scholarly journals Elevated serum CA 19-9 level, combined with D-dimer, could detect the presence of ruptured ovarian endometriosis

2020 ◽  
Author(s):  
Ting Shuang ◽  
Lanbo Zhao ◽  
Kailu Zhang ◽  
Yiran Wang ◽  
Panyue Yin ◽  
...  
Keyword(s):  
Elevated Serum ◽  
Lower Abdominal Pain ◽  
Clinical Importance ◽  
Sudden Onset ◽  
Ca 125 ◽  
Ovarian Endometriosis ◽  
Non Invasive ◽  
History Of ◽  
Auc Value ◽  
D Dimer

Abstract Background: Ovarian endometriosis (OE) is a common type of endometrioma, which is a benign disease of gynecology. For the diagnosis of OE, ultrasonography is a very effective and straightforward. OE rupture is rare, and there is still a lack of a non-invasive and effective method for diagnosis. Elevated serum CA19-9 or CA-125 levels are typically applied as biomarkers for malignancy, besides, the CA-125 and CA19-9 levels have been recommended as a useful marker for the diagnosis of endometriosis. We aimed to clarify the clinical importance of serum CA19-9, CA-125 level, and plasma D-dimer (D-D) for detecting spontaneously ruptured ovarian endometriosis.Results: Among the 21 patients of rupture OE, 16 with a history of detected pelvic cysts, 19 claimed sudden onset of lower abdominal pain, however, only 6 patients detected fluid accumulation in the cul-de-sac by ultrasound. For the serological investigation, the serum CA19-9 was significantly elevated in the ruptured OE group (343.09±367.67 U/ml vs. 36.84±40.01U/ml, P<0.0001). D-D was also abnormally elevated in the ruptured OE group (3.39±4.90 mg/L vs. 0.43 ± 0.29 mg/L, P <0.0001). The AUC value for the combined CA19-9 and D-D was 0.975 (95% CI, 0.939 -0.993), with the highest specificity of 96.69, and sensitivity of 85.71.Conclusion: The combination of serum CA19-9 and plasma D-D levels could serve as an effective biomarker to identify patients with spontaneously ruptured ovarian endometriosis pre-operatively in the context of clinical assessment.

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

scholarly journals Score for Predicting Active Cancer in Patients with Ischemic Stroke: A Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jiwei Jiang ◽  
Xiuli Shang ◽  
Jinming Zhao ◽  
Meihui Cao ◽  
Jirui Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Retrospective Study ◽  
Clinical Laboratory ◽  
Elevated Serum ◽  
Clinical Score ◽  
Predictive Score ◽  
Bayesian Decision ◽  
History Of ◽  
D Dimer ◽  
Active Cancer

Background. We aimed to examine the differences of clinical characteristics between patients with ischemic stroke with active cancer and those without cancer to develop a clinical score for predicting the presence of occult cancer in patients with ischemic stroke. Methods. This retrospective study enrolled consecutive adult patients with acute ischemic stroke who were admitted to our department between December 2017 and January 2019. The demographic, clinical, laboratory, and neuroimaging characteristics were compared between patients with ischemic stroke with active cancer and those without cancer. Multivariate analysis was performed to identify independent factors associated with active cancer. Subsequently, a predictive score was developed using the areas under the receiver operating characteristic curves based on these independent factors. Finally, Bayesian decision theory was applied to calculate the posterior probability of active cancer for finding the best scoring system. Results. Fifty-three (6.63%) of 799 patients with ischemic stroke had active cancer. The absence of a history of hyperlipidemia (odds ratio OR = 0.17 , 95% confidence interval (CI): 0.06–0.48, P < 0.01 ), elevated serum fibrinogen ( OR = 1.72 , 95% CI: 1.33–2.22, P < 0.01 ) and D-dimer levels ( OR = 1.43 , 95% CI: 1.24–1.64, P <0.01), and stroke of undetermined etiology ( OR = 22.87 , 95% CI: 9.91–52.78, P < 0.01 ) were independently associated with active cancer. A clinical score based on the absence of hyperlipidemia, serum fibrinogen level of ≥4.00 g/L, and D-dimer level of ≥2.00 μg/mL predicted active cancer with an area under the curve of 0.83 (95% CI: 0.77–0.89, P < 0.01 ). The probability of active cancer was 59% at a supposed prevalence of 6.63%, if all three independent factors were present in a patient with ischemic stroke. Conclusions. We devised a clinical score to predict active cancer in patients with ischemic stroke based on the absence of a history of hyperlipidemia and elevated serum D-dimer and fibrinogen levels. The use of this score may allow for early intervention. Further research is needed to confirm the implementation of this score in clinical settings.

