Defining a Strategy for Laboratory Evaluation with Expectant Management of Preeclampsia

2021 ◽  
Author(s):  
Gabriella D. Cozzi ◽  
Christina T. Blanchard ◽  
Aalok R. Sanjanwala ◽  
Margaret R. Page ◽  
Dhong-Jin Kim ◽  
...  
Keyword(s):  
Expectant Management ◽  
Laboratory Evaluation ◽  
Testing Time ◽  
Laboratory Assessment ◽  
Laboratory Abnormality ◽  
Receiver Operating Characteristic Curves ◽  
Testing Strategies ◽  
Kaplan Meier ◽  
Key Points ◽  
Tertiary Center

Objective The objective of this study was to compare the frequency and timing of laboratory abnormalities and evaluate optimal laboratory testing strategies in women with preeclampsia (PE) undergoing expectant management. Study Design Retrospective cohort study of women with inpatient expectant management of PE at ≥23 weeks at a tertiary center from 2015 to 2018 was conducted. Women ineligible for expectant management or with less than two laboratory sets (platelets, aspartate aminotransferase, and serum creatinine) before the decision to deliver were excluded. Women were categorized as per the American College of Obstetricians and Gynecologists' definitions by initial diagnosis: PE without severe features, superimposed preeclampsia (SiPE) without severe features, and their forms with severe features. The frequency and timing of laboratory abnormalities were compared across the four PE categories. Kaplan–Meier curves modeled time to a laboratory abnormality (event) with censoring for delivery and were compared using log-rank tests. Logistic regression analysis modeled the development of a laboratory abnormality as a function of testing time intervals (days) for each PE type. Receiver operating characteristic curves and areas under the curve (AUC) were calculated; optimal cut points were determined using the Liu method. Results Among 636 women who met inclusion criteria, laboratory abnormalities were uncommon (6.3%). The median time to a laboratory abnormality among all women was ≤10 days, time being shortest in women with PE with severe features. Time to laboratory abnormality development did not differ significantly between the four PE groups (p = 0.36). Laboratory assessment intervals were most predictive for PE and SiPE with severe features (AUC = 0.87, AUC = 0.72). Optimal cutoffs were every 4 days for PE without severe features, 2 days for PE with severe features, 8 days for SiPE without severe features, and 3 days for SiPE with severe features. Conclusion Most laboratory abnormalities in PE occur earlier and more frequently in those with severe features. Individual phenotypes should undergo serial evaluation based on this risk stratification. Key Points

Management of Endometriosis—A Two Years Study at a Tertiary Care Center

2010 ◽  
Vol 2 (1) ◽  
pp. 41-43
Author(s):  
K Kapur ◽  
M Biswas ◽  
GS Joneja ◽  
R Sharma ◽  
P Talwar
Keyword(s):  
Pelvic Pain ◽  
Ovulation Induction ◽  
Care Center ◽  
Tertiary Care ◽  
Expectant Management ◽  
Male Factor ◽  
Number Of Patients ◽  
Tertiary Center ◽  
Operative Endoscopy ◽  
Ivf Et

ABSTRACT Objective The purpose of this study was to analyze the line of treatment and its outcome in cases of endometriosis presenting with infertility and pelvic pain at a tertiary center having facilities of operative endoscopy and assisted reproductive technology. Methods All cases of Infertility and pelvic pain over a period of two years were subjected to laparoscopy. Patients who were diagnosed with endometriosis were classified into categories. Different system of classification was used for patients of Infertility and pelvic pain. A large number of patients were subjected to expectant management. Selected cases underwent IUI, IVF-ET and ICSI. The numbers of pregnancies were recorded in these cases. Patients with pelvic pain were treated with hormonal therapy. Results 1038 patients were studied over a period of 2 years out of which 983 presented with Infertility and 55 with pelvic pain. 294 cases of infertility were detected and biopsy proven to be having endometriosis and 20 of the 55 cases of pelvic pain were also detected to have endometriosis. In the infertility group 76 patients were found to have bilateral tubal block. 215 patients were detected to have various grades of lesions but with patent bilateral/unilateral tubes. 6 patients with blocked tubes and 11 patients with patent tube/tubes also were associated with male factor infertility. 88 patients with blocked tubes and/or male factor received treatment with IVF-ET/ICSI. 178 patients underwent ovulation induction and 28 were simply observed. There were 42.8% pregnancies in the observation group, 49.4% in the ovulation induction-IUI group and 45.4% in IVF-ET/ICSI group. Conclusion 30% of the cases of Infertility had endometriosis. Following operative endoscopy treatment for all cases, the occurrence of pregnancy was similar in patients who were simply observed and those who received treatment with ovulation induction-IUI. Those with mechanical problems of sperm-egg union are best treated with IVF-ET where facilities exist.

