A supercool powerpoint about thyroid cancer that is very hard to understand unless I am speaking to you and filling in the blanks so check out my blog and look for a related post:
http://m4tt5-b10-bl0g-2o1o.blogspot.com/
Caris Centers of Excellence Virtual Molecular Tumor Board - February 23, 2016...Caris Life Sciences
Slide deck from Caris Life Sciences’ Virtual Molecular Tumor Board (VