scholarly journals Malignant Gastric Tumours: The Role of Pathologist in the Diagnosis and for Therapeutic Decisions

2017 ◽  
Author(s):  
Alexander Quaas
Keyword(s):  
Therapeutic Decisions

Neuromyelitis optica spectrum: novel concept of pathogenesis, diagnosis and treatment of Devic’s disease

2009 ◽  
Vol 150 (46) ◽  
pp. 2101-2109 ◽  
Author(s):  
Péter Csécsei ◽  
Anita Trauninger ◽  
Sámuel Komoly ◽  
Zsolt Illés
Keyword(s):  
Neuromyelitis Optica ◽  
Water Channel ◽  
Diagnostic Procedures ◽  
Diagnosis And Treatment ◽  
Clinical Settings ◽  
Permanent Disability ◽  
Therapeutic Decisions ◽  
Novel Concept ◽  
The Brain

The identification of autoantibodies generated against the brain isoform water channel aquaporin4 in the sera of patients, changed the current diagnostic guidelines and concept of neuromyelitis optica (NMO). In a number of cases, clinical manifestation is spatially limited to myelitis or relapsing optic neuritis creating a diverse. NMO spectrum. Since prevention of relapses provides the only possibility to reduce permanent disability, early diagnosis and treatment is mandatory. In the present study, we discuss the potential role of neuroimaging and laboratory tests in differentiating the NMO spectrum from other diseases, as well as the diagnostic procedures and therapeutic options. We also present clinical cases, to provide examples of different clinical settings, diagnostic procedures and therapeutic decisions.

scholarly journals How I treat hypereosinophilic syndromes

Blood ◽  
2009 ◽  
Vol 114 (18) ◽  
pp. 3736-3741 ◽  
Author(s):  
Amy D. Klion
Keyword(s):  
Kinase Inhibitors ◽  
Therapeutic Agents ◽  
Peripheral Eosinophilia ◽  
Therapeutic Decisions ◽  
Organ Manifestations ◽  
Diagnosis And Classification ◽  
Humanized Monoclonal Antibodies ◽  
Peripheral Blood Eosinophilia

Abstract Hypereosinophilic syndromes (HESs) are a heterogeneous group of uncommon disorders characterized by marked peripheral eosinophilia and end organ manifestations attributable to the eosinophilia or unexplained in the clinical setting. Whereas corticosteroids remain the mainstay of treatment for most patients, recent diagnostic advances and the development of novel targeted therapies, including tyrosine kinase inhibitors and humanized monoclonal antibodies, have increased the complexity of therapeutic decisions in HESs. This review presents a treatment-based approach to the diagnosis and classification of patients with peripheral blood eosinophilia of 1.5 × 109/L (1500/mm3) or higher and discusses the role of currently available therapeutic agents in the treatment of these patients.

scholarly journals 1633 Final non-invasive echo-guided assessment of left atrial pressure after percutaneous edge-to-edge procedure for mitral regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Gavazzoni ◽  
M Z Zuber ◽  
A P Pozzoli ◽  
M T Taramasso ◽  
F M Maisano
Keyword(s):  
Correlation Coefficient ◽  
Left Atrial ◽  
Continuous Wave ◽  
Venous Pressure ◽  
Right Atrial ◽  
Rater Reliability ◽  
Intra Class Correlation ◽  
Therapeutic Decisions ◽  
Intra Class Correlation Coefficient