scholarly journals Prenatal Diagnosis of Neuroblastoma

2014 ◽  
Vol 8 (3) ◽  
pp. 321-327
Author(s):  
Mona Zvanca ◽  
Cristian Andrei
Keyword(s):  
Prenatal Diagnosis ◽  
Case Reports ◽  
Case Series ◽  
Expectant Management ◽  
Individual Case ◽  
Management Options ◽  
Tertiary Center ◽  
Low Incidence ◽  
Tumor In Childhood

ABSTRACT Fetal malignancies are rare complications during pregnancies, but when they appear, they are very challenging for the perinatology team. Because of their low incidence, the information is limited, with data provided from individual case reports or small case series. Although neuroblastoma is the most frequent extracranial solid tumor in childhood, prenatal diagnosis by ultrasound is very rare and almost always discovered during routine third trimester ultrasound. Expectant management is usually indicated prenatally, with serial ultrasound examination. Delivery should be planned in a tertiary center together with pediatric oncologists and surgeons to allow appropriate postnatal management. We present two cases of neuroblastoma diagnosed at 36 and 33 weeks of gestation with multiple aspects of this tumor identified by ultrasound. Both cases needed surgery and had a favorable outcome. The key role of ultrasound in diagnosis and follow-up of neuroblastoma in pregnancy is discussed, together with the management options recommended in literature. How to cite this article Andrei C, Vladareanu R, Zvanca M, Vladareanu S. Prenatal Diagnosis of Neuroblastoma. Donald School J Ultrasound Obstet Gynecol 2014;8(3):321-327.

scholarly journals Suitability and Sufficiency of Telehealth Clinician-Observed, Participant-Collected Samples for SARS-CoV-2 Testing: The iCollect Cohort Pilot Study

10.2196/19731 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e19731 ◽  
Author(s):  
Jodie L Guest ◽  
Patrick S Sullivan ◽  
Mariah Valentine-Graves ◽  
Rachel Valencia ◽  
Elizabeth Adam ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Rnase P ◽  
Ribonuclease P ◽  
Laboratory Assessment ◽  
Testing Strategies ◽  
Specimen Collection ◽  
Oropharyngeal Swab ◽  
Polymerase Chain ◽  
Respiratory Coronavirus ◽  
Serology Testing

Background The severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic calls for expanded opportunities for testing, including novel testing strategies such as home-collected specimens. Objective We aimed to understand whether oropharyngeal swab (OPS), saliva, and dried blood spot (DBS) specimens collected by participants at home and mailed to a laboratory were sufficient for use in diagnostic and serology tests of SARS-CoV-2. Methods Eligible participants consented online and were mailed a participant-collection kit to support collection of three specimens for SARS-CoV-2 testing: saliva, OPS, and DBS. Participants performed the specimen collection procedures during a telehealth video appointment while clinical observers watched and documented the suitability of the collection. The biological sufficiency of the specimens for detection of SARS-CoV-2 by reverse transcriptase–polymerase chain reaction and serology testing was assessed by laboratorians using visual inspection and quantification of the nucleic acid contents of the samples by ribonuclease P (RNase P) measurements. Results Of the enrolled participants,153/159 (96.2%) returned their kits, which were included in this analysis. All these participants attended their video appointments. Clinical observers assessed that of the samples collected, 147/153 (96.1%) of the saliva samples, 146/151 (96.7%) of the oropharyngeal samples, and 135/145 (93.1%) of the DBS samples were of sufficient quality for submission for laboratory testing; 100% of the OPS samples and 98% of the saliva samples had cycle threshold values for RNase P <30, indicating that the samples contained sufficient nucleic acid for RNA-PCR testing for SARS-CoV-2. Conclusions These pilot data indicate that most participant-collected OPS, saliva, and DBS specimens are suitable and sufficient for testing for SARS-CoV-2 RNA and serology. Clinical observers rated the collection of specimens as suitable for testing, and visual and quantitative laboratory assessment indicated that the specimens were biologically sufficient. These data support the utility of participant-collected and mailed-in specimens for SARS-CoV-2 testing. International Registered Report Identifier (IRRID) RR2-10.2196/19054

