scholarly journals Pathogenesis Based Diagnosis and Treatment of Endometriosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Philippe R. Koninckx ◽  
Rodrigo Fernandes ◽  
Anastasia Ussia ◽  
Larissa Schindler ◽  
Arnaud Wattiez ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Clinical Decision ◽  
The Body ◽  
Diagnosis And Treatment ◽  
Aromatase Activity ◽  
Variable Response ◽  
Ovarian Endometriosis ◽  
Deep Endometriosis ◽  
Predictive Values ◽  
Safety Margins

Understanding the pathophysiology of endometriosis is changing our diagnosis and treatment. Endometriosis lesions are clones of specific cells, with variable characteristics as aromatase activity and progesterone resistance. Therefore the GE theory postulates GE incidents to start endometriosis, which thus is different from implanted endometrium. The subsequent growth in the specific environment of the peritoneal cavity is associated with angiogenesis, inflammation, immunologic changes and bleeding in the lesions causing fibrosis. Fibrosis will stop the growth and lesions look burnt out. The pain caused by endometriosis lesions is variable: some lesions are not painful while other lesions cause neuroinflammation at distance up to 28 mm. Diagnosis of endometriosis is made by laparoscopy, following an experience guided clinical decision, based on history, symptoms, clinical exam and imaging. Biochemical markers are not useful. For deep endometriosis, imaging is important before surgery, notwithstanding rather poor predictive values when confidence limits, the prevalence of the disease and the absence of stratification of lesions by size, localization and depth of infiltration, are considered. Surgery of endometriosis is based on recognition and excision. Since the surrounding fibrosis belongs to the body with limited infiltration by endometriosis, a rim of fibrosis can be left without safety margins. For deep endometriosis, this results in a conservative excision eventually with discoid excision or short bowel resections. For cystic ovarian endometriosis superficial destruction, if complete, should be sufficient. Understanding pathophysiology is important for the discussion of early intervention during adolescence. Considering neuroinflammation at distance, the indication to explore large somatic nerves should be reconsidered. Also, medical therapy of endometriosis has to be reconsidered since the variability of lesions results in a variable response, some lesions not requiring estrogens for growth and some being progesterone resistant. If the onset of endometriosis is driven by oxidative stress from retrograde menstruation and the peritoneal microbiome, medical therapy could prevent new lesions and becomes indicated after surgery.

scholarly journals Ovarian tissue freezing and activation after thawing: an update

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Li-fan Peng
Keyword(s):  
Granulosa Cells ◽  
Clinical Decision Making ◽  
Ovarian Function ◽  
Ovarian Tissue ◽  
Clinical Decision ◽  
The Body ◽  
Endocrine Function ◽  
Ovarian Tissue Cryopreservation ◽  
Main Body ◽  
Tissue Cryopreservation

Abstract Background With the growth of women’s age, ovarian failure can be caused by various factors. For the women who need chemotherapy because of cancer factors, the preservation of fertility is more urgent. The treatment of cancer is also a process in which all tissues and organs of the body are severely damaged, especially in the reproductive system. Main body As a new fertility preservation technology, autologous ovarian tissue cryopreservation and transplantation is developing rapidly and showing great potentiality in preserving ovarian endocrine function of young cervical cancer patients. Vitrification and slow freezing are two common techniques applied for ovarian tissue cryopreservation. Thus, cryopreserved/thawed ovarian tissue and transplantation act as an important method to preserve ovarian function during radiotherapy and chemotherapy, and ovarian cryopreservation by vitrification is a very effective and extensively used method to cryopreserve ovaries. The morphology of oocytes and granulosa cells and the structure of organelles were observed under the microscope of histology; the hormone content in the stratified culture medium of granulosa cells with the diameter of follicle was used to evaluate the development potential of ovarian tissue, and finally the ovarian tissue stimulation was determined by the technique of ovarian tissue transplantation. Conclusions Although there are some limitations, the team members still carry out this review to provide some references and suggestions for clinical decision-making and further clinical research.

scholarly journals Chest pain in general practice: a systematic review of prediction rules

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e027081 ◽  
Author(s):  
Ralf E Harskamp ◽  
Simone C Laeven ◽  
Jelle CL Himmelreich ◽  
Wim A M Lucassen ◽  
Henk C P M van Weert
Keyword(s):  
Systematic Review ◽  
General Practice ◽  
Chest Pain ◽  
Coronary Disease ◽  
Clinical Decision ◽  
Clinical Judgement ◽  
Predictive Values ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Rule Out

ObjectiveTo identify and assess the performance of clinical decision rules (CDR) for chest pain in general practice.DesignSystematic review of diagnostic studies.Data sourcesMedline/Pubmed, Embase/Ovid, CINAHL/EBSCO and Google Scholar up to October 2018.Study selectionStudies that assessed CDRs for intermittent-type chest pain and for rule out of acute coronary syndrome (ACS) applicable in general practice, thus not relying on advanced laboratory, computer or diagnostic testing.Review methodsReviewers identified studies, extracted data and assessed the quality of the evidence (using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2)), independently and in duplicate.ResultsEight studies comprising five CDRs met the inclusion criteria. Three CDRs are designed for rule out of coronary disease in intermittent-type chest pain (Gencer rule, Marburg Heart Score, INTERCHEST), and two for rule out of ACS (Grijseels rule, Bruins Slot rule). Studies that examined the Marburg Heart Score had the highest methodological quality with consistent sensitivity (86%–91%), specificity (61%–81%) and positive (23%–35%) and negative (97%–98%) predictive values (PPV and NPV). The diagnostic performance of Gencer (PPV: 20%–34%, NPV: 95%–99%) and INTERCHEST (PPV: 35%–43%, NPV: 96%–98%) appear comparable, but requires further validation. The Marburg Heart Score was more sensitive in detecting coronary disease than the clinical judgement of the general practitioner. The performance of CDRs that focused on rule out of ACS were: Grijseels rule (sensitivity: 91%, specificity: 37%, PPV: 57%, NPV: 82%) and Bruins Slot (sensitivity: 97%, specificity: 10%, PPV: 23%, NPV: 92%). Compared with clinical judgement, the Bruins Slot rule appeared to be safer than clinical judgement alone, but the study was limited in sample size.ConclusionsIn general practice, there is currently no clinical decision aid that can safely rule out ACS. For intermittent chest pain, several rules exist, of which the Marburg Heart Score has been most extensively tested and appears to outperform clinical judgement alone.

scholarly journals Diagnosis and Treatment of Human Salmonellosis in Addis Ababa City, Ethiopia

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Legesse Garedew ◽  
Semaria Solomon ◽  
Yoseph Worku ◽  
Hilina Worku ◽  
Debela Gemeda ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Addis Ababa ◽  
Clinical Signs ◽  
Diagnosis And Treatment ◽  
Widal Test ◽  
Predictive Values ◽  
Blood Samples ◽  
Antimicrobial Susceptibility Tests ◽  
Stool Samples ◽  
Susceptibility Tests

Background. Diagnosis using reliable tools and treatment followingin vitroantimicrobial susceptibility tests are critical to proper addressing of antibiotic-resistantSalmonellainfection.Methodology. A cross-sectional study was conducted to assess the practice of diagnosis and treatment of salmonellosis in Addis Ababa. Tube Widal test (for blood samples only), culture, biochemical and carbohydrate fermentation, serotyping, and antimicrobial susceptibility tests were employed for both blood and stool samples.Results. Of all the diseases listed in the diagnosis, nontyphoidal (n=72, 13.71%) and typhoidal (n=47, 8.95%) salmonellosis were the second and third common diseases. Among the 288 blood samples, almost half were positive for O, H, or both antigens. However, only 1 (0.68%) of the positive blood samples yieldedSalmonellaisolate during culture. The study demonstrated low specificity (0.68%) and positive predictive value (48.78%) of Widal test. Conversely, the test showed 100% sensitivity and negative predictive values.Salmonellaisolates were identified from 7 (7.07%) of 99 stool samples. Two-thirds of salmonellosis suspected patients received antibiotic treatment. However, only half of the confirmed salmonellosis patients were treated with appropriate antibiotics. All of the isolates were susceptible to ciprofloxacin and ceftriaxone but resistant to ampicillin.Conclusions. Majority of the patients who participated in this study were wrongly diagnosed using symptoms, clinical signs, and tube Widal test. Consequently, most of the patients received inappropriate treatment.

