Management Plan For Patients Research Articles

Do Surgical Oncology Multidisciplinary Team Meetings Make a Difference?

Multidisciplinary team (MDT) meetings are important but resource-expensive components of surgical and oncologic care. This cohort study investigated the effectiveness of surgical MDT meetings by assessing the predictability of MDT meeting recommendations, the degree that patient management plans are changed by discussion, and the incidence of recommendation implementation. Multidisciplinary team meetings at The Queen Elizabeth Hospital in South Australia were audited for upper gastrointestinal (UGI) and colorectal (CR) surgical units from August 2021 to June 2022. All cases referred for MDT meeting discussion were included. Prospectively obtained pre-MDT meeting management plans were compared with formal MDT meeting recommendations to assess for concordance and degree of change. Patient records were assessed after 8 months for MDT meeting recommendation implementation. Multivariable analysis of patient factors was performed to identify associations between MDT meeting recommendation predictability and implementation. In 438 patient cases, discussed during 30 MDT meetings, 317 (72.37%) were correctly predicted. Specifically, 226 (51.6%) were correct with no change, 28 (6.39%) were correct with minor changes, 40 (9.13%) were correct with moderate changes, and 23 (5.25%) were correct with major changes. The UGI and CR cohorts differed significantly in moderate changes (P = 0.0217). The female patients were 1.62 times more likely than the male patients to have pre-MDT meeting management plans predicted (P = 0.0201). Formal MDT meeting recommendations were implemented in 380 (89.62%) cases. The MDT meetings changed management for almost 1 in 2 patients discussed. Other than female sex, no identifiable patient factors increased the likelihood of predictability, and no factors predicted recommendation implementation.

Constructing a health management plan for patients with obstructive sleep apnea hypopnea syndrome based on electronic medical record data mining.

Constructing a health management plan for patients with obstructive sleep apnea hypopnea syndrome based on electronic medical record data mining.

Echo triaging works. How to use international guidelines

Abstract Introduction Transthoracic echocardiography (TTE) is the first-choice non-invasive imaging modality for the assessment of cardiac structure and function due to its wide availability, speed, cost-effectiveness and reproducibility. Therefore, there is exponential increase in demand in TTE across all specialties in medicine and surgery. Hence, it is important to carefully triage patients according to current international guidelines. Purpose To reduce inappropriate TTE scans by using guideline driven indications in triaging echo scans in the UK tertiary hospital. Methods Strict list of guidelines driven indications adapted to local practice was used for triaging echo requests which included both inpatient and outpatient TTEs. The 4 objectives: appropriateness, completeness of requests as well as impact of performed studies on the follow-up and patient management plan were assessed before and after implementation of new triaging tool. To ensure similar working and staff environment was sustained we studied the pattern of referrals in the same month of the year- September. The triage process was conducted by accredited physiologists. The same month was chosen to reflect true change of practice. Change in patient management and follow up were evaluated for a minimum duration of 6-months. Results Overall there were 1112 TTEs performed in September 2022 and 1081 - in September 2023. Prospective TTE referral triaging began in March 2023. We have studied and analyzed above criteria retrospectively. In 2022 there were 18% inappropriate requests; 37% of requests lacked sufficient clinical information and 10% of studies did not lead to change in management plan according to clinical letters. There was also high proportion of inappropriate requests for inpatients (9%). Within 6 months of implementation there was a significant improvement in the appropriateness (82% vs. 99%, p<0.001), with increase in supply of adequate clinical information (63.4% vs. 86.1%, p<0.001). However, there was no significant change using TTE study results in changing patient management (10%). All inpatients had 100% appropriate requests. Conclusion The implementation of triage criteria resulted in a significant improvement in TTE referrals: both in appropriateness and completeness of requests. However, some clinicians did not use echo in patient management plan. Future research on lack of use of TTE results in clinical practice might help to utilize the limited echo capacity to full.

