scholarly journals Twin-twin transfusion syndrome - a University Hospital experience with intrauterine treatment

2021 ◽  
Vol 48 ◽  
Author(s):  
THAMYLE MODA DE SANTANA REZENDE ◽  
VIKTORIA WEIHERMANN ◽  
CAMILA GIRARDI FACHIN ◽  
RAFAEL FREDERICO BRUNS ◽  
ANDRÉ IVAN BRADLEY SANTOS DIAS
Keyword(s):  
Laser Ablation ◽  
Gold Standard ◽  
Neonatal Period ◽  
Positive Impact ◽  
Fetal Surgery ◽  
Stage Iv ◽  
University Hospital ◽  
Post Procedure ◽  
Solomon Technique ◽  
Intrauterine Treatment

ABSTRACT Introduction: twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. Objectives: to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. Methods: we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero’s staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. Results: we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero’s staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. Conclusion: the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.

Fetoscopic laser ablation therapy in monochorionic diamniotic twin pregnancies with twin-to-twin transfusion syndrome treated at a single centre over 10 years: a retrospective study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Anna Fichera ◽  
Vita Valentina Azzaretto ◽  
Nicola Fratelli ◽  
Sara Mancino ◽  
Daria Marella ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Laser Ablation ◽  
Survival Rates ◽  
Stage Iv ◽  
Final Analysis ◽  
Single Centre ◽  
Ablation Therapy ◽  
Solomon Technique ◽  
Twin Pregnancies ◽  
Over Time

Abstract Objectives To review experience with fetoscopic laser ablation of placental anastomoses to treat monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in a single centre over a ten-year period. Methods A retrospective study on 142 MCDA twin pregnancies complicates by TTTS treated with equatorial laser ablation of placental anastomoses (2008–2018). Solomon technique was also applied after 2013. Survival rates, neonatal outcome, intraoperative and post-laser complications were recorded, and prognostic factors analysed. Results A total of 133 cases were included in the final analysis; 41 patients were at stage II (30.8%), 73 were at stage III (62.9%), while only 12 (9%) at stage I and two patients (1.7%) at stage IV. Solomon technique was applied in 39 cases (29.3%). Survival of both twins was 51.1% (68/133), of a single twin 20.3% (27/133), and of at least one 71.5% (95/133), with an overall survival of 61.3% (163/266). TAPS and recurrent TTTS occurred in 8 (6%) and 15 (11.3%) patients. Survival of both fetuses increased over time (44.6 vs. 57.3%). A posterior placenta (p<0.003) and the use of the Solomon technique (p<0.02) were more frequent in cases with survival of both fetuses, while TTTS recurrence was significantly associated to the loss of one or two fetuses (p<0.01). Such associations were confirmed at logistic regression analysis. Conclusions Survival of both twins can improve over time and seems to be favourably associated with a placenta in the posterior location and the use of the Solomon technique.

scholarly journals Validation of a Next-Generation Sequencing Assay Targeting RNA for the Multiplexed Detection of Fusion Transcripts and Oncogenic Isoforms

2019 ◽  
Vol 144 (1) ◽  
pp. 90-98 ◽  
Author(s):  
Robyn T. Sussman ◽  
Amanda R. Oran ◽  
Carmela Paolillo ◽  
David Lieberman ◽  
Jennifer J. D. Morrissette ◽  
...  
Keyword(s):  
Next Generation Sequencing ◽  
Solid Tumors ◽  
Gold Standard ◽  
University Hospital ◽  
Fusion Partner ◽  
Next Generation ◽  
Fixed Tissue ◽  
Fusion Transcripts ◽  
Genetic Abnormalities ◽  
Generation Sequencing