An overview on the concept of “Aam” and its significance as mentioned in Ayurvedic texts.

2020 ◽  
Vol 8 (01) ◽  
Author(s):  
Tejaswini Katare ◽  
Disha Sharma ◽  
Ganesh Puradkar ◽  
Arun Dudhamal
Keyword(s):  
Point Of View ◽  
The Body ◽  
Diagnosis And Treatment ◽  
Important Concept ◽  
Root Cause ◽  
Causative Factors ◽  
Undigested Food ◽  
Unhealthy Diet ◽  
Lack Of Exercise ◽  
All Diseases

Aam is an important concept described by Ayurvedic Acharyas which is responsible for many diseases. According to Ayurvedic point of view, all diseases are originated from aamdosh, vitiation of Agni i.e malfunction of Agni produces Aam. Aam is unripe, undigested food which is caused due to Agnimandya. Agnimandya produces aam and viceversa. We all know that all diseases are caused due to Agnimandya. Therefore as agnimandya and aam are the causative factors of each other, aam is the root cause of all diseases. Hence aam and agnimandya plays an important role in diagnosis and treatment of disease. Nowadays due to lack of exercise, unhygienic and unhealthy diet, incapability to obey the rules of sound body maintenance and increasing pollution results in agnimandya and aam production in the body and decrease in immunity resulting into various diseases. The concept of aam is the most important fundamental principal of Ayurveda in understanding the physio- pathology of the disease.

P–331 The #Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J Keckstein ◽  
H Gernot
Keyword(s):  
Classification System ◽  
Working Group ◽  
Complex Disease ◽  
Diagnostic Methods ◽  
Anatomical Location ◽  
Ovarian Endometriosis ◽  
Deep Endometriosis ◽  
Non Invasive ◽  
Complete Mapping

Abstract Study question Is there a classification for a complete mapping of endometriosis, including anatomical location, size of the lesions, and degree of involvement that can be used with both, diagnostics and surgery? Summary answer #Enzian classification improves in both, non-invasive diagnostic methods and surgical therapy for endometriosis as a universally usable classification system for all aspects of the disease. What is known already The most commonly used r-ASRM classification has certain limitations due to its incomplete description of DE, the complexity of the classification, and lack of reproducibility. In contrast, the Enzian classification, which has been implemented in the last decade, has proved to be the most suitable for the description of DE. However, since it does not include peritoneal and ovarian lesions and lacks a description of tubo-ovarian adhesions, it has not gained full acceptance. A combination of classification with different systems such as r-ASRM, EFI score and Enzian, may complicate classification of the disease due to overlaps and time-consuming documentation. Study design, size, duration The result is a consensus of a panel of renowned clinicians (working group), gynaecological surgeons and sonographers with extensive expertise in diagnosis and therapy of endometriosis. A first draft was written in 2019 by a joint effort of the first and last author and sent to all working group members. Taking all comments into account, a revised draft was then sent to all coauthors and repeated until a consensus was reached (9 revisions). Participants/materials, setting, methods Criteria used to invite the experts to participate in this consensus process included their having significant peer-reviewed publications in the field of diagnosis and management of endometriosis. Main results and the role of chance Our current proposal is the first of its kind to universally describe superficial and deep endometriosis, ovarian endometriosis, adenomyosis and adhesions by using a classification system that can be applied by gynaecologists, surgeons, sonographers and radiologists following the same principles. The correlation between preoperative and surgical staging, on the basis of the Enzian scheme, allows for consistent and clear classification of endometriosis, especially DE. Endometriosis can be mapped completely with one single classification system enabling the use of one common language. Limitations, reasons for caution This classification system is anatomically logical and should be easy to use. Further studies are ongoing and are needed to provide proof for the applicability, reproducibility and accuracy of the #Enzian classification for the description of endometriosis. Wider implications of the findings: #Enzian classification now enabled better coverage of various endometriosis localizations. The possibility of using this system preoperatively as well as postoperatively within the framework of diagnostics offers clinicians a significant improvement in the care of patients with such a complex disease. Trial registration number Not applicable

scholarly journals Poorly Differentiated Small-Cell-Type Neuroendocrine Carcinoma of the Prostate: A Case Report and Literature Review