The Management of Patients with Extrapulmonary Sarcoidosis in Rheumatology Clinic

Abstract Background This study aimed to evaluate patients with extrapulmonary and refractory sarcoidosis who were followed up on in our rheumatology clinic for a long follow-up period and to summarise the applications in rheumatology practice. Materials and Methods The study included patients diagnosed with sarcoidosis at our institution between 2010 and 2022. Patientsʼ age, sarcoidosis diagnosis dates, inflammatory rheumatic disease (iRMD) diagnoses, autoimmune markers, and imaging findings were all evaluated. Estimates were made for cases of glucocorticoid (GC) use and cumulative and mean daily GC exposures. Results 90 patients with sarcoidosis, 79 (87.8) female and 11 (12.2) male, whose mean age was 56.4±12.4 years, were included. Since 48 (53.3%) of the patients required at least one additional treatment in addition to CS, they were classified as having refractory sarcoidosis and followed up accordingly. While 43 (89%) of the patients received second-line sarcoidosis treatment, it was found that 5 patients were switched to third-line sarcoidosis treatment (p<0.001). Comorbidity distributions of refractory and nonrefractory patients were similar. It was determined that 9 (10%) patients had a history of osteoporotic fracture. Conclusions In conclusion, it appears critical to develop a detailed patient management plan and a multidisciplinary approach in the early stages of extrapulmonary sarcoidosis management. There is currently no detailed algorithm covering refractory disease definition and treatment practice differences.

Effectiveness of gluteal control training in chronic low back pain patients with functional leg length inequality

Chronic low back pain (LBP) is a common musculoskeletal disorder and is often accompanied by functional leg length inequality (FLLI). However, little was known about the effects of gluteal muscle control training in patients with LBP and FLLI. This study was designed to investigate the effects of gluteal control training in patients with LBP and FLLI. This is a double-blinded, randomized controlled study design. Forty-eight LBP patients with FLLI were randomized to the gluteal control training (GT) (47.58 ± 9.42 years) or the regular training (RT) (47.38 ± 11.31 years) group and received allocated training for six weeks. The outcome measures were pelvic inclination (PI), ilium anterior tilt difference (IATD), FLLI, visual analogue scale (VAS), patient specific-functional scale (PSFS), Oswestry disability index (ODI), hip control ability, global rating of change scale (GRoC), and lower extremity strength and flexibility. The intervention effects were compared using two-way repeated measures analysis of variance and chi-square tests with α = 0.05. The results indicated that the GT group showed greater improvement (P < 0.01) in PI (1.03 ± 0.38∘ vs. 1.57 ± 0.51∘), IATD (0.68 ± 0.66∘ vs. 2.31 ± 0.66∘), FLLI (0.3 ± 0.22 vs. 0.59 ± 0.13 cm), VAS (1.41 ± 1.32 vs. 3.38 ± 1.51), hip control ability (2.20 ± 0.45 vs. 0.89 ± 0.74), GRoC at 3rd and 6th week as compared to the RT group. Hip strength and flexibility also improved more in the GT group (P < 0.05). In conclusion, gluteal control training was more effective in improving low back pain and dysfunctions, and should be integrated in the management plan in patients with LBP and FLLI.

Radiation-Induced Intraosseous Malignant Peripheral Nerve Sheath Tumor: A Case Report.

The significance of radiation therapy in cancer treatment comes with associated complications, including fibrosis, osteonecrosis, and the development of secondary malignancies, such as malignant peripheral nerve sheath tumors (MPNSTs). We emphasize the importance of understanding these complications for an effective patient management. We report a 47-year-old man with a history of squamous cell carcinoma of the tongue, treated with surgery, chemotherapy, and radiation therapy. The patient later presented with symptoms that led to the discovery of an intraosseous MPNST. Histopathological examination revealed characteristic features of MPNST, including spindle cells arranged is sweeping fascicles with contrasting hypercellular and hypocellular areas, producing a marble-like pattern, with atypical wavy, buckled, hyperchromatic nuclei, and brisk mitotic activity. Immunohistochemical analysis showed patchy positive staining for S100 and SOX10, and a complete loss of H3K27me3 expression. This report underscores the challenge of diagnosing secondary malignancies post-radiation therapy and the importance of careful histological examination to differentiate them from other conditions. In conclusion, radiation-induced secondary malignancies are a significant late side effect of radiation therapy that can profoundly impact treatment decision-making and requires a high index of suspicion during post radiation surveillance. Malignant peripheral nerve sheath tumor serves as a pertinent example, highlighting the importance of considering long-term risks when developing optimal management plans for cancer patients.

