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Palliative care emergencies are emergencies in patients with an incurable disease that may lead to death or decreased quality of life. During the palliative care phase of a patient's life, they differ from other medical emergencies and are mainly focusing on symptom control, whereas disease-oriented treatments are less important. Palliative care emergencies can occur on the physical, emotional, and existential field. They involve not only the patient but also the family and sometimes the health care professional. Palliative care emergencies that are addressed are pain, acute dyspnea, major bleeding, acute function loss, acute anxiety, delirium, epileptic seizures, acute decompensation with aggressive behavior of the nonprofessional caregiver, and planning for predictable emergencies. [ABSTRACT FROM AUTHOR]

The incidence, prevalence, and treatment of anemia (hemoglobin [Hb] <12 g/dl) in women with breast cancer and gynecologic cancer were evaluated using data from the European Cancer Anemia Survey (ECAS). Adult patients with newly diagnosed treated or untreated disease, persistent/recurrent disease, and disease in remission were enrolled and followed for up to six chemotherapy cycles or six evaluation points within a 6-month period. At enrollment, 30.4% of breast cancer patients and 49.1% of gynecologic cancer patients were anemic. A significant correlation was shown between low Hb level and poor performance status (World Health Organization criteria) at enrollment for both breast cancer and gynecologic cancer patients. In all, 62.4% of breast cancer patients and 81.4% of gynecologic cancer patients were anemic at some time during the survey. The incidence of anemia, determined in a carefully defined population, was 59.8% for breast cancer patients and 74.8% for gynecologic cancer patients. Despite the high prevalence and incidence of anemia, only 26.3% and 42.7% of patients in the respective groups received anemia treatment. In breast cancer patients, the mean Hb trigger was 10 g/dl for epoetin treatment and 8.6 g/dl for transfusion; corresponding values for gynecologic cancer patients were 10.1 g/dl and 9.1 g/dl. Logistic regression analyses in the overall ECAS population identified five factors as significant and suitable predictors of anemia: lower initial Hb, having lung or gynecologic cancer versus gastrointestinal/colorectal cancer, any other cancer versus gastrointestinal/colorectal cancer, treatment with platinum chemotherapy, and being female. The ECAS data highlight the need for greater awareness of the adverse impact of anemia on cancer patients and for optimal anemia management to ensure maximal patient quality of life. [ABSTRACT FROM AUTHOR]

An epidemiological study of human T-lymphotropic virus type 1 (HTLV-1) and syphilis has been carried out in a multiethnic community of seven neighbouring villages located in eastern Gabon on 1240 subjects over 5 years old (82.7% of the population in this age range). Antibodies to HTLV-1 (anti-HTLV-1) were detected by ELISA with confirmation by Western Blot and antibodies to syphilis by Venereal Diseases Research Laboratory assay with confirmation by the Treponema pallidum haemaglutination assay. The prevalence rate of anti-HTLV-1 was 8.5% and increased from 3.7% in the 5-14 years age group to 23.8% in the over 60 years age group. Logistic regression showed that the positivity for anti-HTLV-1 was associated with age, ethnic group and sex (higher prevalence in females). The seroprevalence rate of syphilis was 8.2%. Seropositivity for syphilis and HTLV-1 were related but age was a confounding variable in this relationship. This study showing a highly heterogeneous distribution of HTLV-1 in a geographically limited area suggests the role of environmental and behavioural factors in HTLV-1 transmission. [ABSTRACT FROM AUTHOR]

Background: Drugs for symptom control in the terminal phase of palliative patients may be used in pump systems. Objective: To investigate the compatibility and stability of solutions of morphine hydrochloride, haloperidol, metoclopramide hydrochloride, atropine sulphate, butylhyoscine bromide and ranitidine hydrochloride, which may be used together under such circumstances. Method: Solutions of the drugs were exposed to ambient light at a temperature of 20±5 °C and±31 °C for 24 h and 7 days and the solutions studied by ultraviolet spectrophotometry. Results: The combination of haloperidol or metoclopramide hydrochloride with different concentrations of morphine hydrochloride seemed to be compatible and stable. The concentration of atropine sulphate or butylhyoscine bromide could not be determined by the study method, but morphine hydrochloride seemed to be stable. The combination of ranitidine hydrochloride and morphine hydrochloride showed a change in colour after 7 days. Conclusion: The results suggest that the combination of different concentrations of morphine hydrochloride with haloperidol, metoclopramide hydrochloride, atropine sulphate, butylhyoscine bromide or ranitidine hydrochloride do not affect their stability when stored for 7 days up to 30 °C under the influence of ambient light. However, more robust stability-indicating methods are required to confirm these results. The proposed method is more useful for identifying combinations that are clearly incompatible than to identify those that are compatible. [ABSTRACT FROM AUTHOR]

