HER2- Ki67 GSTP1 Genes breast cancer

Combined Detection of HER2, Ki67, and GSTP1 Genes on the Di...Preview
https://www.ncbi.nlm.nih.gov/pubmed/30585764
Cancer Biotherapy & Radiopharmaceuticals; Song B, Wang L et. al.

Dec 26th, 2018 - Breast cancer (BC) is a common malignant tumor in females. The combined assay of multiple molecular markers benefits the diagnosis and prognostic prediction. Human epidermal growth factor receptor 2 (HER2) facilitates the proliferation and differentiation of cancer cells through ligand binding. Ki67 is a tumor proliferation-related gene, whereas GSTP1 i...

Association of GSTP1 methylation with aggressive phenotype in ER-positive bre... Preview
https://www.ncbi.nlm.nih.gov/pubmed/24324107
Anticancer Research; Miyake T, Nakayama T et. al.

Dec 11th, 2013 - We investigated the association of glutathione S-transferase P1 (GSTP1) expression and methylation status with clinicopathological characteristics of estrogen receptor (ER)-positive breast cancers. Primary ER-positive breast cancerpatients (n=177, stage I-III) were retrospectively analyzed. A quantitative GSTP1methylation assay was performed using DNA...

Validity of the proliferation markers Ki67, TOP2A, and RacGAP1 in molecular subg... Preview
https://www.ncbi.nlm.nih.gov/pubmed/23135572
Breast Cancer Research and Treatment; Milde-Langosch K, Karn T et. al.

Nov 9th, 2012 - High proliferation rates are characteristic of cancer, and proliferation markers make up the majority of genes included in RNA-based prognostic gene signatures applied for breast cancer patients. Based on prior data on differences in molecular subgroups of breast cancer, we hypothesized that the significance of single proliferation markers might differ ...

Genomic hotspots but few recurrent fusion genes in breastcancer. Preview
https://www.ncbi.nlm.nih.gov/pubmed/29436103
Genes, Chromosomes & Cancer; Fimereli D, Fumagalli D et. al.

Feb 13th, 2018 - The advent of next generation sequencing technologies has boosted the interest in exploring the role of fusion genes in the development and progression of solid tumors. In breast cancer, most of the detected gene fusions seem to be "passenger" events while the presence of recurrent and driver fusions is still under study. We performed RNA sequencing in 55 well-characterized...

Investigation of prognostic value of polymorphisms within estrogen metabolizing gene... Preview
https://www.ncbi.nlm.nih.gov/pubmed/25648141
BMC Medical Genetics; Savukaitytė A, Ugenskienė R et. al.

Feb 5th, 2015 - Breast cancer is the most frequent oncological disease among women. Estrogens are known to play an important role in breast cancer development. Recognition of the relationship between polymorphisms within estrogen metabolizing genes and conventional prognostic factors of breast cancer might improve our knowledge on individualized breast

Levels of uPA and PAI-1 in breast cancer and its correlation toKi67... Preview
https://www.ncbi.nlm.nih.gov/pubmed/30170623
Diagnostic Pathology; Völker HU, Weigel M et. al.

Aug 31st, 2018 - Conventional parameters including Ki67, hormone receptor and Her2/neu status are used for risk stratification for breast cancer. The serine protease urokinase plasminogen activator (uPA) and the plasminogen activator inhibitor type-1 (PAI-1) play an important role in tumour invasion and metastasis. Increased concentrations in tumour tissue are associated with more ag...

Estrogen receptor and HER2/neu status affect epigenetic differences of tumor-rel... Preview
https://www.ncbi.nlm.nih.gov/pubmed/18485221
Breast Cancer Research : BCR; Sunami E, Shinozaki M et. al.

May 20th, 2008 - Estrogen receptor (ER)-positive breast cancers are considered prognostically more favorable than ER-negative tumors, whereas human epidermal growth factor receptor (HER)2/neu-positive breast cancers are associated with worse prognosis. The objective of the present study was to determine whether ER-positive and ER-negative status relates to epigenetic changes in br...

Methylated APC and GSTP1 genes in serum DNA correlate with the presence o... Preview
https://www.ncbi.nlm.nih.gov/pubmed/20696638
European Journal of Medical Research; Matuschek C, Bölke E et. al.

Aug 11th, 2010 - Tumor-related methylated DNA and circulating tumor cells (CTC) in the peripheral blood might be of prognostic importance in breast cancer. Thus, the aim of our study was to examine free methylated DNA and CTC in the blood from breast cancer patients and to correlate it with clinicopathological features known to influence prognosis. We prospectively obtained serum sam...

Prevalence and Prognostic Role of PIK3CA/AKT1 Mutations in Chinese Breast Can... Preview
https://www.ncbi.nlm.nih.gov/pubmed/29540052
Cancer Research and Treatment : Official Journal of Korean Cancer Association; Deng L, Zhu X et. al.

Mar 15th, 2018 - The prevalence of PIK3CA in Chinese breast cancer patients may be underestimated. Therefore, we investigated the distribution of somatic PIK3CA/AKT1 mutations in Chinese breast cancer patients and explored their roles in tumor phenotypes and disease prognosis. Tumors from five hundred and seven breastcancer patients were prospectively collected from th...

