17 research outputs found

    Study on Post-harvest Proximate Composition and Water Activity of Three Cultivars of Frafra Potatoes (Solenostemon rotundifolius [Poir.]) from Upper East Region, Ghana

    No full text
    Solenostemon rotundifolius (frafra potato) is an important food security crop in areas where it is cultivated in Ghana. However, the crop suffers research neglect in Ghana. More research on the crop is therefore needed for the crop to experience any form of meaningful improvement and utilisation beyond the area of its cultivation in Ghana. This present experiment therefore aimed to study the post-harvest proximate composition and water activity of three cultivars (black, white and brown cultivars) of frafra potatoes (Solenostemon rotundifolius) from the Upper East Region of Ghana. The white cultivar recorded the highest water activity value of 0.72 whiles the black and brown cultivar both recorded a lower water activity value of   0.68. The white cultivar recorded the highest moisture content of 7.20% whiles the brown and black cultivars recorded moisture content of 7.00% and 6.60% respectively. The brown cultivar recorded the highest protein content of 5.25 %, followed by 4.81% for the black cultivar and 4.38% for the white cultivar. Considering the ash content, the brown cultivar recorded a higher value of 4.00% followed by 3.80% recorded by the white cultivar and least value of 3.20% recorded by the black cultivar. The white cultivar recorded the highest fat content of 1.00% whiles the brown and black cultivar both recorded the lowest fat content of 0.20%. The black and brown cultivars both recorded the same higher fibre content of 1.00% followed by the lowest fibre content of 0.20% by the white cultivar. The black cultivar recorded the highest Nitrogen free extract (NFE) content (84.19%) followed by that of the white cultivar (83.42%) with the least being that recorded by the brown cultivar (82.55%). In all, mean water activity, moisture, protein, ash, fat, fibre and NFE values for the three cultivars were 0.69±0.02, 6.93±0.31%, 4.81±0.44%, 3.67±0.42%, 0.47±0.46%, 0.73±0.46% and 83.39±0.82% respectively. The mean moisture content and water activity recorded in this study indicate that processing frafra potatoes into flour will extend its post-harvest shelf life. Based on the moisture content and water activity values reported in this present study, the black cultivar of frafra potatoes will have the longest postharvest shelf life followed by the brown and white cultivars when processed into flour

    Effects of Extraction Method and Geographical Location on the Physico-chemical Properties of Shea (Vitellaria paradoxa) Butter

    No full text
    Aim: To determine the effects of extraction technology and geographical location on the quality of shea butter. Study Design: Data for physico-chemical characteristics were entered into Micro soft Excel spread sheet and summarized into mean and standard deviations. Analysis of Variance (ANOVA) was carried out to assess the variation between the parameters. All analyses were carried out in triplicates. Duncan’s Multiple Range Test was used to compare mean variance. Significance was accepted at 5% level of probability. Place and Duration of Study: The study took place in selected villages in the Upper East, Upper West and the Northern regions of Ghana between August, 2015 and February, 2016. Methodology: Oil samples from the chemical (C), mechanical (M) and the traditional (T) extraction methods (EM) and those from different shea butter extraction villages across the north of Ghana were evaluated to determine their effects on the physicochemical properties of shea butter. All analyses were carried out in triplicates and Duncan’s Multiple Range Test used to compare mean difference. Significance was accepted at 5% level of probability. Results: The mean oil yield, saponification, iodine, acid, free fatty acid values were (50.04±3.35%; 40.21±7.21%, 39.09±2.46%), (160.79±1.50; 162.15±40, 193±8.58 mgKOH/g), (49.18±2.83; 49.58±1.39, 54.78±12.88 gI2/100g), (9.77±1.75; 12±0.27, 13.765±1.10 mgKOH/g) and (5.42±0.17; 4.69±0.04, 7.61±0.35 mg/KOH/g) for the CEM, MEM and TEM respectively. While the mean specific gravity, refractive index and peroxide values were (0.97±0.00; 0.92±0.02, 0.88±0.01), (1.46±0.00; 1.45±0.01, 1.47±0.00) and (2.25±0.15; 2.80±0.16, 3.55±0.30) respectively. The mean oil yield, saponification, and iodine values were (43.08±2.75%; 45.87±1.25%), (39.62±1.40%; 39.02±1.16%), (53.27±2.40%; 50.26±1.44%), (155.80±9.46; 127.50±5.96 mgKOH/g), (163.63±2.66; 155.45±1.30 mgKOH/g), (201.39±2.78; 193.29±3.59 mgKOH/g), (46.84±2.06; 43.93±1.47 gI2/100g), (39.19±0.99; 53.96±4.87 gI2/100 g), (66.19±1.52; 47.46±0.97 gI2/100g) for oil samples from (Jonga; Kpongo) in the Upper West, (Doba; Pusunamongo) in the Upper East and (Savelugu; Tantuani) in the Northern region of Ghana respectively. The acid value, specific gravity, refractive index and peroxide values were (9.60±1.11; 12.53±1.17 mgKOH/g), (15.46±1.00; 16.47±1.26 mgKOH/g), (12.81±0.90; 11.57±1.02 mgKOH/g), (0.85±0.16; 0.94±0.01), (0.98±0.01; 0.92±0.01), (0.88±0.02; 0.88±0.01), (1.46±0.01; 1.48±0.01), (1.52±0.11; 1.42±0.01), (1.47±0.01; 1.46±0.01), (2.67±0.05; 3.42±0.18 mEqKOH/g), (2.59±0.06; 2.65±0.02 mEqKOH/g) and (2.84±0.06; 2.26±0.02 mEqKOH/g) respectively. Conclusion: The MEM technology had values almost mid-way between CEM and TEM and therefore yielded butter of superior quality than the other two technologies and should therefore be encouraged even if at a smaller scale. Geographical effect on the quality of shea butter revealed that kernels from the Northern region produced good quality shea butter, followed by those from the Upper West and finally to the Upper East regions. The results showed significant differences in the oil samples extracted by the different extraction methods and from different geographic locations but all fell within the acceptable ranges for edible vegetables oils

