Eltrombopag for advanced myelodysplastic syndromes or acute myeloid leukaemia and severe thrombocytopenia (ASPIRE): a randomised, placebo-controlled, phase 2 trial

In this study (ASPIRE), we aimed to assess eltrombopag, an oral thrombopoietin receptor agonist, for thrombocytopenia (grade 4) treatment in adult patients with advanced MDS or AML. Methods ASPIRE consisted of an open-label, double-blind phase for 8 weeks and a randomised, double-blind phase (parts 1 and 2, reported here) for 12 weeks, and an open-label extension (part 3). Eligible patients were men and women aged 18 years or older, with intermediate-2 or high-risk MDS or AML, with bone marrow blasts of 50% or less, and had either grade 4 thrombocytopenia due to bone marrow insufficiency (platelet counts <25 × 109 per L) or grade 4 thrombocytopenia before platelet transfusion, with 25 × 109 platelets per L or greater after transfusion. Additionally, eligible patients had at least one of the following within the screening period of 4 weeks: platelet transfusion, symptomatic bleeding, or platelet count of less than 10 × 109 per L. During part 1, patients received eltrombopag, and dose-escalation criteria for part 2 were determined. In part 2, we randomly allocated patients 2:1 using an interactive voice-response system to eltrombopag or placebo, stratified by baseline platelet count (<10 × 109 platelets per L vs ≥10 × 109 platelets per L) and disease (MDS vs AML). In parts 1 and 2, patients received supportive standard of care and initiated eltrombopag or placebo at 100 mg per day (50 mg per day for patients of east-Asi...
Source: The Lancet Haematology - Category: Hematology Source Type: research

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Introduction: The United States federally mandated reporting of venous thromboembolism (VTE), defined by Agency for Healthcare Research &Quality Patient Safety Indicator 12 (AHRQ PSI-12), is based on administrative data, the accuracy of which has not been consistently demonstrated. We used IDEAL-X, a novel information extraction software system, to identify VTE from electronic medical records and evaluated its accuracy. Methods: Medical records for 13,248 patients admitted to an orthopedic specialty hospital from 2009 to 2014 were reviewed. Patient encounters were defined as a hospital admission where both surgery...
Source: Medical Care - Category: Health Management Tags: Online Article: Applied Methods Source Type: research
RHEUMATOID arthritis is a type of joint pain condition that affects about 400,000 people in the UK. What is the condition, and what are the signs to look out for? This Morning ’s Dr Chris reveals the symptoms of the autoimmune condition.
Source: Daily Express - Health - Category: Consumer Health News Source Type: news
Objective: For patients with gastroparesis, temporary pyloric disruption has been shown to improve symptoms and gastric emptying. Per-oral pyloromyotomy (POP) is an innovative endoscopic procedure to divide the pylorus from within a submucosal tunnel, as a corollary to surgical pyloromyotomy. Here we evaluate subjective and objective outcomes 12-weeks after POP at a high volume center. Methods: The first 100 consecutive patients undergoing POP were included, with procedure dates between January 2016 and October 2017. Patients were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and 4-hour solid-phase ...
Source: Annals of Surgery - Category: Surgery Tags: Papers of the 138Th ASA Annual Meeting Source Type: research
Objective: Our objective was to identify the postoperative risk associated with different timing intervals of repair. Background: Timing of carotid intervention in poststroke patients is widely debated with the scales balanced between increased periprocedural risk and recurrent neurologic event. National database reviews show increased risk to patients treated within the first 2 days of a neurologic event compared to those treated after 6 days. Methods: Utilizing Vascular Quality Initiative data, all carotid interventions performed on stroke patients between the years 2012 and 2017 were queried. Patients were then ...
Source: Annals of Surgery - Category: Surgery Tags: Papers of the 138Th ASA Annual Meeting Source Type: research
Conclusion: Although use of RA techniques in geriatric trauma patients with multiple rib fractures was associated with higher MED, opioid use decreased after RA initiation and Acute Pain Service consultation, and the risk of delirium was lower.
Source: Annals of Surgery - Category: Surgery Tags: Papers of the 138Th ASA Annual Meeting Source Type: research
Typical food store in Brazzaville, Congo. Credit: WHOBy Adelheid Onyango and Bibi GiyoseBRAZZAVILLE, Congo, Aug 14 2018 (IPS)When faced with a crisis, our natural reaction is to deal with its immediate threats. Ateka* came to the make-shift clinic with profuse diarrhoea: they diagnosed cholera. The urgent concern in the midst of that humanitarian crisis was to treat the infection and send her home as quickly as possible. But she came back to the treatment centre a few days later – not for cholera, but because she was suffering from severe acute malnutrition. Doctors had saved her life but not restored her health. And...
Source: IPS Inter Press Service - Health - Category: International Medicine & Public Health Authors: Tags: Africa Development & Aid Environment Food & Agriculture Headlines Health Humanitarian Emergencies Population Poverty & SDGs Source Type: news
Pneumonia is a common cause of respiratory infection, accounting for more than 800,000 hospitalizations in the United States annually. Presenting symptoms of pneumonia are typically cough, pleuritic chest pain, fever, fatigue, and loss of appetite. Children and the elderly have different presenting features of pneumonia, which include headache, nausea, abdominal pain, and absence of one or more of the prototypical symptoms. Knowledge of local bacterial pathogens and their antibiotic susceptibility and resistance profiles is the key for effective pharmacologic selection and treatment of pneumonia.
Source: Primary Care: Clinics in Office Practice - Category: Primary Care Authors: Source Type: research
Angela Tuffnell, 57, from Cheshire, spent years battling varicose veins hidden inside her pelvis, leaving her in pain so excruciating she could barely stand and would even pass out.
Source: the Mail online | Health - Category: Consumer Health News Source Type: news
Publication date: Available online 13 August 2018Source: The LancetAuthor(s): Peter Kranke, Stephanie Weibel
Source: The Lancet - Category: General Medicine Source Type: research
This study is registered with the ISRCTN registry, number ISRCTN29654603.FindingsBetween May 13, 2014, and Sept 2, 2016, 201 women were randomly assigned to the remifentanil PCA group and 200 to the pethidine group. One participant in the pethidine group withdrew consent, leaving 199 for analyses. The proportions of epidural conversion were 19% (39 of 201) in the remifentanil PCA group and 41% (81 of 199) in the pethidine group (risk ratio 0·48, 95% CI 0·34–0·66; p
Source: The Lancet - Category: General Medicine Source Type: research
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