MicroRNA signatures in hereditary breast cancer. Preview
https://www.ncbi.nlm.nih.gov/pubmed/24129975
Breast Cancer Research and Treatment; Murria Estal R, Palanca Suela S et. al.

Oct 17th, 2013 - This study aims to identify signatures of miR associated with hereditary, BRCA1 or BRCA2 mutation positive breast cancer (BC), and non-hereditary BC, either sporadic (SBC) or non-informative (BRCAX). Moreover, we search for signatures associated with tumor stage, immunohistochemistry and tumor molecular profile. Twenty formalin fixed paraffin embedded (FFPE) BCs, BRCA1, BRCA2, BRC...

C6ORF97-ESR1 breast cancer susceptibility locus: influence on progression... Preview
https://www.ncbi.nlm.nih.gov/pubmed/25370037
European Journal of Human Genetics : EJHG; Yamamoto-Ibusuki M, Yamamoto Y et. al.

Nov 6th, 2014 - Genome-wide association studies have identified a single-nucleotide polymorphism (SNP) to be associated with an increased risk of breast cancer. The biology of one of the susceptibility locus C6ORF-ESR1 and whether it also contributes to progression of established disease has not yet been ascertained. We examined the association of rs2046210 and its six linkage disequilibrium SNPs...

Updated results from MONALEESA-2, a phase III trial of first-line ribociclib plus letro... Preview
https://www.ncbi.nlm.nih.gov/pubmed/29718092
Annals of Oncology : Official Journal of the European Society for Medical Oncology; Hortobagyi GN, Stemmer SM et. al.

Apr 27th, 2018 - The phase III MONALEESA-2 study demonstrated significantly prolonged progression-free survival (PFS) and a manageable toxicity profile for first-line ribociclib plus letrozole versus placebo plus letrozole in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer. Here we report updated efficacy and sa...

Chemoimmunotherapy for Triple-Negative Breast Cancer

Chemoimmunotherapy for Triple-Negative Breast Cancer.Preview
https://www.ncbi.nlm.nih.gov/pubmed/30575878
JAMA Slomski A

Dec 21st, 2018 - Chemoimmunotherapy for Triple-Negative Breast Cancer.|2018|Slomski A,|

Advances in risk assessment and prophylaxis for central nervous system relapse in diffu... Preview
https://www.ncbi.nlm.nih.gov/pubmed/30573511
Haematologica Qualls D, Abramson JS

Dec 20th, 2018 - Central nervous sytem recurrence of diffuse large B-cell lymphoma is an uncommon but devastating event, making identification of patients at high risk for relapse within the central nervous system essential for clinicians. Modern risk stratification includes both clinical and biologic features. A validated clinical risk model employing the 5 traditional international prognostic index risk facto...

First-Line Ibrutinib Confirmed for CLL. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30530733
Cancer Discovery;

Dec 12th, 2018 - Ibrutinib should be a standard of care for many patients with chronic lymphocytic leukemia, according to results from two phase III trials. The BTK inhibitor, given alone or in combination with rituximab, improved clinical outcomes-including progression-free survival-when compared with chemoimmunotherapy regimens.

Targeted Therapies in CLL: Monotherapy Versus Combination Approaches. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30535947
Current Hematologic Malignancy Reports; Khan M, Siddiqi T

Dec 12th, 2018 - While chemoimmunotherapy has improved outcomes in chronic lymphocytic leukemia (CLL), it is not curative, has significant relapse rates, and is not always well tolerated. Recently, novel targeted therapies have been developed to increase response rates and reduce toxicity, especially in high-risk disease. Current goals of CLL therapies are to produce deep and durable, especially minimal ...

Management of unfit elderly patients with chronic lymphocytic leukemia. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30527922
European Journal of Internal Medicine; Eichhorst B, Hallek M et. al.

Dec 12th, 2018 - Chronic lymphocytic leukemia (CLL) is a disease characterized by an increasing incidence with age reaching 35/100,000 in patients over 85 years. Elderly CLL patients carry several challenges, which have to be considered particularly in advanced stages including a higher risk of infections and individual differences in comorbidities and geriatric syndromes. Although no specific tool for geriatri...

Ibrutinib-rituximab 'new standard of care' in younger CLL patients
https://www.mdedge.com/hematologynews/nhlhub/article/190863/cll/ibrutinib-rituximab-new-standard-care-younger-cll-patients
Neil Osterweil

Dec 11th, 2018 - SAN DIEGO – The combination of ibrutinib and rituximab was associated with a two-thirds reduction in chronic lymphocytic leukemia (CLL) progression, compared with standard chemoimmunotherapy in patients younger than 70 years old, interim results of a phase 3 randomized trial showed. Among 529 patients with previously untreated, symptomatic CLL randomly assigned to ibrutinib-rituximab (IR.

Novel therapies for relapsed/refractory aggressive lymphomas.Preview
https://www.ncbi.nlm.nih.gov/pubmed/30504294
Hematology. American Society of Hematology. Education Program; Cohen JB

Dec 7th, 2018 - Most patients with aggressive non-Hodgkin lymphoma will be cured with initial chemoimmunotherapy; however, most patients with relapsed disease will not be cured and will die as a result of their disease. In these cases, continued treatment with conventional chemotherapy is typically not of benefit and can contribute to significant toxicities and decreased quality of life for patients. Fo...

