Cost-analysis comparison of clinical risk assessment with and without ROMA for the management of women with pelvic masses
Published on: 17th August, 2022
Objective: Pelvic masses can be classified as low risk (likely benign) and high risk (likely malignant) based on an initial clinical risk assessment, which involves a detailed history, physical exam, basic laboratory tests, and imaging. In recent years, the Risk of Ovarian Malignancy Algorithm (ROMA), which combines CA125, HE4 and menopausal status, has emerged as a powerful tool in the classification of pelvic masses and triage of patients to either a generalist gynecologist or a gynecologic oncologist for management. The objective of this study was to evaluate whether the use of ROMA, alone or in combination with Initial Clinical Risk Assessment (ICRA), provides cost savings compared to triage based on ICRA alone.Methods: A health-economic decision model was developed to assess clinical and cost differences associated with three different clinical pathways of risk assessment for a pelvic mass: ICRA alone, ROMA alone, or ICRA + ROMA in combination. Using previously reported accuracy rates and patient characteristics from a prospective, multicenter, blinded clinical trial, total healthcare costs were modeled for each clinical pathway using the Medicare 2020 reimbursement rates.Results: A total of 461 patients with pelvic masses were included with 10.4% ultimately diagnosed with epithelial ovarian cancer. Total healthcare costs for patients with benign disease, EOC, or low malignant potential tumors (LMP) (n = 441) triaged using ROMA alone were 3.3% lower than when triaged using ICRA alone. While lab costs increased 55% using ROMA, the use of ROMA alone resulted in a 4% decrease in laparoscopy costs and a 3.1% decrease in laparotomy costs compared with ICRA alone. Similarly, total costs associated with a combination of ICRA + ROMA were 3.9% lower than total costs associated with ICRA alone. The model also predicted a 63% reduction in repeat surgeries resulting from false negative ICRA when using ROMA to triage patients.Conclusion: Triage of women with pelvic masses using the more sensitive ROMA score lowers overall healthcare costs compared to ICRA alone. With fewer false negative results than ICRA alone, the ROMA score improves initial detection of malignancy and reduces second surgical treatments in women with pelvic masses.
The risk of coronary heart disease varies with blood pressure grades and glycemic metabolism statues in a hypertensive
Published on: 30th August, 2022
Coronary heart disease (CHD) is the leading cause of death worldwide [1]. In China, the prevalence of CHD has kept continually increasing, with the number of patients being approximately 11.39 million, at present [2] and CHD poses a substantial threat to human health. Hypertension and diabetes both are the major risk factors for CHD [2,3] and the risk of CHD in patients with coexisting hypertension and diabetes is higher than that in patients with either of the two diseases [4].
An empirical study on factors responsible for Rheumatic Heart Disease (RHD) and its severity levels amongst the Bhutanese populace
Published on: 30th August, 2022
Background and objectives: This paper is aimed at excavating the factors responsible for RHD events and vis-à-vis establishing severity levels of RHD patients referred to Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu’s capital city of Bhutan. Methods: By taking notorious advantage of the data gathered over the past five years (2016-2020) from RHD patients across 20 districts of Bhutan, about 232 RHD patients are involved in this study recorded in JDWNRH by the Cardiology Department. Besides descriptive methods, multivariate linear regression models augmented by the multinomial logistic regression models had been applied to establish the causual links. Results: The findings revealed that RHD prevailed amongst the young populace of Bhutan, especially females. Variables like age, frequency of visits, number of diagnostics, levels of education and region had been found as predictors of RHD prevalence. Other socio-demographic factors like occupation and status of employment did not affect the RHD prevalence. The multinomial logistic regression results indicated that higher levels of education as an important factor for not making the patient fall into the category of ‘severe.’ Age has been constantly found to be a highly significant variable contributing to RHD events and a quadratic relationship is revealed between age and the severity of RHD. Conclusion and implications for translation: This study pigeonholed the significant factors responsible for RHD events and entailed severity levels by gender and age. The findings of this study also provide additional important insights into developing public health policies and programs.