    Study of Pre-storage Plant Extract Application on Sprouting, Rot and Weight Loss of two cultivars of Frafra Potatoes (Solenostemon rotundifolius [Poir.]) from Upper East Region, Ghana

    No full text
    Study of Pre-storage Plant Extract Application on Sprouting, Rot and Weight Loss of two cultivars of Frafra Potatoes (Solenostemon rotundifolius [Poir.]) from Upper East Region, Ghana Present study conducted to determine the effect of pre-storage plant extract treatments (ginger rhizome extract, neem bark extract, and pawpaw leaf extract) on sprouting, rot (decay)  and weight loss of two cultivars of frafra potatoes (Solenostemon  rotundifolius). A 2 x 4 factorial in a completely randomised design was used with two cultivars and four treatments which were replicated three times. Data resulting from individual parameters were subjected to analysis of variance using Statistix Student version 9.0 and means separated at 5 percent (p=0.05) least significant differences. The total percentage sprout at the end of the storage period (week 21) did not show significant differences in all extract treated tubers. The cultivar and interactive effect did not also show any significant effect. However, neem bark extract treated tubers recorded the least sprouting in both cultivars at the end of the storage period. The extracts had no significant effect on weight loss after the storage period. However, the cultivar effect and the interactive effect of extracts and cultivars on weight loss showed significant variation (P< 0.05). There were no significant differences on percentage rot among the extract treated tubers. Also, the cultivar effect and interactive effect were not significant. However, the percentage of rot recorded was very low in all extract treated tubers when compared to the control. The present result suggested that higher concentrations of neem bark extract effect on sprouting should be investigated since its sprout suppressing ability was prominent on both cultivars at the end of the storage period. &nbsp

    Fungal Organisms Associated with Post-harvest Rot of Frafra Potatoes [Solenostemon rotundifolius (Poir.)] in Bongo-Soe, Upper East Region, Ghana

