Haemostatic Issues in Cancer Development and Progression: "The Role of Coagulation and Haemostatic Factors in cancer Development and Metastasis"

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„Centrális véna – nővér módra?” Perifériáról bevezetett centrális vénás kanülökkel szerzett tapasztalataink | Nurse style of central vein! Our experience in the peripherally inserted central venous catheter

Absztrakt: Mi is az a PICC (peripherally inserted central catheter) line kanül? A PICC egy puha, rugalmas katéter, amely poliuretánból vagy szilikonból készült, a kar vagy láb perifériás vénáin keresztül a vena cava superior vagy inferior érhető el vele. A perifériáról bevezetett centrális vénás kanülöket az 1950-es években írták le először. Megjelenése óta nyilvánvalóan nagy változáson esett át mind a metodikát, mind az alkalmazott eszközöket tekintve. Szeretnénk bemutatni a vénabiztosítás e formáját, az előnyeivel, a hátrányaival és a felhasznált eszközrendszereivel együtt. Közleményünkben összefoglaljuk a klinikánkon végzett PICC line beültetések során szerzett tapasztalatainkat. A Pécsi Tudományegyetem ez idáig Magyarországon úttörő abban a tekintetben, hogy kizárólag ápoló implantálja ezeket a kanülöket (külföldön ez már bevett szokásnak számít), és bízunk benne, hogy ez a metodika az ápolói kompetencia fejlődésével hazánkban is elterjed. Orv Hetil. 2017; 158(22): 856–863. | Abstract: What is PICC line insertion? The PICC is a soft, flexible catheter which is made of polyurethane or silicone, and is inserted via an upper or lower extremity peripheral vein into superior or inferior vena cava. The origin of PICC line dates back to the early 1950s. Since the introduction of the PICC catheter, this method of venous catheterization has gone through many changes as regards the technique of insertion or the type of catheter used. Despite the routine use of PICC line worldwide, little progress has been made in its use in Hungary. In this short review we will briefly summarise the use of PICC line, its indications, advantages, disadvantages, and on complementary devices which are necessary during the procedure. We discuss our experience in insertion of PICC line at Pécs University, where the procedure is solely done by a certified registered nurse. We hope that with continuous progression of nurse competency, this procedure will be implemented at a higher scale in Hungary. Orv Hetil. 2017; 158(22): 856–863

Increased Prevalence of Celiac Disease in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis

Objectives: Immune regulation seems to be altered in cystic fibrosis (CF), thus potentially predisposing patients to developing autoimmune diseases (AID). In this meta-analysis, we aimed to evaluate the prevalence of celiac disease (CeD) among CF patients as by far the most commonly reported autoimmune disease in this population and, secondly, to review the observations on other, less frequently studied autoimmune diseases. Methods: We conducted a systematic literature search for studies that discussed AIDs among CF patients. Following standard selection and data collection, we calculated pooled raw prevalence with 95% confidence intervals (CI) for biopsy-verified CeD and seropositivity. Results: Out of the 21 eligible studies, 15 reported on CeD. Pooled prevalence of biopsy-verified CeD was 1.8% (CI 1.1–2.7%) according to a homogeneous dataset from six prospective, consecutive screening studies, while it proved to be 2.3% (CI 1.1–4.7%) according to a heterogeneous dataset from the other studies. Tissue transglutaminase IgA positivity was detected in 4.5% of CF cases (CI 2.8–6.9%), while tissue transglutaminase IgA–endomysial antibody IgA double positivity was found in 2.4% of them (CI 1.5–3.9%). Findings on other AIDs were strongly limited. Conclusions: The pooled prevalence of CeD in CF seemed to be more than twice as high compared to the global prevalence; therefore, routine screening of CeD could be considered in CF

A másodlagos hypogammaglobulinaemia, a fertőzések és a halálozás összefüggései és a preventív immunglobulin-pótlás szükségessége krónikus lymphoid leukaemiás betegekben = Correlations between secondary hypogammaglobulinaemia, infections and mortality and the need for preventive immunoglobulin replacement in patients with chronic lymphoid leukaemia

