CaP Diagnosis Research Articles

Urine Dipstick of Sputum for the Rapid Diagnosis of Community Acquired Pneumonia

IntroductionCommunity acquired pneumonia (CAP) is responsible for an important part of treatment costs across the world. Even though posterior-anterior lung radiography (PALG) and direct sputum smear microscopy are required or routine diagnoses. The purpose of this study is to determine the diagnostic value of the bedside urine strip tests in CAP. MethodsPatients who attended the emergency department (ED) between from February 2016 to September 2016 with expectoration complaints and suspicion of pneumonia. The sensitivity, specificity, and accuracy rate of the urine strip tests, direct sputum smear microscopy, and PALG were calculated and analyzed using SPSS 15.0. ResultsDuring the study period, 100 patients with pneumonia suspicion were evaluated in the ED. The sample was divided into two groups: negative and positive diagnosis of CAP. The leukocytes detecting by urine strip tests are statistical differences between the two groups (p: 0.003). The results show that the sensitivity, specificity, and accuracy rate of leukocytes detected in sputum with urine strip tests in the pneumonia diagnosis were 83.3%, 44.2% and 63% respectively. ConclusionAccording to the study, it is believed that the method of determination of leukocytes with urine strip tests in sputum combined with more detailed results. They can become part of CAP diagnosis methods.

Prostate Cancer Screening Perception, Beliefs, and Practices Among Men in Bamenda, Cameroon.

Prostate Cancer (CaP) is the most commonly diagnosed cancer among Cameroonian men. Due to inadequate infrastructure, record keeping, and resources, little is known about its true burden on the population. There are rural/urban disparities with regards to awareness, screening, treatment, and survivorship. Furthermore, use of traditional medicine and homeopathic remedies is widespread, and some men delay seeking conventional medical treatment until advanced stages of CaP. This study examined the perceptions, beliefs, and practices of men in Cameroon regarding late stage CaP diagnoses; identified factors that influence screening decision; and ascertained how men decided between traditional or conventional medicine for CaP diagnosis and treatment.Semistructured focus groups were used to collect data from men in Bamenda, Cameroon. Qualitative data analysis was used to analyze transcripts for emerging themes and constructs using a socio-ecological framework.Twenty-five men participated in the study, with an average age of 59. Most of the participants had never received a prostate screening recommendation. Socioeconomic status, local beliefs, knowledge levels, awareness of CaP and screening methods, and stigma were prominent themes.A significant number of Cameroonian men receive late stage CaP diagnosis due to lack of awareness, attitudes, cultural beliefs, self-medication, and economic limitation. To effectively address these contributing factors to late stage CaP diagnosis, a contextually based health education program is warranted and should be tailored to fill knowledge gaps about the disease, dispel misconceptions, and focus on reducing barriers to utilization of health services.

MP46-14 LOOKING BEYOND CANCER DETECTION: IS TEMPLATE BIOPSY BETTER THAN TRUS BIOPSY IN PLANNING NERVE SPARING ROBOTIC RADICAL PROSTATECTOMY IN THE MULTIPARAMETRIC MRI ERA?

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2018MP46-14 LOOKING BEYOND CANCER DETECTION: IS TEMPLATE BIOPSY BETTER THAN TRUS BIOPSY IN PLANNING NERVE SPARING ROBOTIC RADICAL PROSTATECTOMY IN THE MULTIPARAMETRIC MRI ERA? Dimitrios Moschonas, Edward Bass, Pavlos Pavlakis, Murthy Kusuma, Stylianos Chintzoglou, Krishnaji Patil, Christopher Eden, Matthew Perry, and Stephen Langley Dimitrios MoschonasDimitrios Moschonas More articles by this author , Edward BassEdward Bass More articles by this author , Pavlos PavlakisPavlos Pavlakis More articles by this author , Murthy KusumaMurthy Kusuma More articles by this author , Stylianos ChintzoglouStylianos Chintzoglou More articles by this author , Krishnaji PatilKrishnaji Patil More articles by this author , Christopher EdenChristopher Eden More articles by this author , Matthew PerryMatthew Perry More articles by this author , and Stephen LangleyStephen Langley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1473AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical decision-making at radical prostatectomy is of vital importance to maximizing biochemical disease-free survival as well as quality of life. Accurate characterisation of a patient′s tumour at diagnosis is thus paramount. Whilst the bulk of existing data has focused on cancer detection, little has been done in regard to whether biopsy strategies have demonstrable effect on surgical outcome. Our aim was to assess the impact of biopsy method on nerve sparing robotic assisted radical prostatectomy (RARP) and positive surgical margin (PSM) rates. METHODS We analysed our prospectively collected data of consecutive patients who underwent primary RARP following a diagnosis of CaP at a single referral centre between October 2010 and June 2017. All patients underwent multiparametric MRI (mpMRI) and either transrectal ultrasound guided (TRUS) or template transperineal biopsy. Data included presenting PSA (pPSA); patient age; clinical and radiological T stage; biopsy type and Gleason grade; D′Amico risk classification; whole-mount Gleason grade, prostate and tumour volumes; PSM status, site and length. PSM status was compared between groups. RESULTS 771 patients were included in the study, with 343 (44.5%) having undergone TRUS and 428 (55.6%) template biopsies. Median age was 66 [IQR 60-69] and median pPSA 7.2 [IQR 5.3-10.7]. Nerve sparing procedures were performed in 273 (79.6%) men following mpMRI and TRUS and 330 (77.1%) following mpMRI and template. PSM rates were significantly higher in the mpMRI and TRUS groups than in the mpMRI and template groups (p=0.005). Subgroup analysis demonstrated advantage of mpMRI and template in D′Amico high (p=0.04) and intermediate (p=0.04) risk groups. CONCLUSIONS MpMRI and template biopsy are superior to the combination of mpMRI and TRUS in surgical planning leading to better pathologic margin outcomes for patients. Targeted biopsy strategies beyond cancer detection, confidently support clinical decision making of nerve sparing prostatectomy approach © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e611-e612 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dimitrios Moschonas More articles by this author Edward Bass More articles by this author Pavlos Pavlakis More articles by this author Murthy Kusuma More articles by this author Stylianos Chintzoglou More articles by this author Krishnaji Patil More articles by this author Christopher Eden More articles by this author Matthew Perry More articles by this author Stephen Langley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia.