Status of hemodialysis patients using complementary and alternative medicine practices during the COVID-19 pandemic
Published on: 31st August, 2022
The use of complementary and alternative medicine (CAM) applications increased by 39.3% of individuals with chronic diseases during the pandemic process in Turkey. For this reason, this descriptive study was conducted to determine the use of integrative and integrated medicine practices in hemodialysis patients during the COVID-19 pandemic. The population of the study consisted of individuals who were treated in a hemodialysis unit in the city center (n = 235). It was planned to include whole of the population by using the whole number method, but patients, who did not agree to participate in the study and did not meet the inclusion criteria of the study, were excluded from the sample and the study was conducted with 160 patients between 1 June and 1 September 2021. As a data collection tool, a questionnaire consisting of 30 questions including socio-demographic and disease characteristics of the patients was prepared by the researcher upon review of related literature. Considering the distribution of phytotherapy method (herbal treatment) usage frequency of integrative and integrated medicine applications of individuals before the COVID-19 pandemic and during the COVID-19 pandemic period, the most vitamins (21.8%), prebiotics (12.5%), and honey (%) 10.6), their use was found to be high. During the COVID-19 pandemic, the use of massage (40%), breathing exercises (30.0%) and spiritual therapy (28.7%) applications increased. As a result, it is seen that integrative and integrated applications are considered in the process of dealing with hemodialysis patients. Physicians need to be aware of and ask patients about their use of integrated and integrated health practices.
Impact of coronavirus pandemic on safety and time of administration of subcutaneous immunotherapy among pediatric patients
Published on: 2nd September, 2022
OCLC Number/Unique Identifier: 9617323801
Introduction: Allergen immunotherapy is the only targeted therapy that can modify the natural course of allergic diseases. In pediatric patients, SCIT with aeroallergens is an effective treatment and should be considered as a preventive strategy in the treatment of allergic diseases, even though one of the major concerns about it is its safety. The main purposes of this study were to assess the safety of SCIT ultra-rush schedules with polymerized extracts in a pediatric population and to determine the impact of the COVID-19 pandemic on the safety and time of administration of subcutaneous immunotherapy among pediatric patients.Methods: A retrospective medical records review of patients under 18 years of age undergoing SCIT was made and re-scheduling due to restrictions imposed by the COVID-19 pandemic was recorded. Results: A total of 192 pediatric patients were included. Fifty-nine (31%) had local reactions and systemic reactions were not reported. In March 2020, the first case of COVID-19 was diagnosed in Portugal and all non-urgent appointments and procedures were postponed. In our group of pediatric patients, 43 (22%) were referred to primary care, 38 (20%) stopped AIT definitively and 111 (58%) maintained administrations in the hospital. Only 2 (2%) of them had reactions upon reinitiation. Conclusion: In this study, the ultra-rush protocol using polymerized extracts was safe in pediatric patients. Although the effectiveness of AIT may be compromised due to prolonged suspension of the treatment, it is important to note that despite longer interruptions, administrations may continue without compromising safety, maintaining shorter visits and a lower number of injections.
Follow-up of patients with sarcoidosis in an internal medicine unit from a hospital in Asturias, Spain. Analysis of extrapulmonary manifestations
Published on: 2nd September, 2022
OCLC Number/Unique Identifier: 9617326596
Sarcoidosis is a multisystem disease of unknown origin that is characterized by non-caseating epithelioid granuloma formation within various organs, mainly the lungs [1]. The objective of this study is the analysis of sarcoidosis patients affected by pulmonary manifestation alone or extrapulmonary expression.
Knowledge and attitudes of pediatric nurses regarding oral health care for hospitalized children in Riyadh, Saudi Arabia
Published on: 6th September, 2022
Background: Pediatric nurses are in a unique position to provide oral health care to hospitalized children and help in the prevention and management of oral diseases. The objectives of this study were to determine pediatric nurses’ level of oral health knowledge and to evaluate their attitude towards the prevention of oral diseases and willingness to obtain more oral health education and training.Methods: A cross-sectional study was conducted at 6 randomly selected hospitals in Riyadh city, Saudi Arabia. A self-administrated questionnaire with items including demographic data, dental knowledge, attitude, and willingness to obtain more information and training was completed by 240 pediatric nurses working in different pediatric medical wards.Results: On average, 64% of surveyed pediatric nurses had acceptable dental knowledge. Only 79% of nurses assess patients’ mouths on admission. About 77% of nurses claimed to receive instructions regarding oral care before qualification and 72% after qualification. However, 91% showed great attitudes and interest in providing oral care to hospitalized children and were willing to obtain more information about oral health care for children.Conclusion: Pediatric nurses working in Riyadh hospitals had limited oral health knowledge, however, they showed good awareness and a positive attitude toward promoting oral health care to hospitalized children.
