Clinical-Pathological and Molecular Evaluation of 451 NIFTP Patients from a Single Referral Center

Background: Non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs) were introduced in thyroid pathology in 2016. NIFTPs are a group of follicular neoplasm with an indolent behaviour. In this study, we gathered a large retrospective cohort of NIFTPs and compared those presenting as solitary lesions and NIFTPs found in multifocal setting. Methods: A retrospective search of NIFTPs was performed, and the clinico-pathological features were recorded. For a subgroup of patients, pre-surgical ultrasound (US) evaluation, cytological diagnosis, and molecular analysis were available. Results: We collected 451 NIFTPs; 254 (56.3%) were truly solitary tumours, while 197 coexisted with one or more NIFTP/cancer. Contrasting unifocal and multifocal settings, NIFTPs size was the only significantly different parameter. Preoperatively, NIFTP nodules mostly showed low-risk US characteristics, indeterminate cytology and a RAS-like molecular profile. Conclusion: NIFTPs often coexist with collateral thyroid tumours. However, no clinical-pathological differences can be observed between solitary and “multifocal” NIFTPs. Despite the well-established clinical indolence of NIFTP, a careful monitoring of the contralateral lobe should not be excluded.

Types of sedation used in pediatric dentistry

Childhood dental anxiety usually results from painful and frightening dental traumas. Accordingly, children might want to avoid dental treatment if not adequate precautions were not taken during these settings. Thus, sedation is being widely used in different dental settings with favorable outcomes. In the present literature review, we have discussed sedation's different types and approaches in pediatric dentistry settings. We also reviewed the main medications that can be administered in these settings, together with the potential routes of administration, safety and contraindications. As a result, the pediatric dentist should identify patients suitable for sedation, choose the right type of sedation, prepare the media for successful procedures, and select the proper medication. Careful monitoring and adequate preparation are also critical to enhance the prognosis and manage the potential complications. Eventually, sedation might improve the compliance of pediatric patients and reduce the dilemma of fear from painful dental procedures. This has been associated with favorable outcomes for the dentist, as well. Therefore, further research is needed for additional validation and innovation in this field.

TO EVALUATE THE RESPIRATORY FUNCTIONS OF COVID-19 PNEUMONIA SURVIVORS THREE MONTHS AFTER RECOVERY AT TERTIARY CARE CENTRE.

BACKGROUND: In this study we provide a suggested structure for the respiratory follow up of patients with clinicoradiological conrmation of COVID 19 pneumonia three months after recovery. OBJECTIVES: 1.To evaluate the respiratory function and functional disability of COVID – 19 Survivors 3 months after recovery.. MATERIALS AND METHODS: This was a retrospective study done on 70patients, who were attending the OPD/ IP of Thanjavur medical college three months after recovery from COVID PNEUMONIA.These patients were enrolled consecutively from August 2020 to January 2021 .Datas during admission had been collected from patient records.Spirometry, 6-minute walk distance, pulse oximetry ,CT chest scan, psychological assessment were performed 3 months after discharge.Statistical Analysis was done by SPSS trial version 20. RESULTS:,Amongthe 70 studypopulations ,Age rangedfrom24 to74 yearswithmeanage 56.9 yearsofageandSD-11.45,mostof them were male (80%).Nearly 75% of the patients had sp02 80-90% during admission and after recovery nearly 95% of the patient had more than 90% spo2.On admission more than half of the patients had moderate CT severity score ,after recovery more than 70%ofthepatientshad mildCTseverity score .Afterrecovery more than70%ofthepatientsdoesnotrequire oxygen. Onspirometry nearly70%ofthepatientswiththeagegroupof 41-60yearsofagehadmildrestrictionsafterrecovery. CONCLUSION: Three months after SARS CoV-2 infection shows signicant improvement in functional and radiological abnormalities on careful monitoring. A systematic follow-up for survivors needs to be evaluated to optimise care for patients recovering from COVID-19.