BackgroundItalian pediatric antimicrobial prescription rates are among the highest in Europe. As a first step in an Antimicrobial Stewardship Program, we implemented a Clinical Pathway (CP) for Community Acquired Pneumonia with the aim of decreasing overall prescription of antibiotics, especially broad-spectrum.Materials and methodsThe CP was implemented on 10/01/2015. We collected antibiotic prescribing and outcomes data from children aged 3 months-15 years diagnosed with CAP from 10/15/2014 to 04/15/2015 (pre-intervention period) and from 10/15/2015 to 04/15/2016 (post-intervention period). We assessed antibiotic prescription differences pre- and post-CP, including rates, breadth of spectrum, and duration of therapy. We also compared length of hospital stay for inpatients and treatment failure for inpatients and outpatients. Chi-square and Fisher’s exact test were used to compare categorical variables and Wilcoxon rank sum test was used to compare quantitative outcomes.Results120 pre- and 86 post-intervention clinic visits were identified with a diagnosis of CAP. In outpatients, we observed a decrease in broad-spectrum regimens (50% pre-CP vs. 26.8% post-CP, p = 0.02), in particular macrolides, and an increase in narrow-spectrum (amoxicillin) post-CP. Post-CP children received fewer antibiotic courses (median DOT from 10 pre-CP to 8 post-CP, p<0.0001) for fewer days (median LOT from 10 pre-CP to 8 post-CP, p<0.0001) than their pre-CP counterparts. Physicians prescribed narrow-spectrum monotherapy more frequently than broad-spectrum combination therapy (DOT/LOT ratio 1.157 pre-CP vs. 1.065 post-CP). No difference in treatment failure was reported before and after implementation (2.3% pre-CP vs. 11.8% post-CP, p = 0.29). Among inpatients we also noted a decrease in broad-spectrum regimens (100% pre-CP vs. 66.7% post-CP, p = 0.02) and the introduction of narrow-spectrum regimens (0% pre-CP vs. 33.3% post-CP, p = 0.02) post-CP. Hospitalized patients received fewer antibiotic courses post-CP (median DOT from 18.5 pre-CP to 10 post-CP, p = 0.004), while there was no statistical difference in length of therapy (median LOT from 11 pre-CP to 10 post-CP, p = 0.06). Days of broad spectrum therapy were notably lower post-CP (median bsDOT from 17 pre-CP to 4.5 post-CP, p <0.0001). No difference in treatment failure was reported before and after CP implementation (16.7% pre-CP vs. 15.4% post-CP, p = 1).ConclusionsIntroduction of a CP for CAP in a Pediatric Emergency Department led to reduction of broad-spectrum antibiotic prescriptions, of combination therapy and of duration of treatment both for outpatients and inpatients.

Avascular necrosis of the femoral head in patients treated for leukaemia. Assessment of the need for a diagnostic protocol

ObjectiveTo evaluate the incidence of avascular necrosis of the hip in leukaemia patients treated in our hospital with high doses of corticosteroids in order to evaluate the necessity for an early detection protocol. Material and methodsObservational-descriptive and retrospective study from 2005 to 2016 of 253 patients diagnosed with paediatric leukaemia. Patients with musculoskeletal pathology were identified and patients with avascular necrosis were analysed. ResultsA total of 26 patients (10%) had musculoskeletal symptoms. Three patients with avascular necrosis (1.2%) were analysed. One girl, 7 years old, was treated conservatively with traction–suspension and discharge. Two boys, an 11 and a 15.4 years old, who developed graft-versus-host disease secondary to bone marrow transplantation, and whose treatment included high doses of corticosteroids, developed avascular necrosis of the hip. One was treated with bisphosphonates and forage and the other ended up with a total hip arthroplasty. DiscussionThe occurrence of musculoskeletal symptoms during the treatment of leukaemia is different according to the bibliographic series (0.43–12.6%). Some authors observe an increased risk in female patients between the ages of 10 and 17. A retrospective study reveals that there is a delay of 3.9 months in the diagnosis of CAP since the onset of pain. Other authors relate NAV to loading joints, age and high doses of corticosteroids. ConclusionBased on the low incidence of avascular necrosis of the hip in our 14-year-old population treated for leukaemia, the creation of diagnostic protocols seems not to be necessary. However, close monitoring of patients with potential risk factors recognised in the literature, is advisable.