Does global longitudinal strain improve stratification risk in heart failure with preserved ejection fraction?
Published on: 8th September, 2022
Background: Heart Failure with Preserved Ejection Fraction (HFPEF) accounts for more than half of the cases of heart failure.Long regarded as an abnormality of left ventricular diastolic function, recent studies using longitudinal strain (two-dimensional speckle tracking mode) have suggested that left ventricular longitudinal systolic function is altered in HFPEF.Despite these interesting pathophysiological perspectives, the data in the literature on the prognostic value of the alteration of longitudinal strain are controversial. Given these conflicting results, it is difficult to confirm the magnitude and prevalence of impaired LV longitudinal systolic function in patients with HFPEF and its prognostic relevance. Purposes: This work aims to study the prognostic value of Global the left ventricle’s Global Longitudinal Strain (GLS) Algerian cohort of patients with HFPEF. Patients and methods: We conducted a monocentric prospective observational study from April 2018 to April 2020, with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 referred to the echocardiography laboratory for chronic or acute HFpEF, defined according to the criteria of ESC 2016. 153 consecutive patients underwent clinical examination, biological tests, and echocardiography with measurement of GLS at rest, in addition to routine management by the attending physicians.Results: 153 patients were collected. The average age of our patients is 73 +/- 11 years ranging from 42 to 91 years old. The female population is predominant with a rate of 67%. Comorbidities are predominant mainly by arterial hypertension (86%) and diabetes (64%), with a history of atrial fibrillation (46%).63% of patients have impaired GLS (< 16%). Contrary to our hypothesis, GLS was not shown to be a powerful predictor of cardiovascular events in HFPEF patients either in dichotomous analysis (OR = 0.79; p = 0.64) or in continuous analysis (OR = 0.97; p = 0.69).We were able to identify that congestive venous signs, anemia, and pulmonary hypertension, are the main independent prognostic factors in our Algerian population study. Conclusion: We were unable to demonstrate the prognostic role of mpaired GLS in our population of patients with HFPEF.
Knowledge, attitude and behaviour of undergraduate medical students towards mentally Ill patients-Suez Canal University, Egypt
Published on: 10th September, 2022
Background: Worldwide, studies show negative attitudes among medical students toward psychiatry and mental illness. The knowledge of the attitude and awareness of the undergraduate medical students toward mental health and psychiatric disorders are most important as they are going to be involved in the care of these patients either directly or indirectly during the years of their careers.Aim: To explore, the knowledge, attitude, and behavior of undergraduate medical students towards mentally ill Patients before their planned psychiatry rotation in the fourth year of undergraduate medical study, faculty of medicine, Suez Canal University, Ismailia, Egypt.Objectives: To assess mental health-related knowledge, attitudes and intended behavior of undergraduate medical students towards mentally ill patients.Subjects and methods: A descriptive, cross-sectional study, conducted on 120 fourth-year undergraduate medical students affiliated with the faculty of medicine-Suez Canal University. A comprehensive sample was used to include all of the students in the fourth year of undergraduate medical study, and the study group participants completed a semi-structured questionnaire including four parts to assess their knowledge, attitudes, and behavioral responses towards individuals with mental illnesses. The data of the study was collected in September-October 2019.Results: Based on the participants’ scores, the cut-off points estimated to dichotomize the responses as poor or good, for mental health-related knowledge, belief towards mental illness and intended behavior were, 17, 55 and 8.5 respectively. This study showed that the study participants had marginally poor mental health-related knowledge with a median score of 17, poor beliefs about mental illness with a median score of 49.5 and poor intended behavior towards the mentally ill with a median score of 7. Conclusion: In this study, undergraduate medical students showed marginally poor mental health-related knowledge, poor stigmatizing beliefs, and behavior towards mentally ill patients. More controlled studies are needed to eliminate the inherent response biases in survey studies and to measure the outcomes of anti-stigma educational and curricular interventions.