Context.— Next-generation sequencing is a high-throughput method for detecting genetic abnormalities and providing prognostic and therapeutic information for patients with cancer. Oncogenic fusion transcripts are among the various classifications of genetic abnormalities present in tumors and are typically detected clinically with fluorescence in situ hybridization (FISH). However, FISH probes only exist for a limited number of targets, do not provide any information about fusion partners, cannot be multiplex, and have been shown to be limited in specificity for common targets such as ALK. Objective.— To validate an anchored multiplex polymerase chain reaction–based panel for the detection of fusion transcripts in a university hospital–based clinical molecular diagnostics laboratory. Design.— We used 109 unique clinical specimens to validate a custom panel targeting 104 exon boundaries from 17 genes involved in fusions in solid tumors. The panel can accept as little as 100 ng of total nucleic acid from PreservCyt-fixed tissue, and formalin-fixed, paraffin-embedded specimens with as little as 10% tumor nuclei. Results.— Using FISH as the gold standard, this assay has a sensitivity of 88.46% and a specificity of 95.83% for the detection of fusion transcripts involving ALK, RET, and ROS1 in lung adenocarcinomas. Using a validated next-generation sequencing assay as the orthogonal gold standard for the detection of EGFR variant III (EGFRvIII) in glioblastomas, the assay is 92.31% sensitive and 100% specific. Conclusions.— This multiplexed assay is tumor and fusion partner agnostic and will provide clinical utility in therapy selection for patients with solid tumors.

Therapeutic and evolutionary characteristics of Diabetic ketosis decompensations after a decade at the University Hospital of Cotonou, Benin

2021 ◽  
Vol 5 (2) ◽  
pp. 01-05
Author(s):  
Gninkoun Jules
Keyword(s):  
Metabolic Diseases ◽  
Positive Impact ◽  
University Hospital ◽  
Glucose Levels ◽  
Diabetic Ketosis ◽  
Blood Glucose Levels ◽  
Compliance To Treatment ◽  
The University ◽  
Improving Patient Care ◽  
Length Of Hospitalization

Aim: To evaluate the therapeutic and evolutionary aspects of diabetic ketosis decompensation, a decade after its previous report in our center. Materials and Method: This was a 3-year retrospective study, including all patients admitted from June 1, 2016 to May 31, 2019 for DKA at the Endocrinology and Metabolic Diseases Department of the National and University Hospital Hubert Koutoukou Maga (CNHU-HKM). Ketosis was defined by the presence of at least 2 acetone crosses on the urine strip. Results: A total of 196 patients were included. The mean age was 43.73 years ± 16.2 years with a sex ratio of 0.96. The prevalence of DKA was 28.99%. The main precipitating factors of DKA were infections (67.86%) and non-compliance to the treatment (29.59%). The most common infections were urogenital (23.30%), respiratory (18.04%) and malaria (32.33%). The mortality was 2.55%. Male subjects (84.36%) had blood glucose levels above 3g/L with a higher mean dose of insulin used (84.71 IU versus 54.29 IU for women p=0.008). Duration of recovery (p=0.008) and length of hospitalization (p=0.006) were statistically longer for men. Conclusion: The prevalence of ketosis decompensations remains high. The main decompensation factors found were infections and non-compliance to treatment. Improving patient care over the past decade had produced a positive impact on mortality, recovery time and length of hospitalization.

IMMEDIATE NEONATAL OUTCOME OF LATE PRETERMS AND EARLY TERMS COMPARED TO TERMS

2021 ◽  
pp. 8-11
Author(s):  
Kausik Sur ◽  
Brajagopal Ray
Keyword(s):  
Retrospective Review ◽  
Congenital Anomalies ◽  
Neonatal Outcome ◽  
Neonatal Period ◽  
Neonatal Morbidity ◽  
University Hospital ◽  
Early Term ◽  
Nicu Admission ◽  
The City ◽  
Pro Forma