Failure to Thrive

2020 ◽  
Keyword(s):  
Physical Examination ◽  
Parental Education ◽  
Failure To Thrive ◽  
Laboratory Evaluation ◽  
Nutritional Rehabilitation ◽  
Key Points ◽  
Bright Futures ◽  
Aggressive Interventions ◽  
Over Time

Key Points Bright Futures prefers the term pediatric undernutrition to failure to thrive.Thorough history and physical examination are the keys to diagnosis, with laboratory evaluation most often not helpful.Comprehensive feeding and social histories are key.Detailed anthropometric measurements over time are critical.The severity of the child’s condition dictates the approach to treatment, which should focus on nutritional rehabilitation, parental education, and behavioral intervention.Although most children with mild undernutrition do well with adequate follow-up, more severely affected children need aggressive interventions to mitigate developmental, behavioral, and social morbidity.

scholarly journals N6-Methyladenosine-Regulated mRNAs: Potential Prognostic Biomarkers for Patients With Lung Adenocarcinoma

2021 ◽  
Vol 9 ◽  
Author(s):  
Junjun Sun ◽  
Yili Ping ◽  
Jingjuan Huang ◽  
Bingjie Zeng ◽  
Ping Ji ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Mrna Expression ◽  
Cox Regression ◽  
Interaction Network ◽  
Prognostic Biomarkers ◽  
Cox Regression Analysis ◽  
Receiver Operating Characteristic Curves ◽  
Network Analyses ◽  
Kaplan Meier ◽  
Selection Operator

Aberrant regulation of m6A mRNA modification can lead to changes in gene expression, thus contributing to tumorigenesis in several types of solid tumors. In this study, by integrating analyses of m6A methylation and mRNA expression, we identified 84 m6A-regulated mRNAs in lung adenocarcinoma (LUAD). Although the m6A methylation levels of total RNA in LUAD patient tumor tissue were reduced, the majority (75.2%) of m6A-regulated mRNAs were hypermethylated. The m6A-hypermethylated mRNAs were mainly enriched in terms related to transcription factor activity. We established a 10-m6A-regulated-mRNA signature score system through least absolute shrinkage and selection operator Cox regression analysis, with its predictive value validated by Kaplan–Meier curve and time-dependent receiver operating characteristic curves. RFXAP and KHDRBS2 from the signature also exhibited an independent prognostic value. The co-expression and interaction network analyses demonstrated the strong correlation between m6A regulators and the genes in the signature, further supporting the results of the m6A methylation modification patterns. These findings highlight the potential utility of integrating multi-omics data (m6A methylation level and mRNA expression) to accurately obtain potential prognostic biomarkers, which may provide important insights into developing novel and effective therapies for LUAD.

scholarly journals Amiodarone-induced thyroid dysfunction in a tertiary center in south Brazil

2005 ◽  
Vol 49 (6) ◽  
pp. 916-922 ◽  
Author(s):  
Beatriz D. Schaan ◽  
Caroline P. Cunha ◽  
Alessandra Francisconi ◽  
Berenice Zottis ◽  
Graciela Brum ◽  
...  
Keyword(s):  
Thyroid Dysfunction ◽  
Thyroid Autoimmunity ◽  
Positive Association ◽  
Laboratory Evaluation ◽  
Amiodarone Therapy ◽  
Clinical Scores ◽  
Highly Sensitive ◽  
Tertiary Center ◽  
Low Prevalence ◽  
Thyroid Abnormalities

