Acquired Factor XIII Deficiency in a Patient with Metastatic Lung Cancer

Acquired factor XIII (FXIII) deficiency can result in life-long bleeding tendency and can be caused by enhanced consumption, impaired synthesis, or as an immune-mediated process. The latter can be related with solid neoplasms, through neutralizing or non-neutralizing antibodies. The relationship between FXIII activity and non-small cell lung cancer (NSCLC) is not well established. This case report is about a patient with NSCLC and acquired FXIII deficiency. Materials and Methods: Clinical records were obtained through the electronic process analysis, and the confidentiality of the patient was always assured. Results and Discussion: A 70-year-old male with no relevant past medical history and a recently diagnosed metastatic NSCLC was admitted for priapism. Five days later, a he developed a bleeding disorder, with slightly elevated coagulation times and normal fibrinogen levels and platelets count. FXIII level was found to be decreased (0.24 IU/mL) and FXIII plasma mixing studies did not confirm the presence of a neutralizing inhibitor. The FXIII level correction with standard plasma mixing studies was in favour of a non-neutralizing antibody. Despite treatment, haemorrhage control was not achieved and the patient died. Conclusion: This clinical report describes a rare case of a patient with metastatic NSCLC presenting a severe haemorrhagic event caused by FXIII deficiency immune-mediated by non-neutralizing antibodies and subsequent increased clearance.

The Evaluation of PSA levels in Libyan Prostate Cancer Patients

Background: Prostate cancer is the second most frequent cancer and the fifth leading cause of cancer death in men with higher prevalence in the developed countries. The use of biomarkers for prostate cancer can improve the diagnosis of prostate cancer and clinical management of the patients. Prostate-specific antigen (PSA) is widely used to screen for prostate cancer and there is evidence that PSA testing reduces prostate cancer mortality. Objective: In this report we have studied the relationship between the Gleason score, age and PSA levels of prostate adenocarcinoma tissues from Libyan patients to evaluate the levels of PSA in prostate cancer patients. Materials and methods: The data was collected from medical files of 40 patients who underwent curative surgical prostatectomy or prostate true cut biopsy at National Cancer Institute (NCI)-Misurata, Libya during 2016 to 2018. The clinical and histopathological information included age, PSA levels, and Gleason score grade. Results: Our data showed that PSA level was statistically significant correlation with Gleason score grade (p- value = 0.007, <0.05). The increased serum PSA level was associated with the progression of prostate cancer. However, we found no statistically significant correlation between PSA and the age of patients (p- value = 0.435). Conclusion: Our data confirmed the association of high levels of PSA and the progress of prostate cancer.

Are anti-CTL4 and anti-PD-1 an effective biomarker in immunotherapy?

The task of the immune system is to prevent foreign organisms from entering the body, if microbes have entered the body, to destroy them, to prevent or delay their spread. One of the most important features of the immune system is that it has the ability to recognize and distinguish millions of different microbes that are foreign to it. The immune system, like the brain, evaluates and synthesizes the situation, which is this breeding organ, and produces different training and special responses to microbes, cancer. This is a feature that does not exist in any system or organ except the brain and immune system. In summary, the task of the immune system is to protect the essence of the individual. For this reason, he knows himself first and does not harm the essence. In this context, it can be said that the immune system spends as much effort on self-knowledge as it does on fighting the enemy. This rewiev article is intended to provide an overview of the CTLA-4 and PD-1 pathways and the description of their efficacy in cancer therapy or immunotherapy.

Assessment of the Haematological Alterations in Cervical Cancer Patients Attending Sabratha

