Eltrombopag post autologous hematopoietic stem cell transplant - an emerging indication in younger pediatric patients

xlomafota13 shared this article with you from Inoreader Eltrombopag post autologous hematopoietic stem cell transplant - an emerging indication in younger pediatric patients Via American Journal of Blood Research Am J Blood Res. 2021 Apr 15;11(2):168-171. eCollection 2021. ABSTRACT BACKGROUND: Engraftment of neutrophils and platelets after hematopoietic stem cell transplant (HSCT) is imperative for optimal outcomes. Eltrombopag has been used in adults after HSCT to boost platelet production. Its use in pediatric post HSCT patients has been limited. METHODS: The clinical and laboratory details of a post autologous HSCT patient were fetched by a retrospective review of the records. RESULTS: A 5-year old male child had primary thrombocytopenia post autologous HSCT for refractory Hodgkin lymphoma. Although the stem cell dose infused was adequate, the child had a delay in the engraftment of platelets. After ruling out the causes of post HSCT thrombocytopenia, eltrombopag was started for the child. With the use of eltrombopag, normal thrombopoiesis was restored in the child. CONCLUSION: Eltrombopag was effective and safe in overcomi ng post-HSCT primary thrombocytopenia in our patient. PMID:34079631 | PMC:PMC8165717 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anti-globulin test positivity indicates advanced disease in Indian CLL patients

xlomafota13 shared this article with you from Inoreader Anti-globulin test positivity indicates advanced disease in Indian CLL patients Via American Journal of Blood Research Am J Blood Res. 2021 Apr 15;11(2):157-162. eCollection 2021. ABSTRACT Autoimmune Hemolytic Anemia (AIHA) occurs in 10% to 25% of Chronic Lymphocytic Leukemia (CLL) while Direct Antiglobulin Test (DAT) positivity seen in 35% of cases. The prevalence and prognostic significance of DAT positivity is not well documented especially in Indian population. The present study was undertaken to know prevalence and prognostic significance of DAT positivity in CLL in India by associating it with stage and CD 38 expression. The study included fifty-eight newly diagnosed and untreated cases of CLL staged according to Binet and Rai system. Complete hemogram, DAT and immuno-phenotyping by flow cytometry was done to diagnose CLL and to assess CD 38 expression. Student's t test and Chi square test was used to calculate difference between means. p value ≤0.05 was considered significant. Results-DAT positivity was found in 27.58% cases. A positive association was seen between DAT and advanced Rai and Binet stage (P = 0.024 and P = 0.014 respectively). A positive association was also seen between DAT and CD 38 (P = 0.008). The study concluded that DAT positivity in Indian CLL patients is high as compared to West. As DAT correlated with advanced Rai/Binet stage, as well as CD 38 positivity, it can be considered as a surrogate marker for advanced disease and used to select patients needing close follow up especially at places where molecular and flow cytometric set up for prognostication is not available. PMID:34079629 | PMC:PMC8165719 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transverse plane ultrasound-guided caudal epidural injections: sonographic anatomy and stepwise technique

xlomafota13 shared this article with you from Inoreader Transverse plane ultrasound-guided caudal epidural injections: sonographic anatomy and stepwise technique Via radiol anat Surg Radiol Anat. 2021 Jun 2. doi: 10.1007/s00276-021-02776-9. Online ahead of print. ABSTRACT PURPOSE: The present study aims to provide a step-by-step procedural and anatomical familiarization guide for transverse plane ultrasound (US)-guided caudal epidural (CE) injection. METHODS: The study cohort consisted of 23 chronic low back pain patients (23-67 years old) previously unresponsive to conservative management. A transverse plane US-guided CE injection was perform ed, with each procedure step documenting and emphasizing sonographic anatomy. Several Thiel's method fixed cadaveric specimen dissections were also performed to demonstrate relevant CE injection-related anatomy. RESULTS: The sacral hiatus location can be estimated by visually forming an equilateral triangle between the posterior superior iliac spines and the sacral apex (trigonum sacrale). Follow-up palpation locates the sacral cornua, guiding transducer placement visualizing over the paired cornua 'bull frog's eye's appearance, with the epidural space visualized as a hypoechoic line, between the eyes. Then, 2-3 ml of 1% lidocaine is injected subcutaneously at the mid-point between the sacral cornua and superficial to the posterior sacrococcygeal ligament (SCL). Although keeping the cornua, superficial posterior SCL and epidural space in view, the needle is slowly advanced to the epidural space at around a 20 degree cephalad angle till the tip becomes visible. Expansion of the epidural space is monitored under the transverse sacral ligament as the injectant is slowly introduced. CONCLUSION: The present study demonstrated the anatomical landmarks necessary for the transverse ultrasound caudal epidural technique and that the cornua, superficial posterior SCL, CE space, and other relevant sacral hiatal anatomy are well visualized with this technique. PMID:34080063 | DOI:10.1007/s00276-021-02776-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Effectiveness and Safety of Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leaks

