Diagnostic Criteria In Patients Research Articles

Low handgrip strength as a marker of severity in the diagnostic criteria for cancer cachexia

Background & AimsThe diagnostic criteria for cachexia, as proposed by the Asian Working Group for Cachexia (AWGC), include weight loss, a low body mass index, and additional factors such as a low handgrip strength (HGS), anorexia, or elevated CRP levels. This study aimed to evaluate the significance of low HGS as a diagnostic criterion in patients with advanced cancer. MethodsThis single-centre, retrospective cohort study was conducted between April 2019 and March 2023. Patients aged ≥18 years with malignant diseases were included. Patients without records on HGS were excluded. Low HGS was defined as a HGS <28 kg for men and <18 kg for women. The overall median survival time (MST) was analysed by univariate and multivariate analyses. ResultsA total of 894 patients were analysed. Cachexia was prevalent in 74%, though only 3.4% were diagnosed based solely on low HGS. The MST in patients with cachexia was 122 days, and in those with low HGS was 73 days. The associations between low HGS and high mortality remained significant after adjusting for AWGC criteria, modified weight loss grading system, age, gender, performance status, calf circumferenceand fluid retention. The MST varied with the number of additional factors being met: 422 days for one criterion, 92 days for two, and 55 days for all three (p <0.0001). ConclusionThis study supports that HGS serve as important prognostic tool in patients with various cancers.

Assessment of international MOGAD diagnostic criteria in patients with overlapping MOG-associated disease and multiple sclerosis phenotypes.

The clinical spectrum and diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has evolved in the setting of an optimized anti-MOG-IgG cell-based assay and expert consensus. The McDonald criteria for MS have been revised multiple times to improve the accuracy and specificity of diagnosis on a framework based on clinical presentation, MRI findings, and CSF results. While the uses of MS and MOGAD diagnostic criteria are helpful for typical cases, such utility for patients with overlapping clinical, laboratorial, and imaging features is unknown, posing diagnostic and management uncertainties. To report a multicenter cohort of patients with overlapping phenotypic features of MOGAD and MS and evaluate the application of new MOGAD diagnostic criteria. A collaborative retrospective cohort study was performed to identify patients with both positive serum anti-MOG-IgG and fulfillment of the MS revised 2017 McDonald criteria. Clinical and radiographic features of patients fulfilling inclusion criteria were reviewed longitudinally, including relapses, repeated MRI, and MOG-IgG testing in detail to allow the panel of expert opinion to assign to each case. The International MOGAD Panel proposed criteria were applied at onset and last follow-up to each case and compared to the expert author diagnosis assignment based on presentation, clinical and imaging features, and response to treatment. Ten of 225 (4%) MOG-IgG seropositive cases met study inclusion criteria [seven of 10 were female; age at initial event: eight adults (mean age 26.8years), two adolescents (mean age 14.5years)]. AQP4-IgG was negative for all. Apart from serum titers of MOG-IgG, distinguishing clinical and radiographic features [i.e., clinical severity of the initial demyelinating event, radiographic features (optic nerve/spine/brain), and presence/absence of lesion normalization on serial scans] led to consensus of three separate classifications differing by degrees of shared features of MOGAD and MS. Patients were classified by expert panel into (1) Classic MOGAD even with MS-like, well-defined brain lesions, when severe events and most T2 lesions normalized (n = 5; MOG-IgG titers 1:100, 1:20, 1:160, 1:40, 1:200); (2) Classic RRMS included cases thought to have likely false positive or clinically irrelevant MOG-IgG, due to mild clinical events and no radiographic normalization of well-defined MS-like lesions (n = 3; MOG titers 1:20, 1:100, 1:40); (3) MOGAD and MS overlapping phenotype was defined by those with a combination of mild and severe clinical events, partial T2 lesion normalization, both well- and ill-defined lesions (n = 2; MOG titers 1:20, 1:100). The application of the International MOGAD Panel criteria categorized five patients (50%) in agreement with expert assignment. One additional patient was classified in agreement to assignment when MOGAD criteria were applied after serial MOG-IgG titers testing. While the International MOGAD Panel diagnostic criteria have helped with accuracy for the diagnosis of this condition, in a group of patients seropositive for MOG-IgG with overlapping clinical and imaging features of RRMS criteria review may lead to increased accuracy. Serial serologies, repeated imaging, close attention to clinical course, and response to therapy are possible variables to consider for further refinement of MOGAD diagnostic criteria.

