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Frontiers in Immunology 2024Melanoma causes the majority of skin cancer-related deaths. Despite novel therapy options, metastatic melanoma still has a poor prognosis. Immune checkpoint inhibition...
Melanoma causes the majority of skin cancer-related deaths. Despite novel therapy options, metastatic melanoma still has a poor prognosis. Immune checkpoint inhibition (ICI) therapy has been shown to prolong overall survival in patients with advanced melanoma, but mucosal melanomas respond less favorably compared to melanomas of cutaneous origin. We report on a patient with a mucosal melanoma of the rectum diagnosed in June 2020. Since a surgical intervention in order to achieve a tumor-free situation would have required an amputation of the rectum, a neo-adjuvant systemic immunotherapy with ipilimumab and nivolumab was initiated. As restaging and colonoscopy after four doses of this combination immunotherapy showed a partial response, the patient decided against the pre-planned surgery and a maintenance therapy with nivolumab was started. Repeated colonoscopy showed a complete response after four doses of nivolumab. After ongoing ICI therapy with nivolumab and no evidence of tumor relapse, immunotherapy was stopped in July 2022 after nearly 2 years of continuous treatment. The patient remained tumor-free during further follow-up. Neo-adjuvant immunotherapy is getting more explored in advanced melanoma. By administering ICI therapy before surgical resection of an essentially operable tumor, a stronger and more diverse immunological response is supposed to be achieved. Our reported case demonstrates that this approach could also be effective in mucosal melanoma despite of its generally lower response to immunotherapy.
Topics: Humans; Ipilimumab; Nivolumab; Melanoma; Neoadjuvant Therapy; Rectal Neoplasms; Male; Antineoplastic Combined Chemotherapy Protocols; Treatment Outcome; Immune Checkpoint Inhibitors; Immunotherapy; Middle Aged
PubMed: 38807589
DOI: 10.3389/fimmu.2024.1369190 -
Medicina (Kaunas, Lithuania) Apr 2024Metastatic colorectal cancer requires a multidisciplinary and individualized approach. Herein, we reported the case of a young woman diagnosed with metastatic rectal... (Review)
Review
Metastatic colorectal cancer requires a multidisciplinary and individualized approach. Herein, we reported the case of a young woman diagnosed with metastatic rectal cancer who received an individualized multimodal treatment strategy that resulted in a remarkable survival. There were several particular aspects of this case, such as the early onset of the disease, the successful use of conversion therapy, the application of liquid biopsy to guide treatment, and the specific nature of the bone metastasis. To offer more insights for navigating such challenges in patients with metastatic colorectal cancer, we have conducted a literature review to find more data related to the particularities of this case. The incidence of early onset colorectal cancer is on the rise. Data suggests that it differs from older-onset colorectal cancer in terms of its pathological, epidemiological, anatomical, metabolic, and biological characteristics. Conversion therapy and surgical intervention provide an opportunity for cure and improve outcomes in metastatic colorectal cancer. It is important to approach each case individually, as every patient with limited liver disease should be considered as a candidate for secondary resection. Moreover, liquid biopsy has an important role in the individualized management of metastatic colorectal cancer patients, as it offers additional information for treatment decisions.
Topics: Humans; Rectal Neoplasms; Female; Adult; Combined Modality Therapy; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Fluorouracil; Neoplasm Metastasis
PubMed: 38792879
DOI: 10.3390/medicina60050696 -
BMC Pediatrics May 2024Limited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.
BACKGROUND
Limited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.
OBJECTIVES
The purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies.
DESIGN AND SETTINGS
A retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021.
INDEPENDENT VARIABLES
(a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors.
RESULTS
Mothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089).
CONCLUSION
Based on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.
Topics: Humans; Infant; Risk Factors; Case-Control Studies; Female; Retrospective Studies; Male; Child, Preschool; Rectal Fistula; Defecation; Breast Feeding; Pregnancy; Infant, Newborn
PubMed: 38783262
DOI: 10.1186/s12887-024-04826-8 -
Cirugia Y Cirujanos 2024Necrotizing fasciitis (NF) is a potentially life-threatening surgical emergency. It is a rapidly progressive infection of soft tissues, and mortality is related to the...
Necrotizing fasciitis (NF) is a potentially life-threatening surgical emergency. It is a rapidly progressive infection of soft tissues, and mortality is related to the degree of sepsis and the general condition of the patient. It is a rare condition that requires a rapid diagnosis and surgical treatment is aggressive debridement. There are a small number of reported cases of perforation of a rectal malignancy leading to NF of the thigh. We present a case with rectal cancer in which the sciatic foramen had provided a channel for the spread of pelvic infection into the thigh.
Topics: Humans; Fasciitis, Necrotizing; Rectal Neoplasms; Thigh; Intestinal Perforation; Male; Debridement; Adenocarcinoma; Middle Aged; Sciatic Nerve; Pelvic Infection
PubMed: 38782396
DOI: 10.24875/CIRU.21000843 -
BMC Pediatrics May 2024Rotavirus has a significant morbidity and mortality in children under two years. The burden of rotavirus diarrhea 4 years post introduction of rotavirus vaccine in...
