Diagnosis and Management of Chronic BCR-ABL-Positive and BCR-ABL-Negative Myeloproliferative Neoplasms in Elderly Patients: An Approach towards Hematologic Oncology and Public Health | Chapter 16 | Issues and Developments in Medicine and Medical Research Vol. 5

 Background: Chronic myeloproliferative neoplasms (CMN) are the most common chronic leukemias among the elderly in the structure of morbidity by hematologic malignancies with primary bone marrow involvement, characterised in advanced stages by a severe, relapsing evolution and unfavourable prognosis, with negative socioeconomic impact.

Study Goals: To improve hematologic oncology care for older patients with chronic BCR-ABL-positive and BCR-ABL-negative myeloproliferative neoplasms, researchers evaluated diagnosis and management choices in chronic BCR-ABL-positive and BCR-ABL-negative myeloproliferative neoplasms.

Methods and Materials: A clinico-analytical, descriptive, prospective-retrospective investigation was carried out, as well as a narrative evaluation of the relevant international literature. From 1995 to 2021, the Institute of Oncology followed and treated 91 elderly patients with chronic myeloid leukaemia (CML), primary myelofibrosis (PMF), and polycythemia vera (PV). In terms of the impact scale, 29 appropriate primary sources were identified and selected using a rigorous, repeatable, and transparent approach to the topic at hand, followed by data extraction and analysis.

Our study followed up on 34 (37.3%) patients with PMF, 26 (28.6%) patients with CML, and 31 (34.1%) patients with PV who were diagnosed in the older age groups. The age group of 60-69 years old dominated CML (22 cases, or 84.6 percent), PV (25 cases, or 80.6 percent), and PMF (25 cases, or 73.5 percent). Overall survival (OS) was 97.6% and 79.8% in CML patients aged greater than or equal to 60 years treated with tyrosine kinase inhibitors (TKIs), respectively, which was lower than the same indicators in the entirety of CML. The OS in older PV patients was 100% after one year, 93.5 percent after five years, and 76.4 percent after ten years, all of which were lower within 5-10 years than in all PV patients (over one year, 98.6% after five years, and 85.9% after ten years). Despite the fact that patients treated with busulfan had a lower relapse rate than those treated with hydroxycarbamide, there was no significant difference in the OS of elderly PV patients receiving treatment with these anticancer drugs. According to contemporary bibliographic databases, a substantial percentage of patients with CMN suffered reduced work hours, job loss, and medical disability: PMF – 38 percent, 35 percent, 33 percent, and PV – 33 percent, 28 percent, and 15%, respectively.

Conclusions: Because of the development of age-related diseases and vascular events as a result of higher values of leukocytes and platelets, the long-term results of treatment in elderly patients with CMN were shown to be poorer to those in CMN totality. TKI-targeted therapy is still the first-line treatment choice for CML patients aged 60 and up. There was no significant difference in short- and long-term results of chemotherapy with busulfan and hydroxycarbamide in combination with phlebotomy in elderly PV patients, who were completely superior than PMF patients.

Author(S) Details

Vasile Musteata
Discipline of Hematology, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Republic of Moldova and Department of Hematology, Institute of Oncology Chisinau, Republic of Moldova.

Valentina Stratan
Laboratory of Immunology and Molecular Genetics, Institute of Oncology Chisinau, Republic of Moldova.

View Book:- https://stm.bookpi.org/IDMMR-V5/article/view/5591

Eichhornia crassipes (Water Hyacinth): Significance and Its Control | Chapter 1 | Recent Progress in Plant and Soil Research Vol. 4

 Water hyacinth, also known as Eichhornia crassipes, is an aquatic plant. It is considered one of the worst weeds, mostly in the tropics and subtropics, and is classified as an Invasive Alien Species (IAS) in Sri Lanka. Despite numerous attempts to remove the species, Eichhornia continues to spread widely, posing a serious threat to aquatic biota in many inland water systems. The study would look into using salinity as a method to control the species. Experiments were set up to explore the species' growth as well as the function of salinity in the species' growth and survival. Salinity tests were set up using various salinity levels of 1, 2, 3, 4, 5, 6, 7, 10, 15, and 20 ppt. Growth experiments were conducted by evaluating the growth of the species in terms of leaf output in fresh water tanks for a period of three months. The zero-salinity water served as the control treatment. Over the course of 16 days, two plants were placed in each dish and observed.