The Effects of Population-based Prostate-specific Antigen Screening Beginning at Age 40

To evaluate population-based prostate cancer (CaP) testing of men in their 40s, given the paucity of prospective data evaluating the consequences of prostate-specific antigen (PSA) testing in younger men for CaP. A total of 1052 men in their 40s were followed longitudinally for prostate outcomes, from 1990 to 2010. A random subset of 268 men was selected to undergo biennial CaP testing including PSA testing, transrectal ultrasound, and a digital rectal examination. A representative population of 609 men with a subset of 159 men who also began CaP testing in their 50s was also evaluated as a comparison group. Risk of prostate biopsy (PBx), CaP, or death from CaP was compared between CaP-tested and the routine-care population cohort. Median follow-up was 17.2 years. Men aged 40-49, who underwent CaP testing were 2.4 times more likely to undergo a PBx (hazard ratio [HR] 2.4 95% confidence interval [CI] 1.8-3.3) and 2.2 times more likely to be diagnosed with low-risk CaP (HR 2.2, 95% CI 1.12-4.0). Those initiating CaP testing a decade earlier were 2.2 times and 1.7 times more likely to be biopsied and be diagnosed with CaP for any given age (HR 2.2 95% CI 1.4-3.5 and 1.7 95% CI 1.1-2.7, respectively). CaP testing in men beginning at age 40 resulted in a significant increase in the risk of PBx and diagnosis of low-risk CaP, without a measurable reduction in risk of CaP-death in this low-risk population. However, given the natural history of CaP, a longer follow-up is needed to confirm this finding.

Necrosis avascular de cabeza femoral en pacientes tratados de leucemia. Evaluación de la necesidad de un protocolo diagnóstico

ObjectiveTo evaluate the incidence of avascular necrosis of the hip in leukaemia patients treated in our hospital with high doses of corticosteroids in order to evaluate the necessity for an early detection protocol. Material and methodsObservational-descriptive and retrospective study from 2005 to 2016 of 253 patients diagnosed with paediatric leukaemia. Patients with musculoskeletal pathology were identified and patients with avascular necrosis were analysed. ResultsA total of 26 patients (10%) had musculoskeletal symptoms. Three patients with avascular necrosis (1.2%) were analysed. One girl, 7 years old, was treated conservatively with traction - suspension and discharge. Two boys, an 11 and a 15.4 year-old,who developed graft-versus-host disease secondary to bone marrow transplantation, and whose treatment included high doses of corticosteroids, developed avascular necrosis of the hip. One was treated with bisphosphonates and forage and the other ended up with a total hip arthroplasty. DiscussionThe occurrence of musculoskeletal symptoms during the treatment of leukaemia is different according to the bibliographic series (0.43 -12.6%). Some authors observe an increased risk in female patients between the ages of 10 and 17. A retrospective study reveals that there is a delay of 3.9 months in the diagnosis of CAP since the onset of pain. Other authors relate NAV to loading joints, age and high doses of corticosteroids. ConclusionBased on the low incidence of avascular necrosis of the hip in our 14-year-old population treated for leukaemia, the creation of diagnostic protocols seems not to be necessary. However, close monitoring of patients with potential risk factors recognized in the literature, is advisable.

Abstract 4645: A serum multiomics signature for enhancing prostate cancer diagnosis and prognosis

Abstract Introduction and Objective: Diagnosis of prostate cancer (CaP) has relied on prostate specific antigen (PSA) level and digital rectal examination (DRE) followed by prostate biopsies. These modalities have the potential to yield false-positive and false-negative results for CaP. These challenges prompted efforts to develop more specific body fluid based assays including PCA3, TMPRSS2:ERG, K4csore and PHI tests. Further, emerging data on significant racial differences of common CaP driver genes, e.g., PTEN and ERG in CaP can lead to significant limitations in biomarker performance. Thus, the goal of our study was to discover CaP serum markers with equal performance among African American (AA) and Caucasian American (CA) men. We employed proteomics, signal- and structural lipidomics and metabolomics platforms to discover serum biomarkers and evaluate their utility for diagnosis and prognosis of CaP in AA and CA men. Methods: Sera from 700 individuals were analyzed, which included AA and CA CaP patients stratified for ERG oncoprotein expression by immunohistochemistry (N=495). Sera from age-matched healthy control men were also included (N=205) in this study. Quantitative global profiles of lipidome, proteome and metabolome were analyzed by high resolution MS-based technologies. Random forest and Interrogative Biology® analytical platforms were used to identify analytes differentiating healthy from CaP cases including clinical-pathologic data. Results: The unbiased global profiling and integration of the data and clinical-pathologic features have led to the identification of molecular fingerprints differentiating cancer patients from healthy controls. Specifically, three analytes in serum metabolome showed robust separation between both AA and CA CaP and control groups. Elevated levels of nicotinamide and eicosenoic acid and decreased levels of a decanoylcarnitate alone have indicated strong separation between cases and controls. Further inclusion of additional 9 analytes provided an optimal multi-omics panel for distinguishing the combined cohort of AA and CA cases vs. healthy controls. Conclusions: The findings presented here support that an integrated multiomics approach has the potential to define serum marker panels for diagnosis of CaP in the context of racial diversity and molecular annotation (e.g., ERG) of CaP. These promising data are undergoing validation in additional patient cohorts. Citation Format: Michael A. Kiebish, Jennifer Cullen, Albert Dobi, Amina Ali, Leonardo O. Rodrigues, Yezhou Sun, Aniruddha Pawar, Aditee Dalvi, Denise Young, Vivek K. Vishnudas, Jason Sedarsky, Gyorgy Petrovics, Emily Chen, Viatcheslav Akmaev, Inger L. Rosner, David McLeod, Isabell A. Sesterhenn, Rangaprasad Sarangarajan, Alagarsamy Srinivasan, Elder Grainger, Niven R. Narain, Shiv Srivastava. A serum multiomics signature for enhancing prostate cancer diagnosis and prognosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4645. doi:10.1158/1538-7445.AM2017-4645