Therapeutic implications of etiology-specific diagnosis of early-onset developmental and epileptic encephalopathies (EO-DEEs): A nationwide Turkish cohort study

ObjectiveTo evaluate the etiology-specific diagnosis of early-onset developmental epileptic encephalopathies (EO-DEEs) in a nationwide Turkish cohort to determine the implications for therapeutic management. MethodsThe cohort comprised 1450 patients who underwent EO-DEE. The utility of genetic testing was assessed with respect to the initial phases of next generation sequencing (NGS) (2005–2013) and the current NGS era (2014–2022). A predefined four-stepwise diagnostic model was evaluated using cost-effectiveness analysis. The diagnostic and potential therapeutic yields of the genetic tests were subsequently determined. ResultsGene-related EO-DEEs were identified in 48.3% (n=701) of the cohort: non-structural genetic (62.6%), metabolic genetic (15.1%), and structural genetic (14.1%). The most common nonstructural genetic variants were SCN1A (n=132, 18.8%), CDKL5 (n=30, 4.2%), STXBP1 (n=21, 2.9%), KCNQ2 (n=21, 2.9%), and PCDH19 (n=17, 2.4%). The rate of ultra-rare variants (< 0.5%) was higher in the NGS era (52%) than that in the initial phase (36%). The potential therapeutic yields with precision therapy and antiseizure drug modification were defined in 34.5% and 56.2% in genetic-EO-DEEs, respectively. The diagnostic model provided an etiology-specific diagnosis at a rate of 78.7%: structural (nongenetic) (31.4%), genetic (38.5%), metabolic (6.1%), and immune-infectious (2.8%). Based on a cost-effectiveness analysis, the presented diagnostic model indicated the early implementation of whole-exome sequencing for EO-DEEs. SignificanceIn the present cohort, the higher rate (48.3%) of gene-related EO-DEE diagnoses in the NGS era provides a potential therapeutic management plan for more patients.

Decoding prognosis: Unraveling physicians' responses in electronic treatment plans.

230 Background: Communicating prognosis to cancer patients is a critical aspect of shared decision making in healthcare. Practices in The US Oncology Network (The Network) use an electronic version of a treatment plan based on the Institute of Medicine (IOM) care management plan for patients receiving cancer treatment. Physicians document in their own words the prognosis section of the treatment plan. This study seeks to better understand the responses provided by physicians in the prognosis section. Methods: We evaluated word frequency analysis using FreqDist library, conducted sentiment analyses using the Natural Language Toolkit (NLTK) Sentiment Intensity Analyzer, and performed thematic analyses using Latent Dirichlet Allocation library on a random sample of 35,000 treatment plans developed in 2023 for practices in The Network. Results: 32% of the responses were 5 words or less, with 3.8% single word responses. Words like “excellent, good, fair, poor, guarded” or a combination thereof were commonly used to describe the prognosis. 26% of responses were ≥12 words in length, and generally were personalized to the patient’s disease, treatment, and/or contained situation specific narratives. Responses &lt;12 words generally contained templated phrases, or minimally customized responses. 38% of the responses contained a numerical value, representing either a percentage probability of survival, chance of response to treatment, or a quantification of time (months, years). Thematic analyses conducted on responses ≥12 words revealed that the predominant theme focused on survival represented in different ways, followed by response to therapy, probability of recurrence or relapse, and disease control. Sentiment analyses revealed that 60.6% of responses denoted a negative sentiment. 71.7% of responses ≤5 words in length had a negative sentiment, compared to 58.3% of responses ≥12 words in length. Conclusions: This study reveals that prognosis responses from physicians used on treatment plans shared with patients are very diverse. The manner in which prognosis is presented to patients can greatly influence their understanding, engagement, and involvement in making treatment decisions. To optimize shared decision making in cancer care, healthcare providers must strive to effectively communicate prognosis by using clear and empathetic language, ensuring patient comprehension, and tailoring the information to individual patient needs and preferences. The data set has high potential for further study to better understand the role and impact of written treatment plans to help physicians refine this documentation for better patient understanding.

Managing the unmanageable: evidence-driven approaches to real-world patient prototypes of TP53-mutant myelodysplastic neoplasms and acute myeloid leukemia.

