The tactics of managing children and adolescents when twisting the uterine appendages from the position of international standards

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 39-41
Author(s):  
Zalina K. Batyrova ◽  
Zaira K. Kumykova ◽  
Elena V. Uvarova ◽  
Vladimir D. Chuprynin ◽  
Natalya A. Buralkina ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Ovarian Tissue ◽  
Standard Of Care ◽  
Lymphatic Drainage ◽  
International Standards ◽  
Delivery Of Care ◽  
National Medical ◽  
Treatment Standard ◽  
Common Causes ◽  
Adolescent Gynecology

Background. Adnexal torsion (AT) takes fifth place among all emergency gynecological conditions. Suspicion of AT requires immediate diagnosis and urgent surgical treatment. The most common causes of AT are various volumetric formations, such as functional or dermoid ovarian cysts, contributing to an increase in its volume and/or anomalies in the development of the ligamentous apparatus. Timely diagnosis and detorsion contributes to the full restoration of impaired venous outflow and lymphatic drainage of the ovarian tissue, preventing the development of severe ischemia and necrosis. Over the past few decades, a surgical organ-preserving approach in managing patients with AT has been the gold standard of care. Materials and methods. The article describes the results of a retrospective study of cases of AT in children and adolescents treated at the Department of Pediatric and adolescent gynecology Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology with an assessment of the clinical and anamnestic features of this cohort of patients and the choice of therapeutic tactics. Conclusion. A multidisciplinary approach is critical to optimizing the delivery of care in cases of AT, including minimally invasive detorsion and preserving the functionality of the ovary as a treatment standard that should be used in the management of children and adolescents.

scholarly journals COVD-25. THE PARADOXICAL EFFECTS OF COVID-19 ON CANCER CARE IN THE NEURO-ONCOLOGY SETTING

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii26-ii26
Author(s):  
Nicole Cort ◽  
Alex Broom ◽  
Katherine Kenny ◽  
Alexander Page ◽  
Jennifer Durling ◽  
...  
Keyword(s):  
Cancer Care ◽  
Standard Of Care ◽  
Adult Brain ◽  
Evidence Based ◽  
Negative Consequences ◽  
Traditional Practice ◽  
Delivery Of Care ◽  
Paradoxical Effects ◽  
Oncology Care ◽  
The Impact

Abstract COVID-19 has caused ongoing interruptions to healthcare systems worldwide, shifting care to virtual platforms, and placing significant economic and logistical burdens on clinical practice. The pandemic has created uncertainty in delivering the standard of care, both in areas of cancer diagnosis and treatment, especially within neuro-oncology. Due to the pandemic, care and operational planning goals have shifted to infection prevention, modifying recommendations to decrease viral transmission and increasing telemedicine use, potentially creating a burden on implementing evidence-based medicine. These dynamics have since begun to redefine traditional practice and research regimens, impacting the comprehensive care that cancer patients can and should receive; and the enduring consequences for the delivery of healthcare. The impact of COVID-19 on oncology practice and trials might endure well beyond the short- to mid-term of the active pandemic. Therefore, these shifts must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care. To address these paradoxical effects, we will conduct iterative, qualitative (face-to-face/video conference) interviews with neuro-oncology clinical and research professionals and adult brain tumor patients receiving care during the pandemic. We will capture unique aspects of oncology care: the lived, subjective, situated, and contingent accounts of patients and medical professionals, especially during a pandemic. We will also specifically compare the impact of telehealth during the pandemic on delivery of care to complex neuro-oncology patients. A summary of this in-depth, qualitative approach will result in a sophisticated understanding of neuro-oncology care on the frontline at a time of crisis, as experienced during a pandemic, to articulate best practices for future implementation.

Current Perspectives on Lymphatic Mapping in Carcinomas of the Uterine Corpus and Cervix

2006 ◽  
Vol 4 (5) ◽  
pp. 471-478 ◽  
Author(s):  
Robert L. Coleman ◽  
Michael Frumovitz ◽  
Charles F. Levenback
Keyword(s):  
Sentinel Node ◽  
Lymphatic Mapping ◽  
Female Genital Tract ◽  
Standard Of Care ◽  
Lymphatic Drainage ◽  
Sentinel Node Identification ◽  
Rare Malignancy ◽  
Clinical Potential ◽  
Current Experience ◽  
Female Genital

Lymphatic mapping and sentinel node identification are rapidly becoming the standard of care in managing many malignancies. These procedures have allowed focused evaluation of relevant regional lymphatics, which has led not only to improved precision of nodal pathology, but also to treatment triage and the potential for reduced postoperative morbidity. Given its clinical potential, new cancer primary sites are being evaluated, including those of the female genital tract. Of these, carcinoma of the vulva seems the most apposite; however, it is a rare malignancy and therefore large randomized treatment trials based on sentinel node triage are difficult to perform. Cancers of the uterus–cervix and corpus are more common. Because the physiologic lymphatic drainage from this organ is ambiguous, principle lymphatic basins are located in many different anatomic locales, making sentinel node identification precarious, yet highly relevant and informative. Current experience in carcinoma of the cervix suggests the concept is feasible. A consensus in corpus cancer has not been reached, although both sites are of keen interest with the increasing use of laparoscopy in surgical management. Prospective multi-institutional validation studies are underway.

Algorithm for the diagnosis of breathing disorders during sleep in children with neurological pathology

2021 ◽  
Vol 2 (2) ◽  
pp. 73-82
Author(s):  
Vladislav V. Lebedev ◽  
Olga V. Kozhevnikova ◽  
Andrey A. Gazaryan ◽  
Victoriya A. Aysina ◽  
Eka A. Abashidze ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Neurological Diseases ◽  
Respiratory Disorders ◽  
National Medical ◽  
Sleep Breathing Disorders ◽  
Breathing Disorders ◽  
Common Causes ◽  
Personalized Approach ◽  
Neurological Pathology

Introduction. Sleep disorders in children with nervous system pathology are more pronounced than in the general population. One of the most common causes of sleep disorders in children is sleep-disordered breathing. The aim of our study was to create an algorithm for the diagnosis of sleep breathing disorders in children with neurological pathology. Materials and methods. The results of night studies (160 polysomnographies, 98 cardiorespiratory monitorings) carried out in the department of instrumental diagnostics at the National Medical Research Center for Children’s Health in 258 children (154 boys and 104 girls, aged one month to 17 years) with neurological pathology were analyzed. Questionnaires were used to assess the quality of sleep. An essential criterion for dividing children into groups was the presence of maxillofacial anomalies (MFA). The results were compared with complaints according to questionnaires, age, BMI and ENT-status of patients. Results. In the general sample, a significant (p < 0.001) relationship between respiratory disorders and complaints and the presence of ENT pathology was obtained. The most severe breathing disorders were recorded in children with MFA (p < 0.001). The result was the creation of an algorithm for examining children with neurological pathology. Conclusion. Children with neurological pathology in sleep-breathing disorders require a personalized approach to correcting the causes of these disturbances, depending on the nosology. Chronic pathology of the ENT organs aggravates respiratory disorders during sleep. Regular monitoring of sleep disorders using questionnaires should be included in the algorithm for managing children with neurological diseases of all ages for early detection of these disorders.

Approach to the Complicated Alcohol Withdrawal Patient

2016 ◽  
Vol 32 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Jason A. Ferreira ◽  
Patrick M. Wieruszewski ◽  
David W. Cunningham ◽  
Kimberly E. Davidson ◽  
Stephanie F. Weisberg
Keyword(s):  
Alcohol Withdrawal ◽  
Care Setting ◽  
Treatment Approach ◽  
Standard Of Care ◽  
Aminobutyric Acid ◽  
Multimodal Approach ◽  
Gaba Agonists ◽  
Severe Withdrawal ◽  
Common Causes ◽  
Withdrawal Syndromes

