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BACKGROUND: Immune checkpoint inhibitors targeting either programmed cell death protein 1 (PD-1) or programmed cell death ligand 1 (PD-L1) have been established as a novel target for immunotherapy in non-small cell lung cancer (NSCLC). Prevalence of PD-L1 expression in NSCLC varies from 13% to 70%, with sparse data from the Indian subcontinent. In this study, we looked at PD-L1 expression and its association with demographic, clinical, radiologic and pathologic parameters in NSCLC patients. METHODS: This was an observational study carried over a period of 18 months in which 65 patients of NSCLC were included. Immunohistochemistry (IHC) for PD-L1 was done using an automated IHC stainer and testing was performed using PD-L1 IHC CAL10. For statistical analysis, unpaired t test, Chi square test, Fisher's exact test and binomial logistic regression were used. P < 0.05 was taken to be statistically significant. RESULTS: Mean age of the patients was 62.9 ± 9.2 years, and majority (87.3%) of them were males. Seventeen (26.2%) patients expressed PD-L1, among whom 10 had high PD-L1 expression (≥50%) and 7 had low PD-L1 expression (1-49%). PD-L1 expression was seen in 13 out of 43 cases of squamous cell carcinoma (SCC) and 4 out of 15 cases of adenocarcinoma. On applying binomial logistic regression analysis, association between smoking and PD-L1 expression was found to be insignificant. CONCLUSION: Almost a quarter of NSCLC cases were PD-L1 positive without any difference in expression between SCC and adenocarcinoma. PD-L1 status was not associated with any specific demographic, clinical or radiologic parameter including the histologic subtype.
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Adenocarcinoma , Carcinoma de Pulmón de Células no Pequeñas , Carcinoma de Células Escamosas , Neoplasias Pulmonares , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Apoptosis , Antígeno B7-H1/análisis , Antígeno B7-H1/metabolismo , Carcinoma de Pulmón de Células no Pequeñas/patología , Ligandos , Neoplasias Pulmonares/patología , Atención Terciaria de SaludRESUMEN
How will the newly discovered coronavirus (COVID-19) affect the world and what will be its global impact? For answering this question, we will require a prediction of overall recoveries and fatalities, as well as a reliable prognosis of coronavirus cases. Predicting, however, requires an ample total of past data related to it. On any particular day, the prediction is unclear since events in the future rarely repeat themselves the way that they did in the past. Furthermore, forecasts and predictions are determined by the absolute interests, accuracy of the data, and prophesied variables. In addition, psychological factors play an enormous role in how people perceive and react to the danger from the disease and therefore the fear that it is going to affect them personally. This research paper advances an unbiased method for predicting the increase of the COVID-19 employing a simple, but powerful method to do so. Assumed that the data are accurate and reliable which the longer term will still follow an equivalent disease pattern, our projections intimate with a large association. Within the COVID-19 cases were documented, in contingency, there is a steady increase. The hazards are far away from symmetric, as underestimating a pandemic's spread and failing to do enough to prevent it is far a lot worse than overspending and being too cautious when it will not be needed. This paper illustrates the timeline of a live forecasting study with huge implied implications for devising and decision-making and gives unbiased predictions on COVID-19 confirmed cases, recovered cases, deaths, and ongoing cases are shown on a continental map using data science and machine learning (ML) approaches. Utilizing these ML-based techniques, the proposed system predicts the accurate COVID-19 cases and gives better performance.
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Esophageal ultrasound-guided bronchoscopic needle aspiration (EUS-B-NA) is a relatively safe procedure with rare complications. A vasovagal attack after EUS-B-NA has not been reported to date. Usually benign and self-limiting, it can cause refractory bradycardia and sudden cardiac arrest. Timely intervention reduces morbidity and mortality. Here, we report a novel case of vasovagal attack after EUS-B-NA and was managed successfully. Management includes identifying the triggering event and keeping the patient in the Trendelenburg position. Atropine is reserved for refractory cases. (www.actabiomedica.it).
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Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Neoplasias Pulmonares , Endosonografía , HumanosRESUMEN
Biphasic pulmonary blastoma (BPB) is an extremely rare highly aggressive malignant tumor that arises from fetal lung tissue and has the classical biphasic histology of epithelial and mesenchymal components. It is usually seen in adults with a slight male predominance and smokers. Previously grouped along with well-differentiated fetal adenocarcinoma (WDFA), and pleuropulmonary blastoma (PPB), now it is considered a separate variant and grouped under sarcomatoid neoplasms. Symptoms include chest pain, cough, hemoptysis and it is asymptomatic in at least one-third of the cases. A biopsy is essential for diagnosis and surgical excision is the treatment of choice. Prognosis is poor with 5-year survival less than 20% and recurrence occurring within 12 months of surgery. An aggressive multimodality approach is required for its management and active follow up surveillance is needed to look for recurrence.