The number of leaves rises over time, reaching a maximum of 40 days. From 55 days onwards, it showed a sharp decrease in leaf output. After 40 days, the leaves that had been created began to decay. The experiment revealed that E. crassipes can survive in 0 ppt saline water for the duration of the trial, with the percentage of green shoots appearing to be 100%. After four days of experimentation at a salinity level of 7 ppt, the shoots became brown and died. With increasing salinity, the plants demonstrated a gradual drop in the development of green shoots between 0 and 6 ppt. Although salinity might be used to manage water hyacinth, its practical application in bigger bodies of water would be difficult.

Author(S) Details

T. Mathiventhan
Department of Botany, Faculty of Science, Eastern University, Sri Lanka.

T. Jayasingam
Department of Botany, Faculty of Science, Eastern University, Sri Lanka.

View Book:- https://stm.bookpi.org/RPPSR-V4/article/view/5192

A Retrospective Evaluation of Morbidity Pattern and Outcome of Patients Admitted in Paediatric Intensive Care Unit in a Tertiary Care Rural Teaching Hospital | Chapter 7 | Recent Developments in Medicine and Medical Research Vol. 8

 Background: One of the most demanding and difficult aspects of paediatrics remains to be the care of extremely ill children. The Paediatric Intensive Care Unit's primary purpose is to prevent death by closely monitoring and treating critically ill children who are at high risk of dying. In impoverished nations, there is a scarcity of data on paediatric critical care. The outcomes of medical interventions can be used to measure therapy efficacy. This allows for better decision-making, higher-quality care, and, if necessary, a shift in management's future direction. This research will also help with the investigation of the causes of morbidity and mortality in our hospital's children. The study's goals and objectives are to assess the morbidity pattern and outcomes of admissions to a rural teaching hospital's PICU, as well as to improve critical care facilities to reduce morbidity and death.

Methods: This was a retrospective analysis of cases admitted to our teaching hospital's paediatric ICU in the previous two and a half years, with the estimated sample size taken into consideration. The PICU and the Medical Records Department will provide information. The medical record will be utilised to research the specifics, which will then be analysed and interpreted depending on the data in the medical record.

Results: Over the duration of the study's 30 months, 417 individuals were admitted to our PICU. The maximum number of cases studied, 180 (43.2%), were under the age of one year. The age range for the participants was 1 day to 18 years. Males accounted for 228 (54.7%) of the cases, while females accounted for 189 (45.3%). The most common diagnosis was LRTI, which accounted for 61 (14.7 percent) of cases. The most commonly implicated system was the respiratory system, which accounted for 101 (21.8%) of all cases. 357 (85.6%) of the overall cases investigated were released, 36 (8.6%) had DAMA (discharge against medical advice), and 24 (5.8%) had expired.

Conclusions: Our PICU had a low mortality rate. Based on the outcomes of this study, we conclude that with better treatment protocols and trained expertise/Pediatric Intensivist, we have a greater possibility of facilitating the care of critically sick patients and obtaining a favourable outcome in our rural PICU.

Author(S) Details

Deepali A. Ambike
Department of Pediatrics, YCM Hospital, Pimpri, Pune, Maharashtra, India.

Vijay L. Bhavari
Department of Pediatrics, MIMER Medical College, Talegaon Dabhade, Pune, Maharashtra, India.

View Book:- https://stm.bookpi.org/RDMMR-V8/article/view/4566

Cardiothoracic Related Complications of Anti-PD/PD-L1 Immunotherapy | Chapter 01 | Recent Developments in Medicine and Medical Research Vol. 7

