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Item does not contain fulltext The purpose of this study was to describe the development and preliminary testing of a new scale assessing knowledge about melanoma risk factors and early detection/secondary prevention. Data was drawn from a longitudinal study assessing barriers and facilitators of skin self- examination among patients diagnosed with melanoma. For the current analysis, 191 patients who completed the new 9-item Knowledge About Melanoma Early Detection Scale and other study measures were included. Exploratory factor analysis with were conducted, which identified a robust scale comprised of 6 items with factor loadings ranging from .56 to .81. Higher scores on the Knowledge About Melanoma Early Detection Scale were associated with younger age and more positive attitudes about melanoma prevention, but not with biological sex, education, melanoma stage, or past self-administered and physician-provided skin checks. Further studies are needed to replicate these findings and to further establish the predictive validity of this scale and its usefulness for health research. 9 p.

Objectives We propose a risk-tailored approach for management of lung cancer screening results. This approach incorporates individual risk factors and low-dose computed tomography (LDCT) image features into calculations of immediate and next-screen (1-y) risks of lung cancer detection, which in turn can recommend short-interval imaging or 1-year or 2-year screening intervals. Methods We first extended the "LCRAT+CT" individualized risk calculator to predict lung cancer risk after either a negative or abnormal LDCT screen result. To develop the abnormal screen portion, we analyzed 18,129 abnormal LDCT results in the National Lung Screening Trial (NLST), including lung cancers detected immediately (n = 649) or at the next screen (n = 235). We estimated the potential impact of this approach among NLST participants with any screen result (negative or abnormal). Results Applying the draft National Health Service (NHS) England protocol for lung screening to NLST participants referred 76% of participants to a 2-year interval, but delayed diagnosis for 40% of detectable cancers. The Lung Cancer Risk Assessment Tool+Computed Tomography (LCRAT+CT) risk model, with a threshold of less than 0.95% cumulative lung cancer risk, would also refer 76% of participants to a 2-year interval, but would delay diagnosis for only 30% of cancers, a 25% reduction versus the NHS protocol. Alternatively, LCRAT+CT, with a threshold of less than 1.7% cumulative lung cancer risk, would also delay diagnosis for 40% of cancers, but would refer 85% of participants for a 2-year interval, a 38% further reduction in the number of required 1-year screens beyond the NHS protocol. Conclusions Using individualized risk models to determine management in lung cancer screening could substantially reduce the number of screens or increase early detection.

Cardiac implantable electronic devices establish proper therapy for the prevention of sudden cardiac death, significantly reducing the morbidity and mortality of patients with arrhythmias and heart failure. It is well-known that the number of electrodes increases the risk of complications. To preserve the benefit of atrial sensing without the need to implant an additional lead, a single-lead ICD system with a floating atrial dipole (DX ICD lead) has been developed. Besides all of the potential benefits, the necessity of a reliable and stable atrial sensing via the floating dipole could be the main concern against the use of this lead type. In the current generation of DX devices, the specially filtered atrial signal seems to be high enough and stable over time, which is crucial in the early detection of atrial arrhythmias, discrimination between different forms of tachycardias in order to prevent inappropriate ICD therapy, and achieving an optimal atrioventricular and interventricular synchrony in patients with a two-lead CRT-DX system. The present review summarizes the benefits and potential drawbacks of the DX ICD systems based on the available literature, furthermore, proposes an evidence-based algorithm of ICD type selection.

Currently, early detection of lung cancer relies on the characterisation of images generated from computed tomography (CT). However, lung tissue biopsy, a highly invasive surgical procedure, is required to confirm CT-derived diagnostic results with very high false-positive rates. Hence, a non-invasive or minimally invasive biomarkers is essential to complement the existing low-dose CT (LDCT) for early detection, improve responses to a certain treatment, predict cancer recurrence, and to evaluate prognosis. In the past decade, liquid biopsies (e.g., blood) have been demonstrated to be highly effective for lung cancer biomarker discovery. In this review, the roles of emerging liquid biopsy-derived biomarkers such as circulating nucleic acids, circulating tumour cells (CTCs), long non-coding RNA (lncRNA), and microRNA (miRNA), as well as exosomes, have been highlighted. The advantages and limitations of these blood-based minimally invasive biomarkers have been discussed. Furthermore, the current progress of the identified biomarkers for clinical management of lung cancer has been summarised. Finally, a potential strategy for the early detection of lung cancer, using a combination of LDCT scans and well-validated biomarkers, has been discussed.

Merkel cell carcinoma (MCC) is a primary neuroendocrine skin cancer that recurs in ~40% of cases. Merkel cell polyomavirus (MCPyV) and ultraviolet (UV)-induced mutations are two major causative factors of MCC. Virus-positive MCCs express polyomavirus oncoproteins that are highly immunogenic yet are required for ongoing tumor growth. Virus-negative MCCs have a high burden of UV-DNA mutations that encode tumor-specific UV-neoantigens. Thus, both UV- and virus-induced MCCs are highly immunogenic, enabling diverse T-cell targeted therapies. Optimal MCC management is challenging given its rarity, aggressive nature, rapidly evolving care guidelines, and fundamental differences in management compared to other skin cancers. MCC is often managed aggressively with extensive surgery, radiotherapy or systemic therapy, frequently leading to toxicities that might have been avoidable while still achieving optimal disease control. Thus, multi-disciplinary care is crucial for providing patients with the best possible outcomes. The outlook for many patients with advanced MCC has progressed remarkably over the past decade due to PD-1 pathway blocking agents that provide durable benefit for a substantial subset of MCC patients. The management of early-stage MCC has also improved due to better approaches to integrate surgery and radiotherapy. Prognostic accuracy and ongoing surveillance have advanced due to stage-specific recurrence data and sophisticated "liquid biopsies" that allow early detection of disease recurrence. Here we summarize both recent striking progress and pressing challenges such as PD-(L)1-refractory MCC, and management of MCC patients with immune dysfunction. We also highlight diverse resources to allow providers to take advantage of recent progress in this fast-moving field.

Individuals with a genetic susceptibility to pancreatic ductal adenocarcinoma (PDAC) may benefit from surveillance to increase the likelihood of early detection. Currently, candidates for surveillance are identified based on genetic test results and family history of PDAC, and surveillance is accomplished through imaging of the pancreas (endoscopic ultrasound or MRI). Novel methods that incorporate personalized risk, biomarkers, and radiomics are being investigated in an attempt to improve identification of at-risk individuals and to increase detection of precursor and early-stage lesions.