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Neoplasias Pulmonares/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Blastoma Pulmonar/diagnóstico , Blastoma Pulmonar/patología , Adulto , Cuidados Posteriores , Biopsia , Broncoscopía/instrumentación , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Tos/diagnóstico , Tos/etiología , Fluorodesoxiglucosa F18/metabolismo , Hemoptisis/diagnóstico , Hemoptisis/etiología , Humanos , Masculino , Terapia Neoadyuvante/métodos , Estadificación de Neoplasias/métodos , Blastoma Pulmonar/tratamiento farmacológicoRESUMEN
We used a publicly available data of 44,672 patients reported by China's centre for disease control to study the role of age, sex, co-morbidities and health-care related occupation on COVID-19 mortality. The data is in the form of absolute numbers and proportions. Using the percentages, retrospective synthetic data of 100 survivors and 100 deaths were generated using random number libraries so that proportions of ages, genders, co-morbidities, and occupations were constant as in the original data. Logistic regression of the four predictor factors of age, sex, co-morbidities and occupation revealed that only age and comorbidities significantly affected mortality. Sex and occupation when adjusted for other factors in the equation were not significant predictors of mortality. Age and presence of co-morbidities correlated negatively with survival with co-efficient of -1.23 and -2.33 respectively. Odds ratio (OR) for dying from COVID-19 for every 10-year increase in age was 3.4 compared to the previous band of 10 years. OR for dying of COVID-19 was 10.3 for the presence of any of the co-morbidities. Our findings could help in triaging the patients in the emergency room and emphasize the need to protect the elderly and those with comorbidities from getting exposed.
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Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/epidemiología , Hipertensión/epidemiología , Neumonía Viral/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , COVID-19 , Niño , Preescolar , China/epidemiología , Comorbilidad , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Ocupaciones/estadística & datos numéricos , Oportunidad Relativa , Pandemias , SARS-CoV-2 , Factores Sexuales , Tasa de Supervivencia , Adulto JovenRESUMEN
The causes of cystic lung diseases are varied. Proper evaluation is required for appropriate management. http://bit.ly/37J7dvE.
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Pleural effusion is easily diagnosed often managed optimally with standard protocols. It at times, is a diagnostic dilemma as it comes with big list of differential diagnosis. Pleural effusion due to pancreaticopleural fistula (PPF) is a rare and on right side is even rarer. Detailed history along with high index of suspicion in required to diagnose PPF, which is confirmed by increased level of pleural fluid amylase and lipase along with magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) demonstrating fistula tract. Here we report the case of a young patient who presented with respiratory distress and was wrongly diagnosed as right sided tubercular effusion which later turned out to be pancreatic effusion. Management in our case was multi-disciplinary involving pulmonologist, gastroenterologist, radiologist and thoracic surgeon.
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Fístula Pancreática/complicaciones , Pancreatitis Crónica/patología , Derrame Pleural/etiología , Adulto , Calcinosis , Colangiopancreatografia Retrógrada Endoscópica/métodos , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Páncreas/patología , Fístula Pancreática/diagnóstico por imagen , Pancreatitis Crónica/diagnóstico por imagen , Pancreatitis Crónica/enzimología , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/patología , Cirugía Torácica Asistida por Video/métodos , Tomografía por Rayos X , Resultado del TratamientoRESUMEN
The Pre-Conception and Pre-Natal Diagnostic Techniques Act was written to prevent societally unacceptable harms including intentional sex selection. The pragmatism required to enforce this law has profound effects on the ability of rural Indians to access diagnostic ultrasonography. In so doing, it may have inadvertently placed a heavier burden on the poorest and worsened health inequity in India, creating serious ethical and justice concerns. It is time to re-examine and update the law such that diagnostic ultrasonography is widely available in even the most peripheral primary health and community health centres. Shorter, more accessible ultrasonography training courses should be offered; collaboration between radiologists and rural practitioners and facilities should be encouraged. Finally, modern ultrasound machines can carefully record all images via a "silent observer" modality. With some modifications to previously used silent observer modalities, this technology allows both greater access and better policing of potential misuse of ultrasound technology.
