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The phenomenon of the BRAF and TERTp mutational duet in melanoma and other cancers
Get PDFThe unique oncogenic duo of BRAF and TERT promoter (TERTp) variants was demonstrated to be associated with aggressiveness and poor prognosis in several different cancer types, including melanoma and thyroid cancer. It has been shown that the coexistence of BRAF and TERTp variants has a significantly more substantial impact on clinical outcomes than the presence of mutated BRAF or TERTp alone. At the same time, the co-occurrence of BRAF and TERTp variants may also be the Achilles Heel of cancer cells in the context of targeted therapies’ effectiveness. This paper aims to summarize data from tumors in which clinically significant variants in BRAF and TERTp were documented as prognostic or predictive markers
Patterns of antiseizure medication use in pregnant women with epilepsy: a 24-year observation in Poland
Get PDFAim of study. The aim of this study was to examine trends in the usage of antiseizure medications (ASM) in pregnant women with epilepsy (WWE) in Poland across 24 years.Clinical rationale for study. Most WWE continue ASM treatment during pregnancy. Over recent decades, third-generation ASMs with different safety profiles have become available. Understanding the long-term trends could provide valuable information for improving clinical practice guidelines.Material and methods. The study is based on prospectively collected data from an institutional database of a tertiary epilepsy centre between 2000 and 2024. Data on ASM use during pregnancy was recorded at conception and each trimester. Trends in ASM use in monotherapy and polytherapy were analysed. The study included 1,454 completed pregnancies with a known outcome and a mean maternal age of 28.99 years.Results. WWE were exposed to 19 different ASMs in monotherapy or polytherapy. Lamotrigine (LTG), valproate (VPA), carbamazepine (CBZ) and levetiracetam (LEV) accounted for 82% of all ASMs. Between 2000 and 2024, there was a statistically significant decrease in the usage of CBZ (Exp(B) = 0.92; p < 0.001; 8% annually) and of VPA (Exp(B) = 0.95; p = 0.005, 5% annually) and an increase in the use of LTG (Exp(B) = 1.03; p = 0.086; 3% annually) and of LEV (Exp(B) = 1.19; p < 0.001; 19% annually). More than two-thirds of the women were on monotherapy, both at conception and throughout pregnancy. WWE not exposed to ASMs accounted for 13.9% at conception and 10.5% in all trimesters. There was a significant increase in the number of women receiving polytherapy across all trimesters over time (Exp(B) = 1.02; p = 0.052; 2% annually) and a decrease in untreated women across all trimesters over time (Exp(B) = 0.97; p = 0.033; 3% annually). The mode of treatment at conception did not change statistically over time.Conclusions/clinical implications. The use of specific ASMs h as c hanged s ignificantly in th e 21 st ce ntury, wi th a no table decrease in the usage of CBZ and VPA in favour of LEV and LTG. There is an increasing trend towards polytherapy across all trimesters, but not at the conception point
Oncology pharmacy education for pharmacy students — should it be improved?
No full textCancer remains one of the most common causes of death worldwide. This makes the process of educating medical students on the subject of oncology pharmacy all the more important. Basic teaching methods focusing on theory can prove insufficient. This paper brings together the modern didactic methods used in teaching oncology pharmacy, to the present time, and evaluates their usefulness
Quality of life and functional status of patients referred for transcatheter edge-to-edge repair of severe tricuspid regurgitation: A single-center prospective observational study
No full textBackground: Recent years have brought a significant increase in the accessibility of interventional treatment of tricuspid regurgitation (TR). However, the characteristics of patients referred for evaluation and factors associated with functional capacity and quality of life (QoL) remain poorly defined.Aims: To characterize patients undergoing qualification for interventional TR treatment with the focus on parameters associated with QoL and exercise capacity and to assess short-term effects of tricuspid transcatheter edge-to-edge repair (T-TEER).Material and methods: This is a single-center prospective observational study enrolling consecutive patients with at least severe TR, who underwent qualification for interventional TR treatment. Baseline data were collected during index hospitalization, and follow-up data were obtained during outpatient visits at 30 days post procedure.Results: We included a total of 147 patients. The qualification process resulted in 77 (52.4%) qualified for T-TEER. Patients presented with severe heart failure symptoms and high comorbidity burden. The mean baseline Kansas City Cardiomyopathy Questionnaire score was 42.4 (26.1), and New York Heart Association functional class had the strongest predictive value. The median baseline 6-minute walk distance (6MWD) was 195.0 (100.0–285.0) meters. The main factors associated with 6MWD were age and low tricuspid annular plane systolic excursion/systolic pulmonary artery pressure. T-TEER reduced TR to moderate or less in 51 of 67 patients and was associated with significant improvement in Kansas City Cardiomyopathy Questionnaire and 6MWD.Conclusions: Patients with severe TR present with high comorbidity burden, severe HF symptoms, and report low QoL. Higher age and low tricuspid annular plane systolic excursion/systolic pulmonary artery pressure are associated with worse 6MWD. Treatment with T-TEER is associated with a significant improvement of QoL and 6MWD at short-term follow-up
Optymalizacja leczenia systemowego chorych na raka pęcherza moczowego, moczowodu i miedniczki nerkowej — stanowisko ekspertów Polskiego Towarzystwa Onkologii Klinicznej
No full textIwosydenib w leczeniu chorych na raka dróg żółciowych z obecnością mutacji genu IDH1 — dane z rzeczywistej praktyki medycznej. Badanie wieloośrodkowe
No full textDespite significant progress in oncology in recent years, CCA, especially in the advanced stage, remains a disease with poor prognosis. It seems that the use of modern therapies, such as immunotherapy and targeted therapy, may improve the prognosis in this group of patients. The paper presents a multicenter analysis of the Polish research group on the treatment of patients with CCA with IDH1 mutation treated with ivosidenib in the second to fourth line of treatment. The study included 13 patients with inoperable or metastatic CCA with IDH1 mutation, who received treatment with ivosidenib, including in the second line - 2 patients (15%), third line - 10 patients (77%) and fourth line - 1 patient (8%). The estimated median PFS and OS from the start of ivosidenib treatment were 2.5 and 6.3 months, respectively, while the median OS from the start of systemic therapy for the entire study group was 20 months. The median duration of treatment with ivosidenib was 2.6 months (range 1.0-13.9 months), 4 (31%) patients are continuing the therapy. Grade 3 adverse events during ivosidenib therapy were reported in 3 (23%) patients. No grade 4 adverse events or deaths related to ivosidenib were reported. The study confirmed the efficacy and safety of ivosidenib in patients with advanced cholangiocarcinoma with IDH1 mutation.Wprowadzenie. Pomimo znacznego postępu, jaki nastąpił w ostatnich latach w leczeniu chorych na nowotwory, rak dróg żółciowych (CCA, cholangiocarcinoma) — szczególnie w stadium zaawansowanym — pozostaje w dalszym ciągu chorobą o złym rokowaniu. Wydaje się, że zastosowanie nowoczesnych terapii, jak immunoterapia oraz leczenie ukierunkowane molekularnie, może przynieś poprawę rokowania w tej grupie chorych.