Interferon (IFN) alpha and gamma were measured by radio-immunoassays in supernatants from cultures of peripheral blood mononuclear cells (PBMC) or purified T cell subsets Incubated with either Plasmodium falciparum schizont-enriched malaria antigen (mAg). uninfected red blood cells (RBC) or pokeweed mitogen (PWM). Cell donors were 24 clinically immune, healthy African adult native residents ofa P, fatciparum-endemlc region. Haut-Ogooué. Gabon, and seven non-immune, European temporary residents with a history of a single to a few malaria infections during the previous 1 to 9 months. When PBMC were cultured in medium alone or with RBC antigen no or low titres of IFN-γ were detected. PBMC proliferation and IFN-γ production observed in the presence of mAg were dose dependent and significantly correlated. When cultured with mAg, PBMC from nonimmune Europeans produced significantly higher levels of IFN-γ than did PBMC from clinically immune Africans. No such difference was found when PBMC were cultured with PWM. The mAginduced IFN-γ production was due mainly to CD4+ T cells and was not enhanced by CD8+ T cell depletion. No IFN-α was detected in culture supernatants. Thus. P. falciparum antigens are able to induce in vitro production of IFN-γ by CD4+ T cells; however, in this sample, individuals considered to be clinically resistant to malaria were low producers of IFN-γ. [ABSTRACT FROM AUTHOR]

Introduction: ECT is an effective treatment for depression. Beyond its therapeutic effect on mood it has a unique impact on psychomotor and cognitive symptoms. Its mechanism of action remains still unclear. To investigate this, we set out to study the brain's response to ECT from a large-scale brain-network perspective. Objectives: The aim of this study was to investigate changes in resting-state functional connectivity following ECT at the whole brain, between-network and within-network level, in patients with a depressive episode. Methods: Resting-state FMRI data were collected from 17 patients with depression before and after an ECT course. Using a group independent component analysis approach, we focused on four networks that are known to be affected in depression: the salience network (SN), default mode network (DMN), cognitive executive network (CEN) and a subcortical network (SCN). Clinical measures including mood, cognition and psychomotor symptoms were assessed. Results: ECT increased connectivity of the left CEN with the left angular gyrus and left middle frontal gyrus. An increase in left CEN within network connectivity was observed. Both the right CEN and the SCN showed increased connectivity with the precuneus. Furthermore, the anterior DMN showed increased connectivity with the left amygdala. Finally, improvement of psychomotor retardation was positively correlated with an increase of within-posterior DMN connectivity. Conclusions: We demonstrate that ECT induces a significant increase of connectivity at both the whole brain and withinnetwork level. Furthermore, we provide first evidence on the association between an increase of within posterior DMN connectivity and an improvement of psychomotor retardation, a core symptom of depression. [ABSTRACT FROM AUTHOR]

Introduction: ECT has a powerful immunomodulatory function. A way to bridge the gap between immunomodulation and ECTs' therapeutic efficacity in depression could be ECT-induced neuroplasticity, as proinflammatory cytokines like IL-6 and TNFalpha tend to decrease after an ECT cure and are implicated in hippocampal neurogenesis, important for the antidepressant effect. I Objectives: To examine the immunomodulatory effect of ECT and analyze whether the hippocampal volumetric changes in depressed patients treated with ECT are related to changes in IL-6 and TNFa levels. Methods: Plasma levels of IL-6 and TNFa as hippocampal volume by magnetic resonance imaging were analyzed before and after an acute ECT course in respectively a total sample of 62 and a sub sample of 14 patients. Mood changes were assessed 1 week before and after ECT with the Hamilton Depression Rating Scale. Results: Participants showed a significant improvement of mood after ECT (p < 0.0001). We observed a significant decrease of IL-6 levels (p<0.05). A significant volume increase of the hippocampus was found (p< 0.001). We did notice a significant negative correlation between IL-6 difference scores and the percentage change in hippocampal volumes (r = -0.8, p < 0.01) . We found no significant correlation between changes in mood and volumetric nor inflammatory variables. Conclusions: Our findings support the immunomodulatory effects of ECT and an association between a volumetric increase of the hippocampus and lower levels of IL-6. These findings suggest that ECTs neuroplastic effect may be mediated by its immunomodulating functions, but the clinical relevance of this biological phenomenon remains uncertain. [ABSTRACT FROM AUTHOR]

Focuses on the cause of the discoloration of the skin due to the treatment of docetaxel treatment. Description on the changes of the skin color; Examination on the effect of treatment; Result in the hyperpigmentation of the skin.