Abstract 5550: Collaborative analyses for delineating mutation variations among different ethnic patients of prostate cancer based on genomic data integration

Abstract Emerging data support the hypothesis that both inherited and somatic alterations of genomes of African American (AA) prostate cancer (CaP) patients are significantly different from that of Caucasian American (CA) men. Recent studies from our and other groups have established that frequencies of the most common genomic alteration, TMPRSS2-ERG fusion, which apparently causes the high expression of ERG oncoprotein, is markedly lower in AA than in CA patients. Some works indicated that the frequency of CaP ERG fusion is the lowest in Asian patients, but this frequency changed from 11% to 78% in different Asian cohorts. Further analysis in Asian men is necessary. In order to systematically and comprehensively address this and related problems, Uniformed Services University of the Health Sciences-Center for Prostate Disease Research (CPDR), the US National Cancer Institute (NCI) and CAS-MPG Partner Institute for Computational Biology (PICB), Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), China, launched an international collaboration project. The overall goal of the project is to evaluate difference of driver gene mutations of prostate cancer in various ethnic groups by integrating genomic and transcriptomic data from CPDR, TCGA and the Chinese Prostate Cancer Consortium (CPCC), specially focusing on somatic alterations (ERG and others), microbiome, mitochondrial sequences and microRNAs. We integrated gene fusion, copy number, and gene expression data to detect potential driver genes and, as anticipated ERG alteration was one of the most commonly detected. The frequency of ERG fusion is the highest for CA, intermediate for AA and the lowest for Asian men, while its expression is significantly higher in ERG-fusion tumors than other tumors cross over all of the three ethnic groups. We did find some genes altered more frequently in Asian patients than in American patients, subject to further validations. We explored the methodology for microbiota profiling using prostate cancer WGS sequencing data. To this date, we have developed an analysis pipeline for the detection of microbiome from prostate tumor tissues and the corresponding blood samples with high confidence but inadequate sensitivity likely due to the low availability of both microbial sequences and bacterial reference genomes. Our preliminary analyses highlight the potential of international collaboration. CPDR-PICB-NCI will work on a seamless approach for data integration, particularly of the raw data to truly enhance CaP diagnosis and treatment by providing more informative biomarker and therapy targets relevant to ethnically diverse patient populations. Citation Format: Qingyu Xiao, Yidi Sun, Hong Li, Yixue Li, Guo-Ping Zhao, Wendy Wang, Sudhir Srivastava. Collaborative analyses for delineating mutation variations among different ethnic patients of prostate cancer based on genomic data integration [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5550. doi:10.1158/1538-7445.AM2017-5550

Predictors of post-surgical race-specific prostate cancer progression.