Applying the 2022 optic neuritis criteria to noninflammatory optic neuropathies with optic nerve T2-hyperintensity: an observational study.

Recent diagnostic criteria for optic neuritis include T2-hyperintensity of the optic nerve (ON), even without associated contrast enhancement. However, isolated ON-T2-hyperintensity is a nonspecific finding found in any optic neuropathy or severe retinopathy. We applied the 2022 optic neuritis diagnostic criteria to a cohort of patients with noninflammatory optic neuropathy and ON-T2-hyperintensity in at least one eye, to assess the rate of optic neuritis misdiagnosis using these criteria. Retrospective study of consecutive patients who underwent brain/orbit MRI with/without contrast between 07/01/2019 and 06/30/2022. Patients with ON-T2-hyperintensity in at least one eye were included. The 2022 optic neuritis diagnostic criteria were applied to patients with noninflammatory optic neuropathies who had an ophthalmologic examination available for review. Of 150 patients included, 85/150 had compressive optic neuropathy; 32/150 had glaucoma; 12/150 had papilledema; 8/150 had hereditary (3), radiation-induced (3), nutritional (1), traumatic (1) optic neuropathies (none fulfilled the criteria); 13/150 had ischemic optic neuropathy and 4 fulfilled the criteria as definite optic neuritis due to contrast enhancement of the ON head. Seven additional patients would have satisfied the diagnostic criteria if red flags for alternative diagnoses had been overlooked. The application of the 2022 optic neuritis diagnostic criteria in patients with noninflammatory optic neuropathy and ON-T2-hyperintensity in at least one ON resulted in misdiagnosis of optic neuritis in only 4 patients because of ON head enhancement, all with nonarteritic anterior ischemic optic neuropathy. Neuro-ophthalmologic evaluation and exclusion of the ON head as a location in the MRI criteria would have prevented optic neuritis misdiagnosis in our study.

Human autoantibodies neutralizing type I IFNs: From 1981 to 2023.

Human autoantibodies (auto-Abs) neutralizing type I IFNs were first discovered in a woman with disseminated shingles and were described by Ion Gresser from 1981 to 1984. They have since been found in patients with diverse conditions and are even used as a diagnostic criterion in patients with autoimmune polyendocrinopathy syndrome type 1 (APS-1). However, their apparent lack of association with viral diseases, including shingles, led to wide acceptance of the conclusion that they had no pathological consequences. This perception began to change in 2020, when they were found to underlie about 15% of cases of critical COVID-19 pneumonia. They have since been shown to underlie other severe viral diseases, including 5%, 20%, and 40% of cases of critical influenza pneumonia, critical MERS pneumonia, and West Nile virus encephalitis, respectively. They also seem to be associated with shingles in various settings. These auto-Abs are present in all age groups of the general population, but their frequency increases with age to reach at least 5% in the elderly. We estimate that at least 100 million people worldwide carry auto-Abs neutralizing type I IFNs. Here, we briefly review the history of the study of these auto-Abs, focusing particularly on their known causes and consequences.

Ultrasound and magnetic resonance imaging neurography assessment of diagnostic criteria in patients with carpal tunnel syndrome using electrophysiological tests as gold standard: A prospective study.

Evaluating peripheral neuropathy mainly relies on physical examination, patient history, and electrophysiological studies. High-resolution ultrasound is a fast, noninvasive modality for dynamic nerve assessment that enables the length of the nerve to be examined. Magnetic resonance imaging is preferred for examining deeper nerves with a high contrast resolution; its use shows excellent benefit in patients with atypical presentation, equivocal diagnosis, suspected secondary causes, and postsurgical relapse. We aimed to assess the measurements and criteria for both ultrasound and magnetic resonance neurography for the diagnosis of carpal tunnel syndrome, based mainly on the three measurements assessed by Buchberger et al. This prospective study was conducted to test diagnostic accuracy. Thirty-two patients who presented clinically with, and were diagnosed by electrophysiological tests as having, carpal tunnel syndrome participated. Superficial ultrasound of the wrist joint was performed on all participants, followed by magnetic resonance imaging within 1 week of ultrasonography. The three main parameters of cross-sectional area measurement, distal nerve flattening, and flexor retinaculum bowing indices showed positive occurrences of 93.7%, 59.4%, and 59.4%, respectively; 90.6% of patients had decreased nerve echotexture. The diagnostic ability of magnetic resonance imaging was decreased when cross-sectional area measurements were used: positive results were achieved in 81.2% of patients, but the positive results showing the distal tunnel nerve increased flattening and bowed flexor retinaculum slightly decreased to 56.2% for each. A high T2 signal of the median nerve was observed in 90.6% of patients. In an agreement analysis, we found a statistically significant difference that supported the use of ultrasound as a primary diagnostic modality for carpal tunnel syndrome. However, magnetic resonance imaging improved tissue characterization and was a good diagnostic modality, with a statistically significant difference, for cases of secondary carpal tunnel syndrome, detection of the underlying entrapping cause, and early abnormality detection in the innervated muscle. Our results demonstrate that ultrasound examination can be used as the first imaging modality after physician evaluation, with results comparable to those of electrophysiological studies for evaluating carpal tunnel syndrome and determining its cause. Magnetic resonance neurography examination is the second step in detecting secondary causes in cases with suspected early muscle denervation changes that cannot be elicited by ultrasound or in cases with equivocal results.