Absztrakt: Krónikus lymphoid leukaemiában szenvedő 186 betegnél vizsgáltuk az immunstatust 2012. január és 2015. március között. Elemeztük az infekciók előfordulását, a mortalitást azoknál, akik nem részesültek profilaktikus immunglobulin-kezelésben. Az immunglobulin-G (IgG)-szint a betegek 62,37%-ában normális (7–17,8 g/l), 35,48%-ában csökkent volt, néhány esetben mértünk magas immunglobulinszintet (2,15%). Az előrehaladottabb betegségstádiumokban (Rai-stádium) egyre alacsonyabbak az immunglobulinszintek. Ezzel fordított arányban növekedtek a fertőzések. A hypogammaglobulinaemia jelenléte fontosabb volt a fertőzés kialakulásának szempontjából, mint a betegség progressziója. A leggyakoribb infekció a felső légúti fertőzés (33,07%) és a szepszis (18,90%) volt. A kemoterápia után két hónappal a kezdetben normális immunglobulinszint átlagosan 21%-kal csökkent, ugyanakkor emelkedett az infekciók kialakulása. A leggyakoribb halálok a szepszis volt: 30% alacsony immunglobulinszint mellett, illetve 20% normális immunglobulinszintnél. A krónikus lymphoid leukaemiás és immunhiányos betegeknél mind a morbiditás, mind a mortalitás csökkentésére az irodalom szerint indokolt a profilaktikus immunglobulin-kezelés. Az irodalmi ajánlások szerint a súlyos vagy közepesen súlyos, visszatérő bakteriális infekció esetén a hypogammaglobulinaemiát korrigálni kell. Az immunglobulin-profilaxis lehet kis dózisú (10 g), fix adagú (18 g) vagy betegre szabottan nagyobb dózisú (300–400 mg/ttkg). Az intravénás kezelés 3 hetente minimum 6 hónapig ajánlott, az immunglobulinszint folyamatos ellenőrzése mellett. Az ajánlás szerint a nagyobb dózisú, 6 alkalommal 3 hetente adott profilaktikus, személyre szabott immunglobulin-infúzió effektívebb és költséghatékony. Ezzel a dózissal az ismétlődő infekcióban szenvedő betegek 50%-át fertőzésmentesen lehet tartani. Orv Hetil. 2019; 160(38): 1487–1494. | Abstract: Immune status was investigated in 186 patients with chronic lymphoid leukaemia between January 2012 and March 2015. Incidences of infections and mortality were analysed in patients who did not receive prophylactic immunoglobulin therapy. Immunoglobulin G (IgG) levels were normal (7–17.8 g/L) or decreased in 62.37% and 35.48% of patients, respectively. We measured high immunoglobulin levels only in a few cases (2.15%). Immunoglobulin levels became increasingly lower in more advanced disease stages (Rai stages). The number of infections was inversely proportional to that. Hypogammaglobulinaemia proved to be more important than disease progression in terms of the development of infections. The most common infections were upper respiratory tract (33.07%) and sepsis (18.90%). Two months after chemotherapy, initially normal immunoglobulin levels decreased by an average of 21%, and at the same time the incidence of infections increased. The most common cause of death was sepsis: 30% occurred at low immunoglobulin levels, while 20% at normal immunoglobulin levels. According to literature, prophylactic immunoglobulin treatment is indicated in patients with chronic lymphoid leukaemia and immunodeficiency for decreasing both morbidity and mortality. According to recommendations in literature, replacement treatment must be administered in severe or moderately severe recurrent bacterial infections. Immunoglobulin prophylaxis may be provided as low dose (10 g), fix dose (18 g) or individually customized higher dose (300–400 mg/kg body weight) treatment. According to recommendations, higher dose immunoglobulin prophylaxis, administered every three weeks on six occasions, is more efficient when customized. With this dose, infection-free condition may be achieved in 50% of patients. Orv Hetil. 2019; 160(38): 1487–1494

Pregnancy outcomes of women whom spouse fathered children after tyrosine kinase inhibitor therapy for chronic myeloid leukemia : A systematic review

The introduction of tyrosine kinase inhibitors (TKIs) has revolutionized the therapy of chronic myeloid leukemia (CML). Although the efficacy of TKIs is beyond dispute, conception-related safety issues are still waiting to be explored, particularly in males. This systematic review aimed to summarize all available evidence on pregnancy outcomes of female spouses of male CML patients who fathered children after TKI treatment for CML.We performed a systematic search in seven electronic databases for studies that reported on male CML patients who did or did not discontinue TKI treatment before conceiving, and the pregnancy outcomes of their female spouse are available. The search centered on the TKI era (from 2001 onward) without any other language or study design restrictions.Out of a total of 38 potentially eligible papers, 27 non-overlapping study cohorts were analyzed. All were descriptive studies (case or case series studies). Altogether, 428 pregnancies from 374 fathers conceived without treatment discontinuation, 400 of which (93.5%) ended up in a live birth. A total of ten offspring with a malformation (2.5%) were reported: six with imatinib (of 313 live births, 1.9%), two with nilotinib (of 26 live births, 7.7%), one with dasatinib (of 43 live births, 2.3%), and none with bosutinib (of 12 live births). Data on CML status were scarcely reported. Only nine pregnancies (from nine males) and no malformation were reported in males who discontinued TKI treatment before conception.Malformations affected, on average 2.5% of live births from fathers who did not discontinue TKI treatment before conception, which is comparable with the rate of malformations in the general population. Large-scale studies with representative samples are awaited to confirm our results