    No full text
    Aims: The study aims to identifying the microorganisms associated with post-harvest rot of frafra potatoes in Bongo-soe, Upper east region of Ghana. Place and Duration of Study: Department of Horticulture and the Pathology laboratory of the Faculty of Agriculture, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. The Solenostemon rotundifolius tubers were stored at the Horticulture Department laboratory whiles rot identification was carried out at the Pathology laboratory of the Faculty of Agriculture. The Tubers were stored from 2nd November, 2012 to 22nd March 2013. Methodology: Four hundred (400) tubers of black cultivar and four hundred (400) tubers of a brown cultivar of Solenostemon rotundifolius tubers showing visible signs of rot during the storage were collected. Pieces of diseased tissues from the margin of the necrotic collected and immersed in 10% commercial bleach solution for sterilisation, for one minute. These were then blotted dry and plated on Potato Dextrose Agar PDA. The plates were sealed with a cellotape until growth occurred. Results: The microorganisms identified to be responsible for causing rot in Solenostemon rotundifolius tubers were six in number. Colletotrichum gloeosporioides was identified to be responsible for 30.76% of rots observed, followed by Aspergillus niger, 23.07%, Curvularia lunata, 19.23%, Aspergillus flavus, 11.54%, Trichoderma sp and Penicillium sp both recorded 7.70% of rots observed. The percentage incidence of Aspergillus niger (15.38%), Curvularia lunata (11.54%) and Aspergillus flavus (7.69%) was higher in the black cultivar as compared with the brown cultivar which had percentage incidence of 7.69%, 7.69% and 3.85% respectively. Also, the percentage incidence of Colletotrichum gloeosporioides (15.38%) and Penicillium sp (3.85%) was the same in both the black and brown cultivars of Solenostemon rotundifolius tubers used in this study. Conclusion: The activities of the damaging microorganisms can be reduced by controlling mechanical injury during harvesting, transportation and storage of Solenostemon rotundifolius tubers should be prevented or reduced because they pave the way for tuber infection by the rot causing microorganisms

    Fungal Organisms Associated with Post-harvest Rot of Frafra Potatoes [Solenostemon rotundifolius (Poir.)] in Bongo-Soe, Upper East Region, Ghana

    Full text link
    Aims: The study aims to identifying the microorganisms associated with post-harvest rot of frafra potatoes in Bongo-soe, Upper east region of Ghana.&#x0D; Place and Duration of Study: Department of Horticulture and the Pathology laboratory of the Faculty of Agriculture, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. The Solenostemon rotundifolius tubers were stored at the Horticulture Department laboratory whiles rot identification was carried out at the Pathology laboratory of the Faculty of Agriculture. The Tubers were stored from 2nd November, 2012 to 22nd March 2013.&#x0D; Methodology: Four hundred (400) tubers of black cultivar and four hundred (400) tubers of a brown cultivar of Solenostemon rotundifolius tubers showing visible signs of rot during the storage were collected. Pieces of diseased tissues from the margin of the necrotic collected and immersed in 10% commercial bleach solution for sterilisation, for one minute. These were then blotted dry and plated on Potato Dextrose Agar PDA. The plates were sealed with a cellotape until growth occurred.&#x0D; Results: The microorganisms identified to be responsible for causing rot in Solenostemon rotundifolius tubers were six in number. Colletotrichum gloeosporioides was identified to be responsible for 30.76% of rots observed, followed by Aspergillus niger, 23.07%, Curvularia lunata, 19.23%, Aspergillus flavus, 11.54%, Trichoderma sp and Penicillium sp both recorded 7.70% of rots observed. The percentage incidence of Aspergillus niger (15.38%), Curvularia lunata (11.54%) and Aspergillus flavus (7.69%) was higher in the black cultivar as compared with the brown cultivar which had percentage incidence of 7.69%, 7.69% and 3.85% respectively. Also, the percentage incidence of Colletotrichum gloeosporioides (15.38%) and Penicillium sp (3.85%) was the same in both the black and brown cultivars of Solenostemon rotundifolius tubers used in this study.&#x0D; Conclusion: The activities of the damaging microorganisms can be reduced by controlling mechanical injury during harvesting, transportation and storage of Solenostemon rotundifolius tubers should be prevented or reduced because they pave the way for tuber infection by the rot causing microorganisms.</jats:p

    Abstract P6-06-31: Prognostic factors and outcomes in triple negative breast cancer - A single institution experience

    Full text link
    Abstract Background: Triple negative breast cancer (TNBC) is characterized by the lack of estrogen, progesterone, and human epidermal growth factor receptor (HER 2) expression. TNBC tumors appear to show aggressive clinical behavior with an increased risk of recurrence. Patients may undergo adjuvant or neoadjuvant chemotherapy depending on their tumor size. The aim of our study is to identify prognostic factors that impact disease free interval (DFI). Materials and Methods: All patients with TNBC from 2006 to 2011 were identified using the MCC Cancer Registry. Individual charts were reviewed for further validation of data and 484 patients were found to be eligible for our retrospective analysis. DFI was calculated as the interval between end of treatment after diagnosis and first recurrence. Patients were classified into two subgroups based on DFI, &amp;lt;3 yrs. and DFI≥3 yrs. 194 patients were excluded when interpreting the DFI as the follow up period was &amp;lt;3 yrs. Multiple characteristics such as race, clinical and pathologic tumor size, type of surgery, radiation, age of menarche, gravida status, and body mass index (BMI) were reviewed, and compared using Wilcoxon Rank Sum Test for continuous variables and Chi-square test for categorical variables. Survival analysis was also performed on all eligible patients. Results: 395(82%) patients were identified as white, 63(13%) were black and 26(5%) were grouped as other. 360(74%) patients were placed in the non-recurred and 124(26%) in the recurred group. 368(76%) patients received adjuvant and 116(24%) were treated with neoadjuvant chemotherapy. The mean follow up time for all patients was 2.52 years. The mean pathologic tumor size was 2.37 cm and clinical tumor size was 2.8 cm. 26% of the patients had recurred at 3yr follow-up. Clinical and Pathologic tumor size variables were significant among both the DFI groups (p&amp;lt;0.0001). Pathologic tumor size was marginally higher in the adjuvant (n = 357) vs. neoadjuvant (n = 90) setting (p = 0.0679) across all patients. Of the 45 patients who underwent lumpectomy, 5 (11%) patients recurred (P-value &amp;lt;0.0001) with a 3yr DFI estimate (95% CI, 0.68-0.94) of 0.86. A total of 140 patients received radiation after lumpectomy; of which 23 (16%) patients developed recurrent disease, with a 3yr DFI estimate (95% CI, 0.78-0.91) of 0.86. 143 patients underwent mastectomy without radiation of which 28 (20%) of them recurred with a 3yr DFI estimate (95% CI, 0.72-0.86) of 0.80. 147 patients underwent mastectomy followed by radiation of which 64 (45%) patients in this group recurred with a 3yr DFI estimate (95% CI, 0.45-0.64) of 0.55. Conclusions: The risk of recurrence increases in proportion with regional lymph node involvement more specifically with ≥3 lymph nodes. Patients who received neoadjuvant chemotherapy also have a higher risk of recurrence, possibly secondary to larger clinical tumor size. Interestingly, gravida status of ≥3 was associated with prolonged survival and a reduced risk of recurrence. Patients who underwent lumpectomy followed by radiation had improved survival over patients who had mastectomy (with or without radiation). Other epidemiologic factors were reviewed including age of menarche and BMI which were not found to be associated with increased risk of recurrence. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-31.</jats:p

    Outcomes in Patients with Acute Myeloid Leukemia Preceded by Breast Cancer

    Full text link
    Abstract Abstract 4316 Background: As breast cancer has become a more curable disease, the risk of second malignancy either related to therapy or genetic alterations has become apparent. Recent data from the National Cancer Institute's SEER database showed an increased risk of Acute Myeloid Leukemia (AML) in female patients with Stage III breast cancer. To investigate the outcomes of AML after breast cancer treatment, we reviewed all annotated cases with AML preceded by breast cancer (BrCa) at our institution. Methods: Between 2001 and 2011, the Moffitt Cancer Center Total Cancer Care database was used to identify patients with a diagnosis of AML preceded by breast cancer. Individual charts were subsequently reviewed. Chi square test was used to compare categorical variables in univariate analysis. Kaplan Meier estimates were used to calculate OS. Log rank test was used for comparison between the 2 groups and Cox regression analysis was used for multivariable analysis of survival. All analyses were conducted using SPSS version 19.0 software. Results: We identified 60 female patients with AML preceded by a diagnosis of breast cancer. Median age at AML diagnosis was 65 years (range 43–81). Median time from BrCa diagnosis to AML diagnosis was 7 years. Twenty nine (48%) had stage ≥ 2 disease at time of BrCa diagnosis. Forty nine (82%) of patients had t-AML, 36 (60%) of whom had received chemotherapy, either alone or in combination with radiation, for breast cancer management. Nineteen (32%) had adverse karyotype and 22 (37%) had MDS that preceded the diagnosis of AML. Thirty-six (60%) underwent induction chemotherapy for AML with an cytarabine/anthracycline-based regimen (most commonly “7+3”), and CR/CRiwas achieved in 21 (54%). Ten (17%) patients eventually proceded to allogeneic hematopoietic cell transplant, with a median survival of 20 months (95% C.I. 10 –29.9 mo) Median survival following AML diagnosis was 10.4 mo (95% C.I. 5.4 – 15.4 months). Univariate analysis of prognostic variables associated with overall survival are shown in Table 1. Variables significantly associated with inferior survival included history of MDS preceding AML, adverse karyotype, and no induction therapy for AML. Interestingly, prior BrCa chemotherapy did not adversely impact survival. None of the individual variables retained prognostic significance in multivariate analysis. Conclusions: AML arising in the setting of prior BrCa has a generally poor prognosis that mimics outcomes in older adults with AML. Many traditional adverse prognostic factors in AML are present in patients with AML from BrCa, likely accounting for the poor outcomes. However, many patients are able to receive and benefit from induction chemotherapy and ultimately proceed to allogeneic transplant, indicating that traditional therapy has an important role in the management of AML from BrCa. Larger numbers of patients will be necessary to confirm the importance of varied risk factors and treatment options in this population. A comparison with matched historic control patients will also be presented. Disclosures: No relevant conflicts of interest to declare. </jats:sec

    Evidence for Selective Benefit of Sequential Treatment with Azanucleosides in Patients with Myelodysplastic Syndromes (MDS)

    Full text link
    Abstract Abstract 4937 Background: Azanucleosides (AZN) remain the mainstay of therapy in Myelodysplastic syndrome (MDS). Azacitidine (AZA) and decitabine (DAC) have distinct differences in nucleic acid specificity and mechanisms of cellular resistance. The only published experience with sequential treatment described 14 patients, with a 28% response with DAC treatment after failure or lack of response to AZA. The response rate to AZA after DAC is unknown. Sequential use of alternative AZNs is common practice given the limited alternatives. To investigate the potential benefit of this approach, we reviewed cases of sequential AZN treatment. Methods: Patients who received treatment with both AZNs were identified through the Moffitt Cancer Center (MCC) MDS database. Two groups were identified; group one who received DAC after AZA failure, and group 2, who received AZA after DAC failure. AZN failure was defined as lack of response, loss of response or discontinuation due to adverse events or disease progression. The primary objective was to estimate response rates according to the International Working Group (IWG) 2006 criteria. Results: A total of 39 MDS patients were identified. Complete records were available in 31 patients, including 21 patients in group 1 (DAC after AZA), and 10 patients in group 2 (AZA after DAC). Table-1 summarizes baseline characteristics. In Group 1, 21 patients received DAC after AZA, 57% were originally red blood cell transfusion dependent (RBC TD). The median time from diagnosis to AZA treatment was 10 month (0. 2–52). The mean number of AZA treatment cycles was 8 (1–20). IWG responses to AZA treatment were 2 (10%) CR, 4 (20%) marrow CR (mCR), 7 (33%) hematological improvement (HI), 1 (5%) stable disease (SD) and 6 (28%) progressive disease (PD). Reasons for AZA discontinuation were 7(33%) no response, 1 (5%) progression, 9 (43%) lost response, and 4 (19%) toxicity. The median interval between end of AZA and initiation of DAC was 118 days (21–948). The mean number of DAC cycles was 4 (1–18). IWG responses to DAC were 1 (5%) mCR, 3 (14%) HI, 14 (67%) PD, and 3 (14%) unknown. The best overall response was 19%. The median OS from time of DAC initiation was 17. 8 month (95%CI 14–21). The rate of AML transformation was 29%. In Group 2, 10 patients received AZA after DAC, and 70% were originally RBC TD. The median time from diagnosis to DAC treatment was 2. 5 month (0–56). The mean number of DAC cycles was 4. 3 (1–9). IWG responses to DAC treatment were 2 (10%) mCR, 4 (40%) HI, 2 (20%) PD. The reasons for DAC discontinuation were no response (n=1), loss of response (n=3), PD (n=2), toxicity (n=3), and physician choice (n=1). The median interval between end of DAC and initiation of AZA was 179 days (19–448). The mean number of AZA cycles was 6 (2–12). The best responses to AZA were 2 (20%) mCR, 2 (20%) HI, 2 (20%) SD, 4 (40%) PD. The best overall response was 40%. The median OS from time of AZA start was 22 month. The rate of AML transformation was 20%. The median OS for Group 1 from diagnosis was 48 month and for group 2 was100 month (p=0. 7). Table-2 summarizes key differences between the two groups. Conclusions: Sequential use of AZNs after failure of first line may be an effective alternative outside the context of clinical trials. Despite limitations of cohort size and retrospective nature of the analysis, our findings suggest that response rate may be higher in patients who receive AZA after DAC, which could reflect the dual RNA/DNA drug actions. Sequential use of HMA should be considered in context of randomized clinical trial of novel agent as the control arm. Disclosures: List: Celgene: Consultancy. Komrokji:Celgene: Honoraria, Speakers Bureau. </jats:sec