Биомеханические свойства роговицы в норме и при прогрессирующем кератоконусе

A prospective study of corneal stiffness parameter of 173 eyes of 173 healthy subjects with different refractions as well as 41 eyes with keratoconus was carried out. The study groups were comparable in age and gender composition. Correlation was performed between corneal stiffness parameter (Stiffness Parameter (SP-A1), minimum corneal thickness (MCT) and biomechanically compensated intraocular pressure (bIOP) determined using Pentacam HR and Corvis ST (OCULUS, Germany), as well as the anteroposterior chamber (APC) value and patient age. Based on multivariate regression analysis, the correlation between corneal stiffness index SPA1, minimum corneal thickness (MCT) and biomechanically compensated IOP (bIOP) in healthy subjects (p = 0.00001, p = 0.005, respectively) as well as in patients with keratoconus (p = 0.00000, p = 0.0032, respectively) was established. Using the obtained data, the tables for determination of corneal stiffness in healthy subjects and patients with different stages of keratoconus, depending on the minimal thickness and level of biomechanically compensated intraocular pressure, were compiled. Application of the tables will allow in practical work to quickly analyze corneal stiffness index which can be used as an important diagnostic criterion in patients with keratectasia. Keywords: corneal stiffness index, biomechanically compensated intraocular pressure, correlation dependence.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as new possible minor criteria for diagnosis of polycythemia vera.

The role of inflammation in the pathophysiology of polycythemia vera (PV) is important. The presence of JAK2 mutations is important in the diagnosis of PV, and serum levels of erythropoietin (EPO) also play a supporting role. However, serum EPO levels show some limitations. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are a readily available marker of inflammation. Thus, we examined whether NLR & PLR might diagnose PV in erythrocytosis patients. We compared NLR & PLR and EPO diagnostic values. We retrospectively reviewed clinical and laboratory data from two referral hospitals. Two hundred and eighty-five patients with erythrocytosis who underwent a test for the JAK2 mutation were included. It wac classified as the PV group and the secondary polycythemia (SP) group. The median NLR & PLR in the PV group (n = 70) was significantly higher than that in the SP group (n = 170) (NLR: 6.04 vs. 1.77, PLR: 283.18 vs. 101.56, respectively, p < 0.001). In the receiver operating characteristic analysis, the area under the curve of NLR & PLR was significantly higher than that of serum EPO (NLR vs EPO: 0.921 vs. 0.827, p = 0.003; PLR vs EPO: 0.917 vs 0.827, p = 0.003). In conclusion, NLR & PLR were higher in PV than in SP and showed better diagnostic value than serum EPO level, highlighting their potential as minor diagnostic criteria in patients with PV.

The influence of different factors on corneal biomechanical properties in norm and in progressive keratoconus

A prospective study of corneal stiffness parameter of 174 eyes of 174 healthy subjects with different refractions as well as 56 eyes with keratoconus was carried out. The study groups were comparable in age and gender composition. Correlation was performed between corneal stiffness parameter (Stiffness Parameter (SP-A1), minimum corneal thickness (MCT) and biomechanically compensated intraocular pressure (bIOP) determined using Pentacam HR and Corvis ST (OCULUS, Germany), as well as the anteroposterior chamber (APC) value and patient age. Based on multivariate regression analysis, the correlation between corneal stiffness index SPA1, minimum corneal thickness (MCT) and biomechanically compensated IOP (bIOP) in healthy subjects (p = 0.00001, p = 0.005, respectively) as well as in patients with keratoconus (p = 0.00000, p = 0.0032, respectively) was established. Using the obtained data, the tables for determination of corneal stiffness in healthy subjects and patients with different stages of keratoconus, depending on the minimal thickness and level of biomechanically compensated intraocular pressure, were compiled. Application of the tables will allow in practical work to quickly analyze corneal stiffness index which can be used as an important diagnostic criterion in patients with keratectasia.