Patients with TP53 aberrations comprise the highest risk subset of all myeloid malignancies. The managerial conundrum of TP53-mutant myelodysplastic neoplasms (MDS) and acute myeloid leukemia (AML) stems from refractoriness to or relapse after conventional chemotherapy, as well as the limited translational success of investigational therapies targeting TP53-mutant cells. Thus far, no targeted therapies have been commercially approved for this mutational subset. As a result, management plans for patients with TP53-mutant MDS and AML are often driven by clinical judgment and/or physician preference rather than consensus guidelines backed by a rigorous evidence basis. This clinical case-based, evidence-driven review highlights the most salient data that guides the management of commonly encountered patient prototypes. This review discusses the therapeutic menu of first-line options that derive from multi-institutional experiences as well as from disease-centric consortia and discusses how these first-line options can be optimally tailored to heterogeneous groups of patients. The debate regarding whether allogeneic stem cell transplant should be offered to these patients is summarized. Finally, this review explores the recent unfortunate news of pauses in clinical trials for the leading investigational agents - eprenetapopt, magrolimab, sabatolimab, and idasanutlin - and offers solutions toward re-invigorating the pipeline of precision therapeutics in 2025.

Paroxysmal nocturnal hemoglobinuria during pregnancy: a case report and literature review

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease, and a standardized treatment and follow-up management strategy for pregnant women with this disease are crucial for ensuring the safety of both the mothers and their newborns. This study includes a case of pregnant women with PNH. In accordance with the guidelines, the patient was successfully delivered after treatment with eculizumab. Furthermore, this study also implemented a treatment plan and follow-up management plan for PNH patients during pregnancy to elevate the standard of care for pregnant women with PNH.

CLONAL HEMATOPOIESIS AND ITS ROLE IN THE DEVELOPMENT OF CARDIOVASCULAR DISEASES

Clonal hematopoiesis (CH) is the increase in somatic clones carrying mutations in hematopoietic stem cells. This biological condition can lead to cancer and is implicated in the development of atherosclerosis and cardiovascular diseases. CH of indeterminate potential (CHIP) refers to somatic mutations in genes that are associated with the development of Coronary heart disease (CHD) and leukemia. Now, with next-generation sequencing, we can detect mutations even if they are present in only a small number of cells in the tissue sample being studied. Consequently, numerous studies have shown that mutations in the DNMT3A, TET2, ASXL1, and JAK2 genes found in the blood are associated with coronary heart disease. The purpose of our study is to detect a genetic variant of genes in Kazakh patients with atherosclerosis, which will further allow us to study the role of CHIP in increasing the risk of developing coronary microvascular dysfunction and CHD. We perform high-throughput whole-exome sequencing in patients with atherosclerosis. The object of the study is samples delivered from the clinic “National Scientific Cardiac Surgery Center” in Astana. The study is carried out in accordance with the principles of the Declaration of Helsinki of the World Medical Association. Genomic DNA extraction was performed on 245 samples using the Illustra Blood Kit (Cytiva, USA). Qualitative and quantitative assessment of the extracted genomic DNA was conducted using the NanoDrop 2000 (Thermo Scientific) and Qubit 2.0 (Thermo Fisher Scientific). Subsequently, DNA library preparation was carried out using the Illumina DNA Prep with Exome 2.5 Enrichment kit. Quality control of the resulting DNA libraries was conducted on a 2100 Bioanalyzer system using the Agilent DNA 1000 Kit and High Sensitivity DNA kit (Agilent Technologies). Following assessment of the DNA library concentration on Qubit 2.0, they were loaded onto the high-performance sequencer NovaSeq 6000 (Illumina, USA) following the manufacturer’s protocol. We conducted human whole-exome sequencing on 245 samples to identify somatic clones in the peripheral blood of patients with atherosclerosis. Patients were divided into three groups – low risk, middle, and high risk of atherosclerotic complications. Bioinformatic analysis of sequence data were performed. We created list of genes associated with CH to deep analysis and to interpreter the data in patient groups. Subsequently, DNA extraction from the remaining samples is performed, followed by sequencing on the NovaSeq 6000 platform. Analysis of the resulting sequenced data is currently underway. Further research and monitoring of CHIP will enable us to understand the mechanisms underlying the development of cardiovascular diseases and to devise a comprehensive management plan for patients with this pathology. Supported by Committee of Science of the Ministry of Science and Higher Education of Republic of Kazakhstan (AP14869903), (BR21881970) and Nazarbayev University CRP (211123CRP1608).

Radiation-associated cardiovascular disease in patients with cancer: current insights from a cardio-oncologist.

