Assessment of second primary malignancies among treated and untreated patients with chronic lymphocytic leukemia using real-world data from the USA.

Aim: Improved management of chronic lymphocytic leukemia (CLL) has resulted in a growing population of CLL survivors; these patients have a higher risk of developing second primary malignancies (SPMs) versus the general population. This retrospective cohort study aims to assess the timing, frequency, incidence and types of SPMs in treated and untreated patients with CLL in the USA, using the Surveillance, Epidemiology, and End Results (SEER) Medicare database, which links a nationally representative cancer registry with Medicare claims data. Patients & methods: Patients aged ≥66 years with newly diagnosed CLL between 1 January 2010 and 31 December 2016, who were enrolled in Parts A and B of Medicare for ≥12 months pre-diagnosis of CLL were selected from the database. Patients were assessed for ≥36 months until the end of continuous enrollment in Medicare Parts A, B and D, a switch to a health maintenance organization, death, or end of the study period (December 2019). Results: Of 3053 patients included in the analyses, 620 (20.3%) were treated and 2433 (79.7%) were untreated within 36 months of diagnosis. Overall, 638 (20.9%) patients developed a SPM, 26.8% of patients in the treated cohort and 19.4% of patients in the untreated cohort. The most common SPMs for both cohorts were squamous cell carcinoma and acute myeloid leukemia. Among the 166 treated patients who developed a SPM, a greater proportion developed their first SPM after treatment initiation versus those who developed their first SPM prior to treatment initiation (p < 0.001). A significantly lower percentage of patients who received targeted therapy developed a SPM (p < 0.05) versus patients treated with anti-CD20 + chemotherapy. Conclusion: Findings indicate that treatment type and timing can affect SPM development in patients with CLL. Combined with previous findings, this can help inform best practices in monitoring for SPM in patients with CLL.

Study of modified technique of ileal neobladder-Frog neobladder.

PURPOSE: Orthotopic neobladder is a well-established technique for continent urinary diversion after radical cystectomy. In this study, we evaluated a new Frog ileal neobladder technique. Since the reconstructed neobladder appears like a frog, the name Frog Neobladder was given to it. We have used two isoperistaltic ileal segments and implanted ureters in the nondetubularized proximal end of the ileal segment. SUBJECTS AND METHODS: This was a prospective, single-center (tertiary care hospital) study conducted from February 2008 to January 2018. Study patients were aged 39-94 years with biopsy-proven muscle-invasive localized bladder carcinoma. One hundred and twenty patients were included in the study, who had undergone Radical Cystectomy and were offered "FROG BLADDER"- a type of neobladder. Evaluation of complications, renal function, urodynamic parameters, post-void residual urine (PVR), continence, and need for clean intermittent catheterization was done in all patients with neobladder. RESULTS: A total of 120 patients were included in the study, the average age of the patients was 62 years. The operative mean time was 280 ± 29.8 min. There was no perioperative death, and perioperative or early and late complication rates were 31.2% and 18.7%, respectively. Six patients had uretero-enteric anastomosis stricture, of which two were managed by retrograde ureteroscopic dilatation, another three strictures were treated with antegrade approach, and one patient underwent open surgery. All patients were able to void urine, except for three patients who required self-catheterization. The mean capacity was increased to average of 398 ± 220 ml at 12 months in all patients. The mean PVR at 1 year was 46 ± 54.4 ml. CONCLUSION: The Frog neobladder has similar outcome similar to other neobladder technique, with added advantage of ability to accommodate shorter ureteric length and the ease of accessing ureter by retrograde approach for intervention.

A Step toward Healthy Newborn: An Assessment of 2 Years' Admission Pattern and Treatment Outcomes of Neonates Admitted in Special Newborn Care Units of Gujarat.

CONTEXT: Facility Based Newborn Care (FBNC) is a key strategy to improve child survival, especially in newborn care where neonatal mortality rate (NMR) is stagnant in declining. Gujarat has achieved considerable amount of reduction in child deaths, but neonatal health requires attention. The study was aimed to assess the admission pattern of Special Newborn Care Units (SNCUs) which supports decision-making. SETTINGS AND DESIGN: A cross-sectional descriptive analysis was done from secondary data of the SNCU reports on the aspects of admission patterns, morbidity, and mortality pattern. The reports had been analyzed on various critical variables. RESULTS: In 2015-2016, Gujarat has operationalized forty SNCUs by saturating each district with at least one SNCU. The study found near proportions of (53%) inborn - (47%) outborn admission and 44% admission of female. Out of 69,662 admissions, 67% were discharged, 16% died, 10% leaving against medical advice, and 7% referred to higher centers. Major reasons for admission were respiratory distress syndrome (RDS) (22%) and infection (21%). Similar pattern in mortality found as final diagnosis of deaths was RDS (23%) and infection (21%). The proportion of neonatal deaths in outborn was high compared to inborn. CONCLUSION: Strengthening of FBNC is essential to address neonatal mortality. NMR is of prime focus because the health interventions needed to tackle NMR differ from those needed for infant mortality rate and under-five mortality rate. This accentuates the need for focused attention on facility- and community-based child health interventions along with quality maternal health services and robust referral mechanisms to all delivery points.