Introduction: Exercise rehabilitation has previously been reported effective in attenuating numerous cancer treatment-related toxicities and enhancing the QOL of patients. Many cancer centers have responded to this by initiating group-based exercise instruction to cancer survivors. However, research from other chronic diseases indicates that an individualized approach is most effective at attenuating treatment related toxicities and maximizing quality of life. Therefore, the purpose of this investigation was to compare a group-based exercise program to individualized exercise on fitness parameters, QOL, and psychological measures.

Methods: 573 individuals who were currently undergoing cancer treatment participated in this investigation. Each group underwent a comprehensive fitness assessment and completed McGill QOL questionnaires at the start of their exercise training, and after 12-weeks of training. Compliance data was also measured for each group. Data was analyzed at the 0.05 level of significance using descriptive statistics.

Results: Exercise has a positive impact on fitness parameters for both groups. On average, the one-on-one exercise group experienced greater improvements in all measured parameters. Likewise, QOL improved for both groups, but to a greater extent in the group exercisers (p<0.05).

Conclusions: Based on these data, it appears as though exercise can improve fitness parameters during cancer treatment. The individualized, one-on-one approach was the most effective at improving fitness

Objectives: To assess how senior citizens followed Telephone CPR (T-CPR) instructions in a simulated cardiac arrest scenario. Methods: Twenty-two voluntary senior citizens were studied in a simulated cardiac arrest scenario following the instructions given to them by an Emergency Medical Dispatcher. The phone calls and the CPR performance were recorded and analyzed. Results: The rescuers reported that they had performed better than the analysis of video and phone call recordings showed. When asked after the scenario the rescuers felt that they had coped with the situation well 72% and quite well 28% of the cases. Every participant evaluated the given telephone CPR instructions as very easy to understand. 35% of the participants thought that performing CPR was physically quite easy. The unexpected result was the EMDs’ bad protocol compliance. Protocol was not strictly followed by the dispatchers. They gave more straight forward instructions without the full knowledge of the situation, than they should have. From the 12 analyzed instructions that the dispatchers should have given to the rescuer, only three instructions (give two deep rescue breaths, correct positioning of the rescuers arms and to compress 15 times) were totally as in the protocol. Conclusions: The quality of CPR given by the senior citizens was inadequate in this study. The EMDs had bad protocol compliance. Standardized and feasible T-CPR instructions by the dispatcher are not seen in this study, even if the rescuers stated that the instructions were clear and easy to understand

Rubinstein-Taybi Syndrome (RTS) is a rare autosomal dominant genetic disease characterized by growth deficiency, broad thumbs and great toes, intellectual disability and characteristic craniofacial appearance. Neurological manifestations of RTS include: seizures, primary brain tumors, cranio-spinal and posterior fossa anomalies. We describe a 21 year-old male with past medical history of congenital heart disease, kypho-scoliosis, intellectual disability, and global developmental delay. Neurological examination revealed spasticity with atrophic changes in all the extremities. Brain MRI was unremarkable and spinal MRI revealed multi-level degenerative changes in cervical spine with cervical spinal stenosis for which patient underwent C4-C6 laminectomy with postero-lateral fusion. In spite of de-compressive surgery, the spasticity persisted making RTS as the most likely etiology of spasticity. Patient spasticity was managed with baclofen and tizanidine. The goal of this case report is to extend our current knowledge on RTS and to define new international guidelines for diagnosis, care and treatment.

Patient dose normalization for optimal doses found in phase 1 clinical trials remains underutilized in Clinical Oncology. The Body Surface Area (BSA) is dominant despite its lack of rigor, apparent inadequacies and the frequent need for dose adjustment. The BSA method has been critiqued over the decades. In this paper, the use of In vivo body composition methods to determine fat mass and fat free mass are proposed, which would form the new basis for normalization of lipophilic and hydrophilic drugs. Issues relating to volume of distribution and drug clearance remain largely unknown, but at least the starting patient dose is expected to be better placed. Clinical trials are needed to justify both this approach and the BSA method

Background: Despite the close anatomical relationship between the pancreatic tail and left colonic flexure, large bowel obstruction due to pancreatic cancer is a rare condition.

Case presentation: We present two cases of large bowel obstruction due to pancreatic cancer.

Conclusion: In case of large bowel obstruction due to pancreatic cancer, an aggressive approach should be considered due to the nature of invasive pancreatic cancer in these cases with a palliative aim

This case report illustrates a patient with Heparin-Induced Thrombocytopenia (HIT) who was successfully treated with Apixaban. HIT is an adverse drug reaction induced by treatment with heparin. The optimal anticoagulation strategy remains uncertain. This case presents a patient who developed massive pulmonary embolisms post total knee replacement, she was then treated with low-molecular-weight heparin (LMWH), which lead to bleeding and a critically platelet count drop, indicating serious HIT 2 syndrome. By discontinuation of LMWH and switch to Apixaban in a modified dose regime, we managed to stop the life-threatening complications of LMWH. The platelet count recovered, and the patient survived.