Radiation-associated cardiovascular disease (RACD), a complex disease characterized with pericarditis, myocardial damage, valvular heart diseases, heart failure, vasculopathy and ischemic heart disease, has a generally poor prognosis. While RACD may be acute, it often manifests in the late years or even decades following radiation exposure to the chest. With an increasing number of cancer survivors, RACD is likely to become an important issue in cardio-oncology. This review discusses pre-radiation therapy (RT) preparation, peri-RT patient management and long follow-up planning post-RT from a cardiology perspective. Additionally, a novel technique of stereotactic radiotherapy, which has been applied for the treatment of intractable cardiac arrhythmias, is presented. Appropriate patient examination and management during and after RT are essential to support patients undergoing cancer treatment to improve long life expectancy. A multidisciplinary team is needed to determine how to manage patients who receive RT to reduce RACD, to detect early phases of RACD and to provide the best treatment for RACD. Recent studies increasingly report advances in diagnosis using new equipment that has the potential to detect early phases of RACD, along with growing evidence for the optimal treatment for RACD. This review provides an overview of recent studies and guidelines to report on the latest findings, and to identify unresolved issues surrounding RACD that require validation in future studies.

Not just a BLiP: early experience with a novel multidisciplinary case conference for benign hepatopancreatobiliary disease at a tertiary Canadian healthcare center.

Benign Liver and Pancreas (BLiPs) rounds, implemented in 2022 at our Canadian tertiary care center, are a novel concept of a multidisciplinary case conference (MCC) for discussion of benign hepatopancreatobiliary (HPB) disease. BLiPs Rounds are a monthly virtual meeting of surgeons, gastroenterologists, and interventional radiologists experienced in biliary and pancreatic disease. This case series was completed to review the patient cases discussed over the first year of BLiPs rounds, and to evaluate the effect of the multidisciplinary discussion on patient management plans. Meeting minutes were reviewed for BLiPs rounds between May 2022 and July 2023. Data were collected retrospectively on all discussed patients by review of the electronic medical record, and analyzed using frequencies and means with standard deviations. Between May 2022 and July 2023, 56 cases were discussed at 12 case conferences. 68% of cases concerned pancreatic pathology, 25% concerned biliary pathology, the remainder liver or duodenal pathology. 49 cases (88%) were presented to discuss therapeutic options, and 7 presented as diagnostic challenges. Cases were usually presented once, but 7 patients were discussed at multiple conferences due to complex issues or ongoing symptomatology. 40 patients (71%) had undergone previous endoscopic, percutaneous, or surgical interventions prior to discussion. Endoscopic intervention was recommended in 32% of cases, percutaneous interventional approach in 13%, a combined endoscopic and percutaneous approach in 9%, and surgery in 18%. Repeat imaging or observation was recommended in 29% of cases. Discussion at rounds led to a change or adjustment in the proposed management in 46 cases (82%). The plan recommended by the MCC was carried out in 71% of cases. BLiPs case conference provides a valuable venue to discuss cases, encourage interdisciplinary collaboration, and refine treatment approaches, leading to a change in proposed management plan in over three-quarters of cases presented.

Distinct impulsivity profiles in subtypes of violence among community-dwelling patients with severe mental disorders: a longitudinal study

BackgroundAlthough only a few patients with severe mental disorders (SMD) can commit violent behaviour in the community, violent behaviour aggravates the stigma towards patients with SMD. Understanding the subtypes of violent behaviour may be beneficial for preventing violent behaviour among patients with SMD, but it has rarely been studied.MethodsThis longitudinal study investigated 1914 patients with SMD in the community at baseline, and the follow-up period ranged from February 2021 to August 2021. The Barratt Impulsiveness Scale Version-11, the Buss-Perry Aggression Questionnaire, the Impulsive/Premeditated Aggression Scale, the Personality Diagnostic Questionnaire and the MacArthur Community Violence Instrument were used at baseline. The Modified Overt Aggression Scale was used to assess the occurrence of violent behaviour (outcome) during the follow-up period. Cox regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Latent class analysis was used to characterise the subtypes of patients with SMD who engaged in violent behaviour at follow-up.ResultsWe found that 7.2% of patients with SMD presented violent behaviour within six months in the community. Younger age (OR = 0.98, 95% CI = 0.96-1.00, p = 0.016) and no economic source (OR = 1.60, 95% CI = 1.10–2.33, p = 0.014) were risk factors for violent behaviour. Patients with SMD who engaged in violent behaviour could be classified into three subtypes: one class characterised by a history of violence and impulsivity, another class characterised by high levels of aggression and motor impulsivity, and the last class characterised by median cognitive impulsivity.ConclusionsSocio-demographic factors were risk factors for violent behaviour among patients with SMD, which could eliminate the discrimination toward this group. Impulsivity played a vital role in identifying the three subtypes of patients with SMD who engaged in violent behaviour. These findings may be helpful for the development of a personalised violence risk management plan for patients with SMD who commit violent behaviour in the community.