Where to start? Upfront therapy for follicular lymphoma in 2018.Preview
https://www.ncbi.nlm.nih.gov/pubmed/30504308
Hematology. American Society of Hematology. Education Program; Leonard JP, Nastoupil LJ et. al.

Dec 7th, 2018 - The initial approach to the management of follicular lymphoma (FL) is challenging for patients and physicians. Most FL patients present with minimal symptoms; given the lack of a survival benefit to early treatment in this population, a period of observation without therapy is often appropriate. Once there is disease progression beyond low-tumor-burden criteria or symptoms prompting interventio...

Selecting Frontline Therapy for CLL in 2018. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30504317
Hematology. American Society of Hematology. Education Program; Jain N

Dec 7th, 2018 - The treatment landscape of chronic lymphocytic leukemia (CLL) has changed dramatically in the last few years. The role of chemoimmunotherapy has declined significantly for patients with CLL. Fludarabine, cyclophosphamide, rituximab chemotherapy remains the standard frontline therapy for young fit patients with CLL, especially if IGHV mutated. For older adults, ibrutinib has been shown to...

Relapsed CLL: sequencing, combinations, and novel agents.Preview
https://www.ncbi.nlm.nih.gov/pubmed/30504318
Hematology. American Society of Hematology. Education Program; Brown JR

Dec 7th, 2018 - Although the therapy of chronic lymphocytic leukemia (CLL) has changed rapidly over the last 5 years, the key considerations in selecting a therapy for a previously treated patient with CLL continue to include the nature of the prior therapy and the duration of prior remission to that therapy, the prognostic features of the disease, and the health and comorbidities of the patient in question. F...

Ibrutinib Regimens versus Chemoimmunotherapy in Older Patients with Untreated CLL. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30501481
The New England Journal of Medicine; Woyach JA, Ruppert AS et. al.

Dec 7th, 2018 - Ibrutinib has been approved by the Food and Drug Administration for the treatment of patients with untreated chronic lymphocytic leukemia (CLL) since 2016 but has not been compared with chemoimmunotherapy. We conducted a phase 3 trial to evaluate the efficacy of ibrutinib, either alone or in combination with rituximab, relative to chemoimmunotherapy. Patients 65 years of age or ol...

Older CLL Patients See Better PFS With Ibrutinib
https://www.mdedge.com/fedprac/avaho/article/190538/leukemia-myelodysplasia-transplantation/older-cll-patients-see-better

Dec 6th, 2018 - SAN DIEGO – In the phase 3 Alliance A041202 trial of older patients with previously untreated chronic lymphocytic leukemia (CLL), ibrutinib showed superior progression-free survival (PFS). Results of the trial were reported by Jennifer A.

For Older Patients With CLL, Ibrutinib Beats StandardChemoimmunotherapy
https://www.ashclinicalnews.org/on-location/older-patients-cll-ibrutinib-beats-standard-chemoimmunotherapy/

Dec 4th, 2018 - Results from a randomized phase III study indicate that the Bruton tyrosine kinase (BTK) inhibitor ibrutinib was superior to standard-of-care chemoimmunotherapy for older patients with chronic lymphocytic leukemia (CLL). Lead author Jennifer A. Woyach, MD, from The Ohio State University Comprehensive Cancer Center in Columbus, presented the findings of the Alliance North American Intergr...

Double-Hit Gene Expression Signature Defines a Distinct Subgroup of Germinal Center B-C... Preview
https://www.ncbi.nlm.nih.gov/pubmed/30523716
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology;Ennishi D, Jiang A et. al.

Dec 3rd, 2018 - High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBL-DH/TH) has a poor outcome after standard chemoimmunotherapy. We sought to understand the biologic underpinnings of HGBL-DH/TH with BCL2 rearrangements (HGBL-DH/TH- BCL2) and diffuse large B-cell lymphoma (DLBCL) morphology through examination of gene expression. We analyzed RNA sequencing data from 157 de novo ...

Waldenstrom Macroglobulinemia Clinical Practice Guidelines (2018)
https://www.medscape.com/viewarticle/905623

Nov 30th, 2018 - The guidelines on the diagnosis, treatment, and follow-up of Waldenstrom macroglobulinemia were released on October 1, 2018, by the European Society for Medical Oncology (ESMO).[1] Diagnosis Waldenstrom macroglobulinemia (WM) is diagnosed based on histopathologic confirmation of bone marrow (BM) infiltration by monoclonal lymphoplasmacytic cells and serum monoclonal immunoglobulin M (IgM), conf...

Chemo-Free Regimen Feasible for Indolent Lymphoma
https://www.medpagetoday.com/hematologyoncology/lymphoma/76531

Nov 26th, 2018 - More than a third of patients with symptomatic indolent lymphoma required no chemotherapy during more than 10 years of follow-up after initial treatment with rituximab (Rituxan), data from two randomized Scandinavian studies showed. Three-fourths of the patients remained alive at the end of follow-up, including 38% of patients with follicular lymphoma never treated with chemotherapy. The random...

Evaluation of subcutaneous rituximab administration on Canadian systemic therapy suites. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30464679
Current Oncology (Toronto, Ont.); Stewart DA, Boudreault JS et. al.