xlomafota13 shared this article with you from Inoreader The Effectiveness and Safety of Intrathecal Fluorescein in the Management of Cerebrospinal Fluid Leaks Via leak of cerebrospinal fluid Am J Rhinol Allergy. 2021 Jun 1:19458924211020564. doi: 10.1177/19458924211020564. Online ahead of print. ABSTRACT BACKGROUND: Cerebrospinal fluid (CSF) leaks can be associated with significant morbidity such as meningitis. Surgical management has proven effective, with endoscopic approaches having become the gold standard due to success rates >90%. Inability to localise the leak site prior to surgery is associated with surgical failure. The use of intrathecal fluorescein (IF) to localise CSF fistulae sites was first demonstrated in 1960. Despite this, its use in this context is unlicensed. OBJECTIVE: Evaluate the safety and efficacy of IF use in the management of CSF leak repairs in our centre. METHODS: All patients who underwent endoscopic repair of CSF fistula by a single surgeon where IF was used between January 2010 - September 2019 at a single-centre (tertiary skull base referral unit in the United Kingdom) were retrospec tively analysed. Primary outcome measures were localisation of CSF fistula with IF (efficacy) and peri-operative complications likely to be attributable to IF (safety). RESULTS: There were 55 patients included (60 procedures) with a positive localisation rate of 90.0% with IF. The overall peri-operative complication rate was 8.3% (n = 5). It is likely that none were related to IF use. However, three complications may be linked giving a complication rate potentially related to IF of 5.0%. There were no peri-operative mortalities. CONCLUSION: Many studies have demonstrated IF to be safe at low doses (<50mg) with a high sensitivity, specificity and positive predicative value. Our results demonstrate that the use of IF in our centre is safe and effective at identifying CSF fistulae. While we have reported some complications in our cohort, these were unlikely to be directly attributable IF use. We have described no serious complications such as seizures, limb weakness or d eath. We believe this study adds to the growing body of evidence that IF use in the management CSF fistula repairs is safe and effective. PMID:34074164 | DOI:10.1177/19458924211020564 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical Indications for Treatment with Multi-Kinase Inhibitors in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer

xlomafota13 shared this article with you from Inoreader Clinical Indications for Treatment with Multi-Kinase Inhibitors in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer Via radioactive iodine Cancers (Basel). 2021 May 10;13(9):2279. doi: 10.3390/cancers13092279. ABSTRACT Differentiated thyroid cancer is usually a slow-growing disease, even if the patients develop distant metastasis. For recurrent or metastatic disease, radioactive iodine therapy is a standard treatment. However, the disease gradually progresses in some of the patients and can ultimately develop into life-threatening conditions. For patients with progressive radioactive iodine-refractory differentiated t hyroid cancer (RR-DTC), multi-kinase inhibitors (MKIs) including sorafenib and lenvatinib prolonged progression-free survival compared with placebo in pivotal randomized phase 3 trials, although the benefit in overall survival has not been clearly confirmed, possibly because the patients who received placebo were permitted to cross-over to lenvatinib upon disease progression. Moreover, the adverse events related to MKIs were not negligible. Therefore, the optimal timing of MKI initiation has long been controversial, and physicians should consider various patient and disease factors. Herein, we comprehensively review the clinical factors that can be helpful in determining the initiation of MKIs for patients with RR-DTC. PMID:34068664 | DOI:10.3390/cancers13092279 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prospective Analysis of TERT Promoter Mutations in Papillary Thyroid Carcinoma at a Single Institution