 Background: Anti-PD/PD-L1-targeted immunotherapy is associated with shockingly high rates of sustained clinical responses in patients with a variety of tumour types, despite the high prevalence of dermatological, gastrointestinal, and endocrine side effects. The hazards of pneumonitis and cardiotoxicity associated with checkpoint inhibitor therapy are understudied.A systematic analysis of the literature on randomised clinical trials (RCTs) comparing anti-PD/PD-L1 mono-immunotherapy (IMM) to chemotherapy (CTH) methods was conducted in cancer patients. The rate of pneumonitis in IMM versus CTH was the primary outcome.Secondary endpoints included (I) high-grade pneumonitis rate in IMM compared to CTH, (II) tumour response rate, progression-free survival (PFS), and overall survival (OS) between IMM and CTH, (III) cardiotoxicity grade comparison in IMM to others, (IV) cardiotoxicity grade difference between IMM and other studies with lung cancer and other cancer subgroups, and in IMM compared to chemotherapy (CTH) only studies, and (V) outcome of IMM We used a random model, a leave-one-out analysis, and meta-regression.Thirteen RCTs with a total of 7,246 patients for pneumonitis and 11 RCTs with a total of 6574 patients for cardiotoxicity were included in the study. When compared to the CTH arm, patients in the IMM arm had more high-grade and all-grade pneumonitis (OR =4.39, 95 percent CI =1.65–11.69, P=0.003 and OR =2.46, 95 percent CI =1.29–4.6, P=0.007). The immunotherapy arm had a significantly higher tumour response rate (OR =2.31, 95 percent CI =1.62–3.29, P0.001). Patients who received IMM had a longer PFS and OS than those who received CTH (HR =0.75, 95 percent CI =0.65–0.85, P0.001, and HR =0.71, 95 percent CI =0.66–0.77, P0.001). There was no difference in all-grade cardiotoxicity across all studies (RR: 1.15; 95 percent CI: 0.73–1.80; p = 0.55) or subgroups of lung cancer (RR: 0.68; 95 percent CI: 0.22–2.09; p = 0.50) or other malignancies (RR: 1.27; 95 percent CI: 0.78–2.08; p = 0.34). Similarly, there was no difference in high-grade cardiotoxicity across all trials (RR: 1.47; 95 percent CI: 0.87–2.46; p = 0.15) or across lung cancer subgroups (RR: 0.80; 95 percent CI: 0.25–2.50; p = 0.70) or other cancers (RR: 1.71, 95 percent CI: 0.96–3.06; p = 0.07).

Conclusions: Anti-PD-1 therapy produced more high-grade and all-grade pneumonitis than standard CTH regimens for NSCLC and melanoma, but not anti-PD-L1 therapy. Aside from that, the CTH arm had a higher rate of high-grade adverse events. IMM outperforms CTH in terms of tumour response rate, PFS, and overall survival. These findings can be used to assist patients choose the right therapy and set realistic treatment goals. Cardiotoxicity was statistically insignificant regardless of whether the patients received chemotherapy or dual immunotherapy. When utilised in the lung cancer subgroup, anti-PD/PDL1 produced improved response and survival rates.

Author(S) Details

Mohamed Rahouma
Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt and Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York 14853, NY, USA.

Massimo Baudo
Cardiac Surgery Department, Spedali Civili di Brescia, Brescia, Italy.

Shon Shmushkevich
Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York 14853, NY, USA and Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.

Ayah Hassan
Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Egypt.

Mostafa Rahouma
Information Technology Department, National Cancer Institute, Cairo University, Egypt.

Maha Yahia
Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.

Abdelrahman Mohamed
Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.

View Book:- https://stm.bookpi.org/RDMMR-V7/article/view/4521

A Review on Brain Metastases Prognostic Scoring Systems | Chapter 9 | New Frontiers in Medicine and Medical Research Vol. 1

 The most prevalent intracranial tumours are brain metastases (BMs), and about 25% of all cancer patients are identified with this poor prognostic illness condition at some point throughout their therapy. The primary prevailing treatment options normally include palliative radiotherapy, chemotherapy, targeted medicines, immunotherapy, optimum supportive care, and surgery in select patients, depending on the possible patient's general well-being status. Previous research has shown that prognostic scoring methods can be used to group BM patients into specific prognostic groups based on realistic combinations of several patient- and tumor-related characteristics. Such frameworks could be effective in accurately predicting survival outcomes and selecting the best-fit treatment option. The goal of this study was to look at the benefits and drawbacks of the widely used on-the-spot prognostic grading systems for BMs, as well as their clinical use.

Author (s) Details

Erkan Topkan
Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey.

Ahmet Kucuk
Mersin City Education and Research Hospital, Radiation Oncology Clinics, Mersin, Turkey.

Duygu Sezen
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.

Sukran Senyurek
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.

Eyub Yasar Aydemir
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.

Nulifer Kilic Durankus
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.

Yasemin Bolukbasi
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.

Berrin Pehlivan
Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey.

Ugur Selek
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.

View Book :- https://stm.bookpi.org/NFMMR-V1/article/view/2788

An Analysis of Perioperative Risk Factors for Long Term Survival after Surgery for Acute Type A Dissection Focusing on Gender-specific Differences | Chapter 7 | New Frontiers in Medicine and Medical Research Vol. 2

 We looked at gender-specific perioperative risk factors for an acute Stanford type A aortic dissection's survival.