The Influence of Cough Reflex Testing on Patient Management.

Cough reflex testing (CRT) is an adjunct to the clinical swallowing evaluation (CSE), providing information on patients' risk of silent aspiration. CRT has been shown to influence diet recommendations, but in previous work, the many varied patient characteristics are not controlled. Therefore, the specific role of CRT results in these decisions remains unclear as this relationship has not been directly assessed. An online survey was sent to speech language therapists working in dysphagia. Two patient cases were presented that differed only by the presence of risk factors for the development of aspiration pneumonia. For each patient case, there were three assessment scenarios: CSE information only, CSE information with a "pass" CRT result, and CSE information with a "fail" CRT result. Clinicians outlined their patient management plans for each of the six scenarios. Ninety-seven data sets were used in the final analysis. A "fail" result was found to lead to the most restrictive patient management. Decisions made when provided with only CSE information were very similar to decisions made for a CSE with a "pass" result. Aspiration pneumonia risk factors were shown to influence decision making, with the low-risk patient more likely to be recommended a less restrictive diet. When information was available regarding silent aspiration risk, clinicians factored the results into their decision making. However, in the absence of a CRT result, airway sensation was assumed to be intact in the absence of information. This finding warrants further investigation given the impact this assumption may have on a patient's pulmonary health.

Determination of Possible Biomarkers for Predicting Well-Differentiated Thyroid Cancer Recurrence by Different Ensemble Machine Learning Methods

Objective: Well-differentiated thyroid cancer (WDTC) is the most common thyroid malignancy and although it is curable, the risk of recurrence is high. In this study, classification algorithms based on clinicopathologic features of WDTC patients were used to determine the possible of recurrence in WDTC and to evaluate potential predictive factors, and possible biomarkers based on the optimal model were identified. Method: In this study, open access data on 383 patients with WDTC, 108 with recurrence and 275 without recurrence, were used. In order to predict recurrence in WDTC patients, features were selected using recursive feature elimination variable selection method among features and classification was performed with two ensemble learning methods (Random Forest, Adaboost). Results: Two different ensemble learning models used to classify recurrence in WDTC were Random Forest with an accuracy of 0.957, sensitivity of 0.889, specificity of 0.978, positive predictive value of 0.923, negative predictive value of 0.967, Matthews correlation coefficient of 0.878, G-mean of 0.945, F1-score of 0.906, and accuracy of 0.940, sensitivity of 0.889, specificity of 0.955, positive predictive value of 0.857, negative predictive value of 0.966, Matthews correlation coefficient of 0.833, G-mean of 0.910, F1-score of 0.873. Conclusion: According to variable importance based on the Random Forest, the 5 possible clinical biomarkers for predicting WDTC recurrence are Response, Risk, Node, Tumor, and age. In the light of these findings, patient management and treatment planning can be organized.

Pulmonary artery aneurysm: computed tomography (CT) imaging findings and diagnosis.

Pulmonary artery aneurysm (PAA) is a rare pulmonary vascular disease with nonspecific symptoms and various etiologies. As the disease progresses, in addition to the dilation of the pulmonary arteries, it may be accompanied by remodeling of the cardiac structure and changes in the morphology of the aorta. Recognizing the cause of PAA is therefore a clinically challenging task. In this review article, we provide an overview of various causes of PAA with the support of corresponding imaging findings on computed tomography pulmonary angiography (CTPA) examination. Firstly, from the perspective of hemodynamics, a logical diagnosis is provided according to whether the main pulmonary artery (MPA) is dilated, and whether the PA is dilated locally or diffusely. Secondly, for the imaging examination of vascular wall lesions, due to the limitations of ultrasound examination and interventional procedures, the irreplaceability of dual-phase CTPA examination in disease assessment is especially emphasized. Finally, for highly suspected disorders, it is necessary to comprehensively check with the patient whether there is a family history or past medical history. For patients with PAA, especially those with Marfan syndrome (MFS) or arteritis, adequate preoperative imaging evaluation, regular postoperative radiographic follow-up, and concurrent treatment of the underlying disease (if necessary) are crucial, which are related to the prognosis and long-term quality of life of such patients. Despite the nonspecific features of PAA presentation, a thorough examination of the patient's clinical history and imaging characteristics will play an important role in diagnosing PAA and planning patient management strategies.