The therapeutic impact of the interaction between horses and patients with mental disorders: Veterinary and psychodynamic reflexions in the clinical application of equine assisted therapy
Published on: 14th September, 2022
An increased scientific interest is observed nowadays in the clinical application of Equine Assisted therapy for patients with mental disorders, reflected on recent numerous systematic reviews, scoping reviews and concept analyses.
SARS-CoV-2 Omicron and centaurus variants induced lymphocytopenia: A multicenter clinical investigation on 118,561 cases across Pakistan during 2021-2022
Published on: 16th September, 2022
The SARS-CoV-2 pandemic is still ongoing. Previously, several studies have been conducted to investigate laboratory markers as a tool for severity assessment during COVID-19 infections. Biological markers such as Platelet count, D-dimer and IL-6, Lymphocytopenia and others have been used for assessment of severity in COVID-19 disease patients (infected by SARS-CoV-2 Alpha, Beta, Gamma, Delta, Epsilon, and other variants). We observed a significant drop in lymphocyte count among suspected SARS-CoV-2 clinical patients with symptoms of fever, running nose, breathing discomfort, cough, and others during Omicron and Centaurus variants spread in Pakistan. A multicenter, cross-sectional study was conducted from Jan 2021 to Aug 2022, on 118,561 subjects to evaluate hematological abnormalities among suspected patients. Of note, significantly decreased lymphocyte levels (lymphocytopenia) were observed among 43.05% of infected patients. Also, the levels of NA (39.03%), HGB (28.27%), MCV (22.62%), PLT (8.17%), and ALB (4.30%) were also reduced among infected patients. This suggests that lymphopenia can be used as an alternative, cost-effective, early diagnostic biomarker for clinical COVID-19 patients, even before the diagnosis via real-time PCR. In resource-limited countries, the current study is critical for policy-making strategic organizations for prioritizing lymphocytopenia-based screening (as an alternative, cost-effective diagnostic test) in clinical COVID-19 patients, before real-time PCR-based diagnosis.
Identification, characterization of candida species isolated from cases of vulvovaginal candidiasis along with their antifungal susceptibility by vitek-2 system
Published on: 29th August, 2022
One of the most severe threats to world health is the Candida species. Many non-Candida species are the major cause of vulvovaginal candidiasis (VVC). During the development of VVC, the host environment and Candida vaginal colonization are assumed to be out of balance, and this might be owing to physiological or non-physiological changes. Host-related and behavioral risks have been connected to VVC. Novel antifungal medications with particular molecular targets may be developed with the use of molecular tools in epidemiological research and the study of resistant Candida species. Using the Vitek-2 Antifungal Susceptibility System, this review will explain the many approaches used to identify and characterize Candida species isolated from vulvovaginal candidiasis patients.
The combination of very-small size proteoliposomes and alum is a safe adjuvant alternative for inducing anti-EGF antibodies: a preclinical study
Published on: 19th September, 2022
Immunization with human recombinant EGF chemically bound to the P64k protein of Neisseria meningitides (hrEGF-P64k) and adjuvanted in Montanide ISA 51 VG (Montanide) is an efficient strategy to induce polyclonal antibodies (PAbs) response targeting this self -antigen in cancer patients, which is the basis of the CIMAvax-EGF vaccine. The neutralizing potential of EGF-specific induced PAbs supports promising clinical data obtained to date with this vaccine. Herein, we evaluated a combination of very small-size proteoliposomes (VSSP) and aluminum hydroxide (Alum) as a novel adjuvant to induce specific PAbs with neutralizing and anti-proliferative properties on tumor cells, considering EGF as a model antigen. Toxicity at the injection site was not detected for the vaccine formulation containing VSSP/Alum, and it was immunogenic in BALB/c mice, as evidenced by the induction of high titers of EGF-specific polyclonal antibodies (PAbs). While schedule optimization increased the magnitude of the PAbs response induced by VSSP/Alum, induced PAbs’s avidity and intrinsic neutralizing potential were comparable to the humoral response induced by Montanide. Also, VSSP addition switched IgG subclasses distribution into a Th1-like pattern, as obtained with Montanide and desirable for a cancer vaccine. Finally, equivalent PAbs titers were induced by the vaccine formulations adjuvanted in VSSP/Alum or Montanide in tumor-bearing-mice, and immunosuppressed mice, suggesting the feasibility of the VSSP/Alum combined adjuvant for inducing anti-EGF antibodies in cancer patients at advanced stages of the disease.