Antecedentes y Objetivo El objetivo fue describir las características clínicas y el pronóstico de los pacientes con infección nosocomial por SARS-CoV-2. Métodos Se realizó un estudio observacional y prospectivo en un hospital de referencia. Se incluyeron todos los pacientes adultos diagnosticados de infección por SARS-CoV-2 nosocomial en octubre de 2020, definida como una PCR para SARS-CoV-2 negativa al ingreso y positiva a partir de los siete días de hospitalización. Resultados Se diagnosticaron 66 casos de infección por SARS-CoV-2 nosocomial: 39 (59%) hombres, edad mediana al diagnóstico de 74,5 años (RIC 56,8-83,1) y mediana del índice de comorbilidad de Charlson de 3 puntos (RIC 1-5). Veintisiete (41%) presentaron neumonía y 13 (20%) fallecieron durante el ingreso. La mortalidad a los 28 días fue del 33% (22 pacientes). La mortalidad a los 28 días en los 242 pacientes con infección por SARS-CoV-2 adquirida en la comunidad y hospitalizados durante el mismo periodo fue del 10%. Conclusiones Se deben extremar las medidas de prevención y detección precoz de brotes nosocomiales de COVID-19 para minimizar el impacto negativo de esta infección.

WT1 overexpression is frequently identified in acute myeloid leukemia (AML) and has been reported to be a potential marker for monitoring measurable residual disease (MRD). We evaluated the use of postinduction WT1 MRD level as a prognostic factor, as well as the interaction between postinduction WT1 MRD response and the effect of allogeneic stem cell transplantation (allo-SCT) in the first complete remission (CR). In the ALFA-0702 trial, patients with AML, aged 18 to 59, had a prospective quantification of WT1 MRD. The occurrence of a WT1 MRD ratio >2.5% in bone marrow or >0.5% in peripheral blood was defined as MRDhigh, and ratios below these thresholds were defined as MRDlow. The prognostic value of MRD after induction chemotherapy was assessed in 314 patients in first CR by comparing the risk of relapse, the relapse-free survival (RFS), and the overall survival (OS). Interaction between MRD response and the allo-SCT effect was evaluated in patients by comparing the influence of allo-SCT on the outcomes of patients with MRDhigh with those with MRDlow. The results showed that patients with MRDhigh after induction had a higher risk of relapse and a shorter RFS and OS. The MRD response remained of strong prognostic value in the subset of 225 patients with intermediate-/unfavorable-risk AML who were eligible for allo-SCT, because patients with MRDhigh had a significantly higher risk of relapse resulting in worse RFS and OS. The effect of allo-SCT was higher in patients with MRDlow than in those with MRDhigh, but not significantly different. The early WT1 MRD response highlights a population of high-risk patients in need of additional therapy.

PURPOSE Breast cancer risk prediction models are used to identify high-risk women for early detection, targeted interventions, and enrollment into prevention trials. We sought to develop and evaluate a risk prediction model for breast cancer in US Black women, suitable for use in primary care settings. METHODS Breast cancer relative risks and attributable risks were estimated using data from Black women in three US population-based case-control studies (3,468 breast cancer cases; 3,578 controls age 30-69 years) and combined with SEER age- and race-specific incidence rates, with incorporation of competing mortality, to develop an absolute risk model. The model was validated in prospective data among 51,798 participants of the Black Women's Health Study, including 1,515 who developed invasive breast cancer. A second risk prediction model was developed on the basis of estrogen receptor (ER)–specific relative risks and attributable risks. Model performance was assessed by calibration (expected/observed cases) and discriminatory accuracy (C-statistic). RESULTS The expected/observed ratio was 1.01 (95% CI, 0.95 to 1.07). Age-adjusted C-statistics were 0.58 (95% CI, 0.56 to 0.59) overall and 0.63 (95% CI, 0.58 to 0.68) among women younger than 40 years. These measures were almost identical in the model based on estrogen receptor–specific relative risks and attributable risks. CONCLUSION Discriminatory accuracy of the new model was similar to that of the most frequently used questionnaire-based breast cancer risk prediction models in White women, suggesting that effective risk stratification for Black women is now possible. This model may be especially valuable for risk stratification of young Black women, who are below the ages at which breast cancer screening is typically begun.

Background Early detection of lung cancer in asymptomatic patients remains challenging, especially for stage I. Considering the substantial interaction with tumor immunogenicity, we hypothesized that lung cancer-associated TCR (LC-aTCR) may serve as potential biomarker in early detection of stage I lung cancer. Methods Individuals who received low-dose computed tomography (LDCT) screening were enrolled in the study. Surgical tissues and peripheral blood specimens were collected and performed with DNA-based T cell repertoire (TCR) sequencing. The motif-based algorithm was used to deconstruct specific lung cancer-associated TCRs (LC-aTCRs). Results A total of 146 individuals participating in the real-world LDCT screening project were enrolled in this study, including 52 patients with pathologically-confirmed stage I lung cancer and 94 non-cancer controls. We developed a motif-based algorithm to define 80 LC-aTCRs in the training cohort. Moreover, in the validation cohort, high sensitivity and specificity was showed in stage I lung cancer with 72% and 91% respectively, and the AUC of the ROC curve was 0.91 (95% CI: 0.85 ∼ 0.96). Conclusion This work provides inspiration for stage I lung cancer detection by using blood TCR profiling data. The combination of TCR-based assay and routine screening deserves further testing in larger cohorts.

В огляді наведені сучасні дані щодо стану проблеми цукрового діабету 2-го типу та ролі оксидативного стресу. За останнє десятиліття кількість пацієнтів, хворих на цукровий діабет, зросла більше ніж на 150 млн по всьому світі; 90 % випадків — це цукровий діабет 2-го типу. За прогнозами Всесвітньої організації охорони здоров’я, до 2030 року цукровий діабет стане сьомою за значенням причиною смертності у світі. При цукровому діабеті створюються ідеальні умови для розвитку оксидативного стресу, основну роль в якому відіграє перекисне окислення ліпідів. Саме оксидативний стрес становить основу судинних ускладнень та уражає β-клітини, що призводить до прогресування захворювання. Раннє виявлення ознак оксидативного стресу та його корекція є пріоритетним завданням предикативної і профілактичної медицини.