Alcohol withdrawal syndromes are common causes for admission to the intensive care unit. As many as one-fifth of the admitted patients have an alcohol-associated disorder. Identifying the benefit of the γ-aminobutyric acid (GABA) agonists has shifted toward methods to improve benzodiazepine (BZD) utilization. Literature validating this treatment approach in severe withdrawal, especially in the critical care setting, is limited, and extrapolation to this population may be dangerous. Multiple therapies have been suggested or utilized in the literature including continuous infusion of GABA agonists, ethanol, dexmedetomidine, antiepileptics, and antipsychotics, introducing a significant amount of variability into clinical practice. This variability in treatment approaches highlights the lack of uniformity and recommendations available for the treatment of severe refractory patients. In patients progressing to severe withdrawal, it may be warranted to escalate care with adjunctive or more aggressive therapies. Although multiple practices are commonly used, the evidence supporting their use after failing symptom-triggered or aggressive therapy with BZDs is virtually nonexistent. These patients commonly receive a multimodal approach, which varies substantially between providers and institutions. Further literature should be directed at the approach most likely to provide benefit when standard of care has failed.

scholarly journals Medullary thyroid cancer. Returning to the need to determine the preoperative basal calcitonin level in patients with thyroid nodular pathology

2019 ◽  
Vol 12 (4) ◽  
pp. 188-195
Author(s):  
Elena E. Stanyakina ◽  
Ilia S. Romanov ◽  
Tatiana T. Kondratieva ◽  
Alexander S. Krylov ◽  
Alexey D. Ryzhkov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Medullary Thyroid Cancer ◽  
Medullary Carcinoma ◽  
International Standards ◽  
Place Of Residence ◽  
Medullary Thyroid ◽  
National Medical ◽  
A Value ◽  
Medical Institutions

There are International and Russian guidelines for the diagnosis and treatment of medullary thyroid carcinoma. There is a recommendation to determine the basal level of calcitonin for all patients with nodular thyroid disease at the all of these documents. However, this test is not performed for this category of patients routinely even in large clinics for a number of reasons, the main one, which seems to be an economic issue. Six months ago a patient addressed to our clinic who underwent surgical treatment for a papillary carcinoma (follicular variant) of the thyroid gland in the volume of thyroidectomy with pre-tracheal lymphodissection and subsequent course of radioiodine therapy at the place of residence. A relapse of the disease was suspected on the control examination at the place of residence and the patient was sent for consultation to the polyclinic of the N.N. Blokhin National Medical Research Center of Oncology. In our clinic, diagnostic studies were carried out, including a revision of the finished cytological and histological preparations and a conclusion was obtained – medullary carcinoma of the thyroid. Determination of basal level of calcitonin in serum showed a value of 1292 pg/ml. The level of basal calcitonin significantly decreased after repeated surgical treatment. This case shows that in order to avoid such mistake, which is described in our clinical case, it seems necessary to follow the national recommendations, international standards to determine the level of basal calcitonin for all patients with thyroid nodal pathology who consulted and treated in medical institutions.

scholarly journals Use of convalescent plasma in patients with coronavirus disease (Covid-19): Systematic review and meta-analysis

2021 ◽  
Author(s):  
Fernando Tortosa ◽  
Gabriela Carrasco ◽  
Martin Ragusa ◽  
Pedro Haluska ◽  
Ariel Izcovich
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Standard Of Care ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Assessment Development ◽  
Treatment Standard ◽  
Study Selection

AbstractObjetivesTo assess the effects of convalescent plasma treatment in patients with coronavirus disease (COVID-19).Study designSystematic review and Meta-analysisData sourcesA systematic search was carried out on the L · OVE (Living OVerview of Evidence) platform for COVID-19 until October 31, 2020Study selectionRandomized clinical trials in which people with probable or confirmed COVID-19 were randomized to drug treatment, standard care, or placebo. Pairs of reviewers independently screened potentially eligible articles.MethodsThe PRISMA guidelines were followed for conducting a systematic review and meta-analysis. The risk of bias of the included studies was assessed using the Cochrane risk of bias tool 2.0, and the certainty of the evidence using the recommendation assessment, development and evaluation (GRADE) approach. For each outcome, the interventions were classified into groups, from most to least beneficial or harmful.ResultsWe identified 10 RCTs (randomized controlled trials) involving 11854 patients in which convalescent plasma was compared with standard of care or other treatments. The results of five RCTs that evaluated the use of convalescent plasma in patients with COVID-19 did not show significant differences in the effect on mortality and the need for invasive mechanical ventilation.ConclusionsCurrent evidence is insufficient to recommend the use of convalescent plasma in the treatment of moderate or severe COVID-19.Contribution of the authors

scholarly journals Experience in implementing the International Standards for Assessing Newborn Growth INTERGROWTH-21st