In a 9-year follow-up, 147 patients who had surgery since 2004 were evaluated. The Cox-proportional hazard model was used to analyse the data, which included 36 variables.

After 1 year (5, 10 years), survival was 98 percent (88 percent , 50 percent ). Early mortality was 25% for males and 27% for women, with women dying at a younger age (+10 years, on average) than men. In the seventh decade, the percentage of women was twofold greater, and in the eighth decade, it was thrice higher. For the first postoperative year, the survival probability (Log rank test) was 0.82/0.77 (male/female), 0.70/0.71 for 5 years, and 0.46/ 0.50 for 10 years. In the case of resternotomy (16.543), bleeding (8.1), and renal insufficiency (8.1), women had a significant hazard ratio for mortality (3.4).

Only the EURO-Score (1.103, p=0.038) and hospital stay time (0.849, p=0.015) were found to be significant risk factors for death.

Between 5 and 10 years, the survival curve begins to deteriorate (88 percent to 50 percent ). Age and resternotomy had a substantial impact on survival in male patients. In the seventh and eighth centuries, women had a greater rate of aortic type A dissection. Gender has no bearing on survival.

Author (S) Details

Frank Harig
Department of Cardiac Surgery, University Hospital Erlangen, Friedrich- Alexander University Erlangen, Erlangen, Germany.

Anna Engel
Department of Cardiology and Angiology, University Hospital Erlangen, Friedrich- Alexander University Erlangen, Erlangen, Germany.

Johannes Rösch
Department of Cardiac Surgery, University Hospital Erlangen, Friedrich- Alexander University Erlangen, Erlangen, Germany.

Michael Weyand
Department of Cardiac Surgery, University Hospital Erlangen, Friedrich- Alexander University Erlangen, Erlangen, Germany.

View Book :- https://stm.bookpi.org/NFMMR-V2/article/view/2680

CXCR4 Expression in Gastric Cancer and Bone Marrow | Chapter 4 | Highlights on Medicine and Medical Science Vol. 2

 CXCR4 is a chemokine receptor that is specific for stromal-derived factor-1 (SDF-1, CXCL12) and is involved in the spread and progression of a number of different tumors. Although evidence suggests that CXCR4 and SDF-1 expression can be used to assess the risk of gastric cancer progression, their impact on the occurrence and progression of gastric cancer (GC) requires further investigation. The current study examined the relationship of CXCR4 expression in both GC and bone marrow (BM) with clinical characteristics using immunohistochemistry, immunocytochemistry, NMR-spectroscopy, and zymography, as well as overall The overall survival (OS) of 65 GC patients was studied. CXCR4 was found to be expressed in 78.5 percent of GC specimens and was associated with tumor hypoxia (p0.05), VEGF expression (p0.01), and gelatinase activity (p0.05). CXCR4-positive cells in the GC were found in 80 percent of patients with disseminated tumor cells (DTCs) in the BM. CXCR4 expression in the brain was linked to DTCs, particularly in patients with M0. Patients with CXCR4-positive tumors had a lower overall survival (OS) than those with CXCR4-negative tumors (p=0.037). CXCR4 expression in the brain was not linked to OS. Patients with M0 and both CXCR4-positive BM and DTCs have a higher risk of a poor outcome (P = 0.03).

Author (s) Details

Dmitry Osinsky
City Clinical Oncological Center, Verchovynna Street 69, Kiev 03115, Ukraine.

Larissa Bubnovskaya
R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, National Academy of Sciences of Ukraine, Vasylkivska Street 45, Kiev 03022, Ukraine.

Dr. Irina Ganusevich,
R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, National Academy of Sciences of Ukraine, Vasylkivska Street 45, Kiev 03022, Ukraine.

Lesya Mamontova
R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, National Academy of Sciences of Ukraine, Vasylkivska Street 45, Kiev 03022, Ukraine.

Sergej Merentsev
City Clinical Oncological Center, Verchovynna Street 69, Kiev 03115, Ukraine.

Professor Sergej Osinsky
R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, National Academy of Sciences of Ukraine, Vasylkivska Street 45, Kiev 03022, Ukraine.