5048 Background: Disparity in prostate cancer (CaP) incidence and mortality for African American (AA) versus Caucasian American (CA) men may reflect tumor biology, comorbidity, treatment, follow-up care, and/or health care access. In a racially diverse cohort of patients undergoing radical prostatectomy (RP), this study examined how race, comorbidity, and PSA doubling time (PSADT) impact CaP progression. Methods: Enrollees in the Center for Prostate Disease Research (CPDR) Multi-Center National Database from 1989-2014 who underwent RP within 12 months of CaP diagnosis were eligible. Biochemical recurrence (BCR) was defined as PSA ≥0.2 ng/mL post-RP. Comorbid conditions included coronary artery disease (CAD), cerebral vascular incident (CVI), Type II diabetes (DB), hypertension (HT), elevated cholesterol (EC), lung disease (COPD), prostatitis (PS), renal insufficiency (RI) and other cancer (OC). Multivariable Cox proportional hazards (PH) analysis was used to examine comorbid conditions (yes vs. no) and PSADT ( &lt; 3, 3-8.9, 9-14.9, and ≥15 mos) to predict BCR, controlling for age at RP, D’Amico risk stratum, pathology features, and adjuvant treatment. Results: A total of 6,785 patients were eligible; 22% AA and 78% CA. Median age and follow-up was 62 and 6.1 years, respectively. Across race, comparable median follow-up time, distributions of pathologic features and adjuvant treatments were observed. However, AA vs. CA patients had greater HT (53 vs. 39% p &lt; 0.0001), DB (17 vs. 7%, p &lt; 0.0001), and RI (3 vs. 1%, p = 0.002). Alternatively, CA vs. AA patients had greater CVD (10 vs. 7%, p = 0.0008) and OC (3 vs. 0.5%, p &lt; 0.0001). Cox PH analysis showed poorer BCR-free survival for AA vs. CA men (HR = 1.28, CI = 1.11, 1.48, p = 0.0009) adjusting for D’Amico risk stratum, pathology, and treatment. PSADT, not comorbidity, was a critical predictor of BCR, with poorest outcome at extremes: HR PSADT &lt; 3 vs. &gt; = 15 months = 41.5, CI = 33.6, 51.3, p &lt; 0.0001). Conclusions: Despite comparable health care access and distribution in clinical risk stratum and pathology features, race persisted in predicting poor CaP outcome. Disparate comorbidity for AA and CA men did not eliminate this difference. PSADT remained the most striking determinant of poor BCR-free survival.

History of PSA screening on prostate cancer aggressiveness.

5066 Background: In 2012, PSA screening for prostate cancer (CaP) detection was given a “Grade D” recommendation for all men by the USPSTF. Recent U.S. studies report declines in PSA screening with concomitant increases in advanced CaP at diagnosis. This study examined the association between PSA screening history and CaP aggressiveness in a racially diverse, military cohort with equal health care access. Methods: This retrospective cohort study evaluated CaP patients undergoing radical prostatectomy (RP) from 1994-2015 at Walter Reed National Military Medical Center. Whole-mounted prostatectomy specimens were classified using 2014 ISUP Gleason grading system. Excluding the diagnostic PSA, screening history was categorized as: ≥ 6 PSA’s prior to CaP diagnosis (uppermost quartile), 1-5 (lower 3 quartiles), vs. no screening history. Multivariable logistic regression (MLR) was used to examine NCCN risk stratum (intermediate-high vs. low) and Gleason upgrade (GU) from biopsy to RP. Multivariable Cox proportional hazards (Cox PH) analyses were used to model time to biochemical recurrence (BCR). Multivariable models controlled for age at RP, race, family history and obesity (BMI &gt; 30 vs. ≤ 30 kg/m2). The GU and BCR models also controlled for NCCN risk classification. Results: There were 1,772 eligible patients with a median follow-up and age at RP of 7.0 and 59.8 years, respectively. Prior to CaP diagnosis, 42% and 19% of men had 1-5 and ≥ 6 PSA’s screenings, respectively. MLR showed greater odds of intermediate or high vs. low risk disease for PSA screening history of none vs. 1-5 (OR = 1.33, CI = 1.03-1.70, p = 0.028) but not for none vs. ≥ 6 (p = 0.44). MLR showed increased odds of GU for none vs. ≥ 6 (OR = 1.81, CI = 1.23-2.7, p &lt; 0.001). Multivariable Cox PH models showed incrementally poorer BCR-free survival as screening history decreased (HRNone vs. ≥6 = 2.27, CI = 1.54-3.33, p &lt; 0.001; HRNone vs. 1-5= 1.49, CI = 1.15-1.92, p = 0.002). Conclusions: In this RP cohort, higher risk stratum, increased GU, and poorer BCR-free survival were associated with no PSA screening history. BCR-free survival was incrementally worsened by less PSA screening. A complete absence of PSA screening may lead to more aggressive disease at presentation and poorer clinical outcomes.

Clinical Presentation and Bacterial Etiology of Adult Community Acquired Pneumonia

Introduction: Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. According to recent WHO data, each year 3-4 million patients die from pneumonia. The clinical presentations and bacterial agents responsible for community acquired pneumonia (CAP) varies according to geography and culture.Methods: A cross sectional observational study conducted among the 53 consecutive patients with a clinical diagnosis of CAP in admitted patient in the department of Medicine, DMCH, during January 2010 to December 2010. Hematological measurements (TC of WBC, Hb%, ESR, platelet count), blood culture, chest X-ray P/A view, sputum for Gram staining and culture sensitivity, sputum for AFB, blood urea and random blood sugar were done in all cases. ELISA for IgM antibody of Mycoplasma pneumoniae and Chlamydia pneumoniae were done in sputum culture negative cases.Results: The mean (±SD) age was 38.9±17.3 years and Male female ratio was 3:1. Fever, chest pain and productive cough were the most common clinical features. The mean (±SD) respiratory rate was 23.0±2.8 /minute . COPD and DM were found in 17.0% and 5.7% of patients respectively . Blood culture was found positive in only 1.9% of the study patients. Gram positive Cocci 62.26%, Gram negative Bacilli 9.43%, mixed Gram positive cocci and Gram negative bacilli 11.32% and Gram negative Cocco Bacilli 1.9% were observed and in 15.03 % cases, no bacteria could be seen. Sputum culture revealed 53.8% streptococcus pneumoniae, 26.9% Klebsiella pneumonia as predominant organism. Mycoplasma pneumoniae and Chlamydia pneumoniae were found in 7.4% and 3.7% respectively by serological test. For Streptococcus pneumoniae, sensitive antibiotics were Amoxyclav and Levofloxacin. For Gram negative bacilli and coccobacilli, more sensitive antibiotics were Meropenem, Ceftriaxone, and Clarithromycin. The best sensitive drug were found meropenem. The mean (±SD) duration of hospital stay was 5.0±1.7 days with ranging from 3 to 10 days.Conclusion: Region based bacteroiological diagnosis of Cap is important for selecting the best and sensitive drugs for complete cure.J Bangladesh Coll Phys Surg 2016; 34(3): 128-134

