Maternal and perinatal outcomes of a venous thromboembolism high‐risk cohort using a multidisciplinary treatment approach

AbstractObjectiveThe aim of this study was to compare position-related changes in fetal middle cerebral artery (MCA) Doppler pulsatility indices (PI).MethodsA prospective study of 41 women with conditions associated with placental-pathology (chronic hypertension, pregestational diabetes, and abnormal analytes) and 34 women without those conditions was carried out. Fetal MCA Doppler velocity flow waveforms were obtained in maternal supine and left lateral decubitus positions. MCA PI Δ was calculated by subtracting the PI in the supine position from the PI in the left lateral position. Secondary outcomes included a composite of adverse perinatal outcomes (fetal growth restriction, oligohydramnios, and preeclampsia). χ2 and Student t-tests and repeated-measures analysis of variance were used.ResultsMCA PI Δ was significantly less for high-risk pregnant women ([P = 0.03]: high risk, left lateral PI, 1.90 ± 0.45 vs. supine PI, 1.88 ± 0.46 [Δ = 0.02]; low risk, left lateral PI, 1.90 ± 0.525 vs. supine PI, 1.68 ± 0.40 [Δ = 0.22]). MCA PI Δ was not significantly different between women who had a composite adverse outcome and women who did not have a composite adverse outcome (P = 0.843).ConclusionOur preliminary study highlights differences in position-related changes in fetal MCA PI between high-risk and low-risk pregnancies. These differences could reflect an attenuated ability of women with certain risk factors to respond to physiologic stress.

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Risk Factors and Prediction Models for Venous Thromboembolism in Ambulatory Patients with Lung Cancer

Healthcare ◽

10.3390/healthcare9060778 ◽

2021 ◽

Vol 9 (6) ◽

pp. 778

Author(s):

Ann-Rong Yan ◽

Indira Samarawickrema ◽

Mark Naunton ◽

Gregory M. Peterson ◽

Desmond Yip ◽

...

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Venous Thromboembolism ◽

High Risk ◽

Prediction Models ◽

Poor Performance ◽

Risk Models ◽

Related Risk ◽

Wide Range ◽

Ambulatory Patients

Venous thromboembolism (VTE) is a significant cause of mortality in patients with lung cancer. Despite the availability of a wide range of anticoagulants to help prevent thrombosis, thromboprophylaxis in ambulatory patients is a challenge due to its associated risk of haemorrhage. As a result, anticoagulation is only recommended in patients with a relatively high risk of VTE. Efforts have been made to develop predictive models for VTE risk assessment in cancer patients, but the availability of a reliable predictive model for ambulate patients with lung cancer is unclear. We have analysed the latest information on this topic, with a focus on the lung cancer-related risk factors for VTE, and risk prediction models developed and validated in this group of patients. The existing risk models, such as the Khorana score, the PROTECHT score and the CONKO score, have shown poor performance in external validations, failing to identify many high-risk individuals. Some of the newly developed and updated models may be promising, but their further validation is needed.

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Progesterone receptor status and tumor grade predict the 21-gene recurrence score of invasive lobular breast cancer

Biomarkers in Medicine ◽

10.2217/bmm-2019-0209 ◽

2019 ◽

Vol 13 (12) ◽

pp. 1005-1012 ◽

Cited By ~ 2

Author(s):

San-Gang Wu ◽

Wen-Wen Zhang ◽

Jun Wang ◽

Chen-Lu Lian ◽

Jia-Yuan Sun ◽

...

Keyword(s):

High Risk ◽

Progesterone Receptor ◽

Lobular Carcinoma ◽

Recurrence Score ◽

Tumor Grade ◽

Lobular Breast Cancer ◽

Well Differentiated ◽

Invasive Lobular Breast Cancer ◽

Clinicopathological Variables ◽

High Risk Cohort

Aim: To assess the association between established clinicopathological variables and the 21-gene recurrence score (RS) stratification of invasive lobular carcinoma (ILC) of the breast. Materials & methods: We identified 9030 ILC patients from the Surveillance, Epidemiology and End Results database. Results: Older age, higher grade tumor and progesterone receptor (PR)-negative disease were independent predictors of high-risk RS stratification. Among patients with PR-positive tumors, 3, 6 and 15% with well-differentiated (G1), moderately-differentiated (G2) and poorly and/or undifferentiated (G3) disease were in the high-risk cohort, respectively. In patients with PR-negative tumors: 16, 24 and 41% of patients with G1, G2 and G3 disease were in the high-risk cohort, respectively. Conclusion: The 21-gene RS testing may not be necessary for patients with PR+/G1–2 ILC.

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Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.1177/1179548420986659 ◽

2021 ◽

Vol 15 ◽

pp. 117954842098665

Author(s):

Muhanad Taha ◽

Paul Nguyen ◽

Aditi Sharma ◽

Mazen Taha ◽

Lobelia Samavati

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

High Risk ◽

Venous Thrombosis ◽

Case Summary ◽

One Year

Background: Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism persists after discharge. Case Summary: We report a case with pulmonary embolism 5 months after COVID-19. No risk factors for venous thrombosis have been identified. Conclusion: In COVID-19 related hospitalization, large studies are needed to identify the risk of venous thromboembolism after discharge.

