Poly (ADP-ribose) polymerase (PARP) inhibitors are approved for patients with metastatic castration-resistant prostate cancer harboring deleterious or suspected deleterious
and/or
mutations. ...Identifying patients with prostate cancer harboring these mutations may be challenging. Circulating cell-free DNA (cfDNA) provides an avenue for an easier detection of these mutations. Herein, we aimed to evaluate the concordance of
mutations in the tumor tissue and cfDNA in patients with metastatic prostate cancer in the real-world setting.
Somatic genomic profiling results were obtained from a clinical cohort of patients at our institution who had at least two samples tested. One of the samples needed to be from either primary or metastatic tissue. Concordance was adjusted to not include mutation types that the cfDNA platforms were not designed to detect.
The presence or absence of mutations in the
gene was assessed in a total of 589 samples, including 327 cfDNA samples, from 260 patients with metastatic prostate cancer. The median time between the first test and any subsequent test was 22.8 (0.0-232) months.
mutation was present in the patient's original prostate tissue in 23 samples (3.9%) of patients. The adjusted concordance between prostate tumor tissue and cfDNA was 97.9% 95% CI, 95.3-99.1%. The adjusted concordance between metastatic samples and cfDNA was 93.5% 95% CI, 86.4-97.3%. Of the patients who had a
mutation detected in their prostate tissue, there was a 70% probability of detecting a
mutation in the patient's cfDNA as well. For patients who did not have a detectable
mutation in their primary prostate tissue, the probability of detecting a subsequent one later in the disease course was less than 0.9%.
There is a high level of concordance between tissue and blood for
mutations. Testing cfDNA can provide reliable information on
mutational status and is a viable alternative to solid tissue sequencing when unavailable. The development of a new
mutation later in the disease course is a rare event.
Background: The bone health of patients with locally advanced and metastatic prostate cancer is at risk from treatment-related bone density loss and skeletal-related events from metastatic disease in ...bones. Evidence-based guidelines recommend using denosumab or zoledronic acid at bone metastasis-indicated dosages in the setting of castration-resistant prostate cancer with bone metastases and at the osteoporosis-indicated dosages in the hormone-sensitive setting in patients with a significant risk of fragility fracture. For the concerns of jaw osteonecrosis, a dental evaluation is recommended before starting bone-modifying agents. The literature review suggests a limited evidence-based practice for bone health with prostate cancer in the real world. Both under-treatment and inappropriate dosing of bone remodeling therapies place additional risks to bone health. An incomplete dental work up before starting bone-modifying agents increases the risk of jaw osteonecrosis. Methods: We created an algorithm-based clinical practice tool to minimize the deviation from evidence-based guidelines at our center and provide appropriate bone health care to our patients by ensuring indication-appropriate dosing and dental screening rates. This order set was incorporated into the electronic medical record system for ordering a bone remodeling agent for prostate cancer. The tool prompts the clinicians to follow the appropriate algorithm in a stepwise manner to ensure a pretreatment dental evaluation and use of the correct dosage of drugs. Results: We analyzed the data from Sept 2019 to April 2022 following the incorporation of this tool. 0/35 (0%) patients were placed on inappropriate bone modifying agent dosing, and dental health was addressed in every patient before initiating treatment. We compared the change in the practice of prescribing and noted a significant difference in the clinician’s practice while prescribing denosumab/zoledronic acid before and after implementation of this tool incorrect dosing: 24/41 vs. 0/35 (p < 0.00001); and an improvement in pretreatment dental checkup before and after implementation of the tool was noted to be missed dental evaluation:12/41 vs. 0/35 (p < 0.00001). Conclusion: We found that incorporating an evidence-based algorithm in the order set while prescribing bone remodeling agents significantly improved our institutional clinical practice of indication-appropriate dosing and dental screening rates, and facilitated high-quality, evidence-based care to our patients with prostate cancer.
Cardiac Myeloid Sarcoma: Review of Literature Gautam, Archana; Jalali, Ghazal Kooshk; Sahu, Kamal Kant ...
Journal of clinical and diagnostic research,
03/2017, Letnik:
11, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Granulocytic Sarcomas (GS) also called as Myeloid Sarcomas (MS) or chloromas are the representatives of extramedullary infiltrates of immature myeloid cells including myeloblasts, promyelocytes and ...myelocytes. Primary cardiac malignancies per se are rare and infiltration of cardiac muscles by secondary malignant cells is also an uncommon finding. Out of these cardiac tumors, contribution of Cardiac Myeloid Sarcoma (CMS) is even more smaller thereby limiting our knowledge about this rare entity. Because of its very lower incidence, an exact guideline for diagnosis and management is still missing and usually haematologists around the world are treating CMS based on their clinical acumen. Aim of this review is to briefly discuss the presenting clinical feature, differential diagnosis, diagnostic workup and management based on published articles related to CMS till date.