Introduction: Increasing number of Late Preterm (LPT) babies are being born in recent years, and they suffer from increased neonatal morbidities and moralities. Objective: +0 +6 To assess the immediate neonatal morbidities and mortalities of Late Pretrem - LPT - (34 -36 weeks) compared to +0 +6 +0 +6 those babies born at Early Term -ET- (37 - 38 weeks) and Term - T- (39 - 40 weeks) gestation. Methodology: A retrospective review of delivery, admission, discharge and death registers and necessary case notes of all live in-born babies excluding those with congenital anomalies were done in RKM Seva Pratisthan Hospital, a teriray level University Hospital in the City of Kolkata, between 1st January 2018 till 31st December 2019. Data collected in a predesigned pro forma were analysed with SPSS vs 23 software, after obtaining necessary permission. All the major neonatal morbidities and morality were compared between the three groups. Results: +0 +6 Total 6511 babies born between gestation 34 and 40 weeks were analysed of which 1021 were in LPT group (31.9%requiring NICU admission), 3408 in ET group (8.3% requiring NICU admission) and 2068 in T group (9.2% requiring NICU admission). There was no signicant difference in mortality (LPT vs ET vsT : 0.5% vs 0.3% vs 0.1%). All the major morbidities ( Respiratory, CNS, Infectious, Metabolic and Any morbidity) were signicantly higher in LPT group. No signicant difference were observed between ET and Term group in terms of any neonatal morbidity or mortality. Conclusion: Late Pretrem newborns suffer from increased neonatal morbidity compared to their Early Term or Term counterpart in immediate neonatal period. No difference of morbidity or mortality were noted between Early Term and Term groups.

scholarly journals Characteristics and treatment outcomes of patients with primary ocular adnexal lymphoma in Northern Thailand

2020 ◽  
Vol 17 (1) ◽  
pp. 86-97
Author(s):  
Kasem Seresirikachorn ◽  
Sakarin Ausayakhun ◽  
Damrong Wiwatwongwana ◽  
Ponsak Mahanupab ◽  
Teerada Daroontum ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Response Rate ◽  
Stage Iv ◽  
High Response Rate ◽  
University Hospital ◽  
Treatment Modalities ◽  
Low Grade ◽  
Northern Thailand ◽  
Ocular Adnexal Lymphoma ◽  
Operative Notes

Purpose: To assess the characteristics and treatment outcomes of patients with primary ocular adnexal lymphoma (OAL) in Northern Thailand. Design: Retrospective cohort study. Methods: Data was collected from electronic medical records and operative notes from Chiang Mai University Hospital between January 2009 and December 2014. All available tissue biopsies of 54 patients were reviewed by agreement of two pathologists. The clinical characteristics and treatment outcomes were collected and analyzed. Results: A total number of 54 patients were identified of which 57.4% were female. The median age was 61.0 years (range, 4-86). The most common subtype of lymphoma was extranodal marginal zone lymphoma (ENMZL) of mucosa-associated lymphoid tissue (MALT) (n = 46, 85.2%). Seventy-five percent of the patients presented with a mass at the ocular adnexa, while 14.8% of the patients presented with proptosis. The sites of origin were as follows: lacrimal (46.3%), orbit (31.5%), conjunctiva (13%) and eyelid (7.4%). Two-thirds of the patients had Ann-Arbor Stage I, while 22% of patients had Stage IV. The majority of the patients (68.1%) had a low-risk international prognosis index (IPI). Treatment modalities involved field radiation (IFRT, 50%), chemotherapy (31.6%), combined chemoradiotherapy (7.9%) and surgical resection (10.5%). The overall response rate was 100% with a complete response rate of 77.8%. In patients with low-grade lymphoma, including MALT lymphoma, the 3-year progression-free survival (PFS) and overall survival were 69.9% and 92.5%, respectively. Conclusion: ENMZL of MALT was the major subtype of primary OAL. Radiotherapy was an effective treatment for the lower stages of disease providing a high response rate and encouraging survival outcomes.

scholarly journals Urinary N-telopeptide- A diagnostic Test or A Screening Test?

2019 ◽  
Vol 10 (2) ◽  
pp. 1298-1301
Author(s):  
Ganesan G Ram ◽  
Jambu N
Keyword(s):  
Diagnostic Test ◽  
Roc Curve ◽  
Gold Standard ◽  
Screening Test ◽  
Dual Energy ◽  
University Hospital ◽  
Control Group ◽  
X Ray ◽  
Dexa Scan ◽  
Group I

