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11.
Uday Yanamandra Prateek Deo Kamal Kant Sahu Ram Vasudevan Nampoothiri Nalini Gupta Anusree Prabhakaran Deb Prasad Dhibhar Alka Khadwal Gaurav Prakash Man Upadesh Singh Sachdeva Deepesh Lad Neelam Varma Subhash Varma Pankaj Malhotra 《Clinical Lymphoma, Myeloma & Leukemia》2019,19(3):183-189.e1
Background
Multiple myeloma (MM) is a hematologic malignancy of plasma cell origin. MM primarily affects bone marrow, but extramedullary sites can also be involved. Myelomatous pleural effusion (MPE) is an atypical and rare complication of MM. We aimed to systematically study the incidence and clinicopathologic profile of patients with MPE in a real-world setting.Patients and Methods
In this retrospective study, 415 consecutive patients with MM managed at a tertiary care center in North India during a study period of January 1, 2010 to December 31, 2015 were evaluated for MPE. The patients with MPE were analyzed for their clinical profile, diagnosis, treatment, and outcomes.Results
Of these 415 patients, 11 (2.65%) patients had MPE. The median age of the study population was 50 years with male preponderance. The majority of these patients had immunoglobin (Ig)G Kappa disease. All patients had higher than International Staging System stage I disease. MPE was a presenting feature at MM diagnosis in 45.45% (n = 5) of the patients, whereas the rest developed MPE during follow-up. MPE presented predominantly (81.8%) as a unilateral effusion. Concurrent extramedullary involvement at other site was seen in 45.45% (n = 5), with 3 (27%) patients having concurrent myelomatous ascites. Six of these were managed aggressively, whereas 5 patients opted for palliation. The outcomes were dismal (90.9% mortality), with a median survival of 2.47 months.Conclusion
MPE is a rare entity, and positive outcomes of therapy remain low with dismal prognosis. 相似文献12.
《Research in social & administrative pharmacy》2022,18(11):3988-3994
BackgroundScarce data exists regarding United States (US) national-level work productivity loss among adults with Multiple Sclerosis (MS).ObjectiveTo address this significant knowledge gap, we examined the national-level productivity loss among adults (18≤ age ≤64 years) with MS compared to propensity score matched non-MS controls.MethodsWe adopted a retrospective, cross-sectional, matched cohort study design with pooled data from alternate years (2005/2007/2009/2011/2013/2015) of the Medical Expenditure Panel Survey (MEPS). We included adults who were employed and alive during the calendar year. Clinical Classification System code of “80” was used to identify individuals with MS. We matched adults with MS to non-MS adults utilizing propensity scores generated based on age, gender, and race/ethnicity using a greedy matching algorithm (8:1-digit matching). Missed workdays measured productivity loss of MEPS respondents. We selected Negative Binomial Regression (NBR) analysis as the count data model for this study. Analyses were conducted using SAS 9.4 and STATA 15.0 and accounted for the complex survey design of MEPS to generate US national-level estimates.ResultsThe final propensity-score matched sample consisted of 104 and 312 (unweighted) adults with and without MS, respectively. US national-level mean [Standard Error (SE)] annual missed workdays among individuals with MS [8.94 (SE:1.59)] was significantly higher (p = 0.001) compared to propensity score matched non-MS controls [3.15 (SE:0.40)]. After adjusting for several factors, NBR showed an approximately two-fold higher rate of missed work days among individuals with MS compared to propensity score matched non-MS controls (Incidence Rate Ratio: 1.98, 95% Confidence Interval: 1.18–3.33). Severity of pain, marital status, region, and hypertension also negatively impacted work productivity in this sample.ConclusionsIndividuals with MS in the US experience significantly higher productivity loss compared to propensity score matched non-MS controls. Interventions (e.g., improved management of MS symptoms) are warranted to reduce productivity loss among individuals with MS. 相似文献
13.