Long-term results of 10 years of observation of cured cases of pulmonary tuberculosis
Published on: 23rd September, 2022
Aim of the study: Conduct long-term monitoring of recovered patients with pulmonary TB and study the frequency of relapses of pulmonary TB and factors contributing to their development in the Republic of Tajikistan.Material and research methods: Of the total number of patients with pulmonary TB, 820 people in 2010-2011 after successful treatment, were transferred for further dispensary observation to PHC facilities, whose health status we monitored for 10 years (including 2020). Of the 820 patients, we were able to track the health status for 10 years in 622 patients (320 men and 302 women, age groups 19-44 years old - 330 people and 45-69 years old - 292 people). The rest - for various reasons were lost from further dispensary observation. All patients in PHC facilities annually during the period of dispensary observation underwent clinical, instrumental, laboratory, and X-ray examinations to exclude the recurrence of TB. Data for each patient were tracked using the National TB Registry OpenMRS data.Research results: The elimination of preventive anti-relapse measures in people with residual post-tuberculosis changes in the lungs led to an increase in the number of relapses of the disease. The analysis of the conducted studies shows that the incidence of relapses of pulmonary TB does not depend on the regions and the severity of TB burden, they often develop with insufficient follow-up after the end of treatment and inadequate preventive measures in dispensaries patients.The study of the reasons for the development of relapses makes it possible to timely identify a group of patients who need anti-relapse measures and prolongation of dispensary observation.Conclusion: Thus, the results of this observation revealed the occurrence of relapses within 10 years in 19.3% of cases. A retrospective analysis of the initial forms of the disease showed that relapses of pulmonary tuberculosis occurred more often in patients who had had fibrous-cavernous pulmonary tuberculosis, than in patients who had disseminated pulmonary TB, and less often after suffering infiltrative pulmonary TB. Relapses of the disease occurred more often in men aged 19-44 years. The results obtained indicate the development of relapses of pulmonary tuberculosis has a statistically significant dependence on the form of the initial disease, the presence of RPTCL, comorbid diseases such as HIV, diabetes mellitus, COPD, and the regularity of taking anti-TB drugs. At the same time, it turned out that the social status of all patients with relapses corresponds to the level of poverty, which should also be taken into account.
Knowledge and self-reported practice of insulin injection device disposal and associated factors among diabetes patients in Addis Ababa, Ethiopia: A cross-sectional study
Published on: 26th September, 2022
Background: Diabetes mellitus is a serious long-term condition with a major impact on the lives and well-being, of societies worldwide. Poor disposal practices of devices potentially result in personal injury and injuries to people in the household and the general community. This study aimed to assess the knowledge and self-reported practice of insulin injection device disposal and associated factors among diabetes patients in TASH, Addis Ababa, Ethiopia. Method: A cross-sectional study was conducted among 182 adults with diabetes. The study participants were selected through systematic random sampling. Data were collected from March/17/2020 - May/18/2020. Patients were interviewed using a structured questionnaire. Data were entered into Epi-data version 4. 6 and exported to SPSS version 25.0 for analysis. Bivariable and multivariable logistic regression with crude and adjusted odds ratios along with the 95% confidence interval was computed and interpreted accordingly. Good practice and adequate knowledge were defined based on median calculation; a result above the median value of good practice and adequate knowledge with a p - value < 0.05 was considered to declare a result as statistically significant.Results: About 54% of the participants had inadequate knowledge about safe insulin injection waste disposal. More than two-thirds (73%) of respondents had poor practice and 92.3% of respondents did not know how to dispose of lancets after use.Conclusion: This study revealed that the knowledge and practice of diabetic patients were inadequate and poor towards safe insulin injection waste disposal in the study area. Educating patients and awareness creation training on proper insulin injection device disposal should be considerable.
