The comparison between oral arsenic plus imatinib and imatinib alone for the treatment of newly diagnosed chronic myeloid leukemia

A recent study has shown that the use of imatinib combined with arsenic realgar-indigo naturalis formula (RIF) as a first-line treatment for newly diagnosed chronic phase chronic myeloid leukemia (CP-CML) could potentially lead to a more effective achievement of a deeper molecular response when compared with imatinib as a standalone therapy. This study’s findings were published in the Journal of Cancer Research and Clinical Oncology. 
In this randomized, double-blind, multicentered phase III trial, 191 outpatients with newly diagnosed CP-CML were randomly assigned to receive oral RIF combined with imatinib (n = 96) or placebo combined with imatinib (n = 95). The primary end point of this study was the major molecular response (MMR) at six months. Secondary end points of this study included molecular response 4 (MR4), molecular response 4.5 (MR4.5), overall survival (OS), progression-free survival (PFS), and adverse events.

Baselines demographic data was well balanced between the two groups. The median duration of follow-up was 51 months. There was no significant difference in the rates of MMR between the combination and imatinib arms at 6 months (11.5% vs 12.6%; p = 0.828) or any other point throughout the trial. The 12-month cumulative rates of MR4.5 in the combination and imatinib arms were 20.8% and 10.5% (p = 0.043), respectively. In the core treatment with the two-year analysis, the frequency of MR4.5 was 55.6% in the combination arm compared to 38.6% (p = 0.063) in the imatinib arm. In both, combination arm and imatinib arm, the PFS (93.7% vs 95.8%; p = 0.546) and OS (92.3% vs 94.6%; p = 0.588) were similar at five years. Both groups exhibited similar safety profiles as well.

According to the above study, the combination of imatinib and RIF as a first-line therapy for CP-CML may potentially yield superior outcomes in terms of attaining a more profound molecular response, when compared to imatinib alone.
 

Transurethral surgery for benign prostatic hyperplasia with detrusor underactivity

According to a recent study, transurethral surgery can enhance the symptoms experienced by individuals with benign prostatic hyperplasia (BPH) and detrusor underactivity (DU). Additionally, surgical intervention offers benefits that surpass those of pharmacological approaches for BPH patients with DU. The results of this study were documented in the journal Systematic Reviews.
The search for relevant evidence involved three databases (Embase, PubMed, and Web of Science) from their inception to May 1, 2023. Different transurethral surgical procedures include photoselective vaporization of the prostate (PVP), transurethral incision of the prostate (TUIP), and transurethral prostatectomy (TURP). The efficacy of the surgical intervention was assessed according to international prostate symptom score (IPSS), maximal flow rate on uroflowmetry (Qmax), maximal detrusor pressure at maximal flow rate (PdetQmax), quality of life (QoL), postvoid residual (PVR), voided volume, and bladder contractility index (BCI). Mean differences from pooled data were utilized for comparison, while the quality of research studies was evaluated using the Newcastle-Ottawa Scale. Sensitivity analysis and funnel plots were utilized to identify potential biases. 
A total of 1142 patients were included from 10 different studies. For patients with BPH and DU, significant enhancements in IPSS (pooled MD, -14.29; 95% confidence interval, -16.67-11.90; P value < 0.05), Qmax (pooled MD, 4.79; 95% confidence interval, 2.43-7.16; P value < 0.05), QoL (pooled MD, -1.57; 95% confidence interval, -2.37-0.78; P value < 0.05), BCI (pooled MD, 23.59; 95% confidence interval, 8.15-39.04; P value < 0.05), voided volume (pooled MD, 62.19; 95% confidence interval, 17.91-106.48; P value < 0.05) and PdetQmax (pooled MD, 28.62; 95% confidence interval, 6.72-50.52; P value < 0.05) were noted within six months post-surgery. 
Additionally, significant improvements in IPSS (pooled MD, -13.76; 95% confidence interval, -15.17-12.35; P value < 0.05), Qmax (pooled MD, 6.75; 95% confidence interval, 4.35-9.15; P value < 0.05), PVR (pooled MD, -179.78; 95% confidence interval , -185.12-174.44; P value < 0.05), PdetQmax (pooled MD, 27.94; 95% confidence interval, 11.70-44.19; P value < 0.05), and QoL (pooled MD, -2.61; 95% confidence interval, -3.12-2.09; P value < 0.05) were observed after more than one year. When compared to DU patients who did not undergo surgery, those who did showed greater improvements in PdetQmax (pooled MD, -8.00; 95% confidence interval, -14.68-1.32; P value < 0.05) and PVR (pooled MD, 137.00; 95% confidence interval, 6.90-267.10; P value < 0.05). 
Thus, it can be concluded that BPH and DU symptoms can be improved through transurethral surgery. Additionally, surgical intervention offers benefits that are superior to pharmacological methods for BPH patients with DU.
 

Anemia Linked to Increased All-Cause Mortality in Critically Ill Patients Post-CRRT

Anemia frequently complicates the clinical course of critically ill patients undergoing continuous renal replacement therapy (CRRT). 
A recent retrospective cohort study examined the implications of anemia, characterized by the need for red blood cell (RBC) transfusions or erythropoiesis-stimulating agents (ESAs), on patient outcomes after discharge from the hospital. 
Utilizing data from the Health Insurance Review and Assessment database in South Korea, the study encompassed 10,923 adult patients who received CRRT for at least three days between 2010 and 2019 and were discharged alive.
The findings indicated that patients with anemia tended to be older, predominantly female, and had a higher prevalence of comorbid conditions compared to those without anemia. 
While anemia did not correlate with an increased risk of new-onset cardiovascular events (adjusted hazard ratio [aHR]: 1.05; 95% confidence interval [CI]: 0.85-1.29), it was significantly associated with a heightened risk of all-cause mortality (aHR: 1.41; 95% CI: 1.30-1.53). 
These results suggest that, for critically ill patients with acute kidney injury requiring CRRT, the presence of anemia may substantially elevate the long-term risk of mortality, highlighting the importance of monitoring and managing anemia in this vulnerable population.
 

Assessment of a combined mouthwash for alleviating pain in cases of pericoronitis

A recent study has shown that the use of both chlorhexidine mouthwash and combined mouthwash resulted in a notable increase in maximum mouth opening. However, there were no notable differences in efficacy observed between the two cohorts. The results of this study were documented in the BMC Oral Health journal. 
In this randomized clinical trial, forty-eight pericoronitis patients (average age of 21.56 yrs) were randomized into two groups. The control group was given a 0.12% chlorhexidine mouthwash, while the case group was provided with a mouthwash that contained Chlorhexidine, Nanosilver, Benzydamine, Amoxicillin, and Metronidazole. Visual Analog Scale (VAS) scores were monitored for seven days, and Maximum mouth opening (MMO) was measured at the beginning and after seven days. The data analysis was performed using SPSS v20.
The groups did not show any substantial variation in pain reduction. However, both groups experienced a decrease in pain and an improvement in Maximum mouth opening (MMO) following the treatment. There was a balanced gender distribution in both groups.
The above study demonstrated that both chlorhexidine mouthwash and combined mouthwash usage led to a marked improvement in maximum mouth opening. However, there were no substantial variations in efficacy between both groups.