《Clinical Lymphoma, Myeloma & Leukemia》2022,22(8):608-617
BackgroundConsiderable progress has been made in therapeutic options for multiple myeloma (MM). Understanding the current landscape of MM treatment options and associated outcomes in the real world is important in providing key insights into clinical and knowledge gaps which could be targeted for further optimization.MethodsThe Canadian Myeloma Research Group Database (CMRG-DB) is a prospectively maintained disease-specific database with >7000 patients. The objective of this study was to describe the trends in the treatment landscape and outcomes including early mortality, time to next treatment, and overall survival (OS) in each line of treatment stratified by autologous stem cell transplant (ASCT) receipt among newly-diagnosed MM patients in Canada between 2007 and 2018.ResultsA total of 5154 patients were identified among which 3030 patients (58.8%) received an upfront ASCT and 2124 (41.2%) did not. At diagnosis, the median age was 64 years and 58.6% were males. Bortezomib and lenalidomide were most frequently used (>50%) in first and second-line treatment respectively among both the ASCT and non-ASCT cohort. The median OS was 122.0 months (95% Cl 115.0-135.0 months) and 54.3 months (95% CI 50.8-58.8 months) for the ASCT and non-ASCT cohort respectively with an incremental decrease in OS in each subsequent line of treatment.ConclusionWe present the largest study to date in the Canadian landscape showing the characteristics, therapy usage, and outcomes among MM patients. This information will be critical in benchmarking current outcomes and provide key insight into areas of unmet needs and gaps for improvement of MM patients nationally. 相似文献
14.
A. Hochsprung S. Escudero-Uribe A.J. Ibáñez-Vera G. Izquierdo-Ayuso 《Neurología (Barcelona, Spain)》2021,36(6):433-439
IntroductionPain is highly prevalent in patients with multiple sclerosis (MS); it is chronic in 50% of cases and is classified as nociceptive, neuropathic, or mixed-type. Pain affects quality of life, sleep, and the activities of daily living. Electrotherapy is an interesting alternative or complementary treatment in the management of pain in MS, with new innovations constantly appearing.Material and methodsThis study evaluates the effectiveness of treatment with monopolar dielectric transmission of pulsed electromagnetic fields (PEMF) for pain associated with MS. We performed a randomised, placebo-controlled clinical trial including 24 patients, who were assessed with the Brief Pain Inventory, the Multiple Sclerosis International Quality of Life questionnaire, the Beck Depression Inventory, and the Modified Fatigue Impact Scale.ResultsStatistically significant improvements were observed in maximum and mean pain scores, as well as in the impact of pain on work, personal relationships, and sleep and rest. Not significant differences were found between the treatment and placebo groups.ConclusionsTreatment with PEMF may be effective in reducing pain in patients with MS, although further research is necessary to confirm its effectiveness over placebo and to differentiate which type of pain may be more susceptible to this treatment. 相似文献
15.
16.
《Revue neurologique》2022,178(8):812-816
IntroductionAs an immune-mediated disease of the central nervous system, multifaceted aspects of a humoral immune response are widely described during multiple sclerosis (MS). However, the prevalence of different auto-antibodies, such as antinuclear antibodies (ANA), during MS is very variable and their clinical relevance remains controversial. Our aim was to evaluate the prevalence and clinical correlations of ANA positivity in South Tunisian MS patients.Material and methodsWe performed ANA screening using indirect immunofluorescence (IIF) on HEp-2 cells (Biosystems®) in 82 MS patients. For ANA positive samples (titer ≥1/160), anti-ds-DNA detection (IIF on Crithidia luciliae (Biosystems®)) and extractable nuclear antigen typing (immunodot (Euroimmun®)) were performed.ResultsANA were positive in 35/82 MS patients (42.7%). The titer was ≥ 1/320 in 16/35 patients. The antigenic specificity of ANA was identified in 7/35 patients. None of the patients had extra-neurological manifestations. No correlation was found between ANA and age, gender, MS course, disease duration, disability, annual relapse rate nor IgG index. ANA positivity was more frequent in patients with IgG oligoclonal bands (OCB) (47.1%) than in patients without IgG OCB (16,6%) (p = 0.049). Regarding disease activity, ANA positivity was significantly more frequent in patients with relapse (52.6%) than in patients in remission (25.9%) (p = 0.031).ConclusionOur results showed that ANA positivity in MS disease is not rare. This positivity was not associated with clinical expression of any connective tissue disease. ANA occurrence in MS was associated with IgG OCB+ profile and relapsing status, probably reflecting an ongoing immune dysregulation. 相似文献
17.