Thrombolytic Efficacy Of Enoxaparin Compared With Unfractionated Heparins In Cardiac Emergency

2021 ◽  
Vol 15 (8) ◽  
pp. 2002-2005
Author(s):  
M. Imran Ashraf ◽  
Shazana Rana ◽  
M. Saleem Akhtar ◽  
Adnan Afzal ◽  
Javaria Fatima ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Unfractionated Heparin ◽  
Antiplatelet Agents ◽  
Tertiary Hospital ◽  
Sudden Onset ◽  
Non Invasive ◽  
History Of ◽  
Artery Disease

Background: Antithrombotic treatment with heparin together with antiplatelet agents reduces the incidence of ischemia in patients with coronary artery disease. associated with fewer adverse reactions. Aim: To evaluate and compare the clinical and obtained results of the use of enoxaparin and standard unfractionated heparin in patients with coronary heart disease. Methods: This is a non-invasive planned surveillance demonstration conducted at a tertiary hospital in Pakistan. Adult male and female patients with coronary artery infection (CAD) between the ages of 30 and 70 were recently analyzed or included patients with a history of heart cancer. The intermediate layer is injected with enoxaparin for 5 days. Resting the ECG position, prothrombin time, and ADRs were measured individually in all patients from 1 to 21 days. Result: Compared to the patient's unfractionated heparin, normal prothrombin times were generally higher (P and <0.002), while total hypokalemia was lower. (P and <0.04) in the patient's enoxaparin stratification. Angina pectoris and side effects such as death, morbidity, encephalopathy and sudden onset were less common in the patient's enoxaparin fraction than in the unfractionated heparin fraction, and the contrast was negligible Conclusions: Antithrombotic therapy with enoxaparin and aspirin is safer and more convincing than unfractionated heparin and headache drugs because it reduces the incidence of ischemic events in patients with unstable or tissue angina. The myocardium dies in the early stages. Keywords: Anticoagulant, coronary heart disease, enoxaparin, safety, and efficacy, unfractionated heparin

scholarly journals Score for Predicting Active Cancer in Patients with Ischemic Stroke: A Retrospective Study

2020 ◽  
Author(s):  
Jiwei Jiang ◽  
Jirui Wang ◽  
Meihui Cao ◽  
Jinming Zhao ◽  
Xiuli Shang
Keyword(s):  
Ischemic Stroke ◽  
Retrospective Study ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Elevated Serum ◽  
Area Under The Curve ◽  
Clinical Score ◽  
History Of ◽  
D Dimer ◽  
Active Cancer

Abstract Background: We aimed to examine the differences between the clinical characteristics of patients with ischemic stroke and active cancer and those without cancer and develop a clinical score for predicting occult cancer in patients with ischemic stroke.Methods: This retrospective study enrolled consecutive adult patients with acute ischemic stroke, who were admitted to our department between December 2017 and January 2019. The demographic, clinical, laboratory, and neuroimaging characteristics of patients with ischemic stroke with active cancer and those without cancer were compared. Multivariate analysis was performed to identify independent factors associated with active cancer. Subsequently, a predictive cancer-risk score was developed using the area under the receiver operating characteristic curve.Results: Fifty-three (6.63%) of 799 patients with ischemic stroke had active cancer. The absence of a history of hyperlipidemia [odds ratio (OR)=0.17, 95% confidence interval (CI): 0.06–0.48, P<0.01], elevated serum fibrinogen (OR=1.72, 95% CI: 1.33–2.22, P<0.01) and D-dimer levels (OR=1.43, 95% CI: 1.24–1.64, P<0.01), and stroke of undetermined etiology (OR=22.87, 95% CI: 9.91–52.78, P<0.01) were independently associated with active cancer. Thus, a score based on the absence of hyperlipidemia and serum fibrinogen ≥4.00 g/L and D-dimer ≥2.00 μg/mL predicted active cancer with an area under the curve of 0.83 (95% CI: 0.77–0.89, P<0.01). The probability of active cancer was 59% at a supposed prevalence of 6.63%, if all three independent factors were present in a patient with ischemic stroke.Conclusions: We devised a score to predict active cancer in patients with ischemic stroke based on the absence of a history of hyperlipidemia and elevated serum D-dimer and fibrinogen that highlights the importance of hypercoagulability in these patients and may help determine early intervention and management.