2018 ◽  
Vol 11 (3) ◽  
pp. 676-681 ◽  
Author(s):  
Kishore Kumar ◽  
Rafeeq Ahmed ◽  
Chime Chukwunonso ◽  
Hassan Tariq ◽  
Masooma Niazi ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Tumor Grade ◽  
Small Cell ◽  
The Body ◽  
Neuroendocrine Cells ◽  
Cell Type ◽  
Variable Response ◽  
Ki 67 ◽  
Platinum Based Chemotherapy ◽  
Poorly Differentiated

Neuroendocrine cells are widespread throughout the body and can give rise of neuroendocrine tumors due to abnormal growth of the chromaffin cells. Neuroendocrine tumors divide into many subtypes based on tumor grade (Ki-67 index and mitotic count) and differentiation. These tumors can be further divided into secretory and nonsecretory types based on the production of peptide hormone by tumor cells. Poorly differentiated small-cell-type neuroendocrine tumors are one of the subtypes of neuroendocrine tumors. These tumors are less common; however, they tend to be locally invasive and aggressive in behavior with poor overall median survival. Treatment of the nonsecretory small-cell type is modeled to small-cell lung cancer with a regimen consisting of platinum-based chemotherapy and etoposide with variable response. Here, we present a case of poorly differentiated small-cell neuroendocrine tumor originating from the prostate.

scholarly journals Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Body ◽  
Representative Sampling ◽  
Real World Evidence ◽  
Wide Range

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

scholarly journals Evaluation and management of blunt injury abdomen based on focussed assessment with sonography in trauma

2020 ◽  
Vol 9 (1) ◽  
pp. 61
Author(s):  
Sameer Ahmed
Keyword(s):  
Computed Tomography ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Blunt Injury ◽  
Predictive Values ◽  
Bedside Test ◽  
Intraabdominal Injuries ◽  
Low Sensitivity

Background: The initial evaluation of patient with multiple trauma is a challenging task. FAST (focussed assessment with sonography in trauma) provides a viable alternative to computed tomography in blunt abdominal trauma patient. The aim of this study was to find the accuracy and utility of FAST in clinical decision making, as well as limitations.Methods: A total of 100 patients with blunt abdominal trauma who underwent FAST examination were included. Positive scan was defined as the presence of free intraperitoneal fluid. The sonographic scoring for operating room triage in trauma (SSORTT Score) was calculated using cumulative sum of ultrasound score, systolic blood pressure, and pulse rate. FAST findings were compared with computed tomography findings and in operated cases compared with surgical findings & clinical outcome.Results: We determined SSORTT score in all 100 cases. In our study, the sensitivity, specificity, positive and negative predictive values for FAST in identifying intraabdominal injuries were 93.9%, 94.2%, 87.5%, and 97.2%. In our study we found out that patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy.Conclusions: In our study we found that FAST is a rapid, reproducible, portable and non-invasive bedside test, and can be performed at the same time as resuscitation. Ultrasound is limited mainly by its low sensitivity in directly demonstrating solid organs injuries.

scholarly journals COMPREHENSIVE STUDY OF BALYA MAHAKASHAYA ON THE BASIS OF THEIR RASAPANCHAK IN RELATION TO NIGHANTU: A REVIEW

2021 ◽  
Vol 9 (7) ◽  
pp. 1501-1506
Author(s):  
Bhagat Seema ◽  
Ramamurthy Aku ◽  
Rathore Poonam
Keyword(s):  
The Body ◽  
Diagnosis And Treatment ◽  
Biological Transformation ◽  
Comprehensive Study