xlomafota13 shared this article with you from Inoreader Prospective Analysis of <em>TERT</em> Promoter Mutations in Papillary Thyroid Carcinoma at a Single Institution Via radioactive iodine J Clin Med. 2021 May 18;10(10):2179. doi: 10.3390/jcm10102179. ABSTRACT BACKGROUND: Papillary thyroid cancer (PTC) has the highest cancer incidence in Korea. It is known that some thyroid cancers have aggressive clinical behavior and a poor prognosis. Genomic studies have described some somatic mutations that are related to the aggressive features of thyroid cancer, such as the BRAFV600E mutation. Recently, TERT promoter mutations were identified and report ed as poor prognostic factors in PTC. Our aim was to identify the frequency and clinical impact of TERT promoter mutation in PTC. METHODS: Analysis of both BRAFV600E and TERT promoter mutations in thyroidectomy specimens began in February 2019. As of December 2020, 622 patients had been tested. Data were prospectively collected and retrospectively reviewed to ascertain clinical and pathologic variables. RESULTS: TERT promoter mutations were identified in 13 patients (2.09%); 12 had the C228T mutation, and one had the C216T mutation. In total, ten patients had the BRAFV600E mutation. TERT promoter mutation was significantly associated with advanced age (46.795 ± 12.616 versus 65.692 ± 13.628 years, p < 0.001), large tumor size (1.006 ± 0.829 versus 2.285 ± 1.938 cm, p = 0.035), extrathyroidal extension, surgical margin involvement, angioinvasion, BRAFV600E mutation and a dvanced TNM stage, a higher MACIS score and a high proportion of radioactive iodine therapy application. Logistic regression showed that lymphatic and angioinvasion and BRAFV600E mutation were predictive of TERT promoter mutation. CONCLUSIONS: Our study is the first to report the prospective results of TERT promoter mutations at a single tertiary hospital in Incheon, Korea. PTC with TERT promoter mutation was associated with more aggressive behavior than PTC with wild-type TERT gene status. PMID:34070093 | DOI:10.3390/jcm10102179 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Updated Incidence of Thyroid Cancer in the North East Region of Romania after 35 Years of Chernobyl Fallout. Is There a Link between?

xlomafota13 shared this article with you from Inoreader Updated Incidence of Thyroid Cancer in the North East Region of Romania after 35 Years of Chernobyl Fallout. Is There a Link between? Via radioactive iodine Diagnostics (Basel). 2021 May 19;11(5):907. doi: 10.3390/diagnostics11050907. ABSTRACT Thyroid cancer (TC) represents a worldwide problem, the consistent growth of the incidence increment issues about management of risk factors and curative treatment. Updated statistical data are not complete in the North East region of Romania and need to be improved. Therefore, through this study, we aim to renew the existing data on thyroid cancer. We conducted a retrospective study covering a p eriod of 10 years. Data were collected from a hospital information system (InfoWorld) between 2009 and 2019. Patients' age groups were stratified in relation with the age at the moment of the Chernobyl event. A database was obtained (Microsoft Excel) and statistical correlations were applied. In the studied period, 1159 patients were diagnosed: 968 females and 191 males, distributed by region, with the highest addressability in Iasi (529), followed by neighboring counties. Age distribution displayed that most of the thyroid cancers were in the range 4060 years old (50.94%), followed by 60-80 years old (32.41%). Most patients were diagnosed with papillary carcinoma 63.10%, then follicular 14.7%, medullary 6.74% and undifferentiated 1.02%. Romania was in the vicinity of the radioactive cloud at Chernobyl fallout, so we must deliberate whether the increased incidence of thyroid cancer in the age group 40-60 years is associated with radiogenicity (iodine 131) given the fact that over ha s 35 years and the half-life of other radioisotopes like Caesium-137 and Strontium -90 is completed. PMID:34069605 | DOI:10.3390/diagnostics11050907 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Stepwise Approach Using Metastatic Lymph Node Ratio-Combined Thyroglobulin for Customization of [18F]FDG-PET/CT Indication to Detect Persistent Disease in Patients with Papillary Thyroid Cancer