2021 ◽  
Vol 66 (1) ◽  
pp. 117-124
Author(s):  
I. I. Ryumina ◽  
M. M. Markelova ◽  
M. V. Narogan ◽  
I. V. Orlovskaya ◽  
A. E. Perepelkina ◽  
...  
Keyword(s):  
Postnatal Growth ◽  
Physical Development ◽  
Premature Baby ◽  
International Standards ◽  
Pediatric Practice ◽  
Anthropometric Parameters ◽  
Intrauterine Growth ◽  
National Medical ◽  
Environment And Health ◽  
Premature Babies

The physical development of newborns and infants is the most important parameter in assessing their health. However, the standards of anthropometric parameters, and most importantly their growth in premature babies, especially those born with low and extremely low body weight, are still controversial.Objective: to apply the methodology for measuring and assessing the main anthropometric indicators of newborns using the international standards of postnatal growth of premature babies INTERGROWTH-21st to resolve the issue of the feasibility of its adaptation and widespread introduction into neonatological and pediatric practice in the Russian Federation. 4876 children were born at Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology (participant of the international project for the implementation of INTERGROWTH-21st standards in neonatological and pediatric practice) from 15.05.2018 to 26.11.2018. 439 (9%) of them were born premature, of which 376 children (89,3%) with gestational age confirmed by ultrasound were included in the study. There was a detailed file for each child to assess the environment and health of the mother, the course of pregnancy, childbirth, the state of health of the child from birth to discharge from the hospital. 2.1% of children classified by INTERGROWTH-21st as children with intrauterine growth retardation, according to Fenton charts, had normal intrauterine growth. When comparing the postnatal growth at discharge from hospital on the Fenton scale, more children were classified as children with impaired postnatal growth; the discrepancy between INTERGROWTH-21st and Fenton diagrams was 8%. At discharge, 52% of premature babies were exclusively breastfed, 28.8% of premature babies were at mixed feeding.Conclusion. On the one hand, the use of INTERGROWTH-21st scales helps to correct nutrition in case of delay in physical development, and, on the other hand, it reduces the risk of metabolic disorders associated with an aggressive desire to achieve rapid growth of a premature baby.

scholarly journals Incidence of venous thromboembolism in children with primary lymphomas

2021 ◽  
Vol 20 (3) ◽  
pp. 46-50
Author(s):  
D. A. Evstratov ◽  
L. H. Anderzhanova ◽  
A. V. Pshonkin ◽  
Yu. G. Abugova ◽  
N. V. Myakova ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Medical Research ◽  
Children And Adolescents ◽  
Median Time ◽  
Statistical Processing ◽  
Research Center ◽  
Sex Distribution ◽  
Pediatric Hematology ◽  
National Medical ◽  
Adults And Children

Cancer increases the risk of venous thromboembolism (VTE) in adults and children. The aim of our study was to evaluate the incidence of VTE in children and adolescents with lymphomas. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. A retrospective analysis based on medical data of 262 children and adolescents (0–18 years) with primary lymphomas (n = 262) who were treated in Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology since 01.01.2013 to 31.12.2019 had been performed. Such parameters as age and sex distribution of patients, the frequency, as well as the cumulative incidence of detection (CI) and differences in localization, the median time of detection of symptomatic (sVTE) and asymptomatic episodes of VT (aVTE), their relationship with central venous catheters (CVC) were analyzed. Statistical processing of the obtained data was carried out using the XLSTAT 2020 program (Addinsoft, France). The median age was 11,1 years (interquartile range (IQR) 6.5–15 years), the ratio of males to females was 2.2:1. There were 71 episodes of VTE in 65 patients (24.8%, 95% confidence interval (CI): 19.6–30). Among all episodes of VTE 31% were defined as sVTE at 400 day CI for sVTE was found to be 8.1% (95% CI: 5.4–12.2) and CI for aVTE – 18.7% (95% CI: 14.4–24.2). The median time to VTE episode was 38 days (IQR 16.5–91.5 days). There was a trend towards an earlier diagnosis of sVTE (median 23.5 days, IQR – 17–42 days) than aVTE (median 62 days, IQR 14–80 days), p = 0.075. VTE was CVC-related in 67.7 of all VTE cases. In one case, asymptomatic thrombosis of right atrium led to pulmonary embolism (PE). VTE is a frequent complication in children and adolescents with lymphomas. Most episodes of VTE were asymptomatic, one of which was the most likely cause of PE in the child. Further research is needed to find risk factors for VTE.