Prevalence and factors associated with rotavirus diarrhea among children aged 3-24 months after the introduction of the vaccine at a referral hospital in Uganda: a cross-sectional study.
BACKGROUND
Rotavirus has a significant morbidity and mortality in children under two years. The burden of rotavirus diarrhea 4 years post introduction of rotavirus vaccine in Uganda is not well established. This study aimed to determine the prevalence, severity of dehydration and factors associated with rotavirus diarrhea among children aged 3 to 24 months after the introduction of the vaccine at Fort Portal Regional Referral hospital.
METHODS
This was a cross-sectional hospital-based study in which children with acute watery diarrhea were included. A rectal tube was used to collect a stool sample for those unable to provide samples. Stool was tested for rotavirus using rapid immunochromatographic assay. Data was analysed using SPSS version 22 with logistic regression done to determine the factors.
RESULTS
Out of 268 children with acute watery diarrhea, 133 (49.6%) were females. Rotavirus test was positive in 42 (15.7%), majority of whom had some dehydration 28(66.7%). The factors that were independently associated with rotavirus diarrhea were; age < 12 months (AOR = 8.87, P = 0.014), male gender (AOR = 0.08, P = 0.001), coming from a home with another person with diarrhea (AOR = 17.82, P = 0.001) or a home where the water source was a well (AOR = 50.17, P = 0.002).
CONCLUSION
The prevalence of rotavirus diarrhea was three times less in the post rotavirus vaccination period compared to pre-rota vaccination period. Majority of the participants with rotavirus diarrhea had some dehydration. There is need for provision of safe water sources to all homes. Surveillance to determine the cause of the non rota diarrhea should be done.
Topics: Humans; Uganda; Cross-Sectional Studies; Male; Female; Infant; Rotavirus Vaccines; Prevalence; Rotavirus Infections; Risk Factors; Child, Preschool; Dehydration; Diarrhea; Feces; Logistic Models; Diarrhea, Infantile
PubMed: 38778329
DOI: 10.1186/s12887-024-04842-8 -
Oncology (Williston Park, N.Y.) May 2024Determining treatment options for patients with locally advanced rectal cancer after the PROSPECT trial data readout adds an important level to the decision-making...
Determining treatment options for patients with locally advanced rectal cancer after the PROSPECT trial data readout adds an important level to the decision-making process.
Topics: Humans; Rectal Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Fluorouracil; Randomized Controlled Trials as Topic; Leucovorin
PubMed: 38776515
DOI: 10.46883/2024.25921019 -
BMC Geriatrics May 2024The purpose of this study was to evaluate the safety and efficacy of preoperative concurrent chemoradiotherapy (preCRT) for locally advanced rectal cancer in older...
Preoperative chemoradiotherapy in older patients with rectal cancer guided by comprehensive geriatric assessment within a multidisciplinary team-a multicenter phase II trial.
BACKGROUND
The purpose of this study was to evaluate the safety and efficacy of preoperative concurrent chemoradiotherapy (preCRT) for locally advanced rectal cancer in older people who were classified as "fit" by comprehensive geriatric assessment (CGA).
METHODS
A single-arm, multicenter, phase II trial was designed. Patients were eligible for this study if they were aged 70 years or above and met the standards of "fit" (SIOG1) as evaluated by CGA and of the locally advanced risk category. The primary endpoint was 2-year disease-free survival (DFS). Patients were scheduled to receive preCRT (50 Gy) with raltitrexed (3 mg/m2 on days 1 and 22).
RESULTS
One hundred and nine patients were evaluated by CGA, of whom eighty-six, eleven and twelve were classified into the fit, intermediate and frail category. Sixty-eight fit patients with a median age of 74 years were enrolled. Sixty-four patients (94.1%) finished radiotherapy without dose reduction. Fifty-four (79.3%) patients finished the prescribed raltitrexed therapy as planned. Serious toxicity (grade 3 or above) was observed in twenty-four patients (35.3%), and fourteen patients (20.6%) experienced non-hematological side effects. Within a median follow-up time of 36.0 months (range: 5.9-63.1 months), the 2-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) rates were 89.6% (95% CI: 82.3-96.9), 92.4% (95% CI: 85.9-98.9) and 75.6% (95% CI: 65.2-86.0), respectively. Forty-eight patients (70.6%) underwent surgery (R0 resection 95.8%, R1 resection 4.2%), the corresponding R0 resection rate among the patients with positive mesorectal fascia status was 76.6% (36/47).
CONCLUSION
This phase II trial suggests that preCRT is efficient with tolerable toxicities in older rectal cancer patients who were evaluated as fit based on CGA.
TRIAL REGISTRATION
The registration number on ClinicalTrials.gov was NCT02992886 (14/12/2016).