Introduction The current psychopharmacological and psychotherapeutic treatment strategies are not successful in all subtypes of Major Depressive Disorder (MDD). Electroconvulsive therapy (ECT) has an important role in the treatment of the melancholic subtype of MDD. We are however currently not able to accurately predict the response to ECT. Earlier studies suggested a role for psychomotor retardation and agitation, but included only small numbers of patients and often made no distinction between psychomotor retardation and agitation. Objectives Our project will validate psychomotor retardation and agitation as prognostic factors for ECT-response. This will help us to optimalize treatment of the severely depressed patient. Methods 50 unipolar and bipolar depressive ECT-candidates will be evaluated with the CORE Assessment of Psychomotor Functioning (CORE) <1 week before starting ECT. A score on the different subscales will be registrated. The Hamilton Rating Scale for Depression (HAM-D) will be scored < 1 week before starting ECT and weekly after start of ECT to guide treatment. Within a week from the last treatment, the definitive HAM-D score will be registered. Patients can be classified as non-responders (<50% lower HAM-D score), responders (>50% lower HAM-D score) or as being in remission (HAM-D ≤ 7). Results Patients are currently recruited. Patients with more severe psychomotor disturbance seem to respond better to treatment with ECT (more response, remission). Further analysis of the score on CORE-subscales has to be executed. Conclusions We carefully conclude that psychomotor disturbance assessed by CORE, is a good predictor of response to ECT. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. Clinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). Remission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. The evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex- specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not. • Sex should be recognized as an important variable in research. • Sex-specific analyses of data may add to personalized application of ECT. • This large GEMRIC study examined sex-specific effects on ECT outcome. • We found no difference in effectivity of ECT between women and men. • A shorter duration of index episode was a sex-specific predictor for remission in women. [ABSTRACT FROM AUTHOR]

The article focuses on the clinical practice guidelines for the treatment of anemia identified in cancer patients relative to the use of erythropoiesis-stimulating agents (ESAs). It mentions that cancer patients with anaemia must be assessed with particular focus on blood examination which involves C-reactive proteins and ferritin levels. It highlights the use of ESAs as treatment for anemia in cancer patients wherein the causes of anemia must be considered before the ESAs could be utilized.

The article reviews the influence of nutritional status on the anti-cancer effect of chemotherapy. It examines the association between malnutrition and negative cancer treatment outcomes. The influence of anti-cancer treatment on body function and the influence of malnutrition on body function are explored. The article also investigates the interaction of vitamins, trace elements and micronutrients and chemotherapy.

The article offers clinical information on cancer pain. The pathophysiology of pain is explained, including nociceptive and neuropathic pain. A discussion on the different pain modulating receptors is presented, particularly opioid and cannabinoid. The article also sites the factors that should be considered when dealing with cancer pain.

Introduction: Electroconvulsive therapy (ECT) is an evidence-based treatment for difficult-to-treat depression, in which an electrical stimulus is applied via right unilateral (RUL) (Fig 1) or bitemporal (BT) electrodes (Fig 2). Current guidelines recommend to start ECT with RUL placement, except for cases where rapid response is needed. BT ECT has the reputation of exerting a stronger and faster antidepressive effect, but is associated with more pronounced cognitive side effects, as compared to RUL ECT. Recent studies, however, suggest comparable outcomes. In patients responding to ECT, most of the improvement in depressive symptom severity is witnessed early in the treatment course. In case of non-response, it is common practice to switch from RUL to BT electrode placement, although scientific evidence is lacking. As an answer to this research gap, the ChaT-trial was designed: a randomized controlled trial (RCT) to address which treatment strategy (either continue RUL ECT or switch to BT ECT) speeds up recovery with the least impact on cognitive function, in case of early non-response after 4 ECT sessions. Objectives: 1) To compare the antidepressant efficacy and cognitive effects of continuing RUL ECT vs switching to BT ECT. 2) To assess group and subject-specific trajectories of depressive symptom severity and neurocognitive performance during the acute ECT course and up to 3 months post-treatment. Methods: This multi-center double-blind RCT includes adult patients with a uni- or bipolar depression. In case of non-response (<50% decrease of IDS-CR score (Inventory of Depressive Symptomatology-Clinician Rated)) after 4 sessions of brief-pulse high-dose RUL ECT, patients are randomized to either continue RUL ECT, or switch to brief-pulse moderate dose BT ECT until remission. Depressive symptoms are assessed by IDS-CR, Psychotic Depression Assessment Scale (PDAS) and CORE assessment of psychomotor change. An extensive neuropsychological test battery is used to assess different domains of cognitive functioning, e.g., autobiographical memory using the Colombia University- Autobiographical Memory Interview Short- Form (CU-AMI-SF)(Fig 3). Results: Our hypotheses are: (1) continuing RUL ECT is non-inferior to switching to BT ECT in terms of depressive symptom severity, and (2) continuing RUL ECT is superior to switching to BT ECT in terms of cognitive side effects. Image: Image 2: Conclusions: The ChaT-trial is the first RCT comparing antidepressant efficacy and cognitive effects of continuing RUL ECT with switching to BT ECT in case of early non-response during an acute ECT-course. The results may optimize clinical decision making, speeding up recovery, while minimizing cognitive side effects. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]