Evaluation of Sepsis-1 and Sepsis-3 Diagnostic Criteria in Patients with Sepsis in Intensive Care Unit.

The use of SIRS and SOFA criteria in diagnosing sepsis among patients has been characterized by increasingly growing criticism. Indeed, the definition of sepsis has attracted significant controversy in history across medical and academic realms. The study used the Medical Information Mart for Intensive Care-III (MIMIC-III) database in assessing the effectiveness of the SIRS and SOFA diagnostic criteria. It ascertained the severity and specificity of sepsis infection in ICU patients. The Medical Information Mart for Intensive Care-III (MIMIC-III) database was established by the Beth Israel Deaconess Medical Center (BIDMC) and MIT's Computational Physiology Laboratory. The database is a voluminous single-center database containing information pertaining to 38,000 adults who were admitted to the BIDMC in the 11 years leading up to 2012. The identification of patients with sepsis was conducted using the International Classification of Diseases (ICD-10-CM) diagnosis codes. The analysis of data for this study was based on the chi-square test, which is significant in comparing the specificity, mortality, and sensitivity of the data. The process of screening the MIMIC-III database resulted in the identification of 21,368 patients with infections from the hospital admissions in the database. The results also indicate a significantly higher mortality rate within 28 days of admission in sepsis-3 patients compared with sepsis-1. In this experiment, we limited the study period to 28 days to restrict the potential of mortality caused by other factors. Additionally, we evaluated the clinical factors associated with the sepsis-1 or sepsis-3 and found out similar results in the analysis for sepsis-1 and sepsis-3. The study results also portray numerous challenges in using the sepsis-3 criteria as a diagnostic tool. In particular, the ICD-10-CM diagnosis approach was limiting because it inhibited the measure of uncertainty of infection present at the beginning of the two diagnostic criteria of sepsis-1 and sepsis-3.

Prognostic role of acute myocardial infarction diagnostic criteria in patients presenting with non-ST segment elevation myocardial infarction

Abstract Background The Fourth Universal Definition of Myocardial Infarction (UDMI) defines acute myocardial infarction (AMI) as an acute myocardial injury associated with clinical evidence of acute myocardial ischemia. However, the prognostic role of each single diagnostic criteria has never been explored. Purpose To evaluate the prognostic role of the different diagnostic criteria of AMI according to the Fourth UDMI in patients with non-ST-segment elevation myocardial infarction. Methods We enrolled all consecutive patients with NSTEMI undergoing coronary angiography at our Centre. The admission diagnosis was performed according to the current guidelines criteria, namely the detection of an increase and/or decrease of high-sensitivity cardiac troponin I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischemia, ECG changes (new ST depression or negative T-waves), echocardiographic evidence of new regional wall motion abnormality. Patients with very high-risk NSTEMI were excluded. Patients were then divided into different subgroups according to the combination of diagnostic criteria presented at admission. A composite endpoint of all-cause mortality, re-hospitalization for myocardial reinfarction or heart failure was collected. The predictive value of AMI diagnostic criteria alone and their combination were evaluated using Kaplan-Meier survival curves and subsequent Cox-regression analysis to find independent predictors of major adverse events. Results Our study population consisted of 2791 patients. The mean age was 68.3±13.4 and 31.5% were female. The mean follow-up time was 23.3±14.5 months. Depending on the AMI diagnostic criteria and their combination, patients were divided into three subgroups: 196 patients fulfilling only clinical criteria (group A), 187 with clinical and ECG-graphic criteria (group B) and 829 patients with clinical, ECG-graphic and echo-graphic criteria (group C). Baseline characteristics of the three groups were similar. At two-year follow-up, patients with clinical criteria alone exhibited the best outcome, whereas those with all three criteria fulfilled showed the worse prognosis (14.8% for group A vs 23.6% for group B vs 28.0% for group C; p-value &amp;lt;0.001). In multivariable Cox-regression model, the presence of clinical criteria alone was the independent predictor of better prognosis compared to the other diagnostic criteria combination (HR=0.48; CI 95% 0.31–0.74; p&amp;lt;0.001). Conclusions In non-very high-risk NSTEMI, not all diagnostic criteria have the same prognostic value. In fact, prognosis is significantly more favorable in patients exhibiting only the clinical criteria at admission. We hypothesize that the absence of ECG-graphic and echocardiographic alterations may indirectly indicate smaller infarct sizes that contribute to patients' outcomes. These findings could enhance the current risk stratification in patients admitted with NSTEMI. Funding Acknowledgement Type of funding sources: None.

