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Despite his growing knowledge of medicine and special access to care as a medical student and then a resident, a patient’s condition is repeatedly misdiagnosed, forcing him to be persistent and self-reliant.
Journal Article
2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer
Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at a high risk of VTE recurrence and bleeding during anticoagulant therapy. The International Initiative on Thrombosis and Cancer is an independent academic working group aimed at establishing a global consensus for the treatment and prophylaxis of VTE in patients with cancer. The International Initiative on Thrombosis and Cancer last updated its evidence-based clinical practice guidelines in 2016 with a free, web-based mobile phone application, which was subsequently endorsed by the International Society on Thrombosis and Haemostasis. The 2019 International Initiative on Thrombosis and Cancer clinical practice guidelines, which are based on a systematic review of the literature published up to December, 2018, are presented along with a Grading of Recommendations Assessment Development and Evaluation scale methods, with the support of the French National Cancer Institute. These guidelines were reviewed by an expanded international advisory committee and endorsed by the International Society on Thrombosis and Haemostasis. Results from head-to-head clinical trials that compared direct oral anticoagulant with low-molecular-weight heparin are also summarised, along with new evidence for the treatment and prophylaxis of VTE in patients with cancer.
Journal Article
Fedratinib for the treatment of myelofibrosis: a critical appraisal of clinical trial and “real-world” data
Fedratinib is a predominantly JAK2 inhibitor that has shown efficacy in untreated and ruxolitinib-exposed patients with myelofibrosis (MF). Based on randomized clinical trial data, it is approved for use in patients with International Prognostic Scoring System (IPSS) or Dynamic International Prognostic Scoring System (DIPSS) intermediate-2 or high-risk disease and is distinguished from ruxolitinib in that it can be administered without dose reduction in patients with thrombocytopenia, to a platelet count above 50,000/µL. In these trials, fedratinib achieved significant spleen volume reduction in ~30–45% of patients and improvement in total symptom scores in 35–40% with good tolerability. In contrast, recently published real-world data suggest that these responses may not be as robust outside clinical trials. In the context of routine clinical practice spleen responses are documented in only 13–68%, with varying degrees of symptom improvement. This may be due to the lack of a uniform definition of ruxolitinib failure, which may influence the timing of initiating fedratinib as a second-line treatment and result in a more prolonged exposure to ruxolitinib prior to intitaing fedratinib treatment. We suggest that given the growing number of drugs available for use in MF, recognizing the failure of first-line (and potentially subsequent) treatments is critical to allow timely transition to potentially more active agents, as highlighted by the data pertaining to fedratinib.
Journal Article
Tham Chiang Dao: A Hotspot of Subterranean Biodiversity in Northern Thailand
The Doi Chiang Dao massif, which became a UNESCO Biosphere Reserve in 2021, is the highest karst mountain in Thailand. Tham Chiang Dao cave is located at the foot of this massif and is among the best-known caves in Thailand, having been visited since prehistoric times, and being a sacred place for the local Shan and Thai people. The cave consists of five main interconnected passages with a total length of 5342 m which ranks it as the 11th longest cave in Thailand. Tham Chiang Dao is the best studied cave in Thailand with a long series of explorations, investigations and zoological collecting. Here, we summarize the 110 years of biological exploration and investigation devoted to this cave. A total of 149 taxa have been recognized in Tham Chiang Dao, of which 61 have been identified to species level. The cave is the type locality for 14 species. The obligate subterranean fauna includes 37 species, of which 33 are troglobionts and 4 are stygobionts. Conservation issues are addressed in the discussion. This work is intended to provide a reference for the knowledge of cave fauna of the Chiang Dao Wildlife Sanctuary and a tool for its management by the local cave management committee, the National Cave Management Policy Committee, and the Department of Mineral Resources. It also documents the biological importance of Tham Chiang Dao in the Doi Chiang Dao UNESCO Biosphere Reserve.
Journal Article
Patterns of Recurrent Thrombosis in Primary Antiphospholipid Syndrome—Multicenter, Real-Life Long-Term Follow-Up
Antiphospholipid syndrome (APS) is an acquired hypercoagulable condition associated with antiphospholipid antibody (aPL) presence. Data on re-thrombosis following APS-diagnosis are limited.
This is a retrospective analysis of new thrombotic events among primary APS (pAPS) patients followed for up to 15 years in three medical centers in Israel.
Among 312 primary-APS patients, 143 (46%) had new thrombotic event classified to three patterns: (1)
associated with heart valve disease (OR 7.24, 95% C.I. 2.26-24.6), hypertension (OR 3, 95% C.I. 1.44-6.25), elevated anti-B2-GPI IgM (OR 1.04, 95% C.I. 0.996-1.08), arterial thrombosis at presentation (OR 1.74 95% C.I. 0.992-3.26), and older age (41 vs. 34 years, p < 0.001). (2)
linked with venous thrombosis at presentation (OR 12.9, 95% C.I. 5.27-31.6, p < 0.001), heart valve disease (OR 9.81 95% C.I. 1.82-52.9, p = 0.018), aGAPSS (OR 1.15 95% C.I. 1.02-1.29), and younger age (31 vs. 36.5 years, p = 0.001); and (3)
-associated with heart valve disease (OR 40.5 95% C.I. 7.7-212) and pulmonary embolism (OR 7.47 95% C.I. 1.96-28.5). A 4th variant \"the Breakthrough pattern\" defined by re-thrombosis despite prophylactic therapy was observed in 100/143 (70%) patients and linked with heart valve disease (OR 8. 95% C.I. 2.43-26.3), venous thrombosis at presentation (OR 2.61 95% C.I. 1.47-4.66), leg ulcers (OR 12.2, 95% C.I. 1.4-107), hypertension (OR 1.99, 95% C.I. 0.92-4.34), and higher aGAPSS (OR 1.08, 95% C.I. 0.99-1.18).
In this real-life observation, re-thrombosis was common among pAPS patients including in those recommended to receive prophylactic therapy. Different patterns of recurrence were identified and linked with presenting symptoms, specific serological markers, APS manifestations, and comorbidities. Studies that will address interventions to prevent recurrences of APS-related events are needed.
Journal Article
Field Drying for Enhancing Biomass Quality of Eucalyptus Logs and Trees in Florida, USA
Field drying Eucalyptus biomass can minimize the storage requirements, transportation costs, and/or the cost associated with biomass drying for biochar and other products. In central Florida, 12 6-year-old and 12 8-year-old Eucalyptus amplifolia and Eucalyptus grandis trees were field dried over two seasons, with two months of field drying in each season, and two tree forms (logs, whole tree). The whole tree average initial moisture content (MCod) on a dry basis ranged between 115 and 121% in E. amplifolia and 116 and 119% in E. grandis. The season and duration of field drying affected drying, but species, tree size, and tree form did not. In southern Florida, 19 3+-year-old coppice stems of an E. grandis × Eucalyptus urophylla hybrid clone (EH1) were field dried over two months of one season, with and without tree tops. The whole tree initial MCod ranged between 119 and 138%. The duration of field drying affected drying, but tree size and tree tops did not. Both studies suggest that field drying can effectively reduce wood MC and thus enhance E. amplifolia, E. grandis, and EH1 biomass quality.
Journal Article