Topics: Humans; Aged; Male; Female; Rectal Neoplasms; Aged, 80 and over; Geriatric Assessment; Chemoradiotherapy; Disease-Free Survival; Preoperative Care; Thiophenes; Patient Care Team; Quinazolines
PubMed: 38773457
DOI: 10.1186/s12877-024-05046-6 -
PloS One 2024The rates of gonorrhea and chlamydia have been increasing in the years preceding the COVID19 pandemic. Because most gonorrhea and chlamydia infections are located in the...
Testing for extragenital Neisseria gonorrhoeae and Chlamydia trachomatis: At-home pharyngeal and rectal self-swabs are non-inferior to those completed in healthcare settings.
INTRODUCTION
The rates of gonorrhea and chlamydia have been increasing in the years preceding the COVID19 pandemic. Because most gonorrhea and chlamydia infections are located in the oropharynx and rectum for men who have sex with men (MSM), and because at-home self-collected swabs for these infections are not licensed by Health Canada or the United States Food and Drug Administration, decreased accessed to in-person care during and since the COVID19 pandemic potentially means missed case findings.
OBJECTIVES
To evaluate the performance of at-home self-collected pharyngeal and rectal swabs for gonorrhea and chlamydia nucleic acid amplification testing.
METHODOLOGY
All persons who contacted our Sexual Health Clinic and who had a clinical indication to complete oral and/or rectal swabs for gonorrhea and chlamydia were invited to complete at-home swabs in advance of their scheduled appointments. We mailed swabs and instructions to those who consented. Participants brought these swabs to their scheduled in clinic appointments, where we repeated the same swabs. All matching swabs were sent to the laboratory for analysis to determine concordance.
RESULTS
From September 8, 2022 to July 18, 2023, we enrolled 296 eligible participants who provided 1184 swabs. For analysis, cancelled specimens and specimens with invalid results were excluded, leaving 1032 swabs for comparison. We identified 66 STI diagnoses in 47 unique participants. Overall accuracy was high (exceeding 99%), except for rectal chlamydia, which was 96.0%. While the performance of self-swabs for chlamydia was lower compared to gonorrhea, at-home swabs identified six chlamydia infections that were missed by in-clinic collected swabs (two pharyngeal, four rectal). Removing these six cases as "false positives" increased overall accuracy for chlamydia detection to 99.7% (pharyngeal) and 97.8% (rectal).
CONCLUSION
Self-collected at-home swabs had good performance acceptable for gonorrhea and chlamydia nucleic acid amplification testing.
Topics: Humans; Chlamydia trachomatis; Chlamydia Infections; Gonorrhea; Male; Neisseria gonorrhoeae; Rectum; Pharynx; Specimen Handling; Adult; Female; Nucleic Acid Amplification Techniques; Homosexuality, Male; Middle Aged; Self Care; Young Adult
PubMed: 38768150
DOI: 10.1371/journal.pone.0302785 -
Endoscopy Dec 2024
Topics: Humans; Angiodysplasia; Gastrointestinal Hemorrhage; Male; Colonic Diseases; Colonoscopy; Peptides; Rectal Diseases; Hemostatics; Female
PubMed: 38759966
DOI: 10.1055/a-2313-3786 -
Zhongguo Ying Yong Sheng Li Xue Za Zhi... Dec 2023Mucoadhesive polymers are a new and exciting development in drug delivery systems that have the potential to significantly increase therapeutic efficacy. These polymers... (Review)
Review
Mucoadhesive polymers are a new and exciting development in drug delivery systems that have the potential to significantly increase therapeutic efficacy. These polymers stick to mucosal surfaces, increasing the amount of time that medications stay at the site of absorption and improving their bioavailability. These mechanisms include longer contact times with the mucosal surface, better drug solubility, and defence against enzymatic degradation of pharmaceuticals. Mucoadhesive polymers also provide a number of benefits over traditional drug delivery methods, including less frequent dosage, better patient compliance, and fewer adverse effects. Due to their adaptability, Mucoadhesive polymers may be used in the rectal, vaginal, ophthalmic, nasal, and oral routes of drug delivery. Mucoadhesive polymers have advantages now, but they also have potential for the future of medication delivery. Mucoadhesion offers excellent possibilities for the delivery of a range of substances through the nasal, vaginal, buccal, and ocular routes of administration. Furthermore, mucoadhesion facilitates the achievement of an extended local or systemic pharmacological effect. In this study, we covered the mechanisms behind mucoadhesion, possible uses for Mucoadhesive polymers in drug administration, and techniques for assessing Mucoadhesive drug delivery systems. The goal of current research is to create innovative Mucoadhesive polymers that have better biodegradability, biocompatibility, and adhesive qualities. Moreover, it is anticipated that the effectiveness of Mucoadhesive polymers would be increased when combined with other cutting-edge drug delivery technologies, such as micro particles and nanoparticles.
Topics: Drug Delivery Systems; Humans; Mucous Membrane; Polymers; Adhesiveness; Adhesives
PubMed: 38751344
DOI: 10.62958/j.cjap.2023.005