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Hudock NL, Kshir SA, Taylor KF. Post-traumatic Stress Disorder as an Independent Risk Factor for Increased Opioid Use Following Carpal Tunnel Surgery. Hand (N Y) 2024; 19:1012-1018. [PMID: 36959761 PMCID: PMC11342694 DOI: 10.1177/15589447231160207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Carpal tunnel release (CTR) is one of the most common hand surgeries. Studies have highlighted a mental-physical connection to hand pathologies and psychological connections to postoperative pain burden. Post-traumatic stress disorder (PTSD) has been identified as a medical-psychological comorbidity like other mental health disorders such as generalized anxiety disorder (GAD). There remains a gap in the literature regarding PTSD as a comorbidity for hand surgeries, where there is this mental-physical connection. We hypothesize PTSD will be associated with increased risk of postoperative pain, evidenced by greater prevalence of opioid usage. METHODS The authors performed a retrospective analysis using the TriNetX Research Database. Patients who underwent elective CTR were identified within the database. Two groups were created and compared against individual controls: the first was identified based on the diagnosis of PTSD, and the second was identified based on the diagnosis of GAD. Cohorts were matched and opioid usage was compared postoperatively. RESULTS Patients with PTSD who underwent CTR were found to be at significantly increased risk of postoperative opioid use (P = .033) and more likely to present to the emergency department (ED) (P = .001). Patients with GAD were found to be significantly less likely to require postoperative opioids (P = .040). CONCLUSIONS We found patients with PTSD to be at increased risk of opioid use and more likely to present to ED following CTR. Patients with GAD were found to be at decreased risk of opioid use after CTR. Owing to the independent significant risks not found in GAD, further research of postoperative pain in patients with PTSD is needed.
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Affiliation(s)
- Nicholas L. Hudock
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - Sean A. Kshir
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - Kenneth F. Taylor
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
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Özmen D, Alpaydın DD, Saldoğan MA, Eşkazan AE. A safety review of tyrosine kinase inhibitors for chronic myeloid leukemia. Expert Opin Drug Saf 2024; 23:411-423. [PMID: 38484148 DOI: 10.1080/14740338.2024.2331190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Since the introduction of first tyrosine kinase inhibitor (TKI) imatinib, the treatment of chronic myeloid leukemia (CML) has reached excellent survival expectancies. Long survival rates bring about issues regarding TKI safety. AREAS COVERED The aim of this review is to compare the side effects of current TKIs both in the first and later lines and outline a safety andprofile of CML treatment. Seminal studies on TKIs and other newer drugs and extended follow-up of these studies; real-life data of each drug were usedduring the course of this. PubMed was used as a search database and onlyarticles in English were included. EXPERT OPINION With longer follow-up CML patients, resistant slowgrade adverse events seem to be the major obstacle in the way of treatmentefficacy. If efficacy is the priority, vigorous treatment of side effect and administration of full dose TKI are reasonable. But when treatment goals are reached, dose modifications or alternative treatment regimens may be acceptedpossible. More studies are needed on dose modification protocols and potential benefits and safety of treatment-free remission.
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Affiliation(s)
- Deniz Özmen
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Duygu Demet Alpaydın
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Hoying D, Dorney I, Otteson T, Thuener J, Kaelber DC. Assessing the Association Between Head and Neck Cancer and Granulomatosis with Polyangiitis. EAR, NOSE & THROAT JOURNAL 2024:1455613231223409. [PMID: 38321643 DOI: 10.1177/01455613231223409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Objective: To determine the odds of head and neck cancer (HNC) in patients with a concurrent or prior diagnosis of granulomatosis with polyangiitis (GPA). Methods and Materials: The TriNetX Analytics Network, a federated research platform that aggregates de-identified electronic health record data of over 130 million patients worldwide, was queried for patients with at least one ICD-10 encounter diagnosis of GPA. Patients within this group with an encounter diagnosis of cancer of the sinonasal, oral cavity, oropharynx, nasopharynx, and larynx concurrent or after the initial encounter diagnosis of GPA were recorded and compared to a standardized control population to determine odds ratios with a 95% confidence interval (CI). Relevant confounding variables, including human papillomavirus, Epstein Barr virus, tobacco, and alcohol exposure, were balanced between cohorts by 1:1 propensity matching. Results: Of the patients in the GPA cohort, 126 (0.48%) had an ICD-10 diagnosis of HNC. When stratifying by head and neck subsites, 20 (0.08%), 18 (0.07%), 23 (0.09%), 70 (0.27%), and 22 (0.084%) GPA patients had an ICD-10 encounter diagnosis of cancer involving the sinonasal, nasopharynx, larynx, oral cavity, and oropharynx. When comparing the experimental GPA group with the standardized control population after matching, patients in the GPA group had 1.3 times (95% CI: 1.03-1.175) greater odds of HNC when including cases diagnosed after or concurrently with the diagnosis of the vasculitis. There was no statistical difference in the odds of cancer at each anatomical subsite between the GPA and control cohort after matching. Conclusion: Our study identifies a statistically significant increase in the odds of HNC encounter diagnoses in patients with GPA.