Penyakit Tidak Menular (PTM) merupakan penyakit yang tidak ditransmisikan dan tidak dapat ditularkan kepada orang lain dengan bentuk kontak apapun yang dapat menyebabkan kematian dan membunuh 60% dari seluruh kematian secara global dan data prevalensi di negara berkembang mencapai 80%. Penyakit Tidak Menular, khususnya penyakit kardiovaskuler, kanker, penyakit pernapasan kronis, dan diabetes melitus merupakan ancaman utama bagi kesehatan dan perkembangan manusia saat ini. Pengabdian masyarakat ini bertujuan untuk mendeteksi penyakit tidak menular yaitu skrining tekanan darah, kadar gula darah sewaktu (GDS), kolesterol, dan asam urat, pada masyarakat Padukuhan Pikgondang Desa Condongcatur Depok Sleman Yogyakarta. Jenis kegiatan yang dilakukan berupa penyuluhan kesehatan, pemeriksaan tekanan darah, kadar kolesterol, gula darah sewaktu dan asam urat. Tekanan darah diukur menggunakan spignomanometer dan stetoskop sedangkan analisis kolesterol, gula darah dan asam urat menggunakan alat pengecekan digital. Pengabdian masyarakat ini, telah dilakukan skrining dan deteksi dini factor risiko penyakit tidak menular terhadap 46 orang responden, meliputi 28 laki-laki dan 18 perempuan. Adapun hasil pemeriksaan tersebut menunjukkan bahwa tekanan darah sistole rata-rata pada laki-laki 135 mmHg, sedangkan perempuan 140 mmHg. Rata-rata tekanan darah diastole pada laki-laki 80 mmHg dan perempuan 80 mmHg dan dapat diketahui bahwa sebagian besar warga memiliki tekanan darah tinggi sebesar 86,96% dan sebesar 58,70 % warga memiliki kadar kolesterol normal (

BACKGROUND: Mutational analysis of circulating tumor DNA (ctDNA) can potentially be used for early detection of recurrence after resection for hepatocellular carcinoma (HCC). Mutations from tumor may be identified in plasma as an early sign of recurrence. We conducted a pilot study investigating if somatic mutations could be detected in plasma in patients undergoing liver resection for HCC and in patients with advanced non-resectable HCC.METHODS AND RESULTS: We prospectively included patients undergoing curative liver resection for HCC. Tumor tissue was investigated with whole exome sequencing and preoperative blood samples were evaluated for ctDNA using targeted next-generation sequencing (NGS) with TruSight Oncology 500 including 523 cancer-associated genes. Subsequently, the method was evaluated in patients with advanced HCC. We included eight patients curatively resected for HCC, where tumor tissue mutations were identified in seven patients. However, only in one patient tumor specific mutations were found in the preoperative blood sample. In all three patients with advanced HCC, tumor mutations were detected in the blood.CONCLUSIONS: In patients with resectable HCC, ctDNA could not be reliably detected using the applied targeted NGS method. In contrast, ctDNA was detected in all patients with advanced HCC. Small tumors, tumor heterogeneity and limited sequencing coverage may explain the lack of detectable ctDNA.

Histologic subtyping offers some prognostic value in lung adenocarcinoma. We thus hypothesized that histologic subtypes may be useful for risk stratification of brain metastasis (BM). In this study, we aimed to investigate the impact of histologic subtypes on the risk for BM in patients with resected lung adenocarcinoma.Of 1099 consecutive patients who had undergone curative-intent surgery (2000-2014), 448 patients who had undergone complete resection for lung adenocarcinoma were included in this study. Correlated clinical variables and BM-free survival were analyzed.Micropapillary predominance was significantly associated with higher risk of BM after complete resection in univariate analyses (P.001). In addition, multivariate analyses showed that micropapillary predominance was an independent risk factor for BM (hazard ratio = 2.727; 95% confidence interval, 1.260-5.900; P = .011), along with younger age and advanced pathologic stage. Unlike the other subtypes, an increase in the percentage of the micropapillary subtype was positively correlated with an increase in BM frequency. Patients with micropapillary adenocarcinoma showed significantly poorer brain metastasis-free survival compared with those with non-micropapillary adenocarcinoma (3 years, 78.2% vs. 95.6%; 5 years, 67.3% vs. 94.3%; P.001).The current study demonstrated a significant correlation between micropapillary subtype and higher risk of BM in patients with resected lung adenocarcinoma. This routine histologic evaluation of resected adenocarcinoma may provide useful information for the clinician when considering postoperative management in patients with lung adenocarcinoma. Histologic subtyping offer some prognostic value in lung adenocarcinoma. Because brain metastasis is critical and often refractory to systemic chemotherapy, early detection is clinically important to achieve effective local treatment. We retrospectively analyzed the association between histologic subtypes and occurrence of brain metastasis and found a significant association between micropapillary predominance and higher risk for brain metastasis. Our findings may be relevant when considering postoperative management.

Objectives The number of composite tissue allotransplant procedures is increasing and has gained popularity. As with other transplant procedures, early detection of possible pathologies is as important as clinical follow-up. The present study investigated the correlation between microRNA expression levels and clinical follow-up of individuals undergoing composite tissue transplant. Materials and methods Whole microRNA expression levels were analyzed from peripheral blood mononuclear cells obtained from preoperative and postoperative blood of patients who underwent facial transplant. Analyses were performed using microRNA levels from patients' preoperative blood samples. Results The clinical findings of patients with facial transplant were correlated with individual miRNA expression level changes. The expression of miR-31, the high expression of which has been linked to rejection, was significantly low in our patients. No expression changes were observed in other rejection-related microRNAs. Grade 1 rejection was generally seen in our patients, and these findings are consistent with the degree and frequency of rejection episodes in our cases. In addition, immunosuppression-associated diseases such as squamous cell carcinoma, posttransplant lymphoproliferative disorders, and aspergillosis, which are encountered clinically, were found to correlate with expression changes in microRNAs such as miR-150-5p, miR-21-5p, miR-17-5p, miR-20a-5p, and miR-3607-5p. Conclusions Defining the clinical findings and immunosuppression-associated pathologies encountered in composite tissue transplant using biomarkers such as microRNA can play an important role in the improvement of these transplant procedures and in predicting patient morbidity. Therefore, the use of microRNAs may be useful in the clinical follow-up of patients who have received composite tissue allotransplant.