Nov 23rd, 2018 - Non-Hodgkin lymphoma (nhl) is the most common hematologic malignancy. Diffuse large B-cell lymphoma (dlbcl) and follicular lymphoma (fl) constitute 55% of new nhl cases and are initially treated with rituximab-based chemoimmunotherapy. Relative to intravenous (IV) rituximab, a subcutaneous (sc) formulation approved in 2016 has comparable pharmacokinetics, efficacy, and safety, and a grea...

What's Hot at This Year's ASH Meeting?
https://www.medscape.com/viewarticle/905521

Nov 23rd, 2018 - The premier event in hematology is celebrating its diamond anniversary. This will be the 60th annual meeting of the American Society of Hematology (ASH). It will be returning to the city of San Diego, California, and will run from November 30 to December 4. More than 25,000 attendees from 155 countries are expected, and more than 4800 abstracts will be presented, Aaron Gerds, MD, chair of ASH's...

ASH 2018 coming attractions look at the big picture
https://www.mdedge.com/jcomjournal/article/189383/aggressive-lymphomas/ash-2018-coming-attractions-look-big-picture/page/0/1

Nov 21st, 2018 - Among these star attractions are results of a phase 3, randomized study of daratumumab (Darzalex) plus lenalidomide and dexamethasone versus lenalidomide-dexamethasone alone for patients with newly diagnosed multiple myeloma who are ineligible for transplant. The investigators found that adding daratumumab reduced the risk of disease progression or death by close to 50%, supporting the combinat.

Outcome of patients aged 80 years or older treated for chronic lymphocytic leukaemia. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30460980
British Journal of Haematology; Al-Sawaf O, Bahlo J et. al.

Nov 21st, 2018 - Clinical management of chronic lymphocytic leukaemia (CLL) in patients aged ≥80 years is based on limited evidence due to the lack of published information. Therefore, we analysed CLL patients aged ≥80 years using data from seven phase III clinical trials of the German CLL Study Group. Among 3552 participants, 152 were ≥80 years old at initiation of first-line study treatment. Median age was 82...

Thyroid nodules in children and teenagers

Pediatr Rev. 
Consultation with the specialist: thyroid nodules.
Osipoff JN1, Wilson TA.
Author information
1
Division of Pediatric Endocrinology, Department of Pediatrics, Stony Brook Children's Hospital, State University of New York, Stony Brook, NY, USA.
Abstract
Based on strong research evidence, thyroid nodules in children and teenagers are more likely to be malignant than in adults. Based on strong research evidence, a history of ionizing radiation to the head or neck is an independent risk factor for the development of thyroid malignancies. There is strong research evidence, including a recent meta-analysis, supporting the use of fine-needle aspiration biopsy in the evaluation of all pediatric and adolescent patients presenting with a thyroid nodule. The surgical management and postoperative care of pediatric and adolescent patients who have well-differentiated thyroid carcinomas remains controversial, because the rarity of the disease limits the ability to conduct randomized, prospective research studies. Numerous studies have demonstrated that, despite presenting with more advanced disease, pediatric and adolescent patients with thyroid carcinoma have a higher survival rate than adults. The American Thyroid Association has issued strong evidence-based recommendations for the management of medullary thyroid carcinoma, including RET mutation testing and early prophylactic total thyroidectomy in children with high-risk mutations.

PMID: 22301033 DOI: 10.1542/pir.33-2-75
https://www.ncbi.nlm.nih.gov/pubmed/22301033

Ravulizumab for treatment of paroxysmal nocturnal hemoglobinuria

FDA approves ravulizumab for treatment of paroxysmal nocturnal hemoglobinuria
https://www.mdedge.com/internalmedicine/article/191740/anemia/fda-approves-ravulizumab-treatment-paroxysmal-nocturnal
Lucas Franki, Internal Medicine News

Dec 21st, 2018 - The Food and Drug Administration has approved ravulizumab(Ultomiris) injection for the treatment of adult patients with paroxysmal nocturnal hemoglobinuria (PNH). Wikimedia Commons/FitzColinGerald/Creative Commons License "The approval of Ultomiris will change the way that patients with PNH are treated.

Ravulizumab (ALXN1210) in patients with paroxysmal nocturnal hemoglobinuria: res... Preview
https://www.ncbi.nlm.nih.gov/pubmed/30171081
Blood Advances; Röth A, Rottinghaus ST et. al.

Sep 2nd, 2018 - Ravulizumab (ALXN1210), a humanized monoclonal antibody to complement component C5, was engineered from eculizumab to have a substantially longer terminal half-life, permitting longer dosing intervals for paroxysmal nocturnal hemoglobinuria (PNH) treatment. Two phase 1b/2 multicenter open-label studies evaluated efficacy and safety of multiple doses and regimens of ravulizumab in ...

Drug is convenient alternative for PNH, doc says
https://www.mdedge.com/content/drug-convenient-alternative-pnh-doc-says
Jen Smith

Jun 22nd, 2018 - Photo from EHA Session at the 23rd Congress of the European Hematology Association (EHA) STOCKHOLM—Results of a phase 3 study suggest the long-acting C5 complement inhibitor ravulizumab produces similar results as eculizumab in patients with paroxysmal nocturnal hemoglobinuria (PNH). Treatment with ravulizumab every 8 weeks proved noninferior to treatment with eculizumab every 2 w.

