Sella Turcica und Hypophyse

Journal of Molecular Medicine -     

Schwangerschaftsödeme und Aussentemperatur

Journal of Molecular Medicine -     

Potenziell inadäquate Medikamente bei älteren hausärztlich versorgten Patientinnen und Patienten

Background

Elderly people are often burdened by several diseases. This accounts for a higher medication intake and increases the risk of adverse drug events. To minimize this risk, several lists (Beers, PRISCUS) have been published of drugs that elderly patients should not take. We present a longitudinal analysis of the use of potentially inappropriate medication (PIM) over a period 4.5 years in a cohort of patients aged 75 years or more.

Methods

Data were collected from the prospective, multicenter, observational study “German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe),” initially enrolling 3,327 patients. We investigated the prevalence of PIM by checking medications during visits to patients’ homes. Furthermore, we analyzed the use of individual PIM agents over time.

Results

At baseline, we found a PIM prevalence of 29?% according to the PRISCUS list, which decreased to 25.0?% 4.5 years later (χ²: 7.87, p?=?0.004). The Beers list yielded a prevalence of 21?% at baseline, decreasing after 4.5 years to 17.1?% (χ²: 10.77, p?=?0.000). A time-dependent multilevel model confirmed these results. Older age, depression, and the use of numerous prescribed agents are independent risk factors for using a PRISCUS-PIM.

Conclusion

Our results seem to support a trend toward a more rational drug therapy because fewer patients were prescribed PIM. Thus, for the individual patient, the risk of adverse effects and side effects is reduced as are the costs of these effects.     

Acute myeloid leukemia: negative prognostic impact of early blast persistence can be in part overcome by a later remission prior to post-induction therapy

In acute myeloid leukemia, there is an ongoing debate on the prognostic value of the early bone marrow assessment in patients receiving intensive therapy. In this retrospective study, we analyzed the prognostic impact of the early response in 1,008 patients with newly diagnosed acute myeloid leukemia, who were treated at our institution with intensive chemotherapy followed by consolidation chemotherapy and/or allogeneic hematopoietic stem cell transplantation (HSCT). We found that early blast persistence has an independent negative prognostic impact on overall survival, event-free survival and relapse-free survival. This negative prognostic impact may only be overcome in patients showing at least a partial remission at the early bone marrow assessment and who subsequently achieve blast clearance by additional induction chemotherapy prior to consolidation therapy with allogeneic HSCT. In accordance, we propose that the time slope of remission is an additional leukemia-related dynamic parameter that reflects chemosensitivity and thus may inform post-induction therapy decision-making. In addition to patient-related factors, European LeukemiaNet risk group, measurable residual disease monitoring and donor availability, this may particularly apply to European LeukemiaNet intermediate-risk patients, for whom a decision between consolidation chemotherapy and allogeneic HSCT remains challenging in many cases.