Diagnostic significance of urinary long non-coding PCA3 RNA in prostate cancer.

Prostate cancer antigen 3(PCA3) is a long non-coding RNA, which was found increased expression in CaP patients than healthy individual. In this study, the individual nucleic acid of PCA3 and PSA was recombinant expressed as a reference reagent, and a quantitative RT-PCR with TaqMan assay was developed to examine the copies of PCA3 and PSA gene in urine. The results showed that the area under the receiver operating characteristic curve (AUROC) was 0.717, 0.444 and 0.916 for the number of PCA3 copy, PSA copy and for the score of PCA3/PSA RNA, respectively. Additionally, the AUROC for serum tPSA was 0.674 with a low specificity of 12.07%. Finally, the algorithm of PCA3 RNA versus PSA RNA was evaluated and corroborated as CaP biomarker by conducting a multicentric clinical trial. This study not only validated the developed technique of qRT-PCR with TaqMan assay for examination of urinary PCA3 and PSA RNA, it also demonstrated that the score of the PCA/PSA RNA was a reliable signature for CaP diagnosis.

MP08-09 POPULATION-LEVEL CANCER DETECTION AND PATTERNS OF CARE FOLLOWING MRI-GUIDED PROSTATE BIOPSY

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 2017MP08-09 POPULATION-LEVEL CANCER DETECTION AND PATTERNS OF CARE FOLLOWING MRI-GUIDED PROSTATE BIOPSY Wen Liu, Dattatraya Patil, David Howard, Renee Moore, Heqiong Wang, Martin Sanda, and Christopher Filson Wen LiuWen Liu More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , David HowardDavid Howard More articles by this author , Renee MooreRenee Moore More articles by this author , Heqiong WangHeqiong Wang More articles by this author , Martin SandaMartin Sanda More articles by this author , and Christopher FilsonChristopher Filson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.296AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use and outcomes of MRI-guided prostate biopsy (MRI-Bx) have not been broadly characterized in a nationwide community setting. We evaluated CaP detection rates across Bx types and evaluated subsequent care patterns at a population-level among men covered by private health insurance. METHODS Using MarketScan Commercial Claims data (2009-2013), we identified men who underwent Bx without prior CaP diagnosis/treatment. We assigned approach (MRI-Bx vs TRUS-Bx vs transperineal (TP-Bx)) using CPT codes for Bx and pelvic MRI. We assigned MRI-guidance if MRI performed ≤3 months before Bx. Primary outcome was new CaP diagnosis (i.e., ICD-9 185.0). Other outcomes included treatment (yes/no) and treatment type (prostatectomy (RP) vs radiation (RT)) Multivariable logistic regression adjusted for patient and geographic covariates to estimate odds of these outcomes. RESULTS We identified 210,894 men who underwent 1+ Bx (MRI-Bx n=1,378; TRUS-Bx n=208,776, TP-Bx n=740). The mean age of this cohort was 57 years (standard deviation 5 years). Overall, a new CaP diagnosis was most common after TRUS-Bx (36.4%) versus MRI-Bx (28.9%) and TP-Bx (29.3%) (p<0.001). Patients with prior negative Bx were less likely to have a new CaP diagnosis (20.5% vs 37.7% Bx-naive, p<0.001). Patients with prior negative Bx who underwent MRI-Bx were not more likely to be diagnosed with CaP (OR 1.12 vs TRUS-Bx, 95% CI 0.88-1.43) (Figure). Among Bx-naive men, MRI-Bx was associated with a lower odds of CaP detection (OR 0.81 vs TRUS-Bx, 95% CI 0.71-0.93). Patients managed with MRI-Bx and diagnosed with CaP were less likely to receive treatment (OR 0.77, 95% CI 0.62-0.98). There is no association between Bx approach and type of treatment (OR 1.19 RP vs RT, 95% CI 0.90-1.58). CONCLUSIONS During initial adoption, use of MRI-Bx was not associated with significantly increased CaP detection among men with prior negative Bx. Furthermore, patients receiving MRI-Bx were less likely to then have treatment for PCa. These findings merit further investigation, taking tumor and provider factors, including operator experience, into account. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e93-e94 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Wen Liu More articles by this author Dattatraya Patil More articles by this author David Howard More articles by this author Renee Moore More articles by this author Heqiong Wang More articles by this author Martin Sanda More articles by this author Christopher Filson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD47-03 FAMILY HISTORY AND INCREASED RISK OF CLINICALLY SIGNIFICANT PROSTATE CANCER IN THE PLCO CANCER SCREENING TRIAL