Background: Cervix cancer is one of the most common cancers in women worldwide, and is the third most common malignant disease in women. It is one of the main health problems in Libyan women. Blood act as a pathological reflector of the status of exposed patient to infections and other conditions. Laboratory tests on the blood are vital tools that help detect any deviation from normal in the human body As the disease progresses, changes appear in haematological parameters which have been of relevant consideration in context of cancer patients. Objectives: The present study aimed to evaluate the alterations in haematological parameters among cervical cancer patients in Sabratha National Cancer Institute. Subjects and Methods: The present study was conducted on 150 cervical cancer patients, attending the National Cancer Institute of Sabratha from the 11th February, 2006 to the 3rd February, 2020. This study was approved by the Research and Ethical Committee of Sabratha University and Sabratha National Cancer Institute. Age was extracted from patient files. Also, 60 healthy individuals without any chronic disease were recruited for the control group. Blood samples were collected by vein puncture, 3 ml of venous blood withdrawn from each participant in the study by using disposable syringes under aseptic technique; they then transferred to a sterile EDTA tube, for complete blood count. The statistical significance of differences between groups was evaluated with the Mann Whitney U test. Results: The results showed that the mean age of the cervix cancer patients was 53.37±11.6 years.RBCs count, hemoglobin concentration, Hct value, MCH, MCHC, and lymphocytes % were significantly (P<0.01) decreased compared with the healthy individuals. On the other hand, leukocytes and platelets count, mixed %, neutrophils %, PLTs/Lymph, and Neutrophils/Lymphocytes ratios were significantly increased as compared with the healthy individuals. Conclusion: It can be concluded that a significant increase in leukocytes and platelets count, mixed %, neutrophils %, and the studied inflammation related haematological parameters and a significant decreased in lymphocytes %, RBCs count and most its indices. Further haematological studies are needed to confirm these results. Also, there is need to routinely monitor the haematological parameters and among cervical cancer patients.

Patients with Advanced Cancer during the COVID‐19 Pandemic in Ukraine

COVID‐19 has overwhelmed the capacity of health care systems, limiting access to supportive and palliative care for patients with advanced cancer. Telemedicine has emerged as a tool to provide care continuity to patients while limiting the risk of contagion. However, implementing telemedicine in resource‐limited settings is challenging. We report the results of a multidisciplinary patient‐navigator‐led telemedicine supportive care program in Dnipro City. One‐hundred sixty‐five telemedicine interventions were provided to 77 patients (median age 67, 47% female). A quarter of the patients had less than or equal to elementary school education, and 18% lived in a rural area. The most common interventions were psychological care (30%), pain and symptom control (27%), and nutritional counseling (10%). Half of the interventions were provided by video conferencing. The most common patient‐reported barrier was limited experience using communication technology. Our results demonstrate the feasibility of providing supportive and palliative care interventions using telemedicine in resource‐limited settings.

Uterine Carcinosarcoma after Prolonged Antiestrogenic Therapy-Pathohistological Characteristics, Immunohistichemical Analysis, Prognosis and Complex Treatment: A case report with literature review

Uterine carcinosarcoma (UCS) is a rare aggressive neoplasm.We present a clinical case with UCS, developed during along-term five years adjuvant tamoxifen treatment and ovarian suppression with LHRH agonist on the occasion of invasive ductal breast carcinoma. Crucial for obtaining diagnosis of this rare aggressive neoplasm is the strict pathohistological and immunohistochemical analysis, carried out by an experienced pathologist. Every patient with a history of breast carcinoma is a subject for periodic monitoring. Genital bleeding is required to perform a separated endometrial abrasion with a precise histological study. For UCS / III C2 FIGO stage without distant metastases is necessary to conduct a maximal surgical tumor reduction, involving ever total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, peritoneal cytology, and omentectomy, followed by a combined simultaneous chemo-radiotherapy of tumor bed and pelvic lymph nodes, definitive radiotherapy of para-aortical lymph nodes, as well as adjuvant chemotherapy.

Clinical and USG Findings of Patients Presented with Breast Pain

Introduction: Breast pain also known as mastalgia is the dull acne in the breast, cause is multifactorial. It can affect any age group. Breast cancer is the most common site-specific cancer in women and is the leading cause of death from cancer for women aged 20-59 years worldwide. In India, breast cancer has ranked number one cancer among females, with age adjusted incidence as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Objective: To find out the Clinical and USG Findings of Patients Presented with Breast Pain. Settings and Design: Prospective cross-sectional descriptive study. Materials and Methods: Patients with complaints of breast pain in the age group 15 to 60 years with clinically no palpable mass attending to the Dept. of Clinical Oncology, Enam Medical College & Hospital, Savar, Dhaka, Bangladesh between January 2020 to December 2020 were included in the study. Detailed history with particular reference to age, duration of symptoms, Size, menstruation, marital status, parity, lactation, Nipple discharge and tenderness are recorded. Pain intensity was evaluated as mild, moderate and severe. Ultrasound of the breast including the axilla was done for all cases and findings recorded to correlate with clinical features. Results: Out of 90 patients studied, majority was in the age group (21-30) years, (43%) followed by (31-40 years) (40%) respectively. 57(63%) were married and 33(43%) were single. 21 patients had 1 child, 18 had 2 children with 6 of them having no children. Out of 90 patients only 3 attained menopause, rest of them have their monthly cycles. 51 patients had cyclical breast pain and 39 had noncyclical breast pain, 39 had pain on right breast, 36 on left side and bilateral in 15 patients. Pain was mild in 15 patients, moderate in 27 patients and severe in 6 patients. Various USG findings of the affected breast were normal study in 48 patients followed by duct ectasia and hetrogenous ectogenicity fibroadenosis, small cystic lesion and enlarged axillary lymph nodes etc. Conclusion: The study results show that majority of patients with breast pain without clinically palpable lump had normal USG study. But it also detects other early changes in the breast tissue. It can be used as a baseline investigation for any breast pain without palpable lump.