Prevalence of Castleman's disease in patients suffering from cervical lymphadenopathy.

ObjectivesTo determine the prevalence of Castleman's disease (unicentric/idiopathic multicentric CD) in a retrospective cohort according to the newly defined international diagnostic criteria in patients, who underwent a lymph node removal at a tertiary care university hospital over a period of 10 years.Study designRetrospective chart review.Material and methodsAll Patients with cervical lymphadenopathy coded by ICD‐10‐CM with “I88.9,” “R59.0,” or “D47.Z2” between January 2010 and December 2020 and who underwent a lymph node extirpation were identified. In cases who met the diagnostic criteria for a potential unicentric or idiopathic multicentric CD (iMCD) diagnosis, the lymph node tissue was re‐evaluated by a pathologist.ResultsA total of 714 patients with cervical lymphadenopathy were included into this single‐center retrospective study. After exclusion of patients with diseases that may mimic iMCD and cases for which material to perform histological re‐evaluation was lacking, a subset of 75 patients with “nonspecific lymphadenitis” or “reactive hyperplasia of lymph node” was identified, who underwent a renewed histopathological examination. One case fulfilled both the major and minor criteria of an iMCD diagnosis, and further 15 cases matched the histological criterion of an iMCD diagnosis (one of the two major diagnostic criteria), so that a UCD diagnosis according to the new criteria could be accepted.ConclusionIn this cohort, the subsequent application of the new diagnostic criteria led to further cases of CD (1.9% compared to 0.1% before) being recognized. Although incidence and prevalence of UCD and iMCD are low, clinicians should keep in mind this differential diagnosis as effective therapies are available.Level of Evidence4.

AUTOIMMUNE DISEASES ASSOCIATED WITH SJÖGREN SYNDROME

<h3>Objectives</h3> To discuss the association between other autoimmune diseases (AID) and secondary Sjögren syndrome (SSS). <h3>Study Design</h3> A literature search was performed between 2002 and 2017 using the following databases: PubMed, Bireme, and Google Scholar. <h3>Results</h3> Rheumatoid arthritis is more frequently associated with SSS, so these patients should be followed due to the possibility of developing SSS. SSS pathogenesis is different from other AIDs, once it is not related to the severity of associated AID, but probably to how long it has been present. In 2016, a consensus defined new diagnostic criteria for patients with xerophthalmia and xerostomia, and questions were created to screen for patients needing further exams. A score was also developed. It is not possible to determine the main factor leading to AID manifestation, but each AID is related to specific genes that may change the defense cells' mechanism of action. Treatment is symptom-related and consists of stimulating the production of secretion from the injured glands and using various lubricating agents. <h3>Conclusions</h3> SSS oral manifestations added to the symptoms of other AIDs affect the patient physically and psychologically, so multidisciplinary treatment is essential to warrant a better quality of life.

378 Real-world utilization of Delphi consensus diagnostic criteria for pyoderma gangrenosum referrals

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by chronic, painful ulcerations. PG is challenging to diagnose due to its variable presentation, clinical overlap with other conditions, and the absence of defining markers. Consensus diagnostic criteria have recently been proposed for the clinical diagnosis of PG but remain underutilized. Our objective was to assess the use of published Delphi Consensus (DC) diagnostic criteria in patients with suspected PG, and to evaluate differences in criteria met between true PG and ulcers due to alternate diagnoses.

