Metastatic tumors to the oral cavity are uncommon, representing approximately 1% of all cases of oral malignant lesions even when a metastatic disease is present. The 53-year-old female is presented ...complaining of abdominal pain, weight loss, and a loose stool recurring not more than three times per day. A computed tomography (CT) scan of the abdomen showed a retroperitoneal mass expanding along the body of the pancreas. Colonoscopy and gastroscopy with a gastric mucosa biopsy showed a normal result. After laparoscopic surgery, the primary site of adenocarcinoma was not confirmed. The patient was referred to the Maxillofacial Surgery Clinic with pain, swelling, and occasional bleeding around the lower right second mollar. Immunohistochemicaly, the tumor cells were positive for Cytokeratin (CK) 19, Cytokeratin (CK) 7, and homebox protein (CDX-2), which are highly sensitive markers of pancreatobiliar cancer. Therefore, the patient was diagnosed with pancreatic carcinoma. This report describes a rare metastasis of malignant pancreatic tumor to the lower right gingiva and highlights the importance of immunohistochemical examination and how it helped identify both the origin and the nature of gingival neoplasm.
Tijekom pandemije virusa SARS-CoV-2 onkološki pacijenti označeni su kao posebno rizična skupina. Posebnu skupinu čine pacijenti u tijeku imunoterapije inhibitorima kontrolnih točaka. Čini se kako su ...koristi imunoterapije u bolesti koje uzrokuje novi koronavirus potpuno potisnule početni strah od očekivanih negativnih utjecaja imunosnog sustava potaknutog inhibitorima kontrolnih točaka. Sprječavanjem iscrpljenosti CD8+ limfocita, smanjenjem razine interleukina-6 i indirektnom regulacijom neutrofila i NK stanica, imunoterapija djeluje na patofiziologiju razvoja blažih oblika bolesti COVID-19. Trenutne spoznaje ističu imunoterapiju kao sigurnu opciju onkološkog liječenja u doba pandemije COVID-19.
With regard to systemic oncological treatments, correlation of the use of immunotherapy with checkpoint inhibitors with the risk of more severe COVID-19 infection is uncertain. However, benefits of immunotherapy in the disease caused by the new coronavirus completely suppressed the initial fear of expected negative impacts of immune system triggered by checkpoint inhibitors. By preventing CD8 + lymphocyte exhaustion, reducing interleukin-6 levels, and indirectly regulating neutrophils and NK cells, immunotherapy affects the pathophysiology of COVID-19. The current findings highlight immunotherapy as a safe option of cancer treatment at the time of COVID-19 pandemic.
Prostate cancer (Pca) is among the most common malignant diseases in men and the fourth leading cause of death worldwide. Surgery and radical radiotherapy (RT) remain the gold standard for the ...treatment of localized or locally advanced prostate cancer. The efficiency of radiotherapy treatment is limited by toxic side effects due to dose escalation. Cancer cells often develop radio-resistant mechanisms that are related to the DNA repair, inhibition of apoptosis or changes in cell cycle. Based on our earlier research on biomarkers that are involved in those cellular mechanisms (p53, bcl-2, NF-kb, Cripto-1 and Ki67 proliferation) and correlation with clinico-pathological parameters (age, PSA value, Gleason score, grade group, prognostic group), we created the numerical index for risk of tumor progression in patients with radioresistant tumors. For each of these parameters, the strength of association with disease progression was statistically assessed, and a specific number of points was assigned proportional to the strength of the correlation. Statistical analysis identified an optimal cut-off score of 22 or more as an indicator of significant risk for progression with a sensitivity of 91.7% and a specificity of 66.7%. The scoring system in the retrospective receiver operating characteristic analysis showed AUC of 0.82. The potential value of this scoring is the possibility of identifying patients with clinically significant radioresistant Pca.
The development of immunotherapy checkpoint inhibitors (ICIs) has revolutionized cancer care. However, old patients are underrepresented in most clinical trials, although they represent a significant ...proportion of real-world patients. We aimed to evaluate the effectiveness and safety of ICIs in patients older than the age of 70.
We performed a retrospective chart review of 145 patients aged 70 or older treated with ICIs for metastatic or unresectable cancer.
Median progression-free survival (PFS) was 10.4 months (95% CI 8.6-13.7), with no differences between octogenarians and septuagenarians (
= 0.41). Female gender (
= 0.04) and first-line treatment setting (
< 0.0001) were associated with a longer median PFS. Median overall survival (OS) was 20.7 months (95% CI 13.5-35.0 months), with no difference based on performance status, cancer site, gender, or between septuagenarians and octogenarians (all
> 0.005). Patients treated with ICIs in the first-line setting reported longer OS compared to treatment in the second-line setting (
< 0.001). Discontinuation of ICIs due to adverse effects was associated with both shorter PFS (
= 0.0005) and OS (
< 0.0001).