Background To date, there is no approved blood‐based biomarker for breast cancer detection. Herein, we aimed to assess semaphorin 4C (SEMA4C), a pivotal protein involved in breast cancer progression, as a serum diagnostic biomarker. Methods We included 6,213 consecutive inpatients from Tongji Hospital, Qilu Hospital, and Hubei Cancer Hospital. Training cohort and two validation cohorts were introduced for diagnostic exploration and validation. A pan‐cancer cohort was used to independently explore the diagnostic potential of SEMA4C among solid tumors. Breast cancer patients who underwent mass excision prior to modified radical mastectomy were also analyzed. We hypothesized that increased pre‐treatment serum SEMA4C levels, measured using optimized in‐house enzyme‐linked immunosorbent assay kits, could detect breast cancer. The endpoints were diagnostic performance, including area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Post‐surgery pathological diagnosis was the reference standard and breast cancer staging followed the TNM classification. There was no restriction on disease stage for eligibilities. Results We included 2667 inpatients with breast lesions, 2378 patients with other solid tumors, and 1168 healthy participants. Specifically, 118 patients with breast cancer were diagnosed with stage 0 (5.71%), 620 with stage I (30.00%), 966 with stage II (46.73%), 217 with stage III (10.50%), and 8 with stage IV (0.39%). Patients with breast cancer had significantly higher serum SEMA4C levels than benign breast tumor patients and normal controls (P < 0.001). Elevated serum SEMA4C levels had AUC of 0.920 (95% confidence interval [CI]: 0.900–0.941) and 0.932 (95%CI: 0.911–0.953) for breast cancer detection in the two validation cohorts. The AUCs for detecting early‐stage breast cancer (n = 366) and ductal carcinoma in situ (n = 85) were 0.931 (95%CI: 0.916–0.946) and 0.879 (95%CI: 0.832–0.925), respectively. Serum SEMA4C levels significantly decreased after surgery, and the reduction was more striking after modified radical mastectomy, compared with mass excision (P < 0.001). The positive rate of enhanced serum SEMA4C levels was 84.77% for breast cancer and below 20.75% for the other 14 solid tumors. Conclusions Serum SEMA4C demonstrated promising potential as a candidate biomarker for breast cancer diagnosis. However, validation in prospective settings and by other study groups is warranted., Breast cancer patients had significantly higher serum SEMA4C levels than patients with benign breast tumor and normal controls. Serum SEMA4C is considered as a candidate diagnostic biomarker for the early detection and diagnosis of breast cancer.

Introduction The combination of biochemical markers, together with the design and implementation of diagnostic algorithms in laboratory computer systems could become very powerful tools in the stratification of cardiovascular risk. Objectives To implement new biochemical markers and diagnostic algorithms not yet available, in order to provide an estimation of cardiovascular risk and the diagnostic orientation of lipid alterations. Material and methods Study of the implementation of Apolipoprotein B and Lipoprotein (a), as well as the inclusion of different diagnostic algorithms. This was carried out jointly by the different Lipid Units of the Spanish Society of Atherosclerosis, Hospital Virgen Macarena in Seville, Hospital Juan Ramon Jimenez, Hospital Infanta Elena, and Hospital de Rio Tinto during 2018 and 2019. Results The four diagnostic algorithms entered into the Laboratory Information System (LIS), showed a total of 9985 patients with c-LDL >200 mg/dL. The diagnostic algorithm was extended to include Apo B, with 8182 determinations showing an Apolipoprotein B > 100 mg/dL). A total of 747 lipoprotein (a) were determined, of which 30.65% were >50 mg/dL. More than two-thirds (71.80%) showed results compatible with small and dense LDL particles. Conclusions The implementation of new analytical parameters and algorithms in Primary Care laboratory results can identify a considerable number of patients with different alterations in lipid metabolism. This, together with the classic risk factors, could contribute to a correct risk stratification in preventing the progression of CVD.

In recent decades, significant progress has been made in the diagnosis and treatment of colorectal carcinomas. Prevention and early detection with endoscopic therapy are of central importance. With the introduction of national screening programs, the early detection of adenomas and small tumors during colonoscopy has been significantly improved, thus reducing the incidence of colorectal carcinoma. In Germany, for example, this has been reduced by 17-26 % since its introduction in 2002. Thus, primary and secondary prevention are of considerable importance, although the annual uptake in Germany for screening Kolonoscopy is still only between 1.9 and 4.4 % and for stool test use between 8.6 and 27.1 %. We present here the importance of primary and secondary prevention based on pathogenesis, risk factors and diagnostic and therapeutic endoscopic options.

Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is vital to addressing the regions rising burden of disease. Tissue from unselected Nigerian patients was analyzed with a multigene, next-generation sequencing assay. The rate of microsatellite instability is significantly higher among Nigerian CRC patients (28.1%) than patients from The Cancer Genome Atlas (TCGA, 14.2%) and Memorial Sloan Kettering Cancer Center (MSKCC, 8.5%, P, Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is important for early detection and treatment. Here, the authors use a multigene next-generation sequencing panel to identify genomic differences in Nigerian CRCs compared to those from TCGA and MSKCC cohorts.

Suzy E Meijer,1,2 Olga Klebanov-Akopyn,3 Vera Pavlov,2,3 Shachar Laks,4 David Hazzan,4 Aviram Nissan,2– 4 Douglas Zippel3,4 1Department of Infectious Disease, Sourasky Medical Center, Tel Aviv, Israel; 2The Surgical Oncology Laboratory, Hadassah-Hebrew University Hospital, Jerusalem, Israel; 3The Surgical Oncology Laboratory, The Chaim Sheba Medical Center, Ramat Gan, Israel; 4Department of General and Oncological Surgery – Surgery C, The Chaim Sheba Medical Center, Ramat Gan, IsraelCorrespondence: Douglas ZippelDepartment of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, IsraelTel +972-3-530-2714Fax +972-3-5341562Email dov.zippel@sheba.health.gov.ilPurpose: Minimal residual disease (MRD) refers to micrometastases that are undetectable by conventional means and is a potential source of disease relapse. This study aimed to detect the presence of breast cancer (BC) biomarkers (MGB-1, MGB-2, CK-19, NY-BR-1) using real-time polymerase chain reaction (RT-PCR) in peripheral blood mononuclear cells (PBMC) of BC patients and the impact of a positive assay on clinical outcome.Patients and Methods: Patients in the analysis included females > 18 years of age with biopsy-proven carcinoma of the breast. A 10 mL sample of venous blood was obtained from 10 healthy controls and 25 breast cancer patients. Comparisons of peripheral blood markers were made with clinicopathological variables.Results: High-quality RNA was extracted from all samples with a mean RNA concentration of 224.8± 155.3 ng/μL. Each of the molecular markers examined was highly expressed in the primary breast tumors (n = 3, positive controls) with none of the markers detected in healthy negative controls. The NY-BR-1 marker was expressed in one (4%) patient with metastatic disease with no MGB-1 and MGB-2 detected in any sample derived from the study patients. The CK-19 marker was detected in 16 (64%) of the BC cases. No correlation was found between CK-19 expression and tumor stage (P = 0.07) or nodal status (P = 0.32). No correlation was identified in the BC patients between CK-19 expression and receptor status in the BC primary tumor.Conclusion: This study showed high expression of all 4 markers NY-BR-1, MGB-1, MGB-2 and CK-19 in the PBMCs derived from breast cancer patients. CK-19 was detected in 64% of the stage I–III cases operated with curative intent, the only recurrent events occurring in the CK-19-positive cases. Our data confirm the need to enhance techniques for detection of MRD, which may better predict patients at risk for relapse.Keywords: breast cancer, circulating tumor cells, cancer biomarkers, early detection, predictive potential

