Coagulopathy as initial manifestation of concomitant celiac disease and cystic fibrosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Celiac disease and cystic fibrosis have many common manifestations, such as malabsorption, steatorrhea and growth failure, and were for many years recognized as one clinical entity. Since their recognition as two separate diseases, their co-existence in a patient has been described sporadically; around 20 cases have been described in the literature. Taking into consideration the incidences of the two diseases, the chance of them occurring together is one in 2,000,000 in the general population.</p> <p>Case presentation</p> <p>We describe the case of a five-year-old boy of Turkish ethnicity with both celiac disease and cystic fibrosis, who presented initially with a skin hemorrhage. The diagnosis of celiac disease was made with a positive serum anti-tissue transglutaminase antibody test and the presence of HLA-DQ2 heterodimer, and confirmed on histology with small intestinal villous atrophy. A positive sweat test confirmed the diagnosis of associated cystic fibrosis.</p> <p>To the best of our knowledge there has been no previous report of this rare presentation of associated celiac disease and cystic fibrosis.</p> <p>Conclusion</p> <p>The clinical significance of this case is the consideration of malabsorption with both celiac disease and cystic fibrosis in patients who present with unexplained coagulopathy.</p

Rate and duration of hospitalisation for acute pulmonary embolism in the real-world clinical practice of different countries : Analysis from the RIETE registry

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When staging for lung cancer, don\u27t forget to screen the pulmonary artery.

EBUS may be a useful diagnostic tool for central pulmonary embolus in cancer patients during bronchoscopy. CASE REPORT A 56 year old female lifelong non-smoker was referred to the pulmonary service for evaluation of multiple pulmonary nodules and mediastinal lymphadenopathy. She reported unintentional weight loss of 70lbs over a period of ten months, dyspnea, non-productive cough and generalized fatigue. She denied hemoptysis. CT chest non-contrast study revealed multiple lung masses and nodules, with the largest mass being 3cm in the right lower lobe as well as enlarged mediastinal lymph nodes. The patient underwent bronchoscopy with endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging, as well as transbronchial biopsy of the right lower lobe mass. During the EBUS assessment of the mediastinum, a large echogenic mass was observed in the lumen of the right main pulmonary artery that extended into the lobar segment of the PA. After the procedure CT chest with contrast was performed and confirmed the diagnosis of a large embolus in the right main pulmonary artery, extending to upper and lower lobe pulmonary arteries and few of the segmental branches in the right lower lobe. DISCUSSION EBUS-TBNA is a key tool in the diagnosis and staging of lung cancer. EBUS is also a potential useful tool for the visualization of pulmonary artery embolus during bronchoscopy; especially in lung cancer patients who have an increased risk of thromboembolic disease. As of now, computed tomography angiography is the gold standard imaging modality for pulmonary embolism. However in clinical practice, many patients have limitations for angio-CT such as allergy to iodinated contrast agents or renal failure. By scanning the pulmonary artery the bronchoscopist will be able to visualize central emboli in real time. The right pulmonary artery lies immediately anterior to the right main stem bronchus near the origin of the right upper lobe bronchus. The left pulmonary artery ascends over the anterior surface of the left main bronchus just distal to the arch of the aorta. It is known that cancer patients have a higher incidence of venous thromboembolism compared to the general population. Lung cancer in particular has a reported incidence of VTE 3-13.8% and that of PE up to 3.8%. The mortality of pulmonary embolism is high and requires prompt diagnosis and treatment. EBUS could become an early diagnostic tool in high risk cancer patients who may have silent thromboembolic disease. (Figure Presented)

A longitudinal outcomes evaluation of an adapted Certified Tobacco Treatment Specialist (aCTTS) for physicians in the Former Yugoslavian Republic of Macedonia (FYROM)

Introduction The CTTS program has been shown to decrease smoking in populations within the United States. The program was adapted into a 1 ½ day training for Macedonian physicians. The overall program aim was to train 100 medical providers in the aCTTS curriculum. The objectives were to: 1) increase provider knowledge and self-efficacy for patient counseling; and, 2) counsel at least 500 patients to quit tobacco use over a one-year period. Methods A longitudinal survey was conducted at baseline, immediate post-intervention (knowledge only), and 6- and 12-months post-intervention. Data were analyzed in SPSS (version 25). Data are analyzed through 6-months post-intervention. Analysis included descriptive data, bivariate analysis to determine significant changes across time, and multivariate analysis to further refine associations between physician demographic characteristics, physician personal smoking history, and changes in knowledge and self-efficacy for counseling between baseline and 6-months post-intervention. In addition, weekly data has been collected from physicians regarding their engagement in tobacco counseling with patients. Results On a 30-item knowledge scale, scores increased between baseline and immediate post-intervention from 10.9 to 17.4 (t=-10.04, p<0.001). Post-intervention, physicians report counseling over 70% of patients who use tobacco. Additional data presented will include impact of the training on physicians’ knowledge about tobacco use, addiction, and health risks, physician-patient communication, physician perceptions and attitudes regarding tobacco use, perceived peer and systemic support for tobacco counseling, and perceived self-efficacy for patient counseling. Conclusions The adapted CTTS program has been well-received by physicians in Macedonia and is contributing to increased counseling for patients of trained providers. Future efforts include expanding the training across Macedonia with potential for use in the broader region. Funding Authors gratefully acknowledge funding through Pfizer Grants for Learning and Change (European Division) and the Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic

Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism.