Managing Cardiovascular Risk in Patients with Autoimmune Diseases: Insights from a Nutritional Perspective.

Autoimmune diseases manifest as an immune system response directed against endogenous antigens, exerting a significant influence on a substantial portion of the population. Notably, a leading contributor to morbidity and mortality in this context is cardiovascular disease (CVD). Intriguingly, individuals with autoimmune disorders exhibit a heightened prevalence of CVD compared to the general population. The meticulous management of CV risk factors assumes paramount importance, given the current absence of a standardized solution to this perplexity. This review endeavors to address this challenge from a nutritional perspective. Emerging evidence suggests that inflammation, a common thread in autoimmune diseases, also plays a pivotal role in the pathogenesis of CVD. Nutritional interventions aimed at reducing inflammation have shown promise in mitigating cardiovascular risk. The integration of nutritional strategies into the management plans for patients with autoimmune diseases offers a holistic approach to reducing cardiovascular risk. While conventional pharmacological treatments remain foundational, the addition of targeted dietary interventions can provide a complementary pathway to improve cardiovascular outcomes.

Preoperative bleeding risk assessment in cardiac surgery patients

Aim: To investigate the role of bleeding risk scores, personal and family medical history, and previous bleeding incidents in assessing the impact on the risk of all possible complications, including mortality, in adult patients following cardiac surgery.Methods. The search for publications was conducted using the PubMed, Transfusion Evidence Library, and eLibrary.ru databases, covering the period from 2019 to 2023. Search terms included: ‘bleeding risk assessment scales in adult cardiac surgery’, ‘preoperative anemia in adult cardiac surgery’, and ‘transfusion of red blood cell-containing components in cardiac surgery adults’. Duplicate articles were manually excluded. An additional search was performed among the reference lists of selected publications.Results. A total of 2,011 publications were found. In the first stage of selection, clinical studies, meta-analyses, randomized controlled trials, reviews, and regular reviews without language restrictions were considered based on the content of the abstract. In the second stage, for studies that passed the initial screening, decisions were made based on an assessment of the full-text versions, which presented the consequences of preoperative anemia, postoperative bleeding, and transfusion therapy in adult cardiac surgery patients. Ultimately, 40 publications were included in the review.Conclusion. Preoperative bleeding risk assessment is a multimodal, interdisciplinary challenge that necessitates a patient-centered approach. It should commence at the preparatory stage and involve primary care physicians, cardiologists, surgeons, anesthesiologists, laboratory diagnostic specialists, and transfusiologists. The cornerstone of this process is the thorough collection of individual and family medical histories. Obtaining detailed information through patient involvement, utilizing bleeding risk rating scales, reviewing previous bleeding incidents, and supporting these findings with laboratory test data represent the most scientific approach to developing an individualized management plan for patients at risk of bleeding.

The Relationship Between Anemia and Parathyroid Hormone Levels in Patients With Kidney Failure Undergoing Hemodialysis Treatment in Georgia.

Chronic kidney disease (CKD) and its associated complications, such as anemia and secondary hyperparathyroidism (SHPT), pose significant challenges to global healthcare systems. This study explores the demographic and clinical characteristics of 284 kidney failure (KF) patients undergoing hemodialysis, in an effort to shed light on the possible association between anemia and SHPT. A proven connection between the two could theoretically influence the management plans for CKD patients, with the hopes of achieving lower morbidity and/or mortality in this patient group. A retrospective, cross-sectional, real-world data analytical study was conducted at a hemodialysis center in Tbilisi, Georgia, encompassing a sample size of n = 284 patients on maintenance hemodialysis. The data analyzed was extracted from patients' medical records. According to our results, the prevalence of anemia was strikingly high at 82.04%, underlining its substantial burden within this patient population.Our analysis revealed a notable systemic association between anemia and SHPT, particularly when considering hemodialysis vintage. However, our final analysis model revealed no statistically significant association between anemia and intact parathyroid hormone (iPTH) levels. Conclusion:Our study revealed a significant systemic relationship between anemia and SHPTwhen hemodialysis duration was considered, despite initial analyses showing no direct association. Future research should focus on longitudinal and multi-center studies to better understand this relationship, aiming to enhance the care and management of CKD patients on hemodialysis.