Amiodarone, used in the treatment of cardiac arrhythmias, is associated with thyroid dysfunction. No reports exist on its frequency in southern Brazil, nor studies evaluating the usefulness of clinical scores to diagnose thyroid abnormalities in these patients. This study aimed at determining the prevalence of amiodarone-induced thyroid dysfunction in a representative sample from a tertiary center, to study the conditions associated to this dysfunction and to evaluate the reliability of clinical scores of hypo and hyperthyroidism. One hundred ninety-five amiodarone users were submitted to a clinical and laboratory evaluation. Of these, 2.1% were hyperthyroid, 25.1% hypothyroid and 9.2% had only a high T4. Considering thyroid dysfunction variables researched, thyroid autoimmunity was positively associated (OR 4.8; p= 0.02), and male gender had a trend to a positive association (OR 1.86; p= 0.06). Clinical scores were highly sensitive for hyperthyroidism (100%), but not for hypothyroidism (8%). The low prevalence of amiodarone-induced hypothyroidism suggests that this specific region is iodine-sufficient. All patients receiving chronic amiodarone therapy should be checked for clinical scores for hyperthyroidism and laboratory evaluation should be performed, as a screening for thyroid dysfunction, especially if they are male or have positive microsomal antibodies.

Dysfibrinogenemia and Thrombosis

2002 ◽  
Vol 126 (11) ◽  
pp. 1387-1390 ◽  
Author(s):  
Timothy Hayes
Keyword(s):  
Medical Literature ◽  
State Of The Art ◽  
Data Extraction ◽  
Initial Assessment ◽  
Laboratory Evaluation ◽  
Diverse Group ◽  
Review Of The Literature ◽  
Thrombotic Risk ◽  
Routine Testing ◽  
Key Points

Abstract Objectives.—To review the state of the art relating to congenital dysfibrinogenemia as a potential risk factor for thrombosis, as reflected by the medical literature and the consensus opinion of recognized experts in the field, and to make recommendations for the use of laboratory assays for assessing this thrombotic risk in individual patients. Data Sources.—Review of the medical literature, primarily from the last 10 years. Data Extraction and Synthesis.—After an initial assessment of the literature, key points were identified. Experts were assigned to do an in-depth review of the literature and to prepare a summary of their findings and recommendations. A draft manuscript was prepared and circulated to every participant in the College of American Pathologists Conference on Diagnostic Issues in Thrombophilia. Each of the key points and associated recommendations were then presented for discussion at the conference. Recommendations were accepted if a consensus of experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached on 5 conclusions and 2 recommendations concerning the use of testing for dysfibrinogens in the assessment of thrombotic risk in individual patients. Detailed discussion of the rationale for each of these recommendations is found in the text of this article. Compared with the other, more common hereditary thrombophilias, dysfibrinogenemia encompasses a diverse group of defects with varied clinical expressions. Congenital dysfibrinogenemia is a relatively rare cause of thrombophilia. Therefore, routine testing for this disorder is not recommended as part of the laboratory evaluation of a thrombophilic patient. This is an evolving area of research, and further clinical studies may change these recommendations in the future.

High Prvalence of Thrombophilia in Perinatal Thrombosis. Reaffirmation of the Recommendations for Routine Testing.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4137-4137
Author(s):  
Neil A. Goldenberg ◽  
Taru Hays ◽  
Marilyn J. Manco-Johnson
Keyword(s):  
Venous Thrombosis ◽  
Complete Blood Count ◽  
Thrombotic Event ◽  
Factor V Leiden ◽  
Anticardiolipin Antibody ◽  
Laboratory Evaluation ◽  
Antiphospholipid Antibody ◽  
Antibody Testing ◽  
Laboratory Assessment ◽  
Age Related