Materiał i metody. Do badania włączono chorych na nieoperacyjnego lub przerzutowego CCA z mutacją IDH1, którzy rozpoczęli leczenie iwosydenibem od 1 sierpnia 2023 roku do 31 lipca 2024 roku w ramach RDTL w dziesięciu referencyjnych ośrodkach onkologicznych w Polsce.
Wyniki. Do badania włączono 13 chorych na nieoperacyjnego lub przerzutowego CCA z mutacją IDH1, którzy otrzymali terapię iwosydenibem, w tym w II linii — dwóch chorych (15%), III linii — dziesięciu chorych (77%) i IV linii — jeden chory (8%). Estymowane mediany PFS i OS od momentu rozpoczęcia leczenia iwosydenibem wyniosły odpowiednio 2,5 i 6,3 miesiąca, natomiast mediana OS od początku terapii systemowej dla całej badanej grupy wyniosła 20 miesięcy. Mediana czasu leczenia iwosydenibem wyniosła 2,6 miesiąca (zakres 1,0–13,9 miesiąca), czterech (31%) chorych kontynuuje terapię. Działania niepożądane w stopniu 3. w trakcie terapii iwosydenibem zanotowano u trzech (23%) chorych. Nie zanotowano działań niepożądanych w stopniu 4. ani zgonów związanych ze stosowaniem iwosydenibu.
Wnioski. W badaniu potwierdzono skuteczność i bezpieczeństwo iwosydenibu u chorych na zaawansowanego raka dróg żółciowych z mutacją IDH1
The application of reflectance confocal microscopy in the diagnosis of facial pigmented lesions — case series
No full textFacial pigmented lesions encompass a heterogeneous group of melanocytic and non-melanocytic disorders, which may pose diagnostic challenges due to overlapping clinical features. The implementation of non-invasive imaging techniques, including dermoscopy and reflectance confocal microscopy (RCM), has significantly improved diagnostic accuracy, minimizing unnecessary biopsies and scarring. In the study, three cases of clinically equivocal pigmented facial lesions are described along with their dermoscopic and RCM presentations. The article highlights the usefulness of RCM in differentiating pigmented facial lesions and its therapeutic implications, which are particularly crucial for this cosmetically sensitive area. Moreover, dermoscopic and RCM features of lentigo maligna, seborrheic keratosis, and lichen planus-like keratosis — three disorders with overlapping clinical manifestations — have been summarized
Invitation to the 3rd Conference of the Section of Dermoscopy and Other Skin Imaging Techniques of the Polish Dermatological Society
No full textThe role of uterine anteversion and flexion angles in predicting pain severity during diagnostic hysteroscopy: a prospective cohort study
No full textObjectives: Diagnostic hysteroscopy (DH) is a gold standard diagnostic imaging tool in gynecology. There is insufficient data in the literature regarding the reduction of pain felt during the DH and there is no study in the literature that examines the relationship between the measurement of uterine version or flexion angles and the pain felt during DH procedure. The aim of this study was to investigate the effects of uterine version or flexion angles on pain severity during DH and to identify predictive factors for severe pain experienced during the procedure.
Material and methods: This prospective single-center cohort study included patients who were eligible for DH within medical indications. Exclusion criteria comprised menopausal status, congenital uterine anomalies, uterine fibroids larger than 2 cm detected on ultrasonography, suspected malignancy, or retroverted uterus. Before hysteroscopy, all patients underwent transperineal ultrasonography to measure uterine version and flexion angles. Patients were asked to rate their pain levels using a 0–10 numerical visual analog scale (VAS). Patients with VAS scores ≥ 6 were categorized into the severe pain group, while those with scores < 6 were classified into the moderate pain group.
Results: The study comprised 98 women undergoing DH. Multivariate binary logistic regression analysis identified anteversion angle and nulliparity as significant predictors of severe pain during DH. The optimal cut-off value for predicting severe pain during DH was identified as 74.5°, providing a sensitivity of 66.7% and specificity of 69.0% [area under curve (AUC) = 0.722, p = 0.001].
Conclusions: This study demonstrates that a uterine anteversion angle narrower than 74.5° is associated with severe pain during DH