Dual-energy X-ray absorptiometry (DEXA) scan is the gold standard investigation for diagnosing osteoporosis. The limitations of "gold standard" Dual-energy X-ray absorptiometry scan were many. The aim of this study is to find whether urinary n telopeptide can be used to diagnose osteoporosis — prospective cohort study done at Sri Ramachandra Medical University between August 2014 to December 2018. The study was done amongst the postmenopausal females and older males who came to the University hospital as an inpatient or an outpatient with suspected osteoporosis. We had 110 persons participated in the study. The patients were divided into two groups. Group, I was cases whose Dexa scan was osteoporosis/ osteopenia, and Group II was a control that had standard Dexa. The results from Dexa Scan are taken as the gold standard against urinary n telopeptide and a 2x2 table formed. Sensitivity, specificity, positive predictive value, likelihood ratio, area under ROC curve will be calculated. The mean value of urinary N Telopeptide in the case group was 182.5 and in control group was 49.8. The ROC curve was formed and cut off was calculated to be 71. Urinary N telopeptide can very well be considered as a diagnostic test and can’t be considered as a gold standard diagnostic test as there is some limitation as it is a bone resorption biomarker having some pre-analytical and biochemical variability which can alter the results. It can be used as an adjuvant and as a screening test along with gold standard Dexa in diagnosing osteoporosis.

scholarly journals Clinical Utilization of Point-of-care Ultrasound After Training: A Prospective Study

2021 ◽  
Author(s):  
Wan-Ching Lien ◽  
Chih-Heng Chang ◽  
Kah-Meng Chong ◽  
Meng-Che Wu ◽  
Cheng-Yi Wu ◽  
...  
Keyword(s):  
Image Quality ◽  
Positive Impact ◽  
University Hospital ◽  
Point Of Care Ultrasound ◽  
Global Rating ◽  
Clinical Trial Registration ◽  
Clinical Utilization ◽  
Global Ratings ◽  
Group 2 ◽  
Group 1

Abstract Background: This study aimed to investigate the clinical utilization of PoCUS of the first post-graduate year residents after a PoCUS curriculum. Methods: It was conducted at the emergency department of the National Taiwan University Hospital between July 2015 and October 2017. Every resident had one-month ED training and a curriculum was implemented during the first week. The post-training objective structured clinical examination (OSCE) global ratings were obtained, as well as the sonographic examinations by the residents. The participants were categorized into 4 groups: group 1 performed PoCUS before and after the curriculum; group 2 performed only after the curriculum; group 3 performed only before the curriculum; the last did not perform any examinations. Results: Two hundred and thirty-nine residents participated. The median global rating was 4 (interquartile ranges, 4-5). A significantly increasing number of residents integrated PoCUS into patient care (64 vs. 170, p=0.037) with acceptable image quality after the curriculum. Nearly 30% of residents did not use PoCUS although no differences existed in the OSCE global ratings. Group 1 performed more cases with better image quality and using ≥2 ultrasound applications (8/100 vs. 82/359, p=0.0009) after the curriculum. Group 1 performed more cases with better image quality than group 2 after the curriculum. In groups 3 and 4, “no suitable cases” (25/69), and “choosing other imaging priorities” (43/69) were the main feedbacks for not performing PoCUS. Conclusions: A focused training had a substantial positive impact on the utilization of PoCUS of the residents. The global ratings could not predict whether to integrate PoCUS into clinical practice. Further studies would be needed for the sustained effects of the curriculum and how to encourage these residents in groups 3 and 4 to use PoCUS.Clinical trial registration: NCT03738033.

scholarly journals Improving the Management of High-Risk Pregnancies with the Use of the Robson Classification

2020 ◽  
Vol 42 (08) ◽  
pp. 448-453
Author(s):  
Mario Dias Correa Junior ◽  
Bárbara Moreira Ribeiro Trindade dos Santos ◽  
José Reinaldo Correa Roveda ◽  
Laura Carolina Menezes Vieira Silva ◽  
Larissa Silva Guimarães ◽  
...  
Keyword(s):  
High Risk ◽  
Cesarean Delivery ◽  
Lower Risk ◽  
Positive Impact ◽  
Risk Groups ◽  
University Hospital ◽  
Cochrane Library ◽  
Cesarean Sections ◽  
Robson Classification ◽  
Maternity Hospitals