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History III1 Apr 2017PD47-03 FAMILY HISTORY AND INCREASED RISK OF CLINICALLY SIGNIFICANT PROSTATE CANCER IN THE PLCO CANCER SCREENING TRIAL Adrien Bernstein, Ron Golan, Jonathan Shoag, Brian Dinerman, and Jim C. Hu Adrien BernsteinAdrien Bernstein More articles by this author , Ron GolanRon Golan More articles by this author , Jonathan ShoagJonathan Shoag More articles by this author , Brian DinermanBrian Dinerman More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2363AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A family history (FH) of prostate cancer (CaP) is associated with an increased risk of CaP. However, it remains unclear how this association impacts the need for screening. The aim of this study is to evaluate the impact of FH of the diagnosis of clinically significant CaP in a large national cohort. METHODS The study included 73,045 men from the control and screening arms of the Prostate Lung Colorectal and Ovarian (PLCO) trial, which had complete information regarding FH and CaP diagnosis. Incidence of clinically significant cancer (CS; intermediate or high risk disease) was compared by FH. The relationship between number of relatives diagnosed and age at CaP diagnosis was evaluated. Multivariable logistic regression was used to estimate odds rato (OR) and 95% confidence intervals (CI). RESULTS FH was associated with a significantly increased risk of both CaP [OR 1.6, (95% CI 1.5-1.8)] and CS-CaP [OR 1.7 (95% CI 1.5-1.8), respectively]. Furthermore, the impact of FH on CS-CaP increased with the number of family members with CaP; for participants with one relative, the OR was 1.6 (95% CI 1.5-1.8); for those with multiple relatives, the OR increased to 2.2 (95% CI 1.6-3.2). Men with younger relatives with prostate cancer (< 65 vs ≥65 years) were more likely to be diagnosed with CS-CaP, [OR 1.6, (95%CI 1.3-2.0)]. FH, number of affected relatives and age of relatives remained significant on multivariable analysis controlling for ages, race, smoking history, history of BPH, marital status employment status and study arm. CONCLUSIONS Detailed FH, including the number of relatives and relatives′ age of at diagnosis significantly affect a man′s risk of CS-CaP and should be taken into consideration during individualized counseling about the frequency and intensity of screening. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e897 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Adrien Bernstein More articles by this author Ron Golan More articles by this author Jonathan Shoag More articles by this author Brian Dinerman More articles by this author Jim C. Hu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A novel biochemical marker for community-acquired pneumonia: Ischemia-modified albumin

IntroductionCommunity-acquired pneumonia (CAP) is a frequent cause of hospitalization and a leading cause of mortality worldwide. Early diagnosis and the initiation of appropriate antibiotic therapy are essential to reduce pneumonia-related morbidity and mortality. CRP is a well-established biomarker in many clinical settings, but has been traditionally considered not specific enough to be a useful guide in the diagnostic process of pneumonia. There is still a need for more specific and practical markers in CAP for diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of CAP in the Emergency Department. MethodsThe study included 81 patients admitted with CAP and 81 control patients. Initial hour levels of IMA and CRP were measured. The IMA mean levels were compared between the study and control group. Correlation analyses were performed to investigate the association of serum IMA levels with CRP. ResultsMean levels of IMA were 0.532±0.117IU/ml in the study group and 0.345±0.082IU/ml in the control group. IMA levels were significantly higher in the study group compared to the control group. The IMA level of 0.442IU/ml had sensitivity of 75.3% and specificity of 91.3% and was positively correlated with CRP levels (r=0.506; p<0.05). ConclusionBlood IMA levels significantly increase in adult patients presenting with CAP. IMA may be considered as a novel biomarker in the diagnosis of CAP.

Prostate cancer outcomes for African American and caucasian patients undergoing radical prostatectomy.

40 Background: A disproportionate burden of prostate cancer (CaP) incidence and mortality is observed for African American (AA) versus Caucasian (CA) patients in the US. Potential underlying reasons for racial disparity include biology, comorbidity profiles, access to health care, adherence to follow-up care and/or treatment aggressiveness. This study examined CaP progression and overall survival (OS) among AA and CA patients undergoing radical prostatectomy (RP). Methods: This retrospective cohort study examined men enrolled in the Center for Prostate Disease Research (CPDR) Multi-Center National Database between January 1, 1990 and December 31, 2014. Patients with biopsy-detected CaP without metastasis and treated with RP within 12 months of CaP diagnosis were eligible. Biochemical recurrence (BCR) was defined as a PSA value of &gt; = 0.4 ng/mL followed by a subsequent increase. PSADT was categorized as &lt; 3, 3-8.99, 9-14.99, and &gt; = 15 months. Kaplan-Meier estimation curves and multivariable Cox proportional hazards analysis were used to examine BCR and OS. Results: A total of 6,785 patients were eligible; 21.5% self-reported as AA and 78.5% self-reported as CA. Median follow-up time was 6.1 years. Comparable distributions of pathologic features at RP and adjuvant treatment over time were observed across race but several comorbid conditions were more common in AA patients including cardiovascular disease, hypertension, diabetes, and other cancer types. In race-specific unadjusted Kaplan Meier analyses, PSADT was an important predictor of BCR and OS for both AA and CA patients (Log rank p &lt; 0.0001 for all KM models). In multivariable analysis, a greater odds of BCR over time was observed for AA versus CA patients (HR = 1.28, CI = 1.11, 1.48, p = 0.0009) after adjustment for D’Amico risk stratum, comorbidity, pathological features, and PSADT. PSADT was a critical predictor of BCR, with worst outcomes at extreme comparison of PSADT categories: HR &lt; 3 vs. &gt; = 15 months= 41.5, CI = 33.6, 51.3, p &lt; 0.0001). Conclusions: In a large racially diverse, longitudinal cohort with equal health care access, there was a striking relationship between PSADT and time to BCR for each racial group and poorer outcomes for AA versus CA patients.