A First Report of HCTZ and Dicyclomine Induced Uncharacteristic Contraction Alkalosis

2021 ◽  
pp. 089719002110528
Author(s):  
Tony J. Eid ◽  
Matthew Horton ◽  
Claire Hendrix ◽  
Janie M. Yu ◽  
Elizabeth A. Browning ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Elevated Serum ◽  
Blood Chemistry ◽  
Sudden Onset ◽  
High Serum ◽  
Normal Limits ◽  
Serum Chloride ◽  
History Of ◽  
Autosomal Dominant Polycystic Kidney ◽  
Irritable Bowel

Background Contraction alkalosis is characterized by low serum sodium and chloride and high serum carbon dioxide and bicarbonate levels. Case Report A 28-year-old Caucasian active-duty male with a history of autosomal dominant polycystic kidney disease and diarrhea-predominant Irritable Bowel Syndrome (D-IBS) presented to his primary care provider (PCP) with elevated blood pressure (136/96 mmHg), was diagnosed with stage-2 hypertension, and started oral HCTZ (25 mg/day). His medications included dicyclomine (10 mg oral three times daily). Subsequently, (Visit 1), his blood pressure was 130/91 mmHg and he was started on telmisartan (20 mg/day). At Visit 2, 4 weeks later, his blood pressure improved (121/73 mmHg); however, blood chemistry revealed elevated serum CO2 (32 mEq/L) and chloride (94 mmol/L). Four days later, the patient presented to the Emergency Department with dyspnea and swallowing difficulty. The patient returned to his PCP 3 days later complaining of cough, congestion, vomiting, and mild dyspnea, blood pressure of 124/84 mmHg. Two months later, sudden onset of projectile vomiting and abdominal pain while running was reported, resolved by rehydration and a single oral dose of prochlorperazine 25 mg. Three months later, (Visit 3), he complained of lightheadedness and cloudy judgment, suggesting contraction alkalosis. HCTZ was discontinued and telmisartan was increased to 20 mg twice daily. A follow-up blood chemistry panel 2 weeks later revealed serum chloride and CO2 levels within normal limits and blood pressure under 130/80 mmHg. Conclusion This is the first known report of contraction alkalosis driven by drug–drug interaction between dicyclomine and HCTZ.

scholarly journals Case Report: Ulcerative Colitis with Multiple Dural Venous Thrombosis

2021 ◽  
pp. 504-509
Author(s):  
Safia Mohamud ◽  
Mosunmola Oyawusi ◽  
Roger Weir ◽  
Richard M. Millis ◽  
Ozra Dehkordi
Keyword(s):  
Ulcerative Colitis ◽  
Magnetic Resonance ◽  
Vital Signs ◽  
Memory Loss ◽  
Lower Abdominal Pain ◽  
Neurological Status ◽  
Sudden Onset ◽  
University Hospital ◽  
History Of ◽  
Sound Sensitivity

<b>Background</b> Cerebral sinus vein thrombosis (CVT) is a rare but serious complication associated with ulcerative colitis (UC), an idiopathic autoimmune inflammatory disease of the gastrointestinal tract. Management approaches for CVT remain unclear but may include anticoagulation and surgical thrombectomy. Herein, we report a case of a 23-year-old male who developed CVT with a history of UC. The patient was presented to Howard University Hospital when he slipped and fell. On arrival at the hospital, he complained of a headache with an aching sensation, associated with light/sound sensitivity. The patient had a history of uncontrolled UC. He had positive bloody diarrhea, lower abdominal pain, but denied any other neurological deficit. Computed tomography of the head showed left frontoparietal lobe hypodensities. Neurological exam was nonfocal. Vital signs were within normal range, but the patient experienced some memory loss and personality changes. Subsequent diagnosis of CVT was made with magnetic resonance angiography and magnetic resonance venography. Immediate treatment with low-molecular-weight intravenous heparin (18 IU/kg) was introduced. His UC was managed with methylprednisolone (60 mg IV daily), proton pump inhibitors, mesalamine, ciprofloxacin, and metronidazole. His condition gradually improved. On discharge, he was prescribed prednisone, azathioprine for his UC, levetiracetam for seizure, and warfarin with an INR goal of 2–3. In conclusion, the sudden onset and/or acute worsening of neurological status such as headache and mental confusion in a patient with UC should alert the treating physician about the possibility of CVT so that timely intervention could be employed to prevent disabling and potentially lethal sequelae of this disease.

Investigations into the Clinical Utility of Latex D-Dimer in the Diagnosis of Deep Venous Thrombosis

1993 ◽  
Vol 69 (01) ◽  
pp. 008-011 ◽  
Author(s):  
Cedric J Carter ◽  
D Lynn Doyle ◽  
Nigel Dawson ◽  
Shauna Fowler ◽  
Dana V Devine
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limb ◽  
Clinical Utility ◽  
Rapid Test ◽  
Fibrin Degradation Product ◽  
Current Form ◽  
Non Invasive ◽  
Clinically Significant ◽  
D Dimer