The Prevalence of Children and Adolescents at Risk for Avoidant Restrictive Food Intake Disorder in a Pediatric and Adolescent Gynecology Clinic

2020 ◽  
Vol 33 (5) ◽  
pp. 466-469 ◽  
Author(s):  
Hanna R. Goldberg ◽  
Debra K. Katzman ◽  
Lisa Allen ◽  
Samantha Martin ◽  
Carolyn Sheehan ◽  
...  
Keyword(s):  
At Risk ◽  
Food Intake ◽  
Children And Adolescents ◽  
Adolescent Gynecology

Female fertility preservation (FP) at pediatric cancer centers: A report from the Children’s Oncology Group (COG).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11567-11567
Author(s):  
Jennifer Levine ◽  
Gwendolyn P. Quinn ◽  
James Klotsky ◽  
Joanne Frankel Kelvin ◽  
Brooke Cherven ◽  
...  
Keyword(s):  
Fertility Preservation ◽  
Ovarian Tissue ◽  
Standard Of Care ◽  
Oocyte Cryopreservation ◽  
Ovarian Tissue Cryopreservation ◽  
Female Survivors ◽  
Conflicting Evidence ◽  
Modifiable Factor ◽  
After Cancer ◽  
Female Fertility Preservation

11567 Background: Preserved fertility after cancer is a priority for female survivors and their families. Embryo/oocyte cryopreservation are standard of care (SOC) for post-pubertal females. Experimental ovarian tissue cryopreservation (OTC) is the only current option for pre-pubertal girls. We surveyed COG sites about their FP infrastructure and practices. Methods: A REDcap survey was emailed to one individual previously identified as knowledgeable about FP or the Principal Investigator at each COG site. Site specific factors associated with outcomes were determined using logistic regression. All study procedures were IRB-approved. Results: Responses were received from 144 of 220 sites (65%). Discussions about fertility at diagnosis were reported as routinely held with all females “at risk” of infertility, all post pubertal females, and all females at 113 (78%), 94 (65%), and 65 (45%) of sites respectively. Embryo/oocyte cryopreservation was offered at 95 (70%) institutions and independently associated with large (>120 new patients/year) sites (OR 6.0 95%CI 1.6-22.8) and presence of a FP navigator/team (OR 4.7 95%CI 1.7-13.5). OTC was offered at 64 (48%) sites: 34 (25%) by referral to another institution, 18 (13%) under an IRB protocol, and 12 (9%) as a clinical service. OTC accessibility was associated with large sites (OR 3.2 95% CI 1.1-8.9) and a FP navigator/team (OR 3.2 95%CI 1.4-7.0). A total of 102/133 (77%) sites use gonadotropin releasing hormone analogues (GnRHa) for any indication; 90 (68%) for menstrual suppression, 75 (56%) with the goal of ovarian suppression for fertility preservation, and 27 (20%) for contraception. Conclusions: Variation in FP services exists across COG. Discussion of infertility risk is not universal. The availability of OTC at treating institutions is limited. The presence of an FP navigator/team is a modifiable factor associated with greater likelihood of accessing SOC and experimental options. Despite conflicting evidence and lack of endorsement from professional societies, GnRHa’s are commonly used for FP. These survey results suggest FP services remain inadequate but highlight opportunities for improvement and areas of needed research.

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