An impressive number of thousands of plants have been utilising for the treatment of diseases for thousands of years. Many of them are clearly explained in Ayurveda. In Ayurveda certain drugs manifest their action by their Rasa (taste); some by their Virya (potency) or other qualities, some by Vipaka (biological transformation) and others by their specific action. As per their Raspanchak, some of these drugs possesses an affinity for bala. The drugs that provide Bala (strength) and vitality to the body have been grouped under Balya mahakashaya by Acharya Charak. Bala (strength) plays an important role in the diagnosis and treatment of various diseases. This study aimed to discuss the details of ten Balya Mahakashya drugs based on their Raspanchak i.e Rasa, Guna, Vi- rya, Vipaka and Karma and in relation to Bhavaprakash Nighantu, Dhanwantari Nighantu, Raj Nighantu and Kaiyadev Nighantu. Keywords: Bala, Balya Mahakashaya, Raspanchak, Nighantu.

scholarly journals A164 UPTAKE OF FECAL CALPROTECTIN IN PRACTICE: PATTERNS IN A TERTIARY GI REFERRAL CENTRE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 28-30
Author(s):  
A Kundra ◽  
T Ritchie ◽  
M Ropeleski
Keyword(s):  
Medical Therapy ◽  
Bowel Disease ◽  
Large Scale ◽  
Clinical Decision Making ◽  
Practice Patterns ◽  
Clinical Decision ◽  
Fecal Calprotectin ◽  
Time Interval ◽  
Chart Audit ◽  
Frequency Pattern

Abstract Background Fecal Calprotectin (FC) is helpful in distinguishing functional from organic bowel disease. Also, it has proven useful in monitoring disease activity in inflammatory bowel disease (IBD). The uptake of its use in clinical practice has increased considerably, though access varies significantly. Studies exploring current practice patterns among GI specialists and how to optimize its use are limited. In 2017, Kingston Health Sciences Centre (KHSC) began funding FC testing at no cost to patients. Aims We aimed to better understand practice patterns of gastroenterologists in IBD patients where there is in house access to FC assays, and to generate hypotheses regarding its optimal use in IBD monitoring. We hypothesize that FC is not being used in a regular manner for monitoring of IBD patients. Methods A retrospective chart audit study was done on all KHSC patients who had FC testing completed from 2017–2018. Qualitative data was gathered from dictated reports using rigorous set definitions regarding indication for the test, change in clinical decision making, and frequency patterns of testing. Specifically, change in use for colonoscopy or in medical therapy was coded only if the dictated note was clear that a decision hinged largely on the FC result. Frequency of testing was based on test order date. Reactive testing was coded as tests ordered to confirm a clinical flare. Variable testing was coded where monitoring tests that varied in intervals greater than 3 months and crossed over the other set frequency codes. Quantitative data regarding FC test values, and dates were also collected. This data was then analyzed using descriptive statistics. Results Of the 834 patients in our study, 7 were under 18 years old and excluded. 562(67.34%) of these patients had a pre-existing diagnosis of IBD; 193 (34%) with Ulcerative Colitis (UC), 369 (66%) with Crohn’s Disease (CD). FC testing changed the clinician’s decision for medical therapy in 12.82% of cases and use for colonoscopy 13.06% of the time for all comers. Of the FC tests, 79.8% were sent in a variable frequency pattern and 2.68% with reactive intent. The remaining 17.5% were monitored with a regular pattern, with 8.57% patients having their FC monitored at regular intervals greater than 6 months, 7.68% every 6 months, and 1.25% less than 6 months. The average FC level of patients with UC was 356.2ug/ml and 330.6 ug/ml for CD. The mean time interval from 1st to 2nd test was 189.6 days. Conclusions FC testing changed clinical decisions regarding medical therapy and use for colonoscopy about 13% of the time. FC testing was done variably 79.8% of the time, where as 17.5% of patients had a regular FC monitoring schedule. An optimal monitoring interval for IBD flares using FC for maximal clinical benefit has yet to be determined. Large scale studies will be required to answer this question. Funding Agencies None

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