Abstract Background/Introduction. Recently the central role of hemodynamic invasive monitoring during MitraClip (Abbott Vascular, Santa Clara, CA, USA) procedure has been raised. After removal of Steerable Guide Catheter (SGC) at the end of procedure, iatrogenic interatrial septum defect determines acute sub-clinical hemodynamic changes depending on right atrial (RA) and left atrial (LA) pressures. The possibility to assess LAP non-invasively by Doppler -echocardiography at the end of the procedure allows to quantify real hemodynamic impact of reduction of MR and leaves the door open to further therapeutic decisions (such as closure of iatrogenic IASd). Purpose This prospective study aimed to assess the role of evaluation of post-procedural mean trans-atrial gradient with continuous-wave (CW) Doppler (DPmean-IAS) in estimating final m-LAP after removal of SGC. Methods We prospectively performed the computation of trans-atrial CW- Doppler tracing for estimation of mean-transatrial gradient (meanGp-LA-RA) in patients treated with MitraClip; we added the estimation of central venous pressure (CVP) according to: i) dilatation of superior vena cava (IVC, mm); ii) presence or not of systolic excursion of IVC (end-inspiratory excursion was not evaluable in patients under sedation); iii) hepatic vein dilatation. The sum of CVP estimated and meanGp-LA-RA (mmHg) represents the m-LAP-Echo-measured at the end of procedure. This value has been compared with m-LAP measured invasively before removal of SGC. We tested the inter-rater reliability with the Intra-class Correlation Coefficient for comparing this method with the gold standard (invasive assessment of LAP). Results we included 19 patients; aetiology of MR was degenerative in 89% of cases. Basal m-LAP was 15 ± 13,3 mmHg and decreased by 32% by the end of procedure (mean-LAP at the end: 10,1 ± 3,3 mmHg, p < 0.001). At the end of the procedure mean Gp-LA-RA was 2.5 ± 1.2 mmHg and CVP 7.5 ± 3.5; the m-LAP-Echo-measured was 9.6 ± 2.4. The delay in time of computation of m-LAP by echocardiography with respect to last invasive assessment available was computed and settled around 5 minutes (IQR 3-9 min). The inter-rater reliability with the Intra-class Correlation Coefficient was high: 0.8, (CI95% 0.647-0.948, p < 0.01); with Bland-Altman test we could assess that bias of measures was acceptable for this clinical context with upper concordance limit of 2,7 mmHg and lower of 4,7 mmHg, with a bias of 0,9 mmHg, not relevant for this clinical purpose. Conclusions The present study represents the first validation of a Doppler-based method for non invasively assessing post-procedural LAP in percutaneous mitral valve interventions requiring transeptal approach. Follow up is needed for correlate this value with clinical outcomes.

Effect of nurses’ religious beliefs on their empathy and life satisfaction

2017 ◽  
Vol 7 (2) ◽  
pp. 18-25
Author(s):  
A Lankau ◽  
E Krajewska-Kułak ◽  
B. Jankowiak ◽  
A. Baranowska ◽  
G. Bejda
Keyword(s):  
Life Satisfaction ◽  
Nursing Students ◽  
Religious Beliefs ◽  
Satisfaction With Life ◽  
Satisfaction With Life Scale ◽  
Continuous Contact ◽  
Work Related ◽  
Therapeutic Decisions ◽  
Life Scale

<b>Introduction</b>: Nursing is one of those medical professions that are inseparably associated with being in continuous contact with other people, and it is worth noting that there are things that cannot be acquired in the course of an education. These include conscience and empathy as subjective and ultimate standards of morality, which help nurses make morally good decisions and that represent criteria for assessing their behavior. <b>Purpose</b>: To assess the effect of nurses' religious beliefs on their empathy and life satisfaction. <b>Materials and methods</b>: The study included 150 nurses and 150 nursing students, using our own questionnaire, the Empathy Understanding Questionnaire (KRE) by Węgliński and The Satisfaction with Life Scale (SWLS). <b>Results</b>: The mean level of KRE-based empathic understanding was 65.7  9.4 points, which indicates that it was relatively high. The lowest level was 39, and the highest was 92 points. Mean SWLS score was about 20 points, which indicates that the studied nurses were neither satisfied nor dissatisfied with their life. Respondents with the highest level of empathy would discontinue treatment due to their beliefs or they would choose another unspecified solution. No significant correlations were found between the levels of empathy and life satisfaction and the opinion on the role of religious beliefs in the choice of nursing profession, and regarding religion as an obstacle in performing work-related tasks. <b>Conclusions</b>: Nurses showed relatively high levels of empathy and average levels of life satisfaction. The importance of nurses’ religiousness in making therapeutic decisions did not correspond with life satisfaction nor their level of empathy.

scholarly journals Repeated Renal Biopsy - A Predictive Tool to Assess the Probability of Renal Flare in Lupus Nephritis

2016 ◽  
Vol 44 (6) ◽  
pp. 439-446 ◽  
Author(s):  
Gastón J. Piñeiro ◽  
Pilar Arrizabalaga ◽  
Manel Solé ◽  
Rosa M. Abellana ◽  
Gerard Espinosa ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Clinical Laboratory ◽  
Predictive Tool ◽  
Renal Flare ◽  
Therapeutic Decisions ◽  
The Mean ◽  
Mean Time