《Motricité Cérébrale》2015,36(2):54-58
Cerebral Palsy motor disorder triggers orthopedic complications. These complications do develop by themselves and gradually degrade the motor function. The functioning of the ventilatory pump is no exception to this process. Other orthopedic impairments are impacting more indirectly ventilation. Some orthopedic treatments used for PC people are likely to worsen this clinical situation, temporarily or more permanently. Any therapeutic intervention must include two essential points: acting previously to realign posture and considering interactions of treatments on different functions. 相似文献
18.
19.
中药汤剂(也称煎剂)是中医师最常用的中药复方剂型,也是中药历史上应用最久和最广的制剂。药材是饮片的原料,饮片是制备提取物、构成中医处方和中药制剂的原料,更体现了传承发展中药的重要性。基于中药饮片标准汤剂,科学认识汤剂质量,提高药典饮片和中成药质量评价研究理论和方法是科学发展的重要策略。开展以中医药理论为指导、临床应用为基础的中药饮片标准汤剂研究,基于中药质量标志物理论和研究方法探讨饮片和煎煮工艺的影响,形成标准汤剂的质量评价体系,既有利于确保中医处方用药的安全和疗效,也有利于认识标准汤剂在"药材-饮片-中成药"的质量及其标准的差异和价值,提升国家对中药饮片监管水平,保障人民用药安全和有效;还有利于认识标准汤剂在中药饮片生产、中药配方颗粒及经典名方的传承研发中的重要意义。 相似文献
20.
《Gait & posture》2020
BackgroundSingle-task (ST) and dual-task (DT) assessments are commonly used to evaluate motor and cognitive impairment in people with multiple sclerosis (MS). Although variability can influence repeated DT testing measures, the reliability of several DT variables over time has not been adequately explored. For instance, a third testing session has never been included to observe whether DT has a learning effect. DT cognition rate reliability has not yet been examined and dual-task cost (DTC), a widely used calculation for DT interpretation, has not been proven reliable.Research questionTo evaluate the reliability of ST and DT measures of gait and cognition over three test sessions.MethodsThis was a cross-sectional study involving 18 people with MS and 12 controls. Participants attended three test sessions, each one week apart. ST and DT (serial seven subtraction) gait variables, DTC, coefficient of variability (CV), and cognition rate were extracted and calculated using an instrumented walkway. Reliability was assessed using intraclass correlation coefficients (ICC) or Kendall’s coefficient of concordance (KCC; nonparametric test) and minimum detectable change (MDC); between-session learning effect was assessed using repeated measures ANOVA.ResultsICC/KCC values for ST and DT gait variables ranged from moderate to excellent (0.50-0.99). However, reliability for DT stride width and cognition rate was lower in controls. In general, DTC and CV variables had poor ICCs and high MDC values (49.19–1478.67 %), although some DTC variables had moderate or higher reliability in controls. Cognition rate was reliable in both MS (ICC 0.91) and controls (ICC 0.84). A learning effect between sessions was observed for DT velocity in both groups and for DTC cadence in people with MS.SignificanceST and DT gait measures as well as DT cognition rate are reliable outcomes for repeated testing, while DTC and CV variables may not be suitable for long-term monitoring. 相似文献