Shoulder recovery for head and neck cancer patients after unilateral neck dissection: a pilot exploratory study
Published on: 28th September, 2022
An established side-effect of neck dissection (ND) for head and neck (HNC) tumour management includes shoulder dysfunction (SD), which can impact quality of life (QOL). Shoulder strength and range of movement (ROM) are key parameters to be monitored in SD. However, such evaluations are not routinely conducted in the clinical setting. The aim of this study was to evaluate objectively the impact of ND on shoulder functions. Methods: This is a pilot exploratory study in a tertiary cancer centre. Five participants with unilateral ND and advanced HNC, completed the study. Outcome measures consisted of self-reported QOL questionnaires, C2–T1 dermatomes and shoulder ROM and strength testing. Data was collected at baseline, 1.5-months after surgery and 6-months after diagnosis (after adjuvant treatment completion). Results: Most outcome measures on the surgically affected side were negatively impacted post-operatively, with varied recovery seen at follow-up. Sensory loss was noted at C3–4 dermatome levels. Shoulder ROM and strength was reduced on the surficial side for all participants, with some recovery after six months except for two participants.Conclusion: Results of SD after ND are diverse and unique to each patient. Findings from this pilot study indicate that regular rehabilitation/exercise may facilitate recovery of shoulder function post HNC surgery. However, customised rehabilitation may yield better outcomes. Future studies with a larger sample are indicated to validate the findings of this study.
Comparison of GFR measurement with [99mTc]-DTPA and clinical methods based on creatinine measurement, in patients over 80 years old
Published on: 28th September, 2022
OCLC Number/Unique Identifier: 9638982949
Introduction and aim: The most accurate way of measuring kidney function in GFR. Clinical formulas based on creatinine measurement may be inaccurate mainly in elderly patients (over 80 years of age). In this study we evaluated the accuracy of commonly used clinical formulas by comparing them with a direct measurement with [99mTc]-DTPA ([99mTc]-diethylene-triamine-peracetic acid) in a population of patients aged eighty and older.Material and methods: 47 patients (27 males and 20 females) with an average age of 81.9 ± 1.7 years, 80% already diagnosed with Chronic Kidney Disease (CKD), were investigated. Two plasma samples were collected between 60-90 and 165-190 minutes after the injection of [99mTc]-DTPA and GFR were calculated. Results: When comparing the GFR values obtained from the various formulae by creatinine levels with the GFR value obtained by measuring [99mTc]-DTPA residue, the following concordance values emerged: (1) MDRD: 55.3%, (2) Cockroft-Gault 55.3% (3) CKD-EPI 57.5% (4) BIS-1 51.1%Conclusion: Our data show a poor correlation between all clinical methods and [99mTc]-DTPA, which remains a gold standard for the direct measurement of GFR.
Medical mystery: Deposition of calcium oxalate and phosphate stones in soft tissues
Published on: 30th September, 2022
OCLC Number/Unique Identifier: 9639226630
Calcinosis cutis (CC) [1] is an unusual disorder characterized by calcium-phosphate deposition into cutaneous and subcutaneous tissues. There are five subtypes: dystrophic, metastatic, idiopathic, iatrogenic and calciphylaxis.Calciphylaxis or calcifying panniculitis is defined as small vessel calcification mainly affecting blood vessels of the dermis and subcutaneous fat. Despite the predominance of cases in patients with ESRD, calciphylaxis can also be found in patients with normal renal function and normal levels of calcium and phosphate. These cases are often referred to as nonuremic calciphylaxis (NUC), a heterogeneous category with several associations. Literature reveals an association with hyperparathyroidism (28%), malignancy (22%), alcoholic liver disease (17%) and connective tissue diseases (11%) while obesity, liver disease, high-serum calcium (Ca) × phosphorus (P) levels, combined therapies of calcium salts with vitamin D, warfarin and corticosteroids have been observed to increase the likelihood of this disease [2]. The lesions in both nonuremic and uremic calciphylaxis tend to be indistinguishable from each other, initially presenting as tender subcutaneous plaques that progress into nonhealing ulcers with overlying black eschar. Skin changes often begin with a livedo reticularis pattern that can progress to livedo racemes and ultimately retiform purpura.In our clinical case, we describe a patient with multiple risk factors for calciphylaxis, intense widespread calcification (vessels, tendons, joints) and cutaneous calcific stone of calcium and phosphate oxalate not elsewhere described before.
