A Meta-Analysis of Randomized Clinical Trials Assessing the Efficacy of PARP Inhibitors in Metastatic Castration-Resistant Prostate Cancer.

Prostate cancer ranks as the second most common malignancy in males. Prostate cancer progressing on androgen deprivation therapy (ADT) is castration-resistant prostate cancer (CRPC). Poly-ADP ribose polymerase (PARP) inhibitors (PARPis) have been at the forefront of the treatment of CRPC. We aim to better characterize the progression-free survival (PFS) and overall survival (OS) in metastatic CRPC patients treated with PARPis. A systemic review search was conducted using National Clinical Trial (NCT), PubMed, Embase, Scopus, and Central Cochrane Registry. The improvement in overall survival was statistically significant, favoring PARPis (hazard ratio (HR) 0.855; 95% confidence interval (CI) 0.752-0.974; p = 0.018). The improvement in progression-free survival was also statistically significant, with results favoring PARPis (HR 0.626; 95%CI 0.566-0.692; p = 0.000). In a subgroup analysis, similar results were observed where the efficacy of PARPis was evaluated in a subgroup of patients without homologous recombination repair (HRR) gene mutation, which showed improvement in PFS favoring PARPis (HR 0.747; 95%CI 0.0.637-0.877; p = 0.000). Our meta-analysis of seven RCTs showed that PARPis significantly increased PFS and OS when used with or without antihormonal agents like abiraterone or enzalutamide.

Recurrent acute-onset of chronic inflammatory demyelinating polyneuropathy after COVID-19 vaccination.

This is the case of 54-year-old male with a past medical history of Chronic Inflammatory Demyelinating Polyneuropathy (CIPD) who was found to have an acute exacerbation of CIPD shortly after receiving his 1st COVID 19 booster (3rd dose of vaccination series) and was successfully treated with intravenous immunoglobulin (IVIG) and then was found to have another acute exacerbation of CIDP 6 months later after receiving his 2nd COVID 19 booster (4th dose of vaccination series) that required intubation and long term tracheostomy. CIPD is an acquired immune-mediated polyneuropathy that mainly affects the peripheral nerve roots nerves. It typically presents with relapsing/remitting, or progressive symmetrical muscle weakness and sensory involvement and can cause decreased respiratory effort. COVID-19 is mainly a respiratory disease, but it has been associated with a wide variety of neurological conditions. Although there have been several findings of acute inflammatory demyelinating polyneuropathy in association with COVID-19, CIDP exacerbation as a result of COVID-19 has rarely been seen in the literature. Furthermore, CIDP exacerbation as a result of COVID-19 vaccination is even less frequently seen.

Impact of prescribing intranasal midazolam as rescue medication for domiciliary management of acute seizure among children with epilepsy.

Prescription pattern of rescue medication like intranasal midazolam (INM) for domiciliary management of seizure is highly variable. The present cross-sectional study was designed to determine the impact of the use of INM on healthcare utilization by those who used INM when compared with those who are not on any rescue medications in a resource-constraint setting. Children with epilepsy aged 1-14 years who have used INM to abort seizure at home (INM group) were compared with those who have not used INM (control group). The baseline demographic and seizure characteristics including the severity of epilepsy were comparable between the INM group (n = 50) and controls (n = 50). The INM group had significantly better knowledge of the correct method of administration when compared with controls [43 (86%) vs. 17 (34%); p < 0.01]. Seizures were aborted in 36 (72%) users in the INM group; of the rest of 14 children, 4 (8%) used it for the second time. The median Interquartile range (IQR) time taken to abort the seizure was 2.5 (1.0, 5.2) min. The need for intensive care admissions was comparable between the INM group and control group, although the number of emergency visits was significantly higher in the former [2.9 vs. 1.4, p = 0.04]. Despite comparable severity of epilepsy and better knowledge of its correct use, children who were prescribed INM required more hospital emergency visits. This study with a limited sample size prompts us to introspect the practice of INM for children with epilepsy.