Background: How one responds to treatment of lupus nephritis (LN) is based on clinical features, but the activity in renal biopsy (RB) is uncertain. We have described the therapeutic decisions after performing a repeated RB on the assessment of response to intravenous cyclophosphamide (IC) and the possible prognostic role of this repeated RB. Methods: Clinical, laboratory and histological features at the initial RB and repeated RB were analyzed in 35 patients. Results: Data in the initial versus the repeated RB were serum creatinine 1.23 ± 1.08 and 0.96 ± 0.45 mg/dl (p < 0.05), glomerular filtration rate <60 ml/min in 12 and 5% patients and proteinuria 4.1 ± 2.8 vs. 0.6 1.1 g/day (p < 0.05). Significant differences were detected in hematuria, nephrotic syndrome and serological immune features. Complete renal remission was reached in 60% (n = 21) at the time of the repeated RB, partial remission in 31.4% (n = 11), and no response IC in 8.6% (n = 3). Nine patients showed proliferative forms in the repeated RB, 3 of them had proteinuria <1 g/day. Just after the repeated RB, 34.3% increased or started a new immunosuppressive therapy, 17.1% remained with the same complementary IST, and 14.3% decreased or stopped it. In the follow-up post repeated RB, 34.5% without active lesions showed a renal flare versus 77.8% with active lesions (p = 0.04). The mean time was 120 and 45 months, respectively. Conclusion: A repeated biopsy in LN distinguishes patients in true remission from those in apparent remission. By doing this, we can identify patients who could benefit from intensified treatment and for whom unnecessary treatment methods can be modified or eliminated.

scholarly journals From Point-of-Care Testing (PoCT) and vaccination to changing the care paradigm: the role of primary care

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Petelos ◽  
C Lionis
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Point Of Care ◽  
Behavioural Change ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Prescribing Patterns ◽  
Patient Treatment ◽  
Therapeutic Decisions

Abstract The speaker will discuss the role of primary care for all patients and cancer patients, elaborating on prescribing patterns vaccinations, recommendations for Over-The-Counter medicines (OTCs) nutritional supplements, and as well as its contribution of behavioural change to raise awareness and change prescription practice. The role of PoCT for reducing the threat of AMR and for improving the differential diagnosis will be discussed, according to the WHO Approach of “diagnostic stewardship” for the appropriate use of microbiological diagnostics to guide therapeutic decisions. In the context of syndromic surveillance and preparedness, as well as in terms of protecting cancer patients at times of epidemics, methods of specimen collection for limited community transmission and for the timely pathogen identification along with accurate, timely reporting of results to guide patient treatment will be discussed. The role of behavioural modification interventions will be discussed, incl. in relation to vaccination and the role it can play in AMR. Improvement of the survivorship experience will be examined in the context of improving health literacy. The case of Greece, currently having the highest antibiotic consumption in Europe and the fourth highest globally, along with an increasing trend on antibiotic use will also be discussed.

scholarly journals THE ROLE OF POINT-OF-CARE ULTRASONOGRAPHY IN THE INITIAL CHARACTERIZATION OF COVID-19 PATIENTS: RESULTS FROM A PROSPECTIVE MULTICENTRIC STUDY.

2020 ◽  
Author(s):  
yale tung chen ◽  
Rafael Llamas Fuentes ◽  
Pablo Rodriguez Fuertes
Keyword(s):  
Emergency Department ◽  
Troponin I ◽  
Point Of Care ◽  
Common Finding ◽  
Multicentric Study ◽  
X Ray ◽  
Therapeutic Decisions ◽  
Chest X Ray ◽  
Point Of Care Ultrasonography

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is a highly contagious illness caused by the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is growing evidence regarding the imaging findings of COVID-19, in Chest X-ray and CT scan, however their availability in this pandemic outbreak might be compromised. At this moment, the role of Point-of-care ultrasonography (POCUS) has yet to be explored. OBJECTIVES: The main purpose of this study is to describe the POCUS findings of the disease in COVID-19 patients admitted to the emergency department (ED). Determining the correlation of these parameters with vital signs, laboratory results and chest X-ray, as well as, therapeutic decisions and prognosis. METHODS: Prospective study carried out in the emergency department (ED) of two academic hospitals. High suspicion or confirmed COVID-19 patients were subjected to the ultrasonographic measurement of the inferior vena cava (IVC), focused cardiac ultrasound (FOCUS), and Lung Ultrasonography (Lung POCUS). RESULTS: Between March and April 2020, ninety-six patients were enrolled. The mean age was 68.2 years (SD 17.5). The most common finding in Lung POCUS was an irregular pleural line (63.2%) followed by bilateral confluent (55.2%) and isolated B-lines (53.1%), which was associated with a positive RT-PCR (OR 4.729, 95% CI: 1.989-11.246; p<0.001), and correlated with IL-6 levels (rho = 0.622; p = 0.002). The IVC moderately correlated with levels of pO2, expiratory (rho = -0.539; p =0.014) and inspiratory (rho = -0.527; p =0.017), with troponin I (rho = 0.509; p=0.03). After POCUS exam, almost 20% of the patients had an associated condition that required a change in the treatment or management. CONCLUSION: In this pandemic era, as the shortage of resources constitutes an undeniable public health threat, POCUS presents the potential to impact in diagnosis, management and prognosis of our confirmed or suspected COVID-19 patients.