New Drug for PHN Taken Only Once Every 8 Weeks
https://www.medscape.com/viewarticle/898793

Jul 2nd, 2018 - STOCKHOLM, Sweden — A new drug under development for the treatment of paroxysmal nocturnal hemoglobinuria (PNH),  ravulizumab (ALXN1210, Alexion Pharmaceuticals), has shown noninferiority compared with eculizumab (Soliris, Alexion Pharmaceuticals), currently the only therapy approved for the syndrome. But it achieved similar outcomes while being administered by intravenous (IV) infusion ...

FDA OKs New Options for Two Rare Blood Diseases
https://www.medpagetoday.com/hematologyoncology/hematology/77084

Dec 21st, 2018 - WASHINGTON -- The FDA announced new approvals for two rare and life-threatening blood diseases on Friday, as blastic plasmacytoid dendritic cell neoplasm (BPDCN) gets its first approved agent and paroxysmal nocturnal hemoglobinuria (PNH) gets a new drug that drastically cuts the frequency of treatments. BPDCN Gets First Approved Drug The FDA approved the infusion therapy tagraxofusp (Elzonris) ...

Elzonris (tagraxofusp-erzs) for blastic plasmacytoid dendritic cell neoplasm (BPDCN)

FDA approves Elzonris for blastic plasmacytoid dendritic cell neoplasm
https://www.mdedge.com/hematologynews/article/191723/rare-diseases/fda-approves-elzonris-blastic-plasmacytoid-dendritic
Laura Nikolaides, Hematology News

Dec 21st, 2018 - The Food and Drug Administration has approved tagraxofusp-erzs (Elzonris) infusion for the treatment of blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adults and pediatric patients, 2 years of age and older. Approval was based on efficacy in two cohorts of patients in a single-arm clinical trial.

Drug under priority review for BPDCN
https://www.mdedge.com/content/drug-under-priority-review-bpdcn
HT Staff

Aug 15th, 2018 - Photo by Bill Branson Vials of drug The US Food and Drug Administration(FDA) has accepted for priority review the biologics license application seeking approval for tagraxofusp (Elzonris, SL-401) to treat blastic plasmacytoid dendritic cell neoplasm (BPDCN). The FDA expects to make a decision on this application by February 21, 2019.

FDA OKs New Options for Two Rare Blood Diseases
https://www.medpagetoday.com/hematologyoncology/hematology/77084

Dec 21st, 2018 - WASHINGTON -- The FDA announced new approvals for two rare and life-threatening blood diseases on Friday, as blastic plasmacytoid dendritic cell neoplasm (BPDCN) gets its first approved agent and paroxysmal nocturnal hemoglobinuria (PNH) gets a new drug that drastically cuts the frequency of treatments. BPDCN Gets First Approved Drug The FDA approved the infusion therapy tagraxofusp (Elzonri...

Acta Medica International

http://www.actamedicainternational.com/currentissue.asp?sabs=n

Simulation in anaesthesia Sanjeev Kumar Jain, Rohit Kumar Varshney Acta Medica International 2018 5(2):53-54

Features of acid–base balance of bone marrow Lyudmila P Nikolaeva Acta Medica International 2018 5(2):55-57 Context: Bone marrow (BM) pH has rarely been measured, and the long BM has barely been studied at all because intravital obtaining of the long BM is impossible due to the extreme strength of the long bone tissue. Aims: The study aimed to investigate the acid–base balance of the BM and to compare the acid–base properties of long BM and flat BM. Subjects and Methods: Forty flat BM samples were extracted by sternal puncture. Forty long BM samples were extracted from the femora in patients who had to have a limb amputated. A blood gas and acid–base status analyzer were used to determine pH. Results: Flat BM pH is similar to blood p; the long BM pH is acidic and ranges from 6.7 to 6.9. Hematopoietic stem cells occur in both acidic and slightly alkaline environments. The blood gas and acid–base status analyzer used in this study are suitable for determining the acid–base properties of BM. Conclusions: The acid–base status appears to be an important factor of stem cell differentiation. This paper can be of interest to biotechnologists and researchers who investigate possibilities to influence the differentiation and properties of the stem cells.

Incidence of atrial fibrillation after cardiac surgery and its pharmacological management Persis Ann George, Anila Varkey, Adithya Nandan, Uday Venkat Mateti, Mundayat Gopalakrishnan, Rovin Mathew Theempalangad Acta Medica International 2018 5(2):58-62 Aim: Postoperative atrial fibrillation (POAF) is one of the most commonly occurring complications after cardiac surgery. The study aims to determine the incidence of POAF and to analyze its pharmacological management in patients scheduled for cardiac surgery. Methodology: A prospective observational study was carried out for 6 months (October 2016 to March 2017) in cardiothoracic surgery. Drug therapy details by medication chart review and clinical review in patients who underwent coronary artery bypass graft, mitral valve replacement (MVR), and aortic valve replacement was carried out and analyzed for the incidence of POAF. The statistical analysis was performed using SPSS. Results: A total of 83 patients were recruited for this study. The POAF incidence was 18.07% with the highest incidence on the 2nd postoperative day. The mean age of patients with POAF was 49.40 ± 12.77 years. Rheumatic heart disease and alcohol were identified as the predisposing factors of POAF. The incidence of POAF was the highest following MVR (80%) than other cardiac surgeries. Patients who developed POAF had a longer length of hospitalization (median 9 vs. 7 days). Amiodarone, metoprolol, verapamil, atorvastatin, clopidogrel, and aspirin were the most frequently prescribed drugs for the management of POAF. Administration of metoprolol, nebivolol, atorvastatin, bisoprolol, metoprolol + atorvastatin + aspirin, and other combinations before cardiac surgery reduced the risk of developing POAF. Conclusion: The overall incidence of POAF was 18.07%. Amiodarone (13.3%), metoprolol (40%), verapamil (66.7%), aspirin (26.7%), clopidogrel (13.3%), and atorvastatin (20%) were found to be safe and effective in the treatment of POAF patients.