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Affiliation(s)
- David Hoying
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ian Dorney
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Todd Otteson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jason Thuener
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David C Kaelber
- Department of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
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Sun S, Qin J, Liao W, Gao X, Shang Z, Luo D, Xiong S. Mitochondrial Dysfunction in Cardiotoxicity Induced by BCR-ABL1 Tyrosine Kinase Inhibitors -Underlying Mechanisms, Detection, Potential Therapies. Cardiovasc Toxicol 2023; 23:233-254. [PMID: 37479951 DOI: 10.1007/s12012-023-09800-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/08/2023] [Indexed: 07/23/2023]
Abstract
The advent of BCR-ABL tyrosine kinase inhibitors (TKIs) targeted therapy revolutionized the treatment of chronic myeloid leukemia (CML) patients. Mitochondria are the key organelles for the maintenance of myocardial tissue homeostasis. However, cardiotoxicity associated with BCR-ABL1 TKIs can directly or indirectly cause mitochondrial damage and dysfunction, playing a pivotal role in cardiomyocytes homeostatic system and putting the cancer survivors at higher risk. In this review, we summarize the cardiotoxicity caused by BCR-ABL1 TKIs and the underlying mechanisms, which contribute dominantly to the damage of mitochondrial structure and dysfunction: endoplasmic reticulum (ER) stress, mitochondrial stress, damage of myocardial cell mitochondrial respiratory chain, increased production of mitochondrial reactive oxygen species (ROS), and other kinases and other potential mechanisms of cardiotoxicity induced by BCR-ABL1 TKIs. Furthermore, detection and management of BCR-ABL1 TKIs will promote our rational use, and cardioprotection strategies based on mitochondria will improve our understanding of the cardiotoxicity from a mitochondrial perspective. Ultimately, we hope shed light on clinical decision-making. By integrate and learn from both research and practice, we will endeavor to minimize the mitochondria-mediated cardiotoxicity and reduce the adverse sequelae associated with BCR-ABL1 TKIs.
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Affiliation(s)
- Sheng Sun
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Medical Oncology, Hospital of Chengdu University of Traditioanal Chinese Medicine, Chengdu, 610075, Sichuan Province, China
| | - Jiqiu Qin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenhao Liao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Gao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhoubiao Shang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dehua Luo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shaoquan Xiong
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
- Department of Medical Oncology, Hospital of Chengdu University of Traditioanal Chinese Medicine, Chengdu, 610075, Sichuan Province, China.
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Lopez-Muñoz N, Hernández-Ibarburu G, Alonso R, Sanchez-Pina JM, Ayala R, Calbacho M, Cuellar C, Cedena MT, Jimenez A, Iñiguez R, Pedrera M, Cruz J, Meloni L, Pérez-Rey D, Serrano P, de la Cruz J, Martinez-Lopez J. Large-scale real-life analysis of survival and usage of therapies in multiple myeloma. J Hematol Oncol 2023; 16:76. [PMID: 37468911 PMCID: PMC10357768 DOI: 10.1186/s13045-023-01474-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
Survival in multiple myeloma has improved significantly in recent years, especially in young patients. We reviewed the evolution of the survival of patients with MM in three groups based on age at MM diagnosis over three time periods between 1999 and 2020 at our 12 de Octubre Hospital institution (H12O). Then, to confirm our results, we used data from TriNetx, a global health research platform that includes patients from Europe to US. Finally, we analysed differences in the patterns of treatment between networks across the world. Kaplan‒Meier analysis was used to estimate survival probabilities, and between-group differences were tested using the log-rank test and hazard ratio. For patients from H12O, the median OS was 35.61, 55.59 and 68.67 months for the 1999-2009, 2010-2014 and 2015-2020 cohorts, respectively (p = 0.0001). Among all patients included in the EMEA network, the median OS was 20.32 months versus 34.75 months from 1999-2009 versus 2010-2014. The median OS from the 2010-2014 versus 2015-2020 time cohorts was 34.75 months versus 54.43 months, respectively. In relation to the US cohort, the median OS from before 2010 versus 2010-2014 was not reached in either time cohort and neither when comparing the 2010-2014 versus 2015-2019 time cohorts. Bortezomib is the most commonly used drug in the EMEA cohort, while lenalidomide is the most commonly used drug in the US cohort. This large-scale study based on real-world data confirms the previous finding that MM patients have increased their survival in the last two decades.
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Affiliation(s)
- N Lopez-Muñoz
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | | | - R Alonso
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | - J M Sanchez-Pina
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | - R Ayala
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | - M Calbacho
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | - C Cuellar
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | - M T Cedena
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | - A Jimenez
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | - R Iñiguez
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain
| | - M Pedrera
- Data Science Group, Hospital 12 de Octubre, Madrid, Spain
| | - J Cruz
- Data Science Group, Hospital 12 de Octubre, Madrid, Spain
| | - L Meloni
- TriNetX Europe NV, Sint-Martens-Latem, Belgium
| | - D Pérez-Rey
- Biomedical Informatics Group, Universidad Politécnica de Madrid, Madrid, Spain
| | - P Serrano
- Data Science Group, Hospital 12 de Octubre, Madrid, Spain
| | - J de la Cruz
- Research Institute imas12, Hospital 12 de Octubre, Madrid, Spain
| | - J Martinez-Lopez
- Hematology Department, Hospital 12 de Octubre, CNIO, Complutense University, Madrid, Spain.
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