Automated Detection and Forecasting of COVID-19 using Deep Learning Techniques: A Review

Coronavirus, or COVID-19, is a hazardous disease that has endangered the health of many people around the world by directly affecting the lungs. COVID-19 is a medium-sized, coated virus with a single-stranded RNA. This virus has one of the largest RNA genomes and is approximately 120 nm. The X-Ray and computed tomography (CT) imaging modalities are widely used to obtain a fast and accurate medical diagnosis. Identifying COVID-19 from these medical images is extremely challenging as it is time-consuming, demanding, and prone to human errors. Hence, artificial intelligence (AI) methodologies can be used to obtain consistent high performance. Among the AI methodologies, deep learning (DL) networks have gained much popularity compared to traditional machine learning (ML) methods. Unlike ML techniques, all stages of feature extraction, feature selection, and classification are accomplished automatically in DL models. In this paper, a complete survey of studies on the application of DL techniques for COVID-19 diagnostic and automated segmentation of lungs is discussed, concentrating on works that used X-Ray and CT images. Additionally, a review of papers on the forecasting of coronavirus prevalence in different parts of the world with DL techniques is presented. Lastly, the challenges faced in the automated detection of COVID-19 using DL techniques and directions for future research are discussed

Early changes in laboratory parameters are predictors of mortality and ICU admission in patients with COVID-19 : a systematic review and meta-analysis

Despite the growing knowledge of the clinicopathological features of COVID-19, the correlation between early changes in the laboratory parameters and the clinical outcomes of patients is not entirely understood. In this study, we aimed to assess the prognostic value of early laboratory parameters in COVID-19. We conducted a systematic review and meta-analysis based on the available literature in five databases. The last search was on July 26, 2020, with key terms related to COVID-19. Eligible studies contained original data of at least ten infected patients and reported on baseline laboratory parameters of patients. We calculated weighted mean differences (WMDs) for continuous outcomes and odds ratios (ORs) with 95% confidence intervals. 93 and 78 studies were included in quantitative and qualitative syntheses, respectively. Higher baseline total white blood cell count (WBC), C-reactive protein (CRP), lactate-dehydrogenase (LDH), creatine kinase (CK), D-dimer and lower absolute lymphocyte count (ALC) (WMDALC = - 0.35 × 109/L [CI - 0.43, - 0.27], p < 0.001, I2 = 94.2%; < 0.8 × 109/L, ORALC = 3.74 [CI 1.77, 7.92], p = 0.001, I2 = 65.5%) were all associated with higher mortality rate. On admission WBC, ALC, D-dimer, CRP, LDH, and CK changes could serve as alarming prognostic factors. The correct interpretation of laboratory abnormalities can guide therapeutic decisions, especially in early identification of potentially critical cases. This meta-analysis should help to allocate resources and save lives by enabling timely intervention

Uncertainty-Aware Semi-supervised Method using Large Unlabelled and Limited Labeled COVID-19 Data

This work was partly supported by the MINECO/ FEDER under the RTI2018-098913-B100, CV20-45250 and A-TIC-080-UGR18 projects.The new coronavirus has caused more than 1 million deaths and continues to spread rapidly. This virus targets the lungs, causing respiratory distress which can be mild or severe. The X-ray or computed tomography (CT) images of lungs can reveal whether the patient is infected with COVID-19 or not. Many researchers are trying to improve COVID-19 detection using artificial intelligence. In this paper, relying on Generative Adversarial Networks (GAN), we propose a Semi-supervised Classification using Limited Labelled Data (SCLLD) for automated COVID-19 detection. Our motivation is to develop learning method which can cope with scenarios that preparing labelled data is time consuming or expensive. We further improved the detection accuracy of the proposed method by applying Sobel edge detection. The GAN discriminator output is a probability value which is used for classification in this work. The proposed system is trained using 10,000 CT scans collected from Omid hospital. Also, we validate our system using the public dataset. The proposed method is compared with other state of the art supervised methods such as Gaussian processes. To the best of our knowledge, this is the first time a COVID-19 semi-supervised detection method is presented. Our method is capable of learning from a mixture of limited labelled and unlabelled data where supervised learners fail due to lack of sufficient amount of labelled data. Our semi-supervised training method significantly outperforms the supervised training of Convolutional Neural Network (CNN) in case labelled training data is scarce. Our method has achieved an accuracy of 99.60%, sensitivity of 99.39%, and specificity of 99.80% where CNN (trained supervised) has achieved an accuracy of 69.87%, sensitivity of 94%, and specificity of 46.40%.Spanish Government RTI2018-098913-B100 CV20-45250 A-TIC-080UGR1