Blood oxygen saturation meter is a tool used to monitor the state of oxygen saturation in the blood and also the patient's heart rate (BPM) and to assist in the physical assessment of the patient without going through blood gas analysis. Oxygen saturation measuring devices usually use the difference in the wavelengths of red and infrared led light that will be captured by the photodiode. The purpose of this research is to make a pulse oximeter equipped with a display of SPO2, BPM values ​​and an additional SP02 signal. The design of this measuring instrument uses the MAX30100 sensor, the minimum system circuit of Arduino ATmega328p and OLED (Organic Light-Emitting Diode). Data from the MAX30100 sensor enters the I2C pin on the minimum Arduino system, then the microcontroller is processed to produce the percentage of SPO2 value, BPM value, and SPO2 signal which is then displayed on the OLED. The test is done by comparing the module with standard measuring instruments which produces the largest % error of 0.81% for Spo2 and 0.87% for BPM. The error presentation is obtained from factor measurements, if there is finger movement it will cause a large error. From the results obtained, the tool is still feasible to use because in the "Guidelines for Testing and Calibrating Medical Devices" Ministry of Health RI 2001, the maximum limit in the pulse oximeter error tolerance is for Spo2 1% and BPM 5%.

Aims Fabry cardiomyopathy (FC) is characterized by progressive left ventricular hypertrophy (LVH). Conventional echocardiography is not sensitive in detecting preclinical FC before the development of LVH. We aim to investigate whether myocardial deformation analysis is useful to detect preclinical FC before LVH. Methods and results One hundred and sixty patients carrying mutated gene were prospectively enrolled, including 86 patients without LVH and 74 patients with LVH. Another 33 healthy individuals were also included for comparison. Standard transthoracic two-dimensional, Doppler, tissue Doppler echocardiography and deformation analysis were performed. The mean age of the overall 193 subjects was 48 ± 15 years, with 51% men. Fabry patients with LVH were older, more often to be men. They also had the worst diastolic function as evidenced by the largest left atrium, lowest E/A, and highest E/e′ ratio. The global longitudinal strain (GLS) deteriorated with the development of LVH (control vs. LVH− patients vs. LVH+ patients = −21.2 ± 2.7 vs. −19.0 ± 2.9 vs. −16.5 ± 4.2%, P Conclusion Reduced GLS could be a marker of early FC before the development of LVH.

Aim: To ascertain early detection of possible kidney injuries in albino rats exposed to formaldehyde by assessing cystatin C, serum electrolytes, urea and creatinine. Materials/Methods: Thirty healthy adult male albino rats, weighing between 100 to 120 grams were randomly divided into three groups A, B and C. Group A served as control. Group B was exposed to low dose (100ppm of Formaldehyde), 3 hrs per day for four weeks, while group C was exposed to high Dose-200ppm of formaldehyde 3 hrs per day for four weeks. At the end of the exposure period, the rats were sacrificed by decapitation under chloroform anesthesia, and 4 ml of blood samples was collected from each rat into a plain bottle. The whole blood was allowed to clot, retracted and centrifuged at 3000 rpm for 10 minutes and serum separated. The serum was stored at -20˚C until analyses for serum electrolytes, creatinine and cystatin C. Serum electrolytes were determined using Ion selective electrode, urea and creatinine were determined using spectrophotometric methods while cystatin C was analyzed using Eliza. Data obtained was analyzed using SPSS. Results: The concentrations of the serum electrolytes, sodium. Potassium, bicarbonate and chloride were compared across the three group, they were not statistically significant (p>0.05). Urea was significantly higher in group C when compared with low dose B and control group A (P

PURPOSE Noise is one of the major environmental health problems and is defined as any unpleasant sound. It was shown that prolonged exposure to noise was associated with progress of diseases. There is no study evaluating the effect of noise on the oxidative parameters of Total Antioxidant Capacity (TAC), Total Oxidant Status (TOS) and DNA damage. AIM This study aimed to evaluate the effect of noise on TOS, TAC and DNA damage. METHODS In this study, we included 100 textile factory workers affected by noise as a noise group, and 56 healthy volunteers employed as office workers in our hospital who were not exposed to noise as the control group. Blood samples were obtained from both the groups. Oxidative Stress (OS) was measured by Oxidative stress index (OSI), TOS and TAC. The DNA damage level was measured by 8-Hydroxydeoxyguanosine (8-OHdG). RESULTS 8-OHdG (21.8 ± 12.0 vs. 14.7 ± 5.6 pg/ml, p = 0.001),TOS (14.1 ± 2.5 vs. 10.9 ± 1.5 mol H2O2 equivalent/l, p

Introducción: Los síntomas extraesofágicos por reflujo son frecuentes en la consulta externa de otorrinolaringología. Al relacionarse con problemas como laringitis crónica, carcinoma laríngeo, entre otras, es importante su comprensión y detección temprana. El monitoreo ambulatorio de pH de 24 horas es el estándar de oro para el diagnóstico, pero no se realiza rutinariamente. Existen otras herramientas para la detección de esta patología como el índice de síntomas de reflujo (ISR) y el puntaje de hallazgos de reflujo (PHR) de Belafsky. Métodos: En este estudio se comparó el ISR y el PHR buscando correlación entre los dos, para contribuir a un mejor acercamiento al diagnóstico en pacientes de consulta externa con sospecha de reflujo extraesofágico (REE). Se incluyeron todos los pacientes que acudieron a consulta de otorrinolaringología con síntomas sugestivos de REE, durante el periodo comprendido entre agosto de 2020 a febrero de 2021. Resultados: Se estudiaron 92 pacientes con una edad promedio de 52 años, a los cuales se les aplicó el ISR y PHR de Belafsky. El ISR fue positivo en 81,5% (n: 75) de los pacientes; el PHR en 83,7% (n: 77). La mejor concordancia estuvo en relación a que los pacientes que obtuvieron un resultado positivo tanto en la el ISR como en el PHR, tuvieron una sensibilidad de 92% (valor predictivo positivo de 90%), y una especificidad del 53% (valor predictivo negativo de 60%). Conclusiones: Concluimos que el ISR y PHR de Belafsky son útiles para estudiar pacientes con sospecha de REE, con bajo costo y alta reproductibilidad.