View Book : https://stm.bookpi.org/HMMS-V2/article/view/1350

Management of Brain Metastases with Preoperative Radiosurgery | Chapter 11 | Highlights on Medicine and Medical Research Vol. 2

Nearly 30 percent to 54 percent of all patients are diagnosed with the most common intracranial tumor brain metastases (BMs) during or after their solid cancer treatment courses. Although the prognosis is extremely poor for BM patients, the estimated median OS is usually less than 7 months. However, nowadays, after the implementation of effective systemic and local therapies, such as surgery and radiotherapy, some patient groups can experience significantly longer survival periods (RT). Neurosurgery, whole-brain RT (WBRT), definitive SRS, postoperative SRS, systemic chemotherapy, targeted therapies, immunotherapy and their various mixtures are currently noteworthy alternatives for the management of BMs. Regarding the local treatment maneuvers, the well-recognized severe neurotoxicity of WBRT and the augmented risk for radionecrosis and leptomeningeal dissemination after postoperative SRS and the ineligibility of certain patients during the postoperative period mandated the search for safer and potentially more effective treatment alternatives for such patients' group. In this regard, it was proposed that the novel preoperative SRS (PO-SRS) should provide at least comparable local control rates with a lower risk of radionecrosis and leptomeningeal spread. This chapter describes the conceivable rationale and available evidence for the new PO-SRS in the management armamentarium for cancer patients who have BMs.

Author (s) Details

Erkan Topkan
Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey.

Ahmet Kucuk
Mersin City Education and Research Hospital, Radiation Oncology Clinics, Mersin, Turkey.

Sukran Senyurek
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.

Duygu Sezen
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.

Nulifer Kilic Durankus
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.

Eyub Yasar Akdemir
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.

Esma Didem Ikiz
Department of Radiation Oncology, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Turkey.

Yasemin Bolukbasi
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.

Berrin Pehlivan
Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey.

Ugur Selek
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.

View Book :- https://stm.bookpi.org/HMMR-V2/issue/view/20

The Lifespan Hormesis Phenomenon in a Population does not Make It's Healthier | Chapter 9 | Challenges in Disease and Health Research Vol. 5

Radiation hormesis, when total-body irradiation (TBI) is administered at a cumulative dose of 1.5 Gy at around 0.1 Gy/day, has recently been considered a type of useful cancer therapy. Many studies have linked hormesis to immune system potentiation. The aim of this research was to examine the impact of natural variation on the signs of hormesis in the regenerative state of dog tissues, which are visible across the life span following complete body exposure to low daily doses of external gamma radiation. Ninety beagle dogs of both sexes, from 1 year after birth to death, were irradiated with cobalt 60 at 0.003 Gy/day. Control (n = 169) and irradiated animals underwent clinical examination and autopsy during their entire life and were then retrospectively divided into two subgroups with (W) or without benign tumors or tumors of unknown nature (WO) that were clinically reported throughout the entire lifespan on a single day. Radiation hormesis was observed only in subgroup WO, which in the absence of radiation had a life span (LS) of 10.7 years. In the WO subgroup (p<0.05), the radiogenic prolongation of life to 11.8 years was close to that in the W control and irradiated W subgroups (11.8 and 11.5 years, respectively). The number of solid malignancies found in the control WO subgroup upon autopsy was smaller (39.5%) than that evident in the control W subgroup (60 percent ). The irradiation of the WO subgroup was followed by a small increase (1.14-fold) in the amount of solid malignancies visible during autopsy and in the clinical signs of tissue atrophy and body weight loss (2.4-fold and 2.4-fold respectively) relative to the irradiated W subgroup, but was accompanied by a sharp decrease in the degree of anemia and hematoblastosis (>10-fold for both). The data exclude the notion that radiation is associated with recovery, but suggest that only in poorer animals can such pathologies (e.g., hematoblastosis) be replaced with other less severe somatic diseases. It implies that, at least in mammals, the notion of radiobiological "stimulation" is unacceptable.

Author(s) Details

Aleksey N. Shoutko
Laboratory for Improvement of the Radiation Treatment Methods, Granov’ Russian Research Center for Radiology and Surgical Technologies, 197758, 70, Leningradskaya str., Pesochny, St. Petersburg, Russia.

Ludmila P. Ekimova
Laboratory for Improvement of the Radiation Treatment Methods, Granov’ Russian Research Center for Radiology and Surgical Technologies, 197758, 70, Leningradskaya str., Pesochny, St. Petersburg, Russia.

View Book:- https://stm.bookpi.org/CDHR-V5/issue/view/7