Introduction: Clostridium difficile infection (CDI) and nontyphoidal Salmonella infection (NSI) have similar clinical manifestations and are seldom seen simultaneously. The decision-making in terms ...of antibiotic therapy becomes difficult when both the pathogens are isolated from the same patient. Case Presentation: We describe a case of Clostridium difficile (CD) enterocolitis in a healthcare provider who concomitantly tested positive for nontyphoidal Salmonella. Discussion: To the best of our knowledge after extensive literature review (English), this is only the fourth report highlighting this association. Conclusion: Although Salmonella is not a risk factor for CDI, it can cause intestinal inflammation and alteration in the intestinal flora. When two pathogens are isolated from the same patient, it is tempting to treat both with antibiotics as highlighted. When it involves healthcare workers, there is no difference in guidelines and should not be prescribed antibiotics with intent of reducing secondary transmission.
Coronary Artery Disease (CAD) is a major global health problem. Recent studies demonstrated that lower vitamin D level (<30ng/ml) is associated with higher blood pressure and directly or indirectly ...with CAD, due to vascular endothelial damage. However the results are inconsistent.
To find the association of vitamin D deficiency with CAD.
In this cross-sectional observational study, serum vitamin D level was measured in 315 patients who underwent coronary angiography.
The mean (±SD) vitamin D was 13.40ng/ml (±10.40). However, the patients with normal coronary artery had much lower mean vitamin D (11.30ng/ml±9.50) as compared to the patients with CAD (14.10ng/ml±10.70). The mean (±SD) vitamin D levels were 19.00ng/ml (±16.50), 14.10ng/ml (±11.10) and 13.20ng/ml (±8.80) in patients with CAD with 50%-70%, >70%-90% and >90% stenosis respectively (p= 0.46) and 15.20ng/ml (±13.00), 15.50ng/ml (±11.30) and 11.80ng/ml (±7.00) in patients with CAD with single, double and triple vessels disease respectively (p= 0.14). The frequency of vitamin D deficiency were 66.70%, 83.20 % and 83.10% in patients with CAD with 50% -70%, >70%-90% and >90% stenosis respectively and 81.40%, 80.00% and 83.50% in patients with single, double and triple vessel disease respectively, as compared to 89.30% in patients with normal coronary artery (p= 0.41 and 0.075). So, all the study groups of CAD had low serum vitamin D level and high frequency of vitamin D deficiency, which was statistically insignificant.
Prevalence of vitamin D deficiency is very high in CAD, but it does not correlate with the angiographic severity of CAD.
The coronavirus disease 2019 (COVID‐19) pandemic has threatened patients, healthcare systems, and all countries across the globe with unprecedented challenges and uncertainties. According to the ...latest literature, most patients with COVID‐19 have mild symptoms that do not require hospital admissions, and only a small percentage of those hospitalized require intensive care. In the intensive care unit (ICU), a registered dietitian nutritionist (RDN) assists the critical care team by formulating, executing, and monitoring the nutrition strategies and interventions to meet the unique requirements of extremely sick patients. However, because of the novelty of COVID‐19, the situation is fluid and guidelines continue to be developed and updated. This article discusses the interim guidelines available for the nutrition support of ICU COVID‐19 patients and the challenges the critical care team and RDN may face from a nutrition standpoint.
Cocaine-induced methemoglobinemia Sahu, Kamal Kant; Mishra, Ajay Kumar; Lal, Amos ...
World journal of emergency medicine,
2021, Letnik:
12, Številka:
1
Journal Article
Recenzirano
Odprti dostop
...whilst ACS/vasospastic phenomenon should be in a list of differentials, it was not the main concern in the index case. In cases, when no antecedent history of bleeding or chronic disease could be ...identified, the workup for intravascular hemolysis with lactate dehydrogenase level, serum haptoglobin level, absolute reticulocyte index, iron profile, and peripheral blood smear findings would be beneficial to look for methemoglobinemia-induced hemolysis. ...the most important long-term plan for this patient is to get enrolled in a substance abuse program and to get educated about the harmful effects of cocaine use.
Pseudotumour is a benign inflammatory lesion. Mycobacterial spindle cell pseudotumour (MSP) is a rare pseudotumour. It is a benign proliferation of spindle-shaped histiocytes containing acid-fast ...mycobacterium, commonly reported in immunocompromised patients. MSP is usually associated with mycobacterium avium complex (MAC). Here, we present the case of a 38-year-old gentleman with acquired immune deficiency syndrome (AIDS) who presented with low-grade fever for 1-month duration. Clinically, he had generalised lymphadenopathy. Chest X-ray showed miliary infiltration in bilateral lung fields. Lymph nodal biopsy showed spindle-shaped histiocytes filled with acid-fast bacilli on Ziehl-Neelsen (ZN) stain, suggestive of MSP. Immunohistochemical (IHC) stains were positive for CD68, S-100 and negative for CD31, which are consistent with MSP. Polymerase chain reaction (PCR) of the biopsy tissue was positive for MTB. Highly active antiretroviral therapy (HAART) was continued and anti-tubercular therapy (ATT) was started. The fever resolved within two weeks and there was a resolution of lymph nodal swelling by 6 weeks. The diagnosis of MSP associated with mycobacterium tuberculosis (MTB) makes our case interesting. It is of utmost importance to differentiate MSP from Kaposi's sarcoma (KS) and other pseudotumours and to know whether it is of tubercular or non-tubercular origin, as the treatment is entirely different.
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