Management of Iron-Deficiency Anemia on Inpatients and Appropriate Discharge

Introduction: Anaemia is a condition in which the number of red blood cells is insufficient to meet physiologic needs; it is caused by many conditions, particularly iron deficiency. Aims and objectives: The main objective of the study is to analyse the management of iron-deficiency anemia on inpatients and appropriate discharge. Material and methods: This cross sectional study was conducted in DHQ hospital Sheikhupura with the permission of ethical committee of hospital. Data were collected from 100 patients. Participants were selected through randomly sampling technique. Iron deficiency criterion for men was defined as hemoglobin under 13 g/dL, and women under 12 g/dL, with ferritin less than 30 ng/dL for any patient. Diagnostic criteria in patients with congestive heart failure were ferritin below 300 ng/dL and transferrin saturation (TSAT) under 20%. Results: The data was collected from 103 patients. The only factors which emerged as statistically significant from the adjusted logistic regression analysis model were insufficient intakes of iron (OR = 7.39; 95% CI: 1.45-37.57) and vitamin C (OR = 6.14; 95% CI: 1.34-28.27), frequent (≥2 times per week) tea consumption (OR = 0.01; 95% CI: 0.01-0.08), infrequent (≤2 times per week) red meat consumption (OR = 3.71; 95% CI: 1.01-13.61), and the possession of a personal history of IDA (OR = 6.00; 95% CI: 1.45-24.76). Conclusion: It is concluded that Iron-deficiency anemia is also tricky in patients with chronic diseases. Iron supplementation has been shown to help reduce mortality in those with blood loss.

A Survey of the Incidence of Constipation in Patients with Chronic Non-cancer Pain Using Opioid Analgesics in Japan.

IntroductionAlthough opioids have potent analgesic properties, their use is associated with side effects, including opioid-induced constipation (OIC). This study investigated the incidence of OIC based on the Rome IV diagnostic criteria in patients using opioid analgesics for chronic non-cancer pain and to explore and compare the risk factors for the development of OIC in opioid analgesic users.MethodsWe surveyed patients aged 20 years or more living in Japan via the internet; who had been using opioid or non-opioid analgesics (N = 500 each) for at least 3 months for relief from chronic non-cancer musculoskeletal pain (low back pain or osteoarthritis); and who provided electronic consent to participate in and complete the survey. The groups were matched for age and sex.ResultsOf the patients using opioid analgesics, 89% were taking weak opioids. The proportion of patients perceiving constipation was comparable between the opioid and non-opioid analgesic groups (34% vs 29%, respectively); however, a significantly higher proportion of patients in the opioid group, compared to the non-opioid group, reported self-assessed constipation (40% vs 18%, respectively) after using an analgesic and fulfilled two or more symptoms of the Rome IV diagnostic criteria for constipation (28% vs 19%, respectively). A higher proportion of patients were taking prescribed medicine for constipation in the opioid group compared with the non-opioid group (33% vs 18%, respectively). Low back pain, but not opioid strength and scheduled dosing, was identified as a risk factor for OIC among various covariates assessed in the logistic regression analysis in 81 patients with OIC and Rome IV diagnosis vs 419 patients without OIC in the opioid group.ConclusionUse of opioid analgesics, including weak opioids, for treating chronic non-cancer musculoskeletal pain is associated with OIC. This finding highlights the need for appropriate treatment of constipation in patients with chronic non-cancer pain in Japan.Trial RegistrationUMIN000043985.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-022-00392-y.

Preliminary assessment of the possibility of using urokinase uPA and urokinase receptor uPAR as universal diagnostic criteria in patients with colorectal and gastric adenocarcinoma

Background. Lack of universal diagnostic parameters that can accurately and reliably diagnose presence of a malignant neoplasm, anticancer drug effectiveness or metastasis development including dormant ones and also to detect the progression or relapse of the disease at an early stage put on the first place studies related to the identification of such markers. Increased secretion and activity of the urokinase type plasminogen activator (uPA), its receptor (uPAR) accompany many types of malignant neoplasms, contributing their progression and metastasis, as well as the emergence of chemoresistance. So today these proteins are promising diagnostic targets in oncology.&#x0D; Aim. To evaluate the diagnostic significance of the expression levels of uPA and uPAR in blood serum of patients with colorectal and gastric adenocarcinoma and uPA/uPAR distribution in samples obtained from the primary tumor node, to assess the possibility of their use as universal diagnostic indicators in cancer patients at the stage of primary treatment.&#x0D; Materials and methods. The study included patients with colorectal and gastric adenocarcinoma in the amount of 50 people and 25 healthy volunteers. The content of uPA and uPAR in blood serum was assessed by enzyme-linked immunosorbent assay, the level of expression of the studied proteins in tumor tissue was assessed using immunohistochemical staining with antibodies to uPA and uPAR.&#x0D; Results. It was found that in comparison with healthy donors uPA serum concentration was significantly higher in all patients with adenocarcinoma, regardless of gender, and the uPAR content in the blood serum was significantly higher in women. Immunohistochemical staining data showed that the expression of these two proteins in tumor tissue significantly exceeds their expression in normal tissue.&#x0D; Conclusion. Based on the obtained data the possibility of using uPA in blood serum as a universal diagnostic criterion in patients with colorectal and gastric adenocarcinoma regardless of gender was shown and uPAR in female patients.