Molekuláris citogenetikai vizsgálatok Baranya és Tolna megye plazmasejtes myelomában szenvedő betegein = Molecular cytogenetic analyses of patients with plasma cell myeloma in Tolna and Baranya counties in Hungary

Bevezetés: A plazmasejtes myeloma változatos klinikai lefolyással járó hematológiai malignitás, melyhez heterogén genetikai háttér társul. A betegség patogeneziséhez és progressziójához asszociáltan gyakran jelennek meg visszatérő kromoszomális és szubkromoszomális eltérések, melyek diagnóziskor való kimutatása segíti a betegek genetikai karakterizálását, klasszifikációját és prognosztikai besorolását. Célkitűzés: Tanulmányunkban átfogóan értékeltük a Pécsi Klinikai Központ és a Tolna Megyei Balassa János Kórház plazmasejtes myelomában szenvedő betegein 2005 és 2018 között általunk elvégzett molekuláris citogenetikai vizsgálatok eredményeit. Módszer: Az említett periódusban 231 beteg csontvelői és perifériás vérmintájában szűrtünk visszatérő genetikai aberrációkat fluoreszcens in situ hibridizációval. A módszerrel az immunglobulin-nehézlánc-gént érintő kromoszómatranszlokációkat, az 1p és 17p kromoszómakarokat érintő vesztéseket, az 1q kromoszómakart érintő többletet, valamint a 13-as kromoszómát érintő kiegyensúlyozatlan aberrációkat vizsgáltuk. Negyvenkét beteg mintáján multiplex ligatiofüggő szondaamplifikációval vizsgáltuk az 1p, 1q, 5q, 12p, 13q, 16q és 17p kromoszómakarok jellemző vesztéseit és többleteit. A vizsgált időszakban 116 csontvelői mintán kariotipizálásra is sor került. Eredmények: Összesen 233 genetikai eltérést azonosítottunk célzottan, az aberrációk gyakorisága megfelelt a korábbi nemzetközi tanulmányok által látottaknak. Azonos kromoszómakarokat fluoreszcens in situ hibridizációval, valamint multiplex ligatiofüggő szondaamplifikációval vizsgálva az eredmények 96,2%-os egyezést mutattak. Az utóbbi technikával a fluoreszcens in situ hibridizációval detektált abnormalitásokon túl további 21 kiegyensúlyozatlan genetikai aberrációt azonosítottunk 16/42 betegben (38%). Következtetés: Eredményeink alapján az általunk használt két molekuláris citogenetikai módszer együttes alkalmazása jelentősen segítheti a jövőben a plazmasejtes myelomában szenvedő hazai betegek átfogóbb genetikai karakterizálását. Introduction: Plasma cell myeloma is a hematological malignancy with heterogeneous genomic landscape and diverse clinical course. Recurrent chromosomal and subchromosomal aberrations commonly occur in this entity and are associated with the pathogenesis and progression of the disease. The identification of these alterations aids genetic characterization, classification and prognostication of patients. Aim: Molecular cytogenetic investigations of plasma cell myeloma patients treated at the University of Pécs Clinical Center and János Balassa County Hospital of Tolna County, Szekszárd, between 2005 and 2018 were evaluated in our study. Method: 231 patients were screened for genetic aberrations using fluorescence in situ hybridization. Translocations involving the immunoglobulin heavy chain gene, losses of 1p and 17p chromosome arms, gains of 1q chromosome arm and unbalanced aberrations of chromosome 13 were investigated. Losses and gains of 1p, 1q, 5q, 12p, 13q, 16q and 17p chromosome arms were analyzed using multiplex ligation-dependent probe implification in 42 patients. During the investigated period, 116 bone marrow karyotyping was also performed. Results: In total, 233 genetic aberrations were identified using our targeted approaches; the frequency of specific aberrations correlated with data of the recent literature. Concordance of results gained by fluorescence in situ hybridization and multiplex ligation-dependent probe amplification was 96.2% by analyzing the same chromosome arms. The latter technique revealed 21 additional genetic aberrations in 16/42 patient samples (38%) as compared to fluorescence in situ hybridization. Conclusions: Our results suggest that the combined application of the two molecular cytogenetic methods may facilitate a more detailed characterization of genetic aberrations of plasma cell myeloma patients in Hungary