Abstract Objective To analyze the rates of cesarean delivery longitudinally in a university hospital using the Robson classification. Methods Data related to births performed between 2014 and 2018 and recorded in the Maternal and Neonatal Health Information System (Sistema de Informações em Saúde Materna e Neonatal, SISMATER, in Portuguese) were analyzed using the Robson classification. As an aid, we used articles published in the last five years that approach the same topic in other Brazilian maternity hospitals; they were retrieved from the LILACS, MEDLINE, CINAHL, Scopus, Web of Science and Cochrane Library databases. Results There was little variation in the total rate of cesarean sections in the period; however, the profile of each group changed over the years. It was possible to verify a significant reduction in the participation of groups of pregnant women with lower risk and an increase in high-risk pregnancies, attributable to the decrease in beds in the institution, with a greater transfer of patients. In addition, there was a reduction in cesarean sections among the lower-risk groups, while the rate among the higher-risk groups remained stable. Conclusion The use of the Robson classification to stratify cesarean deliveries contributes to a better analysis of the indications for cesarean delivery, enabling the establishment of strategies to reduce the rates, generating a positive impact on hospital management and quality of care.

scholarly journals Comparison of Solomon technique with selective laser ablation for twin-twin transfusion syndrome: a systematic review

2015 ◽  
Vol 46 (5) ◽  
pp. 526-533 ◽  
Author(s):  
R. K. Dhillon ◽  
S. C. Hillman ◽  
R. Pounds ◽  
R. K. Morris ◽  
M. D. Kilby
Keyword(s):  
Systematic Review ◽  
Laser Ablation ◽  
Solomon Technique

Triple-negative breast cancer: Epidemiology, characteristics, and survival in a Lebanese cohort

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22228-e22228
Author(s):  
M. Ghosn ◽  
C. Hajj ◽  
F. Nasr ◽  
F. El Karak ◽  
G. Abadjian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Ductal Carcinoma ◽  
Positive Family History ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Stage I ◽  
Stage Ii ◽  
University Hospital ◽  
Stage Iii

e22228 Background: Breast cancer (BC) is the most common malignancy in women in Lebanon. Triple negative (TN) phenotype is known to be associated with an increased likelihood of recurrence and death. The purpose of this study is to determine the incidence, characteristics and survival of TN BC patients in a Medical Oncology department in a University Hospital in Lebanon. Methods: We retrospectively reviewed the pathology of all women with breast cancer that were seen in our institution between 1997 and 2008. TN BC patients (pts) were defined as those that were negative for all 3 receptors (estrogen, progesterone and HER2neu on immunohistochemistry). Pts' characteristics and survival of TN women were analyzed. Results: Of the 1599 breast cancer pts, 155 (9.7%) had a triple negative phenotype. Median age was 52 years. A positive family history of breast/ovarian cancer was found in 15 pts (10%). Pathology studies showed: invasive ductal carcinoma component in 138 pts (89%), pure medullary carcinoma in 7 pts (5%), pure invasive lobular carcinoma in 6 pts (4%), pure mucinous carcinoma in 3 pts (2%) and epidermoid carcinoma in 1 pt (1%). A grade III was found in 98 of specimens (63%). Twenty-six pts (17%) presented with stage I, 73 (47%) with stage II, 37 (24%) with stage III and 19 (12%) with stage IV. Twelve percent had inflammatory breast cancer. After a median follow up of 17 months (mths), 43 pts had relapsed (5 stage I, 18 stage II and 20 stage III). The most common sites of relapse were brain (in 20 % of cases), lungs (in 20% of cases) and bone (in 11% of cases). Five- year disease free survival and 5-year overall survival were respectively 75% and 88% for stage I, 58% and 72% for stage II and 40% and 63% for stage III. Adjuvant therapy was administered to 96% of pts among which a taxane-based regimen was used in 38% of cases . Median survival for stage IV was 19 mths with a first line taxane-based regimen used in 50% of cases. Conclusions: The incidence of TN BC in Lebanon is similar to that described in the literature. It has an aggressive course. Focus on understanding the biology of this particular BC subtype is essential for determining targets for future therapeutic options. No significant financial relationships to disclose.

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