The effectiveness of ICIs in older cancer patients primarily depends on the line of treatment and treatment discontinuation. Octogenarians experienced similar treatment responses, PFS, OS, and adverse effects compared to septuagenarians.
Although subjective expressions and linguistic fluency have been shown as important factors in processing and interpreting textual facts, analyses of these traits in textual health information for ...different audiences are lacking. We analyzed the readability and linguistic psychological and emotional characteristics of different textual summary formats of Cochrane systematic reviews.
We performed a multitrait-multimethod cross-sectional study of Press releases available at Cochrane web site (n = 162) and corresponding Scientific abstracts (n = 158), Cochrane Clinical Answers (n = 35) and Plain language summaries in English (n = 156), French (n = 101), German (n = 41) and Croatian (n = 156). We used SMOG index to assess text readability of all text formats, and natural language processing tools (IBM Watson Tone Analyzer, Stanford NLP Sentiment Analysis and Linguistic Inquiry and Word Count) to examine the affective states and subjective information in texts of Scientific abstracts, Plain language summaries and Press releases.
All text formats had low readability, with SMOG index ranging from a median of 15.6 (95% confidence interval (CI) 15.3-15.9) for Scientific abstracts to 14.7 (95% CI 14.4-15.0) for Plain language summaries. In all text formats, "Sadness" was the most dominantly perceived emotional tone and the style of writing was perceived as "Analytical" and "Tentative". At the psychological level, all text formats exhibited the predominant "Openness" tone, and Press releases scored higher on the scales of "Conscientiousness", "Agreeableness" and "Emotional range". Press releases had significantly higher scores than Scientific abstracts and Plain language summaries on the dimensions of "Clout", and "Emotional tone".
Although the readability of Plain language summaries was higher than that of text formats targeting more expert audiences, the required literacy was much higher than the recommended US 6th grade level. The language of Press releases was generally more engaging than that of Scientific abstracts and Plain language summaries, which are written by the authors of systematic reviews. Preparation of textual summaries about health evidence for different audiences should take into account readers' subjective experiences to encourage cognitive processing and reaction to the provided information.
The European Charter of Patients' Rights (ECPR) presents basic patients' rights in health care. We analysed the characteristics of patients' complaints about their rights submitted through the ...official complaints system and to a non-governmental organization in Croatia.
The official system for patients'complaints in Croatia does not have a common pathway but offers different modes for addressing patient complaints. In this cross-sectional study, we analysed the reports about patients' complaints from the official regional committees sent to the Ministry of Health. We also analysed the complaints received by the Croatian Association for the Protection of Patient's Rights (CAPR) and mapped them to the ECPR.
The aggregated official data from the Ministry of Health in 2017 and 2018 covered only 289 individual complaints from 10 out of 21 counties. Complaints were most frequently related to secondary and tertiary healthcare institutions and details were not provided. CAPR received a total of 440 letters, out of which 207 contained 301 complaints about violations of patients' rights in 2017-2018. The most common complaint was the Right of Access to health care (35.3%) from the ECPR, followed by the Right to Information (29.9%) and the Right to Safety (21.7%). The fewest complaints were about the Right to Complain (1.9%), Right to Innovation (1.4%), Right to Compensation (1.4%), and Right to Preventive Measures (1.0%).
Reporting and dealing with patients' complaints about violations of their patients' rights does not appear to be effective in a system with parallel but uncoordinated complaints pathways. Mapping patient's complaints to the ECPR is a useful tool to assess the perception of patients' rights and to plan actions to improve the complaints system for effective health care.
Global health diplomacy is the applied practice of foreign affairs to further national goals that focus on health issues requiring international cooperation and collective action. We aimed to ...determine how international diplomats and health policy-related professionals in the EU understand the concept of health diplomacy, which impacts both diplomatic relations as well as patients' rights.
In a qualitative interview study, we used a heterogeneous stratified purposeful sampling to reach participants from different countries and different practitioners from the Pyramid of Health Diplomacy: core, multi-stakeholder, and informal. Reflexive thematic analysis was used to identify the main themes.
We contacted 131 practitioners of GHD, of which 37 responded, and nine agreed to be interviewed. From 11 interview questions, four main themes emerged from the analysis of the individual interview. The participants reported limited knowledge about the definition of GHD but also that they engaged in daily activities and decisions of inter-governmental bodies. They were not aware of existing special education and training for health attachés and made suggestions for improving the field and practice of GHD. They were not fully familiar with the European Charter of Patients' Rights. There was a consensus from all participants that patient rights need to improve as a fundamental right. They stressed the fact that the hospital lockdown and the right access to healthcare were impaired during the COVID pandemic.