Caregivers' awareness and perception of cardiopulmonary resuscitation: Our experience Ibrahim Aliyu, Abdulsalam Mohammed, Zainab F Ibrahim Acta Medica International 2018 5(2):63-68 Introduction: Adverse health-related events such as cardiac arrest can occur at any location: it is broadly classified as out-of-hospital or in-hospital cardiac arrest. The location of cardiac arrest however affects outcome; the actions of caregivers and bystanders may influence the outcome of witnessed out-of-hospital cardiac arrest; therefore, their knowledge of cardiopulmonary resuscitation (CPR) is relevant. Materials and Methods: This was a questionnaire-based cross-sectional study conducted at the Paediatric Outpatient Clinic and Paediatric Specialty Clinic of Aminu Kano Teaching Hospital. Results: There were 120 (33.3%) males and 240 (66.7%) females, with a male-to-female ratio of 1:2. Only 57 (15.8%) respondents were aware of CPR. However, 69 (19.2%) respondents were aware of chest compression. One hundred and twenty-nine (35.8%) respondents reported that they could perform mouth-to-mouth resuscitation on their own children; however, 66 (18.3%) respondents reported willingness to perform mouth-to-mouth resuscitation on another person's child if the need arose. Only 15 (4.2%) respondents had training on CPR. Six (40%) respondents were trained at school. However, caregivers in the chronic illness subgroup were more willing to perform mouth-to-mouth resuscitation. Caregivers of children with acute illnesses would use palm kernel oil to treat convulsion; however, those of the chronic illness group would mostly use herbs to treat convulsion; this observation was statistically significant (Fisher's exact test = 32.457, P = 0.00). Conclusion: There was poor awareness of CPR among respondents; furthermore, there was lack of willingness to perform CPR by most respondents on children.

A comparative analysis of the baska mask versus I-gel for general anesthesia in surgical patients undergoing laparoscopic cholecystectomy Usha Kumari Chaudhary, Som Raj Mahajan, Monika Mahajan, Charu Sharma, Mukesh Sharma Acta Medica International 2018 5(2):69-73 Background and Aims: Baska mask is a newly introduced membranous cuffed supraglottic device whereas I-gel is made up of thermoplastic elastomer, both suitably designed from the anatomical perspective of the airway. Settings and Design: We conducted randomized controlled comparative trial of the Baska mask versus I-gel in a patient undergoing laparoscopic cholecystectomy. Subjects and Methods: A total of 100 adult patients in the age group of 20–70 years undergoing elective laparoscopic cholecystectomy were randomly divided into two groups as follows: (1) Baska mask group and (2) I-gel group. The primary outcome was to compare oropharyngeal leak pressure (OLP) of Baska mask and I-gel groups. The secondary outcome was the ease of insertion and removal, number of attempts, insertion time, leak fraction, and laryngopharyngeal morbidity. Statistical Analysis Used: Demographic details were compared using the Chi-square and t-tests. Student's t-test for independent variables was used to compare means of data obtained. Results: Mean OLP was significantly higher in Baska mask group than I-gel group at insertion (29.54 ± 1.41 cm H2O vs. 23.16 ± 3.07 cm H2O, P = 0.02) and 30 min after insertion (33.54 ± 1.16 cm H2O vs. 25.97 ± 2.25 cm H2O, P = 0.001). Insertion time was 12.33 ± 2.61 s with Baska mask and 11.31 ± 1.84 s with I-gel (P = 0.02). Insertion was very easy in 58% of patients in Baska mask and 76% of patients in I-gel (P = 0.03). The leak fraction of Baska mask was significantly less than I-gel (3.56 ± 3.6 vs. 7.16 ± 2.45, P = 0.01). Laryngopharyngeal morbidity was comparable in the two groups. Conclusion: Baska mask is more effective in providing greater OLP compared to I-gel without any increase in laryngopharyngeal morbidity.