Las infecciones odontogénicas afectan al 80-90% de la población y pueden dar lugar a complicaciones potencialmente mortales como la mediastinitis necrotizante descendente, una infección polimicrobiana aguda en el mediastino con una tasa de mortalidad entre el 11-40%. La detección precoz y el tratamiento adecuado representan factores influyentes en el pronóstico de la enfermedad.

This review introduces clinicians to the basic concepts of the biology of circulating tumour DNA (ctDNA), which is required to understand clinical use of ctDNA technology. We provide an overview of how new technology has improved the sensitivity of ctDNA detection over the last decade and the available techniques for ctDNA analysis including whole-genome sequencing (WGS), targeted cancer-associated gene panels, and methylation analysis. We discuss the most recent evidence from clinical trials for ctDNA in patient care including precision treatment of advanced cancers, disease monitoring, improving adjuvant treatment, and screening for early detection of cancer. Finally, we outline how ctDNA is likely to directly impact radiologists, and identify further research required for ctDNA to progress into routine clinical application.

PURPOSE: Early detection of SARS-CoV-2 patients is essential to contain the pandemic and keep the hospital secure. The rapid antigen test seems to be a quick and easy diagnostic test to identify patients infected with SARS-CoV-2. To assess the possible role of the antigen test in the Emergency Department (ED) assessment of potential SARS-CoV-2 infection in both symptomatic and asymptomatic patients. METHODS: Between 1 July 2020 and 10 December 2020, all patients consecutively assessed in the ED for suspected COVID-19 symptoms or who required hospitalisation for a condition not associated with COVID-19 were subjected to a rapid antigen test and RT-PCR swab. The diagnostic accuracy of the antigen test was determined in comparison to the SARS-CoV-2 PCR test using contingency tables. The possible clinical benefit of the antigen test was globally evaluated through decision curve analysis (DCA). RESULTS: A total of 3899 patients were subjected to antigen tests and PCR swabs. The sensitivity, specificity and accuracy of the antigen test were 82.9%, 99.1% and 97.4% (Cohen's K = 0.854, 95% CI 0.826-0.882, p

Background: Cardiovascular disease (CVD) has become increasingly recognized as a cause of mortality, especially in patients with long-standing systemic lupus erythematosus (SLE). Aim of the work: To detect subclinical cardiac involvement and its relation to clinical characteristics, disease activity and damage. Patients and methods: Transthoracic echocardiography (TTE) was performed in 36 SLE patients. Cardiac magnetic resonance (CMR) sections were obtained. T1-weighted inversion recovery scout images were obtained after injection of gadolinium. Results: Thirty-six patients were included with a mean age of 32.4 ± 8.5 years; 35 females and 1 male; with disease duration of 7.9 ± 5 years. The frequent cardiac presentations on TTE were tricuspid regurgitation (TR) (41.6%), mitral regurgitation (MR) (36.1%), mitral thickening (25%), early diastolic mitral flow/mitral flow during atrial contraction (E/A)

Background We developed a laboratory test-based regression model for early detection of hepatocellular carcinoma (HCC) associated with HCV in its surveillance. Methods This matched case–control study was conducted by enrolling 452 patients with chronic hepatitis and/or cirrhosis, including 129 patients complicated with HCC. One-to-one propensity score matching was performed by referring to sex, age, and fibrosis-4 index, which resulted in 102 patients each in HCC and non-HCC groups. Logistic regression models (LRM) for distinguishing the two groups were explored from variable combinations of laboratory tests. The model was validated by our new scheme of applying it retroactively to trimonthly previous datasets. Results Models with a practical level of diagnostic accuracy (C-statistic) were α-fetoprotein (AFP) alone (0.810), LRM3 comprising AFP, AST, and ALT (0.850), and LRM4 comprising AFP, AFP/(AST × ALT), and AST (0.862). After retroactive application of each model, LRM4 showed the highest distinction of the two groups at −12M, −6M, −3M with C-statistics of 0.654, 0.786, 0.834, respectively. LRM4 was accurate even after limiting cases to early-stage HCC. Conclusions LRM4 was proved useful in prompting clinicians to perform timely image study in the surveillance. The retroactive validation scheme is applicable to assess diagnostic models of other neoplastic diseases.

With an increasing prevalence of metabolic syndrome (MS) early detection and timely management of cardiometabolic risk factors are crucial to prevent complications such as type 2 diabetes m...

Background The increasing incidence of breast cancer necessitates the need to explore alternate screening strategies that circumvent the setbacks of conventional techniques especially among population that report earlier age at diagnosis. Serum autoantibodies is one such potential area of interest. However, their ubiquitous presence across cancer types limits its applicability to any one specific type of cancer. This review was therefore carried out to explore and consolidate available evidence on autoantibodies for early detection of breast cancer and to identify those that demonstrated a higher sensitivity. Methods A diagnostic test accuracy (DTA) review was carried out to ascertain serum autoantibodies that could be used for early detection of breast cancer among women. All relevant articles that investigated the role of autoantibodies in early detection of breast cancer were included for the review. MEDLINE, Scopus, ProQuest, Ovid SP, and Cochrane Library were searched extensively for eligible studies. Quality of the included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. RevMan 5.3 was used for exploratory and MetaDTA 2019 for hierarchical analyses. The review helped identify the most frequently investigated autoantibodies and a meta-analysis further consolidated the findings. Results A total of 53 articles were included for the final analysis that reported over a 100 autoantibodies that were studied for early detection of breast cancer in women. P53, MUC1, HER2, HSP60, P16, Cyclin B1, and c-Myc were the most frequently investigated autoantibodies. Of these P53, MUC1, HER2, and HSP60 exhibited higher summary sensitivity measures. While the individual pooled sensitivity estimates ranged between 10 and 56%, the panel sensitivity values reported across studies were higher with an estimated range of 60–87%. Conclusion Findings from the review indicate a higher sensitivity for an autoantibody panel in comparison to individual assays. A panel comprising of P53, MUC1, HER2, and HSP60 autoantibodies has the potential to be investigated as an early detection biomarker for breast cancer.

Item does not contain fulltext The literature gives limited data or guidance on how to select or combine biomarkers and magnetic resonance imaging (MRI) for the early detection of prostate cancer. We strongly recommend prospective studies large enough to address questions such as the properties of biomarkers in cases with high versus low Prostate Imaging-Reporting and Data System scores or the correlation between biomarkers and MRI, and that evaluate results in the context of reasonable clinical scenarios.

