Open Access Journals at IU Indianapolis
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Clinical Utility of Dupilumab for the Treatment of Eosinophilic Esophagitis in Pediatric Patients
Get PDFBackground:Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and 15 or more eosinophils per high-powered field (HPF) on esophageal biopsy. Treatment options for EoE include proton pump inhibitors (PPIs), topical corticosteroids (TCS), dietary elimination, and dupilumab. Dupilumab is monoclonal antibody against IL-4 and IL-13 administered subcutaneously and was granted FDA approval for EoE in adults and adolescents recently in 2022. Outcomes of real-world, clinical use of dupilumab for EoE remains unknown.
Objectives:To observe outcomes in pediatric patients with EoE treated with dupilumab.
Methods:A retrospective cohort study of pediatric patients prescribed dupilumab for EoE was conducted. Medical records were reviewed for demographic and clinical information as well as endoscopic and histologic findings before and after dupilumab treatment.
Results:A total of 28 patients were included (mean age 15y, 71.4% male). Mean baseline maximum eosinophils/HPF was 48 ± 41. 75% of patients were treated with combination therapy of EoE with diet elimination, PPIs, or TCS prior to being prescribed dupilumab. Prior authorization for dupilumab was required in 85.7% of cases. Ten patients had follow-up endoscopy with biopsy after starting dupilumab, and among these patients the mean maximum eosinophils/HPF with dupilumab significantly improved from 44 ± 37 to 13 ± 15 (p=0.027). Among 12 patients who had follow up clinic visits, two patients reported pain or swelling at injection sites, but no otheradverse events were reported
Conclusions:Dupilumab significantly improves histologic findings of EoE and is well tolerated among pediatric patients. We hope for continued monitoring of these patients to understand the clinical utility of dupilumab for EoE over time
Clinical Applications of Next-Generation Sequencing for Cancer Diagnostics and Targeted Cancer Therapy
Get PDFBackground: Next-generation sequencing (NGS) is a revolutionary technology that has effectively sequence massive quantities of genomic DNA or RNA at a shorter time and a lower cost. The NGS is routinely used in oncology to tailor care for individual patient. In this review, we discuss the role of NGS how it can provide a more personalized approach to targeted cancer therapy.
Methods: A literature review was conducted via PubMed and articles were screened for publication dates within the past 10 years. Primary literature consisting of clinical trials and review articles were utilized. Search terms included “(next-generation sequencing) AND (cancer)”, “(next-generation sequencing) AND (cancer diagnostics)”, and “(next-generation sequencing) AND “(cancer therapy)”.
Results: From the literature review, we found that NGS is indicated for daily practice as a diagnostic tool for advanced NSCLC, colon cancer, prostate cancer, cholangiocarcinoma, and some advanced rare cancers. We also found evidence suggesting that NGS is helpful in identifying actionable mutations that will, in turn, allow the patient to be matched to a more individualized cancer treatment.
Conclusion: As oncology care continues to move in the direction of more personalized care, the potential applications of NGS in the field of oncology will continue to evolve. Our review will help further the understanding of NGS and provide context for its value in patient care and its ability to provide an avenue for targeted therapy
“There’s Healing in Music”: Veteran Perceptions of Music Interventions for Their Chronic Musculoskeletal Pain
Get PDFBackground/Objective: For veterans suffering from chronic musculoskeletal pain, finding alternative treatments to analgesics is critical for safer, more effective pain management. While music interventions have shown promise for acute pain, their acceptability for chronic pain and telehealth delivery needs more rigorous examination.
Methods: The Feasibility and Acceptability of Music Imagery and Listening Interventions for Analgesia (FAMILIA) study randomized 60 veterans with chronic musculoskeletal pain to receive usual care, telehealth music listening (ML), or telehealth music imagery (MI). ML involved independent listening to songs of each participant’s choosing, while MI consisted of one-on-one music therapist-led sessions combining ML, imagery, and verbal processing. To complement quantitative analysis of patient-reported outcomes, qualitative interviews of participants were conducted to understand perceived benefits, acceptability, barriers, and facilitators of study interventions. We analyzed 15 interviews using thematic analysis to assess acceptability of the music interventions.
Results: All interviewees perceived mental-emotional benefits and almost all experienced physical pain relief during their music listening or therapy sessions. However, many noted that the pain relief was short term, and for some veterans randomized to ML, certain songs evoked negative associations. Participants also benefited from study participation and its formal structure, in contrast to their prior informal music listening experiences. Planned study activities like participant check-ins with staff and interactions with therapists fostered a deeper understanding of how music can be therapeutic and increased veterans’ confidence in their own ability to use music therapeutically. Study acceptability was further evidenced by interviewees’ intention to continue using music listening and imagery techniques after study completion and their strong support for expanding access to music interventions to other veterans.
Conclusion/Implications: The FAMILIA study not only supports telehealth music interventions as acceptable treatments for chronic musculoskeletal pain, but the reported physical pain and mental-emotional benefits necessitate a larger, fully powered study
How Social Discrimination and Housing (Un) Affordability Causes Gender-Expansive Homelessness and Policy Recommendations to Ensure that Everyone is Housed
Get PDFTransgender, gender non-binary and gender-questioning people (gender-expansive) in the United States are more likely than their cisgender counterparts to experience housing precarity and homelessness. While this results from discrimination that limits our access to economic, social and political capital, it also results from a massive gap in the amount of affordable and adequate permanent housing available to all low-income members of our society.
When people are inevitably unable to exceed these barriers to rent or own permanent housing, they rely on the emergency shelter system. Despite a diligent and attentive emergency shelter workforce as well as abundant evidence demonstrating that emergency housing can help stabilize mental health, physical health and financial challenges, there is a systemic lack of funding to keep up with the need for emergency shelter beds. Compounded with incomplete antidiscrimination rules, the emergency shelter system does not serve the needs of low-income, gender-expansive people