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Apixaban and rivaroxaban near approval for nonvalvular atrial fibrillation; fidaxomicin for C. difficile infections; guideline for intensive insulin therapy; and FDA Actions.
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The optimal standard salvage therapy for relapsed or refractory AML remains undetermined. The authors retrospectively compared two regimens at a single institution: CLAG (cladribine, high-dose cytarabine, and G-CSF) with MEC (mitoxantrone, etoposide, and cytarabine). These observational data without adjustment suggest CLAG may be superior to MEC. Nevertheless, outcomes for relapsed or refractory AML remain poor and clinical trials should be entertained when available.
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Among three distinct cohorts of lung cancer patients and matched controls (without tumor), the authors present data on the capacity for an assay that detects antibody to tumor-associated antigens to discriminate those with lung cancer and those without. Using a panel of six antigens, they found their assay to have sensitivity/specificity of approximately 40%/90%. If confirmed in an independent prospective study, such screening may be a very effective adjunct to imaging studies in the early recognition of lung cancer.
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Using the SEER database, data for patients with adenocarcinoma of the pancreas diagnosed in 1995-2005 were analyzed for the occurrence of suicide. As expected, the rates were higher than those reported for the general population, but among men, particularly those who were recovering from surgery, the mortality rate from suicide was 10 times greater than that of the general population. Care providers should be aware of this heightened risk and intervene as possible.
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Approximately 10% of patients with newly diagnosed acute myelogenous (AML) leukemia have a history of prior treatment with chemotherapy, radiation, or both (t-AML).
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A 58-year-old auto salesman was referred for initial management of metastatic pancreatic cancer. He had been well until approximately 3 months prior when he began to experience epigastric and mid-back pain.
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Escitalopram for menopausal hot flashes, rifaximin for IBS without constipation, herpes zoster vaccination, antiepileptics drugs and fracture risk, and FDA Actions.
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Myelodysplastic syndromes (MDS) usually occur in older adults and, as such, comorbid conditions are common. The investigators found that among 418 MDS patients, at least one comorbid condition existed in 93% at diagnosis. Comorbidity scores were generated using three common scoring systems: the HCT-CI, MDS-CI, and CCI. Worse survival was linked to higher CCI (p = 0.01) and MDS-CI (p = 0.02) but not HCT-CI. Higher CCI scores were associated with non-leukemic death and progression of red blood cell dependency, whereas higher comorbidity by HCT-CI and MDS-CI did not. Higher comorbid burden by CCI in MDS predicts for worse survival and non-leukemic death. Comorbidity data may help refine prognosis for MDS patients.
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Uric acid as a weak organic acid (pka 5.8) is poorly soluble at physiological pH.