By means of the formidable emergence of medical technology, the future role of the traditional clinician is called into question, because of the risk of becoming just a technician of operating devices, and progressively moving away from patients as individuals.

We present a case of a woman with progressive parkinsonistic features, and a previous history of breast cancer with no recurrence since 20 years.

Intravenous Urography (IVU) has been used in emergency departments for the evaluation of patients with acute renal and urinary tract colic. A non-contrast computed tomography (NCCT) is rapidly becoming the preferred imaging modality for the evaluation of patients with suspected renal colic. The purpose of this work is to investigate whether NCCT can replace IVU as the primary modality for the evaluation of patients with acute renal colic in radiology departments at four hospitals from the perspective of comprehensive diagnosis of both techniques. The methods employed in this study monitor and review the radiological investigation records of 520 patients with acute renal calculi who visited four hospitals between April 2016 and March 2017 and analyse the use of IVU and NCCT. Patients have been adopted based on their radiological examinations records for renal colic in four hospitals. NCCT showed a more comprehensive diagnosis and a short study time, whereas IVU indicated a lower radiation dose and better cost-effectiveness. An intravenous urogram (IVU) showed 81% sensitivity and 89% specificity, while non-contrast computed tomography (NCCT) had sensitivity and specificity of 95% and 97%, respectively. In conclusion, NCCT is highly sensitive and specific for renal and ureteral calculi but the challenges it faces are that CT examination generates higher radiation doses compared to examination by IVU, even when using a low radiation dose CT protocol

Purpose: Diabetes is an increasing and relevant public health problem due to the increasing prevalence and incidence. Despite the recommendations, a large proportion of patients do not achieve the desired level of glycemic control even after starting basal insulin. In the past years new therapeutic options have been made available, providing an alternative to insulin treatment initiation after the failure of oral therapy; for these reason, we performed an economic evaluation to estimate the impact on the Italian National Health Service (INHS) expenditure of treating with exenatide once weekly those patients for whom basal insulin would be the treatment of choice.

Patients and Methods: A budget impact model based on Italian data (drug market composition, healthcare resource use and costs) was developed as indicated by international guidelines.

Results: Hypothesizing a greater uptake of exenatide once weekly versus basal insulin’s, even considering the high cost of exenatide once weekly, the model estimates a relevant saving for INHS expenditure due to the reduction in use and related costs for consumables, outpatients and hospitalization. The reduction in healthcare expenditure is estimated at national level in €5.8 million the first year, €15.5 million the second year and €27.3 million the third.

Conclusions: The increased use of exenatide once weekly as a possible effective and safe treatment option in patient’s candidate to basal insulin, by reducing healthcare resource use as ospitalizations, outpatients and consumables, could be associated with a reduction in total healthcare expenditure in Italy.

Objective: We aimed to compare off-pump technique with on-pump technique on renal function in patients with non-dialysis-dependent renal dysfunction who underwent CABG.

Introduction: Preoperative non-dialysis-dependent renal dysfunction is a predictor of renal failure in patients undergoing CABG with CPB. Off-pump coronary revascularization has been shown to be less deleterious than on-pump bypass in patients.

Methods: The 94 patients with renal dysfunction undergoing isolated coronary artery bypass grafting were retrospectively analyzed. No patient was receiving dialysis. Patients were randomly assigned to conventional evascularization with CPB and beating heart. Both groups were compared in terms of renal dysfunction parameters and dialysis requirement. The logistic regression models were constructed to identify risk factors associated with dialysis requirement.

Discussion: Renal dysfunction requiring dialysis developed in 9 patients in the on-pump group. The measures analysis of variance was performed on the data that showed worsening of renal function in the on[1]pump group compared with the off-pump group. CPB is significant as independent predictor for the development of postoperative dialysis.

Conclusion: These results suggest that off-pump coronary revascularization offers a superior renal protection and has a significantly lower risk for renal complications in patients with non-dialysis-dependent renal dysfunction when compared with conventional coronary revascularization with CPB.

A recent cluster of patients presenting with idiopathic, severe, coagulopathy was reported in Illinois and traced to contaminated cannabinoids. The contaminating substance was determined to be brodifacoum, a potent, long acting, rodenticide that inhibits vitamin K dependent clotting factor production. Since the original reports from the Midwest, multiple additional cases have been reported in at least 11 states. Brodifacoum toxicity has now reached the proportions of a public health crisis. Patients can present with bruising, epistaxis, oropharyngeal and gum bleeding, excessive menstrual bleeding, hematemesis, hematuria, flank pain, or abdominal pain mimicking an acute abdomen. We present a case of brodifacoum toxicity that was rapidly reversed with parenteral Vitamin K and K-centra, four factor clotting concentrate. The use of intermittent prothrombin complex concentrates has the ability to control life threatening hemorrhage and is a potential important adjunctive treatment to minimize use of large doses of vitamin K.