How CAR-T Cell Therapy is Impacting Solid Tumor Cancer Research

By David Haas
Wednesday June 5, 2019

Treatment options available to cancer patients have both improved and grown over the past decade. The development of personalized medicine has enabled patients to seek a new route, tailoring their treatments specifically to their situations. One outcome of this unique treatment approach is the development of CAR-T (chimeric antigen receptor T) cell therapy (see: Taking Personalized Medicine to a New Level: CAR-T Cell Therapy). Continue reading “How CAR-T Cell Therapy is Impacting Solid Tumor Cancer Research”

Do Large Clinical Trials Adequately Consider Individual Patient Physiology? Debating The RELIEF Study

By Michael Keane, BMBS, FANZCA and Shashikanth Manikappa, MD, DNB, FANZCA
February 21, 2019

Patient safety requires a well-informed debate about the rationale of large, randomized controlled trials (RCTs) and whether, by their very nature, they can adequately consider the unique physiology of every individual patient. 

RCTs must be reproducible; the fundamental premise of any scientific experiment. In their day-to-day practice, clinicians must, therefore, be willing to reproduce the same treatment of individual patients’ physiology. If clinicians would treat individual patients (including physiological outliers) differently to that in which individual patients were treated in a trial, then that trial data becomes meaningless to their practice.  Continue reading “Do Large Clinical Trials Adequately Consider Individual Patient Physiology? Debating The RELIEF Study”

WAKE-UP Time for Thrombolysis in Acute Stroke?

By Martina McGrath, MD
October 30, 2018

MRI thrombolysis for stroke of unknown time of onset

Current clinical guidelines recommend thrombolysis in acute stroke where patients present within 4.5 hours of onset of symptoms. However, for up to a quarter of patients, the time of symptom onset is unknown as they wake from sleep with neurological deficits.1 Such patients frequently do not meet criteria for therapies such as thrombolysis or mechanical thrombectomy.

Prior studies have suggested a particular pattern may be seen on an MRI of the brain in the early hours following stroke onset; a visible ischemic lesion on diffusion-weighted imaging along with the lack of a hyperintense signal in the same area on fluid-attenuated inversion recovery (FLAIR). The benefit of aggressive stroke intervention in patients with the combination of unknown time of symptom onset and this particular signal mismatch on MRI brain scans is unknown. Continue reading “WAKE-UP Time for Thrombolysis in Acute Stroke?”

Worldwide Trends in HIV Vaccine: Are We There Yet?

By Olivier Lucar
October 16, 2018

Chronic HIV infection remains a major public health issue. According to 2017 data from UNAIDS, there are still 36.9 million HIV-positive individuals worldwide, including 1.1 million in the USA, of whom 1 in 7 are unaware of their status. HIV infection usually has a slow and paucisymptomatic infectious development, which makes recognition of infection difficult and leads to its persistence. HIV disproportionately affects individuals in less developed countries and can only be treated with multiple expensive drugs, the availability of which depends on the country. Furthermore, despite the phenomenal progress in anti-HIV drug efficacy (leading to sustained undetectable levels of viral load), long-term infection and treatment are associated with other comorbidities from cardiovascular diseases to certain cancers (Taiwo et al., 2013). The search for therapeutic or prophylactic vaccines remains the best option to fight HIV and prevent its permanent development. Continue reading “Worldwide Trends in HIV Vaccine: Are We There Yet?”

Restrictive versus Liberal Fluid Therapy in Abdominal Surgery

By Connor Emdin
August 28, 2018

Abdominal surgery can result in significant fluid loss, arising from multiple sources, including fasting prior to surgery, evaporation during surgery, from blood loss and from other sources.1 Traditionally, individuals undergoing abdominal surgery received liberal fluid resuscitation (up to 7L on the day of surgery) which frequently exceeded their losses and led to weight gain of 3-6kg.2 Excessive fluid loading can lead to elevated rates of postoperative heart failure, arrhythmias, and wound infection due to local tissue edema, and in small clinical trials, restrictive hydration strategies (targeting net zero fluid balance) have been associated with fewer complications than liberal fluid replacement.3 Consequently, clinical guidelines now recommend more restrictive fluid therapy for abdominal surgery.4,5 Continue reading “Restrictive versus Liberal Fluid Therapy in Abdominal Surgery”

Epinephrine in Out-Of-Hospital Cardiac Arrest: Increased Survival but at What Cost?