Cancer cachexia: Comparing diagnostic criteria in patients with incurable cancer.

Cancer cachexia (CC) is a multifactorial syndrome that is associated with worse outcomes. Several criteria for its diagnosis have been suggested, but notable disparities exist. This study compared different diagnostic criteria for CC in patients with incurable cancer who are in palliative care. A prospective cohort study was conducted at the National Cancer Institute in Brazil. Patients were classified by three CC diagnostic criteria, and comparisons between clinical, nutritional, and functional variables were verified according to the CC stage identified. Kaplan-Meier survival curves and Cox regression were used for the survival analysis. Concordance statistics were used to test the prognostic predictive accuracy of the criteria. The prevalence of cachexia in the 1384 patients included in the study varied from 13.8% to 53.9% according to the classification criteria used. All criteria distinguished noncachectic patients from other categories according to the majority of the domains studied. However, the results were inconsistent in distinguishing patients with intermediate cachexia (mainly precachexia) from noncachectic and cachectic patients. Patients with cachexia or refractory cachexia faced a higher risk of 90-d mortality. The criteria described by Vigano et al. were found to be better at distinguishing the stages of CC regarding overall survival (hazard ratio increases according to CC severity: 1.87 to 2.87; concordance statistic: 0.74). Our results demonstrate the disparities in existing CC diagnostic criteria and their inability to discriminate intermediate stages. Vigano et al.'s criteria is/was the most effective in predicting the prognosis. The development of new diagnostic criteria to improve CC classification requires future exploration.

Effectiveness of Dual Antibacterial Therapy and Effectiveness of Recommendation Criteria as a Diagnostic Tool in Children with Uncomplicated Acute Appendicitis

Summary Introduction Acute appendicitis (AA) – acute inflammation and infection of the appendix – is one of the most common cause for abdominal surgery in pediatrics. Appendectomy has been the gold standard since 1735, but in recent years there have been several studies that investigate antibacterial therapy for uncomplicated acute appendicitis. In 2016 new recommendations for suspected AA were implemented in emergency department setting of Children's Clinical University Hospital (CCUH). Aim of the Study To evaluate whether diagnostic criteria for patients with a suspected acute appendicitis is effective as a diagnostic tool and to evaluate whether dual antibacterial therapy is safe and effective as first line treatment for children with diagnosis of uncomplicated acute appendicitis in CCUH. Material and methods A retrospective study was made in CCUH from January 2017 to December 2017. Patients aged 7 to 18 with suspected uncomplicated acute appendicitis were identified and data were collected from an internal hospital management system and patients’ medical records. Patients were divided into two groups – A and B. In group A were patients who met the criteria of uncomplicated AA, and in group B – patients who met the criteria of complicated AA. Both groups received ampicillin and metronidazole. For statistical analysis IBM SPSS Statistics 22 program was used. Results From 98 patients majority were boys (51% (n=50)) with mean age 12.6 years. As a result of antibacterial therapy clinical condition improved in 93% (n=89) of patients who were discharged without surgery. 7 patients did not improve and underwent surgery within 48 hours after admission, another 2 had elective appendectomy. There was a significant positive moderate correlation between C–reactive protein (CRP), white blood cell count (WBC), basophil granulocytes (BASO) and appendix diameter at admisson and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p&lt;0.001 vs. r=0.41, p=0.017 vs. r=0.51, p=0.013). In group A (68% (n=67)) there was a significant positive moderate correlation between CRP, WBC and appendix diameter at admission and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p&lt;0.001 vs. r=0.51, p=0.013). In group B (30% (n=31)) 7 patients underwent appendectomy and 2 patients received a broad spectrum antibacterial therapy prior to elective appendectomy. There is evidence of significant association between ALVARADO score (p=0.004), rebound tenderness (p&lt;0.001), WBC (p=0.004), CRP (p&lt;0.001) and stage in which appendicitis has progressed to. Conclusions Antibiotic-alone treatment may be a safe and effective initial management choice in children with uncomplicated acute appendicitis. However, to fully evaluate effectiveness of antibacterial therapy and diagnostic criteria, further follow–up research is needed. A normal C–reactive protein value does not rule out uncomplicated acute appendicitis, therefore it can not act as a single marker to diagnose AA or to differentiate between complicated and uncomplicated AA. Recommendations of treatment of UCAA are acceptable for use in emergency department as they act as a unified tool that allows pediatricians and pediatric surgeons to quickly assess suspected acute appendicitis.