The possible role of genetic testing in the early identification of patients at increased risk of developing anthracycline-induced cardiotoxicity

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Piazzani ◽  
F Fioretti ◽  
M Gheza ◽  
L Lupi ◽  
A Madureri ◽  
...  
Keyword(s):  
At Risk ◽  
Genetic Markers ◽  
Early Identification ◽  
Troponin I ◽  
Genetic Profile ◽  
Risk Variant ◽  
Therapeutic Decisions ◽  
Increased Risk

Abstract Background In the last years prognosis of cancer patients (pts) has been improved, but the develop of cardiotoxicity (CTX) in pts with low CV risk treated with cumulative doses of Anthracycline (ANT) considered safe, led to investigate the possible role of the genetic profile in the onset of CTX. Purpose To study the role of some single nucleotide polymorphisms (SNPs) as predictive genetic markers of individual susceptibility to CTX induced by anticancer treatment. Methods We have enrolled women with non-metastatic breast cancer who had to start a therapy with ANT. The presence of a known heart disease, a previous mediastinal irradiation and a previous treatment with ANT, were the main exclusion criteria. All pts underwent complete cardiological evaluation (ECG, echo) before the beginning of the therapy (T0), after each ANT cycle and every 3 months up to 1 year of follow-up after the end of treatment. During each visit, we performed the determination of troponin I (TnI) and NT-proBNP. The genetic profile of each pts was also investigated, analyzing 6 SNPs belonging to 3 different genes (two for each genes) coding for enzymes or enzyme systems involved in the metabolism of ANT. DNA extraction from blood samples was performed using the QIAamp DNA Mini kit (QIAGEN). The DNA extracted was genotyped (by performing TaqMan SNP Genotyping assays) identifying 3 possible variants for each SNPs: homozygosity for the protective and “at risk” variant and heterozygosity. Results 179 pts finished the follow-up and from the analysis of the trend of biomarkers we found that 53 pts (30%) showed a significant increase in TnI (&gt;0.04ng/mL) or less than this cut-off but persistently &gt;0.015ng/mL in at least 2 measurements (“TnI+ group”), in the remaining 126 pts the TnI remained non-measurable (“TnI− group”); 76 pts (43%) showed NT-proBNP values ≥125 ng/L in at least two consecutive determinations (“NT-proBNP + group”),in the remaining 57% of pts this increase was not detected (“NT-proBNP - group”). Comparing “TnI+ group” to “TnI− group” we observed that only the genotyping of the SNPs rs1149222 (G/T) belonging to the ABCB4 gene is distributed differently in the two groups, in particular the homozygosity for the “at risk” variant (G/G) was present in 13% of the pts of the “TnI+ group” vs 5% in the “TnI− group” (p 0.06). The results of the comparison of “NT-proBNP+ group” vs “NT-proBNP− group”, showed that the genotyping of the SNPs rs6759892 (G/T) belonging to the UGT1A6 gene was distributed differently, the homozygosity for the “at risk” variant (G/G) was present in 28% of the “NT-proBNP+ group” vs 17% in the “NT-proBNP− group” (p 0.07). Conclusion Together with the baseline clinical evaluation, genetic markers could contribute to the early identification of pts at high risk of developing CTX especially following treatment with ANT and they could support future therapeutic decisions and the planning of taylored strategies for the prevention of the CTX development. Funding Acknowledgement Type of funding source: None

Role of Ancillary Techniques in Fluid Cytology

2019 ◽  
Vol 64 (1-2) ◽  
pp. 52-62 ◽  
Author(s):  
Gordon H. Yu ◽  
Laurel J. Glaser ◽  
Karen S. Gustafson
Keyword(s):  
Molecular Testing ◽  
Prognostic Information ◽  
Relative Paucity ◽  
Therapeutic Decisions ◽  
Precise Diagnosis ◽  
Abnormal Cells ◽  
The Subject ◽  
Cellular Components ◽  
Ancillary Studies

The cytologic evaluation of serous effusions may be challenging for a number of reasons. Distinction of benign, reactive conditions from malignancy represents the main focus when examining these specimens. The morphologic diagnosis of malignancy may be difficult due to the relative paucity of abnormal cells. In other situations, cellularity is not an issue, but the ability to confidently identify a second, foreign (i.e., tumor) population within a background mesothelial cells on the basis of cytomorphologic features alone may pose problems. Cases with definitive morphologic evidence of malignancy may require additional studies in order to determine the tumor subtype and, in the case of carcinoma, the primary site of origin. Cases in which a definitive and precise diagnosis of malignancy is made may be optimal candidates for further molecular testing in order to gain prognostic information and guide personal therapeutic decisions. Finally, while an inflammatory or infectious condition can be suggested on the basis of cellular components and associated background elements, the identification of causative agent(s) may be difficult without additional studies. In all of these situations, the use of ancillary studies and techniques is critical; their utility and appropriate application are the subject of this review.

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