Octogenarians with AML Can Have Durable Remissions with Venetoclax and Hypomethylating Agent Therapy Despite Significant Dose Reductions

Introduction Venetoclax in combination with a hypomethylating agent (VEN-HMA) has become a standard of care for older or unfit patients with newly diagnosed AML. Although primarily administered in the outpatient setting, VEN-HMA is associated with significant cytopenias and infectious complications, requiring careful monitoring and dose adjustments. Patients treated with VEN-HMA on clinical trials had a median age of ~75 years. The optimal dose and schedule, safety, and efficacy of VEN-HMA in octo- and nonagenarians is not clearly defined. Methods We performed a retrospective analysis of AML patients ≥80-years-old who received at least 1 day of VEN-HMA at our institution from 11/2018 to 7/2021. Patients with de novo or secondary AML with or without prior HMA or chemotherapy were included. Venetoclax starting dose was 200-400 mg for 14-28 days. Dose adjustments for drug interactions with azole anti-fungals were implemented. HMA was started at 50-75 mg/m2 for 5-7 days of azacitidine or 20mg/m2 for 5 days of decitabine. Dose reduction was defined as any decrease from the starting dose and schedule. Patients who did not complete cycle 1 were included in the overall survival and safety analysis but excluded from response assessment. Results Among 21 patients ≥80-years-old treated with VEN-HMA (20 newly diagnosed, 1 relapsed/refractory), median age was 82 years (range: 80-89) (Table 1), 57% had antecedent MDS, and 38% received HMAs previously. Most patients (81%) were ELN adverse risk, 38% had a complex karyotype, 24% had a TP53 mutation, and 43% had ECOG PS of 2-3. Median overall survival for all patients was 8.0 months (0.5-31.4 months). At time of analysis, 12 patients (57%) were still alive and in remission on VEN-HMA with a median follow-up of 11.5 months (range 2.3-31.4 months). Five patients (24%) died during cycle 1 from sepsis. Of these 5 patients, 4 had a TP53 mutation, 3 had prior MDS, and 3 had received prior therapy for lymphoma. In the remaining 16 patients, median overall survival was 9.9 months (2.3-31.4 months) and the CR/CRh rate was 81% (13/16 patients). Median duration of response was 8.9 months (range 1.0-30.0). Consistent with previous reports, all patients who achieved CR/CRh did so by the end of cycle 2 (median 2 cycles). Most patients also received the standard dose and schedule of VEN (75%) and HMA (57%) during the first cycle. All patients (100%) required venetoclax dose and schedule reduction, with a median final venetoclax dose of 200 mg and duration of 14 days. Average final cycle length was 35 days. Most patients (69%) also required dose reduction of HMA. Median duration of treatment was 7.5 months (range 0.5-31.4). Treatment emergent grade 3-4 anemia occurred in 67% of patients, thrombocytopenia in 81%, and neutropenia in 86%; 17 patients (81%) had treatment emergent febrile neutropenia. There were no infectious deaths in patients who survived cycle 1. The median number of neutropenic fever episodes per patient was 1 (0 to 2). The 4 deaths after cycle 1 were due to progressive disease (n=3) or relapse (n=1). Conclusion VEN-HMA can be safely and effectively given to octogenarians with careful monitoring and dose adjustments. All patients required dose reduction of venetoclax after CR/CRh was achieved, and most also required adjustment of HMA. Despite this, over half of patients achieved durable remissions. The greatest risk of infectious death was in the first cycle, in patients who were heavily pre-treated and enriched for TP53 mutations. When compared to historical controls, outcomes in octogenarians who survive the first cycle appear similar to younger age groups. This work highlights the need for a prospective multi-center effort to optimize the dose and schedule of VEN-HMA in older patient populations. Figure 1 Figure 1. Disclosures Bradley: AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees. Sekeres: Takeda/Millenium: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Watts: Rafael Pharmaceuticals: Consultancy; Genentech: Consultancy; Bristol Myers Squibb: Consultancy; Takeda: Consultancy, Research Funding; Jazz Pharmaceuticals: Consultancy; Aptevo Therapeutices: Research Funding.

Features of Providing Medical Care to Patients with IBD in the Context of a Pandemic of the New Coronavirus Infection COVID-19 in the Voronezh Region

In March 2020, an outbreak of a new coronavirus infection COVID-19 occurred in Russia. During a pandemic, patients do not always have the opportunity to receive full-time medical care. It became necessary to choose other methods of communication "doctor-patient" to solve the problems associated with the need to maintain the availability of medical care for patients with IBD. The progressive nature of the course of ulcerative colitis and Crohn's disease in some cases requires careful monitoring of the patient's condition. During a pandemic, doctors are advised to make wider use of the telemedicine resource. The article presents options for using distance counseling methods during the period of coronavirus restrictions

Remdesivir-Associated Significant Bradycardia: A Report of Three Cases

Recently, remdesivir was approved by the United States Food and Drug Administration for patients with Coronavirus disease 2019 (COVID-19). We herein describe 3 patients with COVID-19 who showed significant bradycardia and QTc prolongation after remdesivir administration. Bradycardia did not respond to atropine treatment in 2 of the patients, one of whom received theophylline and the other required a temporary pacemaker. Fortunately, the patients’ heart rate and rhythm returned to normal after the discontinuation of remdesivir, albeit it lengthened their hospital stays. Careful monitoring during remdesivir infusion may decrease the risk of adverse cardiovascular side effects.