xlomafota13 shared this article with you from Inoreader A Stepwise Approach Using Metastatic Lymph Node Ratio-Combined Thyroglobulin for Customization of [<sup>18</sup>F]FDG-PET/CT Indication to Detect Persistent Disease in Patients with Papillary Thyroid Cancer Via radioactive iodine Diagnostics (Basel). 2021 May 6;11(5):836. doi: 10.3390/diagnostics11050836. ABSTRACT We investigated whether an indication for [18F]FDG-PET/CT to detect FDG-avid persistent disease (PD) could be identified precisely using the extent of metastatic lymph nodes (MLNs) and serum thyroglobulin (Tg) in papillary thyroid cancer (PTC) patients. This retrospective study included 429 PTC patients who underwent surgery and radioactive iodine (RAI) therapy. [18F]FDG-PET/ CT and serum Tg were evaluated just before RAI therapy. The MLN ratio (LNR) was defined as the ratio of the number of MLNs to the number of removed LNs. To derive the LNR-combined criteria, different Tg cut-off values for identifying the PET/CT-indicated group for PD detection were applied individually to subgroups initially classified based on LNR cut-off values. The cut-off values for serum Tg, the number of MLNs, and LNR for a PET/CT indication were 6.0 ng/mL, 5, and 0.51, respectively. Compared to a single parameter (serum Tg, total number of MLNs, and LNR), the LNR-combined criteria showed significantly superior diagnostic performance in detecting FDG-avid PD (p < 0.001). The diagnostic performance of PET/CT in detecting FDG-avid PD was significantly improved when the PET/CT-indicated group was identified through the LNR-combined criteria in a stepwise manner; this can contribute to a customized PET/CT indication in PTC patients. PMID:34066574 | DOI:10.3390/diagnostics11050836 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

xlomafota13 shared this article with you from Inoreader Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jun 2:34894211015582. doi: 10.1177/00034894211015582. Online ahead of print. ABSTRACT OBJECTIVE: We sought to identify risk factors associated with long-term dysphagia, characterize changes in dysphagia over time, and evaluate the incidence of otolaryngology referrals for patients with long-term dysphagia following anterior cervical discectomy with fusion (ACDF). METHODS: About 56 patients who underwent ACDF between May 2017 to February 2 019 were included in the study. All patients were assessed for dysphagia using the Eating Assessment Tool (EAT-10) survey preoperatively and late postoperatively (≥1 year). Additionally, 28 patients were assessed for dysphagia early postoperatively (2 weeks-3 months). Demographic data, medical comorbidities, intraoperative details, and post-operative otolaryngology referral rates were collected from electronic medical records. RESULTS: Of the 56 patients enrolled, 21 patients (38%) had EAT-10 scores of 3 or more at long-term follow-up. None of the demographics, comorbidities, or surgical factors assessed were associated with long-term dysphagia. Patients who reported no long-term dysphagia had a mean EAT-10 score of 6.9 early postoperatively, while patients with long-term symptoms had a mean score of 18.1 (P = .006). Of the 21 patients who reported persistent dysphagia symptoms, 3 (14%) received dysphagia testing or otolaryngology referrals post-operatively. CON CLUSION: Dysphagia is a notable side effect of ACDF surgery, but there are no significant demographics, comorbidities, or surgical risk factors that predict long-term dysphagia. Early postoperative characterization of dysphagia using the EAT-10 questionnaire can help predict long-term symptoms. There is inadequate screening and otolaryngology follow-up for patients with post-ACDF dysphagia. PMID:34075815 | DOI:10.1177/00034894211015582 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Social Representation of ‘Vocal Hygiene’ in India and Bhutan: A Cross-Sectional Survey

xlomafota13 shared this article with you from Inoreader Social Representation of 'Vocal Hygiene' in India and Bhutan: A Cross-Sectional Survey Via Journal of Voice The study aimed to explore the professional and recreational and/or personal voice use patterns and social representation of 'vocal hygiene' in two culturally and geographically diverse societies: India and Bhutan. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Controversy of Pepsinogen A/Pepsin A in Detecting Extra-Gastroesophageal Reflux

xlomafota13 shared this article with you from Inoreader The Controversy of Pepsinogen A/Pepsin A in Detecting Extra-Gastroesophageal Reflux Via Journal of Voice Pepsinogen A (PGA)/pepsin A is often used as a diagnostic marker of extra-gastroesophageal reflux. We aimed to explore whether its positivity in upper aerodigestive tract (UADT) was specific enough to diagnose reflux. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.