Low-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty. We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancer patients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study. After propensity matching, 482 cancer patients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20). In cancer patients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH

E-learning as a tool to harmonize education and good quality assurance system in radiopharmacy

Porpose Basic education in radiopharmacy in an essential component of the scientific and technical background of a radiopharmacist and the inescapable route by which quality assurance in radiopharmacy can be implemented. The purpose of this study was to evaluate e-learning as a method to improve worldwide education in radiopharmacy and increase the awarness about concepts pertaining the quality of radiopharmaceuticals. Design and Methodology to establish e-learning platform designed as an innovative learning apparatus that, working along side conventional teaching methods, integrates education in all aspects of Radiopharmacy into the curricula being offered by universities at existing education and training institutions is the step forward to the global recognition of the unified standards. In this study, a few lines of analysis for developing a suitable e-learning platform in radiopharmacy were as follows: -Course flexibility to improve access and personalization by Students, rigorous definition of basic concepts and methods according to international standards, significantly decrease costs for education in radiopharmacy, enable fast practical implementation of theoretical concepts through virtual laboratory, building up a worldwide available, virtual repoitory of learning resourced in radiopharmacy. findings. Each module is designed as a "basic unit of knowledge", comprising a group of minimum competencies and knowledge about a specific subject and used independently or in combination with other modules or training resources, students can select the module and the time that best suits his/her professional needs for accessing the material. diversity and interactions between different educational contexts are exploited to increase harmonization and integration

Current Practice of Airway Stenting in the Adult Population in Europe: A Survey of the European Association of Bronchology and Interventional Pulmonology (EABIP)

Background: Airway stenting (AS) commenced in Europe circa 1987 with the first placement of a dedicated silicone airway stent. Subsequently, over the last 3 decades, AS was spread throughout Europe, using different insertion techniques and different types of stents. Objectives: This study is an international survey conducted by the European Association of Bronchology and Interventional Pulmonology (EABIP) focusing on AS practice within 26 European countries. Methods: A questionnaire was sent to all EABIP National Delegates in February 2015. National delegates were responsible for obtaining precise and objective data regarding the current AS practice in their country. The deadline for data collection was February 2016. Results: France, Germany, and the UK are the 3 leading countries in terms of number of centres performing AS. These 3 nations represent the highest ranked nations within Europe in terms of gross national income. Overall, pulmonologists perform AS exclusively in 5 countries and predominately in 12. AS is performed almost exclusively in public hospitals. AS performed under general anaesthesia is the rule for the majority of institutions, and local anaesthesia is an alternative in 9 countries. Rigid bronchoscopy techniques are predominant in 20 countries. Amongst commercially available stents, both Dumon and Ultraflex are by far the most commonly deployed. Finally, 11 countries reported that AS is an economically viable activity, while 10 claimed that it is not. Conclusion: This EABIP survey demonstrates that there is significant heterogeneity in AS practice within Europe. Therapeutic bronchoscopy training and economic issues/reimbursement for procedures are likely to be the primary reasons explaining these findings. © Copyright 2017 S. Karger AG, Basel. All rights reserved

Current Practice of Airway Stenting in the Adult Population in Europe: A Survey of the European Association of Bronchology and Interventional Pulmonology (EABIP)

Background: Airway stenting (AS) commenced in Europe circa 1987 with the first placement of a dedicated silicone airway stent. Subsequently, over the last 3 decades, AS was spread throughout Europe, using different insertion techniques and different types of stents. Objectives: This study is an international survey conducted by the European Association of Bronchology and Interventional Pulmonology (EABIP) focusing on AS practice within 26 European countries. Methods: A questionnaire was sent to all EABIP National Delegates in February 2015. National delegates were responsible for obtaining precise and objective data regarding the current AS practice in their country. The deadline for data collection was February 2016. Results: France, Germany, and the UK are the 3 leading countries in terms of number of centres performing AS. These 3 nations represent the highest ranked nations within Europe in terms of gross national income. Overall, pulmonologists perform AS exclusively in 5 countries and predominately in 12. AS is performed almost exclusively in public hospitals. AS performed under general anaesthesia is the rule for the majority of institutions, and local anaesthesia is an alternative in 9 countries. Rigid bronchoscopy techniques are predominant in 20 countries. Amongst commercially available stents, both Dumon and Ultraflex are by far the most commonly deployed. Finally, 11 countries reported that AS is an economically viable activity, while 10 claimed that it is not. Conclusion: This EABIP survey demonstrates that there is significant heterogeneity in AS practice within Europe. Therapeutic bronchoscopy training and economic issues/reimbursement for procedures are likely to be the primary reasons explaining these findings

Estimating the Reduction in the Radiation Burden From Nuclear Cardiology Through Use of Stress-Only Imaging in the United States and Worldwide

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