    Evidence for selective benefit of sequential treatment with azanucleosides in patients with myelodysplastic syndromes (MDS).

    No full text
    7113 Background: Azanucleosides (AZN) remain the mainstay of therapy in myelodysplastic syndrome (MDS). Sequential use of AZNs is common practice given the limited alternatives. The only published experience described 14 patients showing a 28% response with decitabine (DAC) after failure or lack of response to azacitidine (AZA). To investigate the potential benefit of this approach,we reviewed cases of sequential AZN treatment. Methods: Patients who received treatment with both AZNs were identified through the Moffitt Cancer Center MDS database. Two groups were identified; group one who received DAC after AZA failure and group 2, who received AZA after DAC failure. The primary objective was to estimate overall response rates according to the International Working Group (IWG) 2006 criteria. The Kaplan–Meier method was used to estimate median OS. Results: A total of 39 MDS patients were identified who received treatment with both AZNs. Complete records were available in 31 patients, including 21 patients in group 1 (DAC after AZA) and 10 patients in group 2 (AZA after DAC). The Table summarizes baseline characteristics and response rates. The median OS for Group 1 from diagnosis was 48 months and for group 2 was 100 months (p=0.7). Conclusions: Sequential use of AZNs after failure of first line may be an effective alternative outside the context of clinical trials. Response rate is higher in patients who receive AZA after DAC. Sequential use of HMA should be considered in context of randomized clinical trial of novel agent as the control arm. [Table: see text] </jats:p

    Ipilimumab alone or in combination with nivolumab after progression on anti-PD-1 therapy in advanced melanoma

    Full text link
    BACKGROUND: The anti-programmed cell death-1 (PD-1) inhibitors pembrolizumab and nivolumab alone or in combination with ipilimumab have shown improved objective response rates and progression-free survival compared to ipilimumab only in advanced melanoma patients. Anti-PD-1 therapy demonstrated nearly equal clinical efficacy in patients who had progressed after ipilimumab or were treatment-naïve. However, only limited evidence exists regarding the efficacy of ipilimumab alone or in combination with nivolumab after treatment failure to anti-PD-therapy. PATIENTS AND METHODS: A multicenter retrospective study in advanced melanoma patients who were treated with nivolumab (1 or 3 mg/kg) and ipilimumab (1 mg or 3 mg/kg) or ipilimumab (3 mg/kg) alone after treatment failure to anti-PD-1 therapy was performed. Patient, tumour, pre- and post-treatment characteristics were analysed. RESULTS: In total, 47 patients were treated with ipilimumab (ipi-group) and 37 patients with ipilimumab and nivolumab (combination-group) after treatment failure to anti-PD-1 therapy. Overall response rates for the ipi- and the combination-group were 16% and 21%, respectively. Disease control rate was 42% for the ipi-group and 33% for the combination-group. One-year overall survival rates for the ipi- and the combination-group were 54% and 55%, respectively. CONCLUSIONS: Ipilimumab should be considered as a viable treatment option for patients with failure to prior anti-PD-1 therapy, including those with progressive disease as best response to prior anti-PD-1. In contrast, the combination of ipilimumab and nivolumab appears significantly less effective in this setting compared to treatment-naïve patients
    corecore