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Role of Interventional Radiology in Children with Biliary and Gallbladder Diseases

Seminars in Interventional Radiology ◽

10.1055/s-0041-1731374 ◽

2021 ◽

Vol 38 (03) ◽

pp. 356-363

Author(s):

Anel Yakupovich ◽

Shankar Rajeswaran ◽

Jared Green ◽

James S. Donaldson

Keyword(s):

Interventional Radiology ◽

Treatment Approach ◽

Multidisciplinary Treatment ◽

Anatomical Variations ◽

Vital Role ◽

High Morbidity ◽

Comprehensive Overview ◽

Gallbladder Diseases ◽

Fundamental Understanding

AbstractBiliary and gallbladder diseases in infants and children often present unique diagnostic and therapeutic challenges that require a fundamental understanding of notable biliary diseases and anatomical variations. Surgical and endoscopic approaches that are often the gold standard in adult biliary treatment may be technically challenging and are associated with a high morbidity that may warrant a multidisciplinary treatment approach. This article will provide a comprehensive overview of the biliary conditions where interventional radiology can play a vital role in the diagnosis, management, and treatment. Differences in approach or technique between children and adults will be highlighted.

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INOVASIA Study: A Randomized Open Controlled Trial to Evaluate Pravastatin to Prevent Preeclampsia and its Effects on sFlt1/PLGF Levels

American Journal of Perinatology ◽

10.1055/a-1673-5603 ◽

2021 ◽

Author(s):

Muhammad Ilham Aldika Akbar ◽

Angelina Yosediputra ◽

Raditya Eri Pratama ◽

Nur Lailatul Fadhilah ◽

Sulistyowati Sulistyowati ◽

...

Keyword(s):

High Risk ◽

Pregnant Women ◽

Controlled Trial ◽

Intervention Group ◽

Perinatal Outcomes ◽

Neonatal Morbidity ◽

Clinical Risk Factor ◽

Control Group ◽

Significant Deterioration ◽

Plgf Ratio

Objectives To evaluate the effect of pravastatin to prevent preeclampsia (PE) in pregnant women at a high risk of developing preeclampsia and the maternal and perinatal outcomes and the sFlt1/PLGF ratio. Study Design This is an open labelled RCT part of INOVASIA trial. Pregnant women at a high risk of developing PE were recruited and randomized into an intervention group (40) and a control group (40). The inclusion criteria consisted of pregnant women with positive clinical risk factor and abnormal uterine artery doppler examination at 10-20 weeks gestational age. The control group received low dose aspirin (80 mg/day) and calcium (1 g/day), while the intervention group received additional pravastatin (20 mg twice daily) starting from 14-20 weeks gestation until delivery. Research blood samples were collected before the first dose of pravastatin and before delivery. The main outcome was the rate of maternal preeclampsia, maternal-perinatal outcomes, and sFlt-1, PLGF, sFlt-1/PlGF ratio and sEng levels. Results The rate of preeclampsia was (non-significantly) lower in the pravastatin group compared with the control group (17.5% vs 35%). The pravastatin group also had a (non-significant) lower rate of severe preeclampsia, HELLP syndrome, acute kidney injury and severe hypertension. The rate of (iatrogenic) preterm delivery was significantly (p=0.048) lower in the pravastatin group (n=4) compared with the controls (n=12). Neonates in the pravastatin group had significantly higher birthweights (2931 + 537 vs 2625 + 872 g; p=0.006), lower Apgar scores < 7 (2.5 vs 27.5%, p=0.002), composite neonatal morbidity (0 vs 20%, p=0.005) and NICU admission rates (0 vs 15%, p=0.026). All biomarkers show a significant deterioration in the control group compared with non significant changes in the pravastatin group. Conclusions Pravastatin holds promise in the secondary prevention of preeclampsia and placenta-mediated adverse perinatal outcomes by improving the angiogenic imbalance.

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Multidisciplinary Treatment Approach in a Patient with History of Nasopharyngeal Carcinoma

Case Reports in Dentistry ◽

10.1155/2014/918461 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Atacan Yavuz ◽

Ömer Birkan Ağralı ◽

Zeynep Lale Çalışkan ◽

Dilek Türkaydın ◽

Atilla Sertgöz ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Multidisciplinary Approach ◽

Dental Treatment ◽

Treatment Approach ◽

Multidisciplinary Treatment ◽

Preventative Care ◽

Self Confidence ◽

Dental Hospital ◽

History Of

Radiotherapy in NPC patients has side effects on the dentition, which affects quality of life dramatically. This case report presents multidisciplinary dental treatment approach in a 17-year-old male patient with a history of nasopharyngeal carcinoma (NPC), which was treated with chemotherapy and radiotherapy. The adolescent patient applied to dental hospital 4 years after the radiotherapy with aesthetic and functional problems on dentition affecting psychological, social, and physical aspects of his life. The dentition of the patient demonstrated the severe destruction as a devastating side effect of radiotherapy. With a successful multidisciplinary approach, our patient’s aesthetics, function, and self-confidence were obtained. Well-established procedures, which include preventative care and maintenance, can reduce the duration and expenses of the treatment and help in challenging the life-long complications of radiotherapy.

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