Anesthetic management “Abdominal Aortic Aneurysm” in the well-known case with Wolff-Parkinson-White syndrome

Wolff-Parkinson-White syndrome is an electrophysiological disorder of the heart caused by pre-stimulation of an abnormal lateral pathway that can be asymptomatic or may be accompanied by palpitations or shortness of breath. We reported a case of a 66-yearold man with a history of Wolff-Parkinson syndrome who was transferred to the operating room for simultaneous nephrectomy due to RCC and abdominal aortic aneurysm. Managing the anesthesia of these patients is challenging because they are prone to life-threatening tachyarrhythmias. Observance of all necessary precautions to prevent tachyarrhythmias, balanced anesthesia, careful monitoring and preparation with the necessary drugs and equipment to treat any complication, is the cornerstone of a positive surgical outcome. Keywords: Wolff Parkinson white syndrome; abdominal aortic aneurysm; electrophysiological disorder; anesthetic management.

A case of spinal nerve neurotoxicity with ropivacaine after combined spinal and epidural anesthesia

Background Neurotoxicity caused by a local anesthetic after regional anesthesia is a rare but serious problem for anesthesiologists. It is difficult to diagnose neurotoxicity from anesthetics because of the large number of possible diagnoses. In this case report, careful monitoring by neurological examinations helped to diagnose local neurotoxicity caused after epidural anesthesia. Case description A 41-year-old pregnant woman who underwent emergency cesarean delivery under combined spinal-epidural anesthesia suffered left leg paralysis after surgery. Multiple neurological examinations (e.g., electromyography, nerve conduction study) revealed that the paralysis was induced by the neurotoxicity of ropivacaine. The neurological examinations were also useful to monitor the recovery process. Conclusions This is the first clinical case report that describes the diagnosis of and recovery from local anesthesia-induced neurotoxicity monitored by electromyography and nerve conduction study. Neurological disorders caused by regional anesthetics should be carefully examined and diagnosed using these neurological examinations.

Characteristics of Presentations to the Emergency Department following Attempted Suicide with Drugs

A relatively high proportion of attempted suicides employ self-poisoning with medication. Data from emergency department presentations can help to identify possible risk drug classes and provide a basis for preventive measures. This retrospective analysis included cases presenting at the emergency department of the University Hospital of Bern, Switzerland, from May 2012 to August 2016, after attempted suicide with drugs. We excluded attempted suicides with only alcohol or other non-medical substances. During the study period, there were 488 cases (466 patients) of attempted suicide with medical substances. The median patient age was 33 years (range 16–93) and 354 (73%) cases were female. The most commonly involved substances/drug classes were benzo-diazepines (n = 167, 34%), neuroleptics (n = 114, 23%) and paracetamol (n = 111, 23%). A total of 231 (47%) cases employed only a single substance. Common symptoms included somnolence (n = 245, 50%), tachycardia (n = 119, 24%) and nausea/vomiting (n = 76, 16%). In most cases, the poisoning was of minor severity (n = 231, 47%) and the patients were admitted to a psychiatric hospital (n = 264, 54%). Important preventive measures may include careful monitoring for suicidal behaviour when prescribing psychotropic drugs, in addition to restrictions in pack size. Efforts should also be made to enhance the awareness of health professionals qualified to prescribe or supply paracetamol.

Epigenetics and Modulations of Early Flavor Experiences: Can Metabolomics Contribute to Prevention during Weaning?

The significant increase in chronic non-communicable diseases has changed the global epidemiological landscape. Among these, obesity is the most relevant in the pediatric field. This has pushed the world of research towards a new paradigm: preventive and predictive medicine. Therefore, the window of extreme plasticity that characterizes the first stage of development cannot be underestimated. In this context, nutrition certainly plays a primary role, being one of the most important epigenetic modulators known to date. Weaning, therefore, has a crucial role that must be analyzed far beyond the simple achievement of nutritional needs. Furthermore, the taste experience and the family context are fundamental for future food choices and can no longer be underestimated. The use of metabolomics allows, through the recognition of early disease markers and food-specific metabolites, the planning of an individualized and precise diet. In addition, the possibility of identifying particular groups of subjects at risk and the careful monitoring of adherence to dietary therapy may represent the basis for this change.