Diabetes mellitus is one of the major non-communicable diseases in India. Kamareddy district, with the support of Novartis under its Public Health Initiatives, has implemented secondary screening camps for subjects with higher risk of diabetes through screening under NPCDCS. In this analysis, we aim to identify the utility of the camps in monitoring diabetes management and early detection complications like diabetic retinopathy (DR). Seventeen camps were conducted in the rural Kamareddy district during Jun 2019 to Mar 2020. Subjects with RBS ≥ 140 mg/dl in the field screening were counselled and referred to the camps conducted as per schedule for further assessment through HbA1c, fundoscopy, ECG and lipid profile in an algorithm-based screening protocol. Twelve percent (24,965/208,685) of screened subjects had abnormal RBS and were referred to the camps. Of them, 9.2% (n = 2287; male = 1291; female = 996) could avail HbA1c testing in the camps, which consisted of 45% (1022) known diabetics. Forty-nine percent of the subjects belonged to age group 40–59 years (range: 6–88). Nearly one-third (34%) had HbA1c levels ≥ 7%. More than 63% of the known Diabetic subjects had HbA1c ≥ 7% indicating the need for strengthening treatment adherence (p

Globally, colorectal cancer (CRC) is one of the most often diagnosed solid tumors, with a significant death and morbidity rate. CRC biomarkers are desperately needed for early detection. Traditional CRC tumor markers do not have the best diagnostic performance. The levels of leptin and vitamin D were evaluated. CRC patients before treatment (n=16), CRC patients after treatment (n=14), and 20 patients with benign tumors were included in this case-control study. ELISA was used to determine the levels of traditional tumor markers (CA19.9 and CEA) as well as candidate markers (leptin and vitamin D). Using area receiver-operating characteristic analysis (AUC), the diagnostic performance of single and combination markers was assessed (ROC). The levels of CEA and CA 19.9 in the three groups studied were not significantly different. Vitamin D and leptin were significantly decreased (p= 0.03 and p= 0.02; respectively) in CRC patients than after benign patients. A novel combination, based on the combination of vitamin D and leptin was developed for CRC diagnosis using stepwise multivariate discriminant analysis (MDA). The combination can be represented as = (4.65 – vitamin D ((ng/ml)) × 0.009 + Leptin (ng/ml) × 0.441). AUCs were reported when leptin was used as a single biomarker for distinguishing CRC from benign (0.78) and non-treated CRC from treated CRC (0.67). When leptin and vitamin D were combined, the AUCs increased to 0.84 and0.72, respectively. Conclusion: Leptin and vitamin D were shown to be promising diagnostic and follow-up indicators for CRC in our investigation.

Background: Worldwide, tuberculosis (TB) is one of the top 10 causes of death. Drug resistant tuberculosis has lately become a major public health problem that threatens progress made in Tuberculosis (TB) care and control worldwide. The aim of this study was to determine the prevalence of Pre-extensive drug resistant TB among MDR TB in North Central of Nigeria. Methods: This study was conducted from October, 2018 to August, 2019 with 150 samples. In Nigeria, guidelines for DR-TB as recommended by WHO is followed. All the samples from the patients who gave their consent were transported to a zonal reference TB laboratory (ZRL). Results: Mean age was 38.6 ± 13.4 years with peak age at 35-44. Out of these 103 samples processed with LPA, 101(98%) were rifampicin resistant and 2 were rifampicin sensitive, 99(96%) were INH resistant and 4 (4%) were INH sensitive, 5(5%) were fluoroquinolone resistant, 98(95%) were fluoroquinolone sensitive, 12 (12%) were Aminoglycoside + Capreomycin resistant, 91(83%) were Aminoglycoside + Capreomycin sensitive. Conclusion: Multidrug resistant TB and its severe forms (Pre-extensive & extensively drug resistant TB) can be detected early with rapid tool- Line Probe Assay rapid and prevented timely by early initiation on treatment. Keywords: Pre-XDR TB; line probe assay in a high TB burden country.

Introduction:The use of dasatinib in patients with CML has improved life expectancy and follow-up with transthoracic echocardiography (ECOTT) for early detection of PAH allows modifications to the treatment.Objective:To determine the echocardiographic parameters and echocardiographic probability for PAH in patients with CML treated with dasatinib.Methods:Correlation, cross-sectional, retrospective, single-center study; patients with CML treated with dasatinib were included. Spearman and Pearson correlation was used.Results:16 patients were analyzed, mean age 53.5 years; 62.5% men, 37.5% women. The dasatinib dose was 50 mg / day in 18.7%, and 100 mg / day in 81.2%, mean pulmonary arterial pressure (mPAP) 26.3 mmHg, mean maximum tricuspid regurgitation velocity (VmxRT) 2.9 m / s, mean pulmonary artery systolic pressure (PSAP) 41 mmHg. 56.2% had right ventricular diastolic dysfunction (RVDD). 43% were categorized as low probability for PAH, 18.7% intermediate, and 37.5% as high. Relationship between PAPm and VmxRT with p = 0.012. Relationship between mPAP and RV diastolic function, with p = 0.002. Relationship between probability for PAH and mPAP, with p = 0.008.Conclusion:The echocardiographic parameters PAPm, VmxRT, PSAP, DDVD and echocardiographic probability for PAH are useful and necessary for the diagnosis of PAH. The determination of all these parameters should be carried out early and as a follow-up, since a considerable positive relationship was found for each one with the presence of PAH, which is not dependent on the treatment time or the dose of dasatinib. Introducción:La leucemia mieloide crónica (LMC) es un desorden clonal de células madre hematopoyéticas, predomina en el género masculino entre 55 y 65 años. El ecocardiograma transtorácico (ECOTT) para detección temprana de hipertensión arterial pulmonar (HAP) permite hacer modificaciones al tratamiento con dasatinib.Objetivo:Determinar los parámetros ecocardiográficos y la probabilidad ecocardiográfica para HAP en pacientes con LMC tratados con dasatinib.Métodos:Estudio de correlación, transversal, retrospectivo, unicéntrico; se incluyeron pacientes con LMC tratados con dasatinib. Se utilizó correlación de Spearman y Pearson.Resultados:Se analizaron 16 pacientes, edad promedio 53,5 años; 62,5% hombres, 37,5% mujeres. La dosis de dasatinib fue 50 mg/día en 18,7%, y 100 mg/día en 81,2%, presión media de la arteria pulmonar (mPAP) 26,3 mmHg, velocidad máxima de regurgitación tricuspídea (VmxRT) media 2,9 m/s, presión sistólica de arteria pulmonar (PSAP) media 41 mmHg. El 56,2% presentó disfunción diastólica del ventrículo derecho (DDVD). Se categorizaron 43% en baja probabilidad para HAP, 18,7% intermedia y 37,5% en alta. Relación entre mPAP y VmxRT con p=0,012. Relación entre mPAP y función diastólica del ventrículo derecho (FDVD), con p=0,002. Relación entre probabilidad para HAP y mPAP, con p=0,008.Conclusión:Los parámetros ecocardiográficos mPAP, VmxRT, PSAP, DDVD son útilesy la probabilidad ecocardiográfica para HAP deben realizarse de forma temprana y como seguimiento, ya que se encontró relación positiva con la presencia de HAP, la cual no es dependiente del tiempo de tratamiento ni de la dosis de dasatinib.

