cohort (median survival time 821 days), and 76% in patients who received other regimens (median survival time 223 days). Initial treatment with BDex+AA was associated with decreased mortality after multivariable adjustment (hazard ratio: 0.209; 95% confidence interval: 0.069 to 0.636; p = 0.006). This association remained after further adjustment for components of the Mayo Stage. Conclusions Use of BDex+AA in the treatment of AL amyloidosis in patients presenting with symptomatic heart failure is associated with improved survival after adjusting for clinical variables.
Though mass vaccination programs helped to reduce the severity of the ongoing pandemic, various unwanted effects were reported in Turkey and Bangladesh after taking vaccines. The purpose of this ...study was to evaluate and compare the adverse effects of several vaccines in Turkey and Bangladesh and how the population of both countries prioritizes the continuation of vaccination compared to the side effects. An online survey with a pretest was conducted to gather data over the research period from July 10, 2021 to December 10, 2021. Finally, the questionnaire was shared with the mass population of Turkey and Bangladesh who have received at least one or two doses of the COVID-19 vaccines. The quality of the questionnaire was evaluated with Cronbach’s alpha test. The study consisted of 1508 respondents from Bangladesh and 602 respondents from Turkey. Among the total 2110 respondents, 50.0% were male 66.8% were from the 18–30 years age range, and 77.5% reported living in the city area. Among all the respondents, 64.99% of those vaccinated in Bangladesh and 67.28% of those vaccinated in Turkey reported side effects after vaccinations. Participants receiving mRNA vaccines (Pfizer and Moderna) experienced the most side effects, with many reporting pain at the injection site in both nations. Following that, fever, body pain, and headache were common in Bangladesh, whereas body pain, fatigue, and arm numbness were common in Turkey. The study found no significant adverse events reported in Turkey and Bangladesh following the first and second doses of COVID-19 vaccination. These COVID-19 vaccines showed similar patterns of efficacy and safety during the short period of analysis. Vaccines from different manufacturers showed a non-significant level of adverse events during this binational AEFI approach to COVID-19 vaccines. More studies are recommended on the efficacy and safety of several vaccines to discover unexpected effects.
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