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Revelación , Intención , Diagnóstico Prenatal/ética , Servicios de Salud Rural/ética , Población Rural , Tecnología/métodos , Ultrasonografía , Conducta Cooperativa , Ética Médica , Femenino , Equidad en Salud , Instituciones de Salud/ética , Instituciones de Salud/legislación & jurisprudencia , Personal de Salud/educación , Personal de Salud/ética , Estado de Salud , Humanos , India , Acceso de los Pacientes a los Registros/ética , Pobreza , Embarazo , Atención Prenatal/ética , Atención Prenatal/legislación & jurisprudencia , Atención Prenatal/métodos , Diagnóstico Prenatal/métodos , Preselección del Sexo/ética , Justicia SocialAsunto(s)
Accesibilidad a los Servicios de Salud , Cardiopatía Reumática , Población Rural , Adulto , Femenino , Humanos , India/epidemiología , Masculino , Estenosis de la Válvula Mitral , Pobreza , Cardiopatía Reumática/tratamiento farmacológico , Cardiopatía Reumática/epidemiología , Cardiopatía Reumática/prevención & control , Servicios de Salud RuralRESUMEN
Access to language services is a required and foundational component of care for patients with limited English proficiency (LEP). National standards for medical interpreting set by the US Department of Health and Human Services and by the National Council on Interpreting in Health Care establish the role of qualified medical interpreters in the provision of care in the United States. In the vignette, the attending physician infringes upon the patient's right to appropriate language services and renders unethical care. Clinicians are obliged to create systems and a culture that ensure quality care for patients with LEP.
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Accesibilidad a los Servicios de Salud/ética , Lenguaje , Obligaciones Morales , Relaciones Médico-Paciente/ética , Calidad de la Atención de Salud , Traducción , Poblaciones Vulnerables , Adulto , Ética Médica , Femenino , Haití , Humanos , Médicos/ética , Estados UnidosRESUMEN
PROBLEM: Health disparities are pervasive worldwide. Physicians have a unique vantage point from which they can observe the ways social, economic, and political factors impact health outcomes and can be effective advocates for enhanced health outcomes and health equity. However, social medicine and health advocacy curricula are uncommon in postgraduate medical education. APPROACH: In academic year (AY) 2012, the Cambridge Health Alliance internal medicine residency program transformed an elective into a required social medicine and research-based health advocacy curriculum. The course has three major innovations: it has a yearlong longitudinal curriculum, it is required for all residents, and all residents complete a group research-based health advocacy project within the curricular year. The authors describe the structure, content, and goals of this curriculum. OUTCOMES: Over the last four years (AYs 2012-2015), residents (17/32; 53%) have rated the overall quality of the course highly (mean = 5.2, where 6 = outstanding; standard deviation = 0.64). In each year since the new course has been implemented, all scholarly work from the course has been presented at conferences by 31 resident presenters and/or coauthors. The course seems to enhance the residency program's capacity to recruit high-caliber residents and faculty members. NEXT STEPS: The authors are collecting qualitative and quantitative data on the impact of the course. They will use their findings to advocate for a national health advocacy competency framework. Recommendations about how to initiate or further develop social medicine and health advocacy curricula are offered.
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Defensa del Consumidor , Curriculum , Investigación sobre Servicios de Salud , Medicina Interna/educación , Internado y Residencia , Medicina Social/educación , Disparidades en el Estado de Salud , Humanos , Liderazgo , Cambio Social , Determinantes Sociales de la SaludRESUMEN
BACKGROUND AND OBJECTIVES: Epidemiologic data on hospitalizations for acute pericarditis are scarce. We sought to study the trends in these hospitalizations and outcomes in the USA over a 10-year period. METHODS: We used the 2003-2012 Nationwide Inpatient Sample database to identify admissions with a primary diagnosis of acute pericarditis. Outcomes included hospitalization rate, case fatality rate (CFR), length of stay (LOS), hospital charges, complications and diagnostic and therapeutic procedures. RESULTS: We observed an estimated 135,710 hospitalizations for acute pericarditis among patients ≥16 years during the study period (mean age 53.5 ± 18.5 years; 40.5% women). The incidence of acute pericarditis hospitalizations was significantly higher for men than for women [incidence rate ratio (IRR) 1.56; 95% confidence interval (CI) 1.54-1.58; p < 0.001]; it decreased from 66 to 54 per million person-years (p < 0.001). CFR and LOS declined significantly during the study period (CFR: 2.2% in 2003 to 1.4% in 2012; LOS: 4.8 days in 2003 to 4.1 days in 2012; p < 0.001 for both). The average inflation-adjusted health-care charge increased from USD 31,242 to 38,947 (p < 0.001). CONCLUSION: The hospitalization rate, CFR and LOS associated with acute pericarditis have declined significantly in the US population. Average charges for acute pericarditis hospitalization have increased.