Abstract Background: Comprehensive laboratory testing for genetic and acquired thrombophilia traits is recommended for the evaluation of children with thrombosis by the Perinatal and Pediatric Subcommittee of the International Society on Thrombosis and Haemostasis (ISTH), and is becoming a standard of care. Evidence to date suggests that the incidence, etiology, and pathophysiology of thrombosis in the perinatal period exhibit important differences from those of older infants and children. The frequency with which thrombophilia laboratory evaluation reveals clinically useful information in perinatal thrombosis has not been well established. Objective: To determine the prevalence and nature of thrombophilia in perinatal thrombosis. Methods: All children had been referred to the Thrombosis/Thrombophilia Program at The Children’s Hospital, Denver, and were consecutively recruited for participation in collection of laboratory and clinical data for this research. Perinatal thrombosis was defined as a venous and/or arterial thrombotic event diagnosed at birth or within the first month of life. The ISTH-recommended thrombophilia laboratory panel was performed clinically, and consisted of the following: a complete blood count; detection of the factor V Leiden (FVL) and prothrombin 20210 (PT20210) polymorphisms by PCR; functional assays of antithrombin (AT), protein C (PC), factor VIII (FVIII), and the lupus anticoagulant (LA); immunologic assays of lipoprotein(a) [Lp(a)], free protein S (PS), and anticardiolipin antibody (ACA); and detection of plasma homocysteine (Hcy) concentration by gas chromatograph mass spectroscopy. Antiphospholipid antibody testing was performed in the neonate and/or mother. Age-related abnormal values for non-genetic tests were defined as PC and PS &lt; 20%, AT &lt; 25%, FVIII &gt; 150%, Lp(a) &gt; 30 mg/dL, and homocysteine &gt; 13.9 mM. Results: Forty neonates with thrombosis were referred for evaluation during an 8-year period, of which data were available in 37. Sixteen (43%) had venous thrombosis (including cerebral sinovenous, inferior vena caval, renal vein thrombosis, and isolated pulmonary embolism), an equal number had isolated ischemic arterial stroke in the distribution of the middle cerebral artery, and the remaining 5 (14%) had both arterial and venous thrombosis. Twenty-one (57%) of the 37 neonates with thrombosis exhibited thrombophilia upon comprehensive testing. Among these children, two had three-trait thrombophilia (low PC + low PS + high FVIII), four had two-trait thrombophilia (PT20210 + FVL; PT20210 + high Lp(a); low PC + low AT; and LA + ACA), and fifteen had single thrombophilia traits (low PC in 4; high Lp(a) or high FVIII in 3 each; LA, ACA, low AT, or polycythemia in 1 each). Conclusions: Upon comprehensive standardized laboratory assessment, thrombophilia was detected in greater than half of all children with perinatal thrombosis. Given that in many cases the identified abnormalities impact upon antithrombotic management and call for follow-up testing to guide duration of antithrombotic therapy and the need for secondary prophylaxis as well as consideration of future pregnancy management, comprehensive thrombophilia testing is warranted in perinatal thrombosis.

Folfirinox (FFX) versus gemcitabine with nab‐paclitaxel (GNP) in the first line treatment (1LTx) of metastatic pancreatic cancer (mPC): A tertiary center experience.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 414-414 ◽  
Author(s):  
Ivan Barrera ◽  
Sabina Hamalova ◽  
Jill Ranger ◽  
Henry Rho ◽  
Aline Mamo ◽  
...  
Keyword(s):  
Gastrointestinal Symptoms ◽  
Pancreatic Head ◽  
Sensory Neuropathy ◽  
Progression Free Survival ◽  
Primary Tumors ◽  
Exact Test ◽  
Kaplan Meier ◽  
Tertiary Center ◽  
Common Grade ◽  
Grade 3