The role of health diplomacy in linking public health and foreign affairs is key to respecting patients' rights. Health over other interests is becoming an increasingly critical element in foreign policy. Establishing a clear career path for health attachés is necessary to foster effective global health agreements and coordination across countries.
Certain macrolide antibiotics, azithromycin included, possess anti-inflammatory properties that are considered fundamental for their efficacy in the treatment of chronic inflammatory diseases, such ...as diffuse pan-bronchiolitis and cystic fibrosis. In this study, we disclose a novel azithromycin analog obtained via Barton-McCombie oxidation during which an unprecedented epimerization on the cladinose sugar occurs. Its structure was thoroughly investigated using NMR spectroscopy and compared to the natural epimer, revealing how the change in configuration of one single stereocenter (out of 16) profoundly diminished the antimicrobial activity through spatial manipulation of ribosome binding epitopes. At the same time, the anti-inflammatory properties of parent macrolide were retained, as demonstrated by inhibition of LPS- and cigarette-smoke-induced pulmonary inflammation. Not surprisingly, the compound has promising developable properties including good oral bioavailability and a half-life that supports once-daily dosing. This novel anti-inflammatory candidate has significant potential to fill the gap in existing anti-inflammatory agents and broaden treatment possibilities.
What is known and Objective
There is no optimal standardized model in the transfer of care between hospitals and primary healthcare facilities. Transfer of care is a critical point during which ...unintentional discrepancies, that can jeopardize pharmacotherapy outcomes, can occur. The objective was to determine the effect that an integrated medication reconciliation model has on the reduction of the number of post‐discharge unintentional discrepancies.
Methods
A randomized controlled study was conducted on an elderly patient population. The intervention group of patients received a medication reconciliation model, led entirely by a hospital clinical pharmacist (medication reconciliation at admission, review and optimization of pharmacotherapy during hospitalization, patient education and counselling, medication reconciliation at discharge, medication reconciliation as part of primary health care in collaboration with a primary care physician and a community pharmacist). Unintentional discrepancies were identified by comparing the medications listed on the discharge summary with the first list of medications prescribed and issued at primary care level, immediately after discharge. The main outcome measures were incidence, type and potential severity of post‐discharge unintentional discrepancies.
Results and discussion
A total of 353 patients were analysed (182 in the intervention and 171 in the control group). The medication reconciliation model, led by a hospital clinical pharmacist, significantly reduced the number of patients with unintentional discrepancies by 57.1% (p < 0.001). The intervention reduced the number of patients with unintentional discrepancies associated with a potential moderate harm by 58.6% (p < 0.001) and those associated with a potential severe harm by 68.6% (p = 0.039). The most common discrepancies were incorrect dosage, drug omission and drug commission. Cardiovascular medications were most commonly involved in unintentional discrepancies.
What is new and Conclusion
The integrated medication reconciliation model, led by a hospital clinical pharmacist in collaboration with all health professionals involved in the patient's pharmacotherapy and treatment, significantly reduced unintentional discrepancies in the transfer of care.
Elderly are especially vulnerable to the occurrence of medication errors at transition of health care. The integrated medication reconciliation model, led by a hospital clinical pharmacist in collaboration with all health professionals involved in the patient's pharmacotherapy and treatment, significantly reduced unintentional discrepancies in the transfer of care.
Macrolide antibiotics, like erythromycin, clarithromycin, and azithromycin, possess anti-inflammatory properties. These properties are considered fundamental to the efficacy of these three macrolides ...in the treatment of chronic inflammatory diseases like diffuse panbronchiolitis and cystic fibrosis. However, long-term treatment with macrolide antibiotics presents a considerable risk for promotion of bacterial resistance. We have examined antibacterial and anti-inflammatory effects of a novel macrolide class: N′-substituted 2′-O,3′-N-carbonimidoyl bridged erythromycin-derived 14- and 15-membered macrolides. A small focused library was prepared, and compounds without antimicrobial activity, which inhibited IL-6 production, were selected. Data analysis led to a statistical model that could be used for the design of novel anti-inflammatory macrolides. The most promising compound from this library retained the anti-inflammatory activity observed with azithromycin in lipopolysaccharide-induced pulmonary neutrophilia in vivo. Importantly, this study strongly suggests that antimicrobial and anti-inflammatory activities of macrolides are independent and can be separated, which raises development plausibility of novel anti-inflammatory therapeutics.
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