Деякі ревматологічні показники у хворих із діабет-асоційованими остеоартритами

Наразі актуальною є проблема асоціації поширених ревматичних захворювань, таких як ревматоїдний артрит, остеоартроз та остеопороз із цукровим діабетом (ЦД). До теперішнього часу немає єдиного погляду на роль біохімічних та імунних чинників, які викликають ураження суглобів в умовах коморбідності. Метою даного дослідження була оцінка біохімічних ревматологічних показників у хворих на ЦД 1-го та 2-го типів із діабет-асоційованими остеоартритами. Матеріал і методи. У дослідженні взяли участь 105 пацієнтів, яких розподілили на групи за типом діабету, наявністю та ступенем діабетичної артропатії. Пацієнтам проводили діагностику артропатій за допомогою УЗД суглобів і ревмапроби імунотурбодиметричним методом. Результати. У групі пацієнтів із ЦД 1-го типу артропатію виявлено в 64,4% випадків, у групі із ЦД 2-го типу — у 80,0% (t=1,8; p=0,07). У хворих з артропатіями виявлено прямий кореляційний зв’язок стадії артропатії з чинниками «антистрептолізин» (r=0,33; p&lt;0,01), «ревматоїдний чинник» (r=0,26; p&lt;0,05) і «С-реактивний білок» (r=0,43; p&lt;0,001). Встановлено підвищення середнього рівня сечової кислоти зі збільшенням стадії артропатіїяк у групі з ЦД 1-го типу (F=4,4; p=0,009), так і в пацієнтів із ЦД 2-го типу (F=17,9; p&lt;0,001). Висновок. Отримані результати продемонстрували, що як найбільш чутливі діагностичні критерії у хворих із діабет-асоційованими остеоартритами можна рекомендувати використовувати рівень сечової кислоти в крові, ревматоїдного чинника та С-реактивного білка.

Prediction of the effectiveness of spontaneous breathing in patients with brain damage of various etiologies

BACKGROUND: Long-term respiratory support is a severe disabling factor and is accompanied by a long stay of patients in intensive care units.&#x0D; AIMS: The analysis of the predictors of the success of disconnection from mechanical ventilation on the basis of clinical and diagnostic criteria in patients with brain damage of various etiologies.&#x0D; METHODS: The study included 53 patients (husband ― 28, women ― 25; cf. age 53.69 2.34) who are in 2019 with the consequences of traumatic brain injury (TBI) (n = 18; 33.9%); consequences of acute cerebrovascular accident (n = 24; 45.3%); the effects of anoxic brain damage (n = 3; 5.7%); consequences of subarachnoid hemorrhage (n = 8; 15.1%).&#x0D; RESULTS: The statistically significant predictor of recovery of spontaneous breathing in the 1st and 2nd groups of patients were preserved chemoreflex sensitivity (IPCS), the sensitivity and specificity of IPCS was 78.57% [95 % DI 49.295.26] and 83.3 % [95 % CI 62.695.26]. The index of peripheral chemoreflex sensitivity (IPCS) was calculated using the formula: IPCS = [RRe / RRi] [Vt(e) / Vt(i)] [VE(e) / VE(i)] [Vt(e) VE(i)], where IPCS is the index of peripheral chemoreflex sensitivity in l/min; RRi and RRe; Vt(i) and Vt(e); VE(e) and VE(i) ― respiratory rate (RR, breaths/min), tidal volume (Vt), minute ventilation (VE), (l/min) of the starting point ― (i) before carrying out a functional stress test and (e) ― during a functional test of normobaric hypoxia with SpO2 in the range of 9080 %.&#x0D; CONCLUSIONS: The most significant clinical parameters statistically reliably hampering the process of successful recovery of spontaneous breathing in addition to chemoreflex sensitivity are the presence of severe heart failure, pneumonia, autonomic dysfunction, level of consciousness, age, higher levels of inspiratory and expiratory pressure mounted on a respirator.