Chromosomal aberrations in multiple myeloma: A study on Indian population Angel Beula P. Royal, Syeda Sabiha S. Lubna, P Beaulah Angel, Vijaya V Mysorekar, TS Sundareshan Acta Medica International 2018 5(2):74-78 Aims: The aim of this study was to evaluate the complexity of the chromosomal abnormalities in multiple myeloma (MM) cases and to correlate the findings with the previous reported cases. Materials and Methods: Bone marrow samples were obtained from patients with MM and sent for cytogenetic study. The patient's details were logged and the cytogenetic test was performed. The karyotypes were analyzed and interpreted as per the standard guidelines. Results: Of the compiled data of cases from 2013 to 2016, 34 patients were diagnosed with MM. About 15% were below the age of 50, maximum patients were between ages of 61 and 70 years (50%). There were 25 male and 9 female. Twenty-one cases had normal karyotypes and few cases showed structural rearrangements and numerical abnormalities. Conclusions: From the data compiled, only a total of 34 cases were positive for MM, indicating that the disease is quite rare in our population. It has been previously reported that the disease usually occurs in people over the age of 50 years, however, in this study, 5 (15%) were below the age of 50 indicating that MM can affect the age group below 50 years as well. The numerical, structural abnormalities and few clonal abnormalities observed in our study added a few more to the previously reported abnormalities. However, the interesting finding of our study was a case with a combination of clones of hypodiploidy, hyperdiploidy, hypotetraploidy, and hypertetraploidy which was in contrary to the reported literatures, which were only one type of ploidy were observed. Thus, the heterogeneity and complexity of the chromosomal abnormalities in MM and the challenge in staging the disease have been proven in our study.

Prevalence of exclusive breastfeeding and knowledge related to breastfeeding among mothers attending immunization center and well-baby clinic Shuvendu Roy, Ashish K Simalti, Bindu T Nair Acta Medica International 2018 5(2):79-83 Background: The World Health Organization defines exclusive breastfeeding (EBF) as giving baby only breast milk for the first 6 months without adding any additional drink including water or food. We undertook this study with an objective to assess the prevalence of breastfeeding among mothers in North Indian setting. Aims: The aims of this study were to assess the prevalence of EBF among mothers attending a well-baby clinic and to look for variable significantly impacting probability of breastfeeding and assessing the challenges faced and existing knowledge regarding breastfeeding. Materials and Methods: This was a questionnaire-based one-point survey to assess the prevalence of EBF. The questionnaire was based on the review of literature and included parameters considered significant by various studies. Mother's knowledge regarding breastfeeding was assessed by another questionnaire. Results: A total of 970 mothers were approached who visited immunization center and well-baby clinic during the study. After taking out those who were unwilling and did not meet the criteria, we had 634 mothers who participated in our study. They were divided into two groups based on whether they exclusive breastfed their babies for 6 months or not. Comparison of both these groups revealed breastfeeding counseling to be the most important variable. Statistical Analysis Used: It is a cross-sectional type of study with a questionnaire-based one-point survey. The minimum sample size required was calculated using Daniel's formula: n = z2pq/d. Consequent sampling was done. Chi-square test for independence was done to assess the association between both the groups for all the parameters recorded. Conclusions: All mothers were aware that breast milk is beneficial for their baby; however, the biggest problem was anxiety regarding the adequacy of their breast milk. There is also need for a widespread campaign related to harm done by prelacteals and substitutes of breast milk including cow milk.

Treatment of patients suffering from exercise-induced asthma: Prevention of exercise-induced bronchial spasm – Literature review Leonid Oleksijovych Bezrukov, Olena Kostiantynivna Koloskova, Lorina Alimivna Ivanova, Tetiana Mykhailivna Bilous, Olena Grygorivna Grygola, Yuliia Igorivna Voitkevich Acta Medica International 2018 5(2):84-89 Exercise-induced bronchial asthma (EIBA) or exercise-induced bronchial spasm is all terms that describe the phenomenon of transient obstruction of the bronchi after intensive physical stress. This article presents the recommendations about the rational administration of pharmacological and nonpharmacological methods of treatment of EIBA that in the majority of cases enables to provide considerable control over the disease without limitation of the physical activity of patients.

Penile entrapment: A case where innovation is the need of the hour Gajanan Shripad Bhat Acta Medica International 2018 5(2):90-91 Penile entrapment is a rare and unique condition requiring urgent decompression to preserve the organ function and prevent complications. There is no universal method that is applicable to all cases as there are hardly any guidelines. Management of a 35-year-old male who presented to our emergency room with a metal ring around his penis has been described here. The case report highlights the need to devise one's own method to decompress the entrapped penis based on the available technology and manpower on hand in a given situation.

The effectiveness of continuous venovenous hemodiafiltration in phenobarbital intoxication Yasemin Çoban, Dinçer Yildizdas, Özden Özgür Horoz, Nagehan Aslan, Didar Arslan Acta Medica International 2018 5(2):92-94 Phenobarbital continues to be widely used in childhood epilepsy. Incorrect drug prescription can sometimes lead to intoxication, particularly in young children. A 40-month-old female infant presented to our emergency department due to failure to awaken. The patient was assessed in terms of etiology of coma, and her history revealed that she had been given a 100 mg phenobarbital pill instead of 15 mg. Her blood phenobarbital level was high (>80 mg/dl). At physical examination, her Glasgow coma score was 6, the pupils were isochoric, pupillary light reflex was bilateral positive, deep tendon reflexes were absent, respiration was superficial, and pulmonary bilateral diffuse secretory rales were present, and the patient was intubated. Continuous venovenous hemodiafiltration (CVVHDF) was performed due to prolonged coma, intubation, and potentially fatal phenobarbital level. Blood phenobarbital levels at 4 and 12 h improved to >80 and 33.4 mg/dl, and the patient was extubated at 14 h. CVVHDF was effective in intoxication despite long-acting barbiturate phenobarbital not binding to protein. We think that this is a useful method capable of use in phenobarbital intoxications.