414 Background: The efficacy of FFX and GNP as 1LTx of mPC were established in phase 3 trials against Gemcitabine alone. However, no head‐to‐head trial has been performed. This analysis was conducted to compare the use of the two regimens in the 1LTx of mPC patients (pts). Methods: Retrospective study collected data of pts diagnosed with mPC (ECOG 0‐1) that received FFX or GNP as 1LTx at the Jewish General Hospital between 2010‐2016. Pt selection for 1LTx was based in ASCO Guidelines 2016 Criteria (AGC2016). Progression free survival (PFS) and overall survival (OS) were estimated using a Kaplan Meier method. Rate of 1LTx discontinuation and start of 2LTx was compared using two‐sided Fisher's exact test. Results: Among 75 pts with mPC (median age 69), 44 (59%) received FFX and 31 (41%) received GNP. In the FFX group 57% were male and 24 pts (55%) had primary tumors localized in the pancreatic head (PTPH). The majority of patients [n = 36 (82%)] had ECOG 1 at the start of FFX. The most common grade 3‐4 adverse events (AEs) were gastrointestinal symptoms (GI) [n = 12 (27%)], neutropenia (N) [n = 9 (20%)], fatigue (F) [n = 5 (11%)], and peripheral sensory neuropathy (PSN) [n = 2 (4%)]. In the GNP group 61% were male and 20 pts (65%) had PTPH. The majority of pts [n = 23 (74%)] had ECOG 1 at the start of GNP. The most common grade 3‐4 AEs were F [n = 8 (26%)], N [n = 4 (13%)], GI [n = 3 (10%)], and PSN [n = 2 (7%)]. Similar rates of 1LTx discontinuation due to AEs were seen in both groups: 5 pts (11%) in the FFX group due to GI, 2 pts (6.5%) in the GNP group due to F (p = 0.69). In the FFX cohort, 68.2% (30/44) went on to 2LTx whereas in the GNP cohort, 32% (10/31) received 2LTx (p = 0.0001). Of the FFX cohort receiving 2LTx, 40% (12/30) received GNP. The median PFS for the FFX and GNP groups were 5.75 and 4.63 months, respectively, and were not statistically significant (p = 0.523). The OS with FFX and GNP was 9.23 vs. 6.6 months (p = 0.09). Conclusions: For pts selected as per ASC2016, FFX and GNP cohorts showed similar PFS, OS, AEs, and 1LTx discontinuation rate. Our data highlight the importance of optimal therapeutic sequencing to prolong OS. A randomized trial will be needed to confirm 1LTx in mPC.

scholarly journals Intra-Arterial Chemotherapy for Retinoblastoma: Four-Year Results from Tertiary Center in India

2019 ◽  
Vol 6 (1) ◽  
pp. 66-73 ◽  
Author(s):  
Pukhraj Rishi ◽  
Ashutosh Agarwal ◽  
Pritam Chatterjee ◽  
Tarun Sharma ◽  
Minal Sharma ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Tumor Regression ◽  
Survival Curve ◽  
Case Series ◽  
Secondary Outcome ◽  
Complete Regression ◽  
Multicenter Studies ◽  
Kaplan Meier ◽  
Tertiary Center ◽  
Group B

Background: There are limited reports of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) from developing world. Objectives: In this study, we report our 4-year experience of IAC for RB from India. Methods: Retrospective, interventional case series. Primary outcome measures included tumor regression, vitreous seeds and subretinal seeds control, and globe salvage. Secondary outcome measures were best-corrected visual acuity and treatment complications. Results: Fifteen eyes underwent 53 IAC procedures over mean 28.6 ± 13.8 months (range 10–51 months). IAC was employed as primary (n = 6) or secondary (n = 9) chemotherapy. Following IAC, complete regression of main tumor was seen in 7 eyes (47%) and partial regression in 3 (20%) eyes. Enucleation was done in 5(33%) eyes. Globe salvage rates were achieved in 1 eye (100%) in group B, 2 eyes (67%) in group C (n = 3), 6 eyes (67%) in group D (n = 9), and 1 eye (50%) in group E (n = 2). Following IAC, Kaplan-Meier survival curve showed 93% globe survival rate at 1 year, 76% at 2 years, and 66% at 3, and 4 years. Conclusion: IAC has enhanced globe salvage rates in eyes with RB. Multicenter studies with longer follow-up are necessary to better understand outcomes in the long term.

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