New insights of liquid biopsy in ovarian cancer
Published on: 29th September, 2022
Through the development of new analysis technologies, many issues regarding the approach to tumoral diseases have been elucidated. With analytical assays developed in the last years, various omics technologies have evolved in such a manner that the characteristics of tumor cells and products can be evaluated (assessed) in the bloodstream of cancer patients at different times. Ovarian Cancer (OC) is one of the most difficult to diagnose umors, with low survival rates due to the high heterogeneity of these diseases that are distinct in terms of etiology and molecular characteristics, but which simply share an anatomical appearance. Recent findings have indicated that several types of ovarian cancer classified into different histotypes are in fact derived from non-ovarian issues and share few molecular similarities. Within this context, ovarian cancer screening and diagnosis can be made through the evaluation of circulating tumor cells in peripheral blood using liquid biopsy technologies. Advances in the study of various molecules analyzed by liquid biopsy have shown that elucidation of intratumoural and intertumoural heterogeneity and spatial and temporal tumor evolution could be traced by serial blood tests rather than by histopathological analyses of tissue samples from a primary tumor. Therefore, evaluation of some molecules such as circulating tumor cells (CTC), circulating tumor DNA (ctDNA), circulating cell-free RNA (non-coding and mRNA, extracellular vesicles), tumor-educated platelets or different miRNAs using liquid biopsy could lead to improvement of patient management.
The outcome of autologous hematopoietic stem cell transplantation in patients with multiple myeloma. The experience of King Fahad Specialist Hospital in Dammam, Saudi Arabia
Published on: 29th September, 2022
Background: Aautologous hematopoietic stem cell transplants (HSCT) is the standard of care for newly diagnosed patients with multiple myeloma (MM) who are eligible for autologous transplantation. Although cryopreservation is routinely employed, autologous HSCT can be performed using non-cryopreserved stem cells.Methods and materials: A retrospective study of patients with MM who received autologous HSCT between the 10th of October 2010 and the 31st of January 2022 at King Fahad Specialist Hospital (KFSH) in Dammam, Saudi Arabia was performed.Results: Over 11 years and 113 days, a total of 135 autologous HSCTs were performed for 119 patients with MM at our institution. Single autologous HSCTs were performed for 119 patients, while 16 of these patients received either planned tandem autologous transplants or second autografts due to either progression or relapse of their myeloma. The median age of patients with MM at autologous HSCT was 51.5 years. At presentation of their MM, the following high-risk (HR) features were encountered: stage III disease according to the revised international scoring system (RISS) in 12.3%; adverse cytogenetics in 31.93% of patients; advanced bone disease in 60.50%; and renal dysfunction or failure in 11.76% of patients. A total of 104 autologous HSCTs (77.04%) were performed without cryopreservation while 31 autografts (22.96%) were performed using cryopreserved apheresis stem cell products. Additionally, 54 autologous HSCTs (40.00%) were done at outpatient while 81 autografts (60.00%) were performed in an inpatient setting. Survival for 100 days post-HSCT for all patients with MM who received autologous transplants including those done at outpatient was 100%. The 4 years overall survival (OS) an progression-free survival (PFS) for patients with MM who received non- cryopreserved or fresh autologous HSCTs were 82% and 68% respectively.Conclusion: Autologous HSCT without cryopreservation is safe, and feasible and can lead to short-term as well as long-term outcomes that are comparable to autologous transplantation with cryopreservation. Non- cryopreserved autologous grafts allow the performance of autologous transplants in an outpatient setting to save beds and reduce costs.
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