Pediatric Respirology and Critical Care Medicine

http://www.prccm.org/currentissue.asp?sabs=n

Outcomes and prediction Rina Triasih Pediatric Respirology and Critical Care Medicine 2018 2(4):57-57

Obstructive sleep-disordered breathing in children: Impact on the developing brain Lisa M Walter, Rosemary S C Horne Pediatric Respirology and Critical Care Medicine 2018 2(4):58-64 Obstructive sleep-disordered breathing (SDB) affects up to 11% of children and forms a continuum of severity ranging from primary snoring to obstructive sleep apnea. Children with SDB exhibit significant neurocognitive and cardiovascular dysfunction, which is associated with repetitive hypoxia and sleep fragmentation that characterize the condition. We reviewed the recent literature pertaining to the effect of SDB on the brain in children. These include studies that utilized near-infrared spectroscopy to determine cerebral oxygenation and structural and functional magnetic resonance imaging (MRI) of the brain. Studies have identified that the effect of SDB on cerebral oxygenation in children is minimal and not clinically significant. There are conflicting reports on the association between the measures of cerebral oxygenation and peripheral arterial oxygen saturation (SpO2), and further research needs to be conducted to elucidate the relationship between peripheral SpO2, cerebral oxygenation, and SDB in children. MRI studies have reported significant structural and functional changes to the brains of children with SDB, in brain regions associated with neurocognition, behavior, and autonomic function. These include reduced white and gray matter and structural changes to a multitude of brain areas including, but not limited to, the hippocampus, cortex, amygdala, insula, thalamus, cerebellum, and basal ganglia. These studies utilize a variety of MRI techniques to address different research questions, but contribute to the gradually developing picture of the adverse effects of SDB on the brain in children.

Validation of a modified pediatric risk of mortality III model in a pediatric intensive care unit in Thailand Kanokpan Ruangnapa, Sittikiat Sucheewakul, Tippawan Liabsuetrakul, Edward McNeil, Kantara Lim, Wanaporn Anantaseree Pediatric Respirology and Critical Care Medicine 2018 2(4):65-72 Objective: The objective of this study is to compare the performance of a modified Pediatric Risk of Mortality (PRISM) III model with the original PRISM III in prediction of mortality risk in a Thailand pediatric intensive care unit (PICU). Subjects and Methods: Children aged 1 month to 18 years who stayed in the PICU for more than 8 h during November 2013 to December 2016 were included in the study. Results: The medical records of 1175 PICU patients were included in the analysis. The patients were randomly split into two equal groups: a development (n = 588) and a validation (n = 587) sample. A modified PRISM III model was derived from the original PRISM III by omitting arterial blood gas parameters and adding selected clinical variables. The model was developed using a multiple logistic regression model on the development sample and assessed using the area under the curve (AUC) obtained from a receiver operating characteristic curve. The modified PRISM III scores were significantly higher in nonsurvivors (median = 9, interquartile range [IQR] = 4 − 13) compared to survivors (median = 2, IQR = 0 − 5). The modified PRISM III model had similar discriminative performances compared to the original PRISM III in predicting 2-day mortality (AUC: 0.874 vs. 0.873), 7-day mortality (AUC: 0.851 vs. 0.851) and overall mortality (AUC: 0.845 vs. 0.956). The modified PRISM III model was calibrated in the validation sample, and the standardized mortality ratios (SMRs) were similar. Conclusions: The performance of a modified PRISM III model in predicting mortality risk was comparable to the original PRISM III. Both had similar discriminative performance and SMR for overall mortality prediction in a PICU.

Pulmonary function abnormalities in Nigerian children with sickle cell anaemia: Prevalence, pattern and predictive factors Bankole Peter Kuti, Samuel Ademola Adegoke Pediatric Respirology and Critical Care Medicine 2018 2(4):73-79 Background: Advances in care of children with sickle cell anaemia (SCA) have increased their chances of survival to adolescence and adulthood though this is often associated with multi-organ system pathologies including lung dysfunctions. This study aimed to determine the prevalence, pattern and factors associated with pulmonary function abnormalities in Nigerian children with SCA. Methods: Pulmonary functions of 104 children with SCA in steady state and 104 age- and sex-matched haemoglobin AA controls aged 6 to 16 years at the Wesley Guild Hospital, Ilesa Nigeria, were assessed using Spirolab III (Medical International Research, Italy) spirometer following standard protocol. Socio-demographic characteristics, nutritional status and pulmonary function parameters of these children were compared, and the predictive factors of pulmonary function abnormalities in SCA children were determined using binary logistic regression. Results: SCA children had lower lung volumes and capacities and higher prevalence of pulmonary function abnormalities compared to controls, and a restrictive ventilatory pattern (22.1%) was the most predominant form. Adolescent age, previous acute chest syndrome (ACS), repeated painful crises and multiple hospitalisations in the previous year were significantly associated with pulmonary function abnormalities (P < 0.05). Only adolescent age group (odds ratio [OR] = 3.738; 95% confidence interval [CI] = 1.480–9.440; P = 0.005) and previous ACS (OR = 8.500; 95% CI = 2.044–12.959; P = 0.044) independently predicted pulmonary function impairments among the SCA children. Conclusion: SCA predisposes children to pulmonary dysfunction, particularly during adolescent years and in those with ACS, multiple crises and hospitalisations. Routine pulmonary function assessment in these children will facilitate early recognition and prompt management.