Association of endothelin-1 gene single-nucleotide polymorphisms and haplotypes with risk of hormone refractory prostate cancer.

Androgen deprivation is often the treatment of choice for patients with a new diagnosis of metastatic or locally advanced prostate cancer (CaP). However, most CaP patients showing a first response to androgen deprivation will progress to a hormone refractory phase of the disease (HRPC) with a much poorer prognosis. Accumulating evidence suggests that endothelin-1 (ET-1) plays an important role in CaP progression. Singlenucleotide polymorphisms (SNPs) of the ET-1 gene reportedly have been associated with cancer progression and chemoresistance. In the present study, we explored the association of SNPs and haplotypes of the ET-1 gene with the risk of HRPC. We genotyped three SNPs (rs1800541, rs2070699 and rs5370) in the ET-1 gene in a case-control study; 234 CaP patients who developed HRPC within six years after androgen deprivation therapy was used as HRPC cases, and 234 age- and primary therapy-matched CaP patients who had not developed HRPC within six years after androgen deprivation therapy were used as non-HRPC controls. Our results revealed that the G allele at rs1800541 and the G allele at rs2070699 were respectively associated with reduced and increased risk of HRPC at borderline statistical significance (p=0.047 and p=0.058, respectively). With adjustment for potential confounders including body mass index, initial Gleason score at diagnosis of CaP, and post-treatment nadir serum PSA level, we found that rs1800541-rs2070699 TG haplotype was significantly associated with increased risk of HRPC (p=0.033; adjusted OR, 2.10; 95% CI, 1.37-5.04). In conclusion, this study provides the first evidence that a 2-SNP haplotype of the ET-1 gene is associated with increased risk of HRPC, which adds new insights into early identification of CaP patients who are likely to develop HRPC in a later stage of the disease.

Autoantibodies against oncogenic ERG protein in prostate cancer: potential use in diagnosis and prognosis in a panel with C-MYC, AMACR and HERV-K Gag.

Overdiagnosis and overtreatment of prostate cancer (CaP) is attributable to widespread reliance on PSA screening in the US. This has prompted us and others to search for improved biomarkers for CaP, to facilitate early detection and disease stratification. In this regard, autoantibodies (AAbs) against tumor antigens could serve as potential candidates for diagnosis and prognosis of CaP. Towards this, our goals were: i) To investigate whether AAbs against ERG oncoprotein (overexpressed in 25-50% of Caucasian American and African American CaP) are present in the sera of CaP patients; ii) To evaluate an AAb panel to enhance CaP detection. The results using an enzyme-linked immunosorbent assay (ELISA) showed that anti-ERG AAbs are present in a significantly higher proportion in the sera of CaP patients compared to healthy controls (p = 0.0001). Furthermore, a panel of AAbs against ERG, AMACR and human endogenous retrovirus-K Gag successfully differentiated CaP patient sera from healthy controls (AUC = 0.791). These results demonstrate for the first time that anti-ERG AAbs are present in the sera of CaP patients. In addition, the data also suggest that AAbs against ERG together with AMACR and HERV-K Gag may be a useful panel of biomarkers for diagnosis and prognosis of CaP.

Anatomical Visions of Prostate Cancer in Different Modalities

Objectives: Prostate cancer (CaP) is the second utmost diagnosed cancer among aged men all over the world. CaP contributes as a main health issue for men, posing a challenge to oncologists, urologists, and radiologists for diagnosis purpose. Methods: There are several ways to delineate the prostate capsule using different imaging modalities, which act as one of the vital step for development of Computer Aided Diagnosis (CAD) system. Findings: In order to assist novice researchers for CaP diagnosis, this paper presents the general working theme of CAD system and highlights the different classes of existing prostate segmentation techniques. In order to study different cancerous or non-cancerous anatomical views of CaP in different modalities, the key role of this paper is to fill the gap between the actual CaP view and beginner perception about CaP Region of Interest (ROI). Application/Improvement: Various research gaps that are current open challenges for competent and effective development of Computer Aided Diagnosis (CAD) system for CaP are also a part of this paper.