By Martina McGrath, MD
August 8, 2018

It is estimated that 1 in every 7.5 people in the US will die of sudden cardiac death.1 Survival following out-of-hospital cardiac arrest has increased in recent years, from 10.2% in 2006, to 12.4% in 2015.1 However, only 9% of those surviving to hospital discharge were classified as having good functional status. Therefore, significant long-term neurologic impairment is a common outcome of cardiac arrest. Continue reading “Epinephrine in Out-Of-Hospital Cardiac Arrest: Increased Survival but at What Cost?”

Cervical Cancer Screening Using HPV Testing Alone: Are We There Yet?

By Martina McGrath, MD
July 18, 2018

Although the overall incidence of cervical cancer is decreasing, it is estimated that over 200,000 women are living with cervical cancer in the US, and it is expected to lead to over 4,000 deaths in 2018.1 Cervical cancer is predominantly caused by infection of the cervical mucosa with human papilloma virus (HPV), particularly by several pro-oncogenic subtypes. Multiple HPV genotypes can infect the genital tract mucosa, but types 16 and 18 are responsible for the majority of cervical cancers. HPV infection is highly prevalent in sexually active young woman, and the majority will clear the infection within 8–24 months.2 Although cleared, HPV infection can lie dormant for prolonged periods. It can recur and be detected again decades later, mandating the need for cervical screening throughout a patient’s lifetime.3 In addition, observational data indicates that the relative risk of abnormal cervical cytology is markedly increased in those with persistent HPV infection, particularly where infection is with a high-risk type of HPV.2 Continue reading “Cervical Cancer Screening Using HPV Testing Alone: Are We There Yet?”

Dulaglutide in Type 2 Diabetes: Do GLP-1 agonists delay progression of diabetic nephropathy?

By Connor Emdin
June 27, 2018

Forty percent of patients with type 2 diabetes go on to develop chronic kidney disease (CKD).1 These patients are at markedly elevated risk of death from cardiovascular disease.2 They also suffer from reduced quality of life, particularly when CKD progresses to end-stage renal disease and dialysis.3 Despite the substantial morbidity and mortality associated with diabetic kidney disease, therapies are limited. In the National Kidney Foundation Clinical Practice Guidelines for Diabetes and CKD from 2012, only angiotensin converting-enzyme-inhibitors (ACE-inhibitors) and angiotensin-receptor blockers were recommended for protection of renal function in patients with CKD and diabetes with albuminuria.4 Continue reading “Dulaglutide in Type 2 Diabetes: Do GLP-1 agonists delay progression of diabetic nephropathy?”

Nitrofurantoin versus Fosfomycin for Acute Uncomplicated Cystitis

By Martina McGrath, MD
May 9, 2018

Acute uncomplicated cystitis is defined as infection localized to the bladder without signs of further extension such as fever, flank pain/tenderness, or systemic symptoms. It is a highly prevalent problem and over half of all women experience at least one urinary tract infection (UTI) in their lifetime.1 In otherwise healthy women, with normal urinary tract anatomy, treatment can commonly be instituted without the need for urine culture. Both nitrofurantoin and fosfomycin are currently recommended as first-line agents for treatment of uncomplicated cystitis. However, some older studies have suggested that fosfomycin may have inferior efficacy.2 Continue reading “Nitrofurantoin versus Fosfomycin for Acute Uncomplicated Cystitis”

Unraveling the Science Behind Personalized Diets and Low-Fat vs Low-Carb Genotypes

By Lea Borgi, MD
May 1, 2018

The Centers for Disease Control reports that almost 71% of adults over the age of 20 are overweight or obese, making obesity one of the most pressing concerns in public health.1 While dietary guidelines set recommended intakes of the various food groups,2 some data suggests that patients may lose weight more effectively when recommendations are tailored to certain genetic traits.3,4 Continue reading “Unraveling the Science Behind Personalized Diets and Low-Fat vs Low-Carb Genotypes”