Medicina
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Review
The Prognostic Role of Cytogenetics Analysis in Philadelphia Negative Myeloproliferative Neoplasms.
Myeloproliferative neoplasms (MPNs) are clonal stem cell disorders characterized collectively by clonal proliferation of myeloid cells with variable morphologic maturity and hematopoietic efficiency. Although the natural history of these neoplasms can be measured sometimes in decades more than years, the cytogenetics analysis can offer useful information regarding the prognosis. ⋯ NGS techniques can find adverse mutations with clear prognostic value and are currently included in the prognostic evaluation of MPNs in scores such as MIPSS, GIPSS, MIPSS-PV, and MIPSS-ET. We suggest that cytogenetics (considering its availability and relative cost) has a role regarding prognostic and therapeutic decisions.
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Background and objectives: The use of appropriate outcome measures can help guide multidimensional low back pain (LBP) management, elucidate the efficacy/effectiveness of interventions, and inform clinicians when selected targets have been achieved and this can be used for educational or research purposes. Aim: This study aimed to explore and describe the use, attitudes, knowledge, and beliefs regarding patient-reported outcome measures used by healthcare practitioners practising in Saudi Arabia who are frequently involved in the healthcare of individuals with LBP. Materials and Methods: A cross-sectional design was undertaken using a web-based survey. ⋯ A lack of Arabic versions of PROMs was reported as a barrier to using them to assess pain. Conclusions: This study shows that, although primary care physicians and physical therapists in Saudi Arabia frequently use patient-reported outcome measures in their clinical management of patients with LBP, there is a noticeable gap in the knowledge and use of the multidimensional outcome measures for LBP management among the participants. This highlights a need for professional training on the use of standardised outcome measures related to LBP.
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Severe hyperkalemia is a potentially life threatening cardiac emergency, especially in patients with renal failure, and can lead to fatal arrhythmias such as ventricular fibrillation or asystole, leading to cardiac arrest. We report a case of a 39-year-old woman who developed sudden cardiac arrest secondary to hyperkalemia (9.95 mEq/L) with renal insufficiency. ⋯ Hemodialysis was then initiated via the right femoral vein during CPR, and the patient restored spontaneous heartbeat 40 min later. Hemodialysis should be considered in the course of CPR in severe hyperkalemia induced cardiac arrest if conventional therapies fail.
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Background and Objectives: The aim of this study was to evaluate the diagnostic accuracy and prognostic value of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios and to compare them with other biomarkers and clinical scores of sepsis outside the intensive care unit. Materials and methods: In this retrospective study, 251 patients with sepsis and 126 patients with infection other than sepsis were enrolled. NLR and PLR were calculated as the ratio between absolute values of neutrophils, lymphocytes, and platelets by complete blood counts performed on whole blood by Sysmex XE-9000 (Dasit, Italy) following the manufacturer's instruction. ⋯ The best value of NLR in predicting 90-day mortality was 9.05 with sensibility, specificity, AUC, PPV, and NPV of 69.57%, 61.44%, 0.66 (p < 0.0001), 28.9%, and 89.9%, respectively. Sensibility, specificity, AUC, PPV, and NPV of NLR increase if PLR, PCR, PCT, MR-proADM, SIRS, qSOFA, and SOFA scores are added to NLR. Conclusions: NLR and PLR represent a widely useful and cheap tool in diagnosis and in predict-ing 90-day mortality in patients with sepsis.
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Cardiotoxicity is a well-recognised side effect of cancer-related therapies with a great impact on outcomes and quality of life in the cancer survivor population. The pathogenesis of chemotherapy-induced cardiotoxicity in patients with gastrointestinal cancers involves various molecular mechanisms, and the combined use of various chemotherapies augments the risk of each drug used alone. In terms of cardiotoxicity diagnosis, novel biomarkers, such as troponins, brain natriuretic peptide (BNP), myeloperoxidases and miRNAs have been recently assessed. ⋯ Corroborated data have shown the importance of CMR in the early evaluation of patients with gastrointestinal cancers, treated with anticancer drugs, but further studies are required to improve risk stratification in these patients. In this article, we review some important aspects concerning the cardiotoxicity of antineoplastic drugs used in gastrointestinal cancers. We also discuss the mechanism of cardiotoxicity, the role of biomarkers and the imaging methods used in its detection.