Introduction:New communication technologies allow new opportunities to optimize medical work.Objective:To determine the assessment of WhatsApp for communication and organization of group work among resident physicians during a healthcare management course.Methods:Descriptive, prospective, cross-sectional study. The population consisted of 140 resident physicians who participated in a healthcare management course in 2019 and 2020. A non-probability convenience sample of 132 participants was obtained. We applied the instrument to assess WhatsApp for regulating group work, through the dimensions “WhatsApp for organizing group work” and “WhatsApp as a communication system for group work”, with a reliability of 0.92. Based on the scores assigned to this dimension by the participants, we divided them into three groups: low, medium and high rating.Results:Resident physicians from eight specialties participated: psychiatry, internal medicine, otolaryngology, clinical pathology, cardiovascular surgery, anatomic pathology, legal medicine and pediatric ophthalmology. The average age was 33.37 years. 86.4% of residents use WhatsApp daily. Activity planning and sending text messages and brief instructions had favorable scores. Both dimensions scored 47.36% in the low rating group, 46.35% in the high rating group and 39.3% in the medium rating group. The global result showed a predominance of the high and low rating groups.Conclusion:The majority of resident physicians use WhatsApp as a non-formal communication tool, helpful for sending messages, developing group tasks and planning activities. Additionally, resident physicians and professors consider WhatsApp to be a useful app, and it could facilitate knowledge acquisition. Introducción:Las nuevas tecnologías de comunicación permiten nuevas oportunidades para optimizar el trabajo médico.Objetivo:Determinar la valoración de WhatsApp para la comunicación y organización del trabajo grupal en médicos residentes durante el desarrollo del curso de gerencia en salud.Métodos:Investigación descriptiva, prospectiva y de corte transversal. La población estuvo conformada por 140 médicos residentes matriculados en el curso de gerencia en salud durante 2019 y 2020. Se empleó una muestra no probabilística por conveniencia conformada por 132 participantes. Se utilizó el instrumento para valorar WhatsApp en la regulación del trabajo en grupo mediante la dimensión WhatsApp para la organización del trabajo grupal y como sistema de comunicación para las tareas grupales, contiene una confiabilidad de 0,92. Los resultados se establecieron en 3 grupos; bajo, medio y alto.Resultados:Participaron ocho especialidades médicas; psiquiatría, medicina interna, otorrinolaringología, patología clínica, cirugía cardiovascular, anatomía patológica, medicina legal y oftalmología pediátrica. La edad promedio fue 33,4 años. 86,4% utiliza WhatsApp en forma diaria. La planificación de actividades, envío de mensajes e instrucciones cortas obtuvieron puntuaciones favorables. Las dos dimensiones mostraron 47,4% para grupo bajo; 46,5% grupo alto y 39,3% grupo medio. El resultado global evidenció un predominio del grupo alto y bajo.Conclusión:La mayoría de médicos residentes utiliza WhatsApp como una herramienta de comunicación no formal, útil para el envío de mensajes, desarrollo de tareas grupales y planificación de actividades. Asimismo, WhatsApp es considerado un aplicativo útil para los médicos residentes y los profesores permitiendo la adquisición de conocimientos.

The risk of carcinogenesis increases after 20 years old in patients with Fanconi anemia (FA). We herein report three rare cases of FA combined with esophageal cancer in women; all patients were diagnosed with FA in early childhood. Patients 1 and 2 were diagnosed with advanced and superficial esophageal cancer, respectively, at 21 and 30 years old, respectively. Patient 3 was diagnosed with superficial esophageal cancer, underwent curative surgery at 26 years old, and survived for over 5 years without recurrence. Therefore, establishing a protocol for the early detection of esophageal cancer in FA patients over 20 years old is important.

Extra medullary relapse (EMR) is the major concern of treatment failure in acute lymphoblastic leukemia (ALL). Hence, their early detection may improve prognosis. Aim of the study is to identify risk factors and outcome of EMR patients with and without concurrent medullary relapse. We retrospectively analyzed 113 patients of ALL who presented with EMR in a tertiary cancer care hospital. Patients were divided into two groups; Group 1, combined EMR (with medullary relapse) and Group 2, isolated EMR (without medullary relapse). Clinical characteristics including total leukocyte count (TLC) & peripheral blood blast percentage during presentation, phenotype, initial central nervous system (CNS) involvement and BCR-ABL translocation were analyzed to identify risk factors for EMR. Incidence of EMR in our study was 15.7% (113/720 patients). Two year incidence of combined EMR and isolated EMR was 10.1% and 5.5% respectively. CNS, followed by testis was common sites of EMR. TLC >50x109/L and peripheral blood blast percentage >50% at presentation was common in Group 1. BCR-ABL translocation was frequent in Group 2 and in adults compared to children (p=0.027). While Group 1 patients presented with leukocytosis (TLC >10X109/L), Group 2 patients presented with leukopenia (TLC 50X109/L and BCR-ABL translocation were identified as risk factors for combined EMR (p=0.004) and for in adults with isolated EMR (p=0.001) respectively.

Leadless pacemakers have become a major breakthrough in the management of bradyarrhythmia as an attractive alternative to the standard transvenous pacemakers, but safety and long-term outcomes of the new Micra-AV, which is capable guarantee atrioventricular (AV) synchrony, have been poorly described. Hence, we describe how we managed a 57-year-old patient who developed pacemaker syndrome due to significant Micra-AV dyssynchrony. This case emphasizes how leadless pacemaker AV synchrony could be overestimated, thereby requiring a stepwise process leading to adequate device reprogramming. Holter-ECG monitoring and exercise test resulted to be valuable tools for an early detection of inadequate AV synchrony, integrating and completing device reports.