SummaryThe serial use of non-invasive tests has been shown to be a safe method of managing outpatients who are suspected of having lower limb deep venous thrombosis (DVT). Objective testing has shown that the majority of these outpatients do not have venous thrombosis. A rapid test to exclude DVT in these patients, without the need for expensive and inconvenient serial non-invasive vascular testing, would have practical and economic advantages.Studies measuring the fibrin degradation product D-dimer using enzyme-linked immunoassays (EIA) in patients with veno-graphically proven DVT suggest that it should be possible to exclude this condition by the use of one of the rapid latex bead D-dimer tests.We have examined 190 patients with suspected DVT using both a latex and an EIA D-dimer assay. The latex D-dimer test used in this study was negative in 7 of the 36 proven cases of DVT. This sensitivity of only 80% is not sufficient to allow this type of assay, in its current form, to be used as an exclusion test for DVT. The same plasma samples were tested with an EIA assay. This information was used to mathematically model the effects of selecting a range of D-dimer discriminant cut off points for the diagnosis of DVT. These results indicate that 62% of suspected clinically significant DVT could have this diagnosis excluded, with a 98% sensitivity, if the rapid latex or equivalent D-dimer test could be reformulated to measure less than 185 ng/ml of D-dimer.

scholarly journals Prediction of Incident Cancers in the Lifelines Population-Based Cohort

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2133
Author(s):  
Francisco O. Cortés-Ibañez ◽  
Sunil Belur Nagaraj ◽  
Ludo Cornelissen ◽  
Gerjan J. Navis ◽  
Bert van der Vegt ◽  
...  
Keyword(s):  
Cancer Incidence ◽  
Binary Classification ◽  
Predictive Performance ◽  
Population Based ◽  
Support Vector ◽  
Clinical Variables ◽  
Incident Cancer ◽  
History Of ◽  
Diagnosis Of Cancer ◽  
Auc Value

Cancer incidence is rising, and accurate prediction of incident cancers could be relevant to understanding and reducing cancer incidence. The aim of this study was to develop machine learning (ML) models that could predict an incident diagnosis of cancer. Participants without any history of cancer within the Lifelines population-based cohort were followed for a median of 7 years. Data were available for 116,188 cancer-free participants and 4232 incident cancer cases. At baseline, socioeconomic, lifestyle, and clinical variables were assessed. The main outcome was an incident cancer during follow-up (excluding skin cancer), based on linkage with the national pathology registry. The performance of three ML algorithms was evaluated using supervised binary classification to identify incident cancers among participants. Elastic net regularization and Gini index were used for variables selection. An overall area under the receiver operator curve (AUC) <0.75 was obtained, the highest AUC value was for prostate cancer (random forest AUC = 0.82 (95% CI 0.77–0.87), logistic regression AUC = 0.81 (95% CI 0.76–0.86), and support vector machines AUC = 0.83 (95% CI 0.78–0.88), respectively); age was the most important predictor in these models. Linear and non-linear ML algorithms including socioeconomic, lifestyle, and clinical variables produced a moderate predictive performance of incident cancers in the Lifelines cohort.

scholarly journals Architectural ruins: geoculture of the anatomy of buildings as illustrated by Casa Ippolito, Malta

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Lino Bianco
Keyword(s):  
Material Culture ◽  
Building Materials ◽  
Raw Materials ◽  
Primary Source ◽  
Secondary Sources ◽  
Non Invasive ◽  
History Of ◽  
Aerial Vehicle ◽  
Materials Used ◽  
Building Physics

AbstractRuins are a statement on the building materials used and the construction method employed. Casa Ippolito, now in ruins, is typical of 17th-century Maltese aristocratic country residences. It represents an illustration of secondary or anthropogenic geodiversity. This paper scrutinises these ruins as a primary source in reconstructing the building’s architecture. The methodology involved on-site geographical surveying, including visual inspection and non-invasive tests, a geological survey of the local lithostratigraphy, and examination of notarial deeds and secondary sources to support findings about the building’s history as read from its ruins. An unmanned aerial vehicle was used to digitally record the parlous state of the architectural structure and karsten tubes were used to quantify the surface porosity of the limestone. The results are expressed from four perspectives. The anatomy of Casa Ippolito, as revealed in its ruins, provides a cross-section of its building history and shows two distinct phases in its construction. The tissue of Casa Ippolito—the building elements and materials—speaks of the knowledge of raw materials and their properties among the builders who worked on both phases. The architectural history of Casa Ippolito reveals how it supported its inhabitants’ wellbeing in terms of shelter, water and food. Finally, the ruins in their present state bring to the fore the site’s potential for cultural tourism. This case study aims to show that such ruins are not just geocultural remains of historical built fabric. They are open wounds in the built structure; they underpin the anatomy of the building and support insights into its former dynamics. Ruins offer an essay in material culture and building physics. Architectural ruins of masonry structures are anthropogenic discourse rendered in stone which facilitate not only the reconstruction of spaces but also places for human users; they are a statement on the wellbeing of humanity throughout history.

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