The Royal Victoria Hospital (RVH) (French: Hôpital Royal Victoria), colloquially known as the "Royal Vic" or "The Vic", is a hospital in Montreal, Quebec, Canada. It forms the biggest base hospital of the McGill University Health Centre (MUHC), which is affiliated with McGill University. The hospital was established in 1893 and was based at Pine Avenue, now known as the Legacy site, until 2015, when major hospital operations were moved to the Glen site (1001 Décarie Boulevard), named for the former Glen railway yards. The future uses of the "Legacy site' are now under study and it seems likely that McGill University will restore, modernise and use several of the heritage buildings on the site - which is adjacent to the main University campus.
INTRODUCTION:This study evaluated noninferiority of darbepoetin alfa versus placebo for overall survival (OS) and progression-free survival (PFS) in anemic patients with NSCLC treated to a 12.0-g/dL hemoglobin (Hb) ceiling. METHODS:Adults with stage IV NSCLC expected to receive two or more cycles of myelosuppressive chemotherapy and Hb less than or equal to 11.0 g/dL were randomized 2:1 to blinded 500 μg darbepoetin alfa or placebo every 3 weeks. The primary endpoint was OS; a stratified Cox proportional hazards model was used to evaluate noninferiority (upper confidence limit for hazard ratio [HR] < 1.15). Secondary endpoints were PFS and incidence of transfusions or Hb less than or equal to 8.0 g/dL from week 5 to end of the efficacy treatment period. RESULTS:The primary analysis set included 2516 patients: 1680 were randomized to darbepoetin alfa; 836 to placebo. The study was stopped early per independent Data Monitoring Committee recommendation after the primary endpoint was met with no new safety concerns. Darbepoetin alfa was noninferior to placebo for OS (stratified HR = 0.92; 95% confidence interval [CI]: 0.83‒1.01) and PFS (stratified HR = 0.95; 95% CI: 0.87‒1.04). Darbepoetin alfa was superior to placebo for transfusion or Hb less than or equal to 8.0 g/dL from week 5 to end of the efficacy treatment period (stratified odds ratio = 0.70; 95% CI: 0.57‒0.86; p < 0.001). Objective tumor response was similar between the groups (darbepoetin alfa, 36.4%; placebo, 32.6%). Incidence of serious adverse events was 31.1% in both groups. No unexpected adverse events were observed. CONCLUSIONS:Darbepoetin alfa dosed to a 12.0-g/dL Hb ceiling was noninferior to placebo for OS and PFS and significantly reduced odds of transfusion or Hb less than or equal to 8.0 g/dL in anemic patients with NSCLC receiving myelosuppressive chemotherapy.
In Northern Ireland there are concerns about candidaemia, with rates higher than those reported in England and Wales. Our aim was to explore the epidemiology of candidaemia during a 10 year period and the clinical management upon suspicion of cases during a one year enhanced investigation in Northern Ireland.Candidaemia reports to the Public Health Agency were validated during 2002-2011 and used to examine incidence and antifungal sensitivity trends (during 2007-2011). A clinical proforma was used to collate information for all patients with candidaemia in 2011.The majority (96%) of isolates were captured through voluntary laboratory reporting. There was a year-on-year increase in candidaemia from 2002-2011, from 80 to 131 episodes (incidence rate ratio 1.09 95% CI 1.05-1.13). Rates were highest in males under 1 year and over 75 years. 83/98 (85%) of case notes were available from candidaemia patients during 2011. The most prevalent risk factors were patients on total parenteral nutrition (26 people, 31.3%), surgery in the two months prior to the candidaemia (25 people, 30.1%), significant steroid use in the previous 3 months (24 people, 28.9%) and active neoplastic disease (23 people, 27.7%),This study confirmed an increase in candidaemia rates over time, with the observed incidence in 2011 higher than England and Wales. We identified areas for improvement around the clinical management of candidaemia. We recommend raising the awareness of guidelines for fundoscopy, echocardiography and central venous catheter removal.
Case history: We evaluated a live donor (D1) and recipient (P1) pair for potential kidney donation however their flow crossmatches (FXM) continuously result in B-cell positive. P1 was tested negative by single antigen beads and no donor specific antibody (DSA) was evident. Patient has been transfused once in 2014 and treated with adalimumab for ankylosing spondylitis in the past. Methods: Autologous FXM of D1 was conducted. A series of FXM with surrogate donors was conducted. Supplemental single antigen beads, FlowPRA beads and Luminex-based mixed screening beads were also conducted but results are questionable. Results: After the first allo FXM, a repeat was done to rule out B cell positive FXM whether it was reproducible. Since patient was screened negative by single antigen beads assay and supplemental beads, absence of DSA could not explain why B cell FXM can be positive. When patient serum subject to two other surrogate donors (D2 "O" and D3 "A") interestingly B cell FXM has become negative. To rule out blood type issue and non–HLA factors, autologous FXM of D1 and allo-FXM with zero PRA serum (P2 "A"), and with positive PRA serum (absence of DSA, P3 "A") were performed and all were found negative, but remained positive with diluted serum of P1. Patient P1 was tested again in 3 months however the same result remains. The final FXM was then focused on testing with surrogate donors (D4 and D5) who carry the same class II antigens as D1. The result became positive with D5. Although no clear evidence can confirm the antibody to DR11 to be allele specific, the collective results infer that suspected DSA DR11 is not distinguishable by FlowPRA screening beads and mixed beads and not detectable by single antigen and supplemental beads. Conclusion: This is the first case in our experience to discover such a situation with "cold bead" or specificity-unproven DSA. Transplantation is not recommended. Correlation between different assays and diligent testing to clarify unreasonable positive FXM is very important especially in cases of autoimmune disease.