Candidates for Treatment of Novel Corona virus disease, COVID-19: Current Scenario and Way Forwards

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has spread across the globe resulting in a pandemic affecting 215 countries. At the time of this review, COVID-19 has been diagnosed in more than 15,000,000 patients and associated with over 1,00,000 deaths globally (Canters for Disease Control and Prevention, World Health Organization). In this review, we herein summarize the current evidence as on June 15, 2020 to provide guidance on potential drugs for COVID-19 treatment or prophylaxis, their scientific rationale and their clinical efficacy and safety. New data continue to emerges daily regarding clinical characteristics, treatment options, and outcomes for COVID-19. Optimized supportive care remains the mainstay of therapy, and the clinical efficacy for the potential therapeutic agents is still under investigation.

Identification of non-invasive biomarkers for early detection of breast cancer: A Review

Despite decades of research, diagnostic tests with specificity and accuracy for early breast cancer are yet unavailable. Major problems associated with poor diagnosis are either due to incompetency of reported biomarkers or small volume of patients under study. Moreover, heterogeneity of the disease further complicates the struggle of identifying effective biomarkers. Therefore, to improve the survival rate, look for new, sensitive and specific biomarkers for early breast cancer diagnosis is need of hour. In this study, we have reviewed recently reported serum biomarkers and categorized them based on their biomolecular nature such as protein, ctDNA, epigenetics regulation and miRNA. Potential role of these available biomarkers in early diagnosis of breast cancer has also been discussed. Based on the facts obtained from literature review, it is revealed that using any individual biomolecule as a biomarker is not sufficient to diagnose breast cancer at early stages rather it is suggested that a panel of proteins or miRNAs would offer better sensitivity and specificity. Whereas, unavailability of a potential ctDNA and epigenetics regulation candidate for diagnostic purpose is and suggest the use of more sophisticated techniques to unwound these regulations in serum especially at early stages of breast cancer.

Determination of Protein C Antigen Levels in Hospitalized Patients with Blood Coagulative Defects

Protein C, a vitamin K-dependent anticoagulant serine protease, is involved in blood coagulation. Activated protein C inactivates Va and VIIIa in purified protein systems and stimulates fibrinolysis by indirectly increasing the level of circulating plasminogen activator. In this process, protein S serve as an important factor for activated protein C. In recent years, excess protein S drives cancer cell proliferation and cell survival through oncogenic receptor Axl (Anexelekto). We determined changes of plasma protein C antigen by using rocket immunoassay both in 50 healthy individuals and 103 distinct hospitalized patients. In healthy individuals protein C antigen(PC:Ag) ranges o.6439- 1.4752 µ/ml. The results showed that plasma protein C antigen was considerably high in 22 diabetes mellitus. In contrast, the PC:Ag was significantly decreased in 19 liver cirrhosis(p< 0.001) and in closely line with serum albumin levels(p< 0.05). In 31 acute leukemias, on the average, there was slightly lower values in PC:Ag, and accompanied with the distribution of significant decrease of PC:Ag values in 5 FAB M5 subtype and in 9 hyperleukocytic leukemias. However, the 3 acute promyelocytic leukemia (APL) with overt laboratory criteria of disseminated intravascular coagulation (DIC) had protein C concentration no lower than the remaining 2 patients with infectious DIC, which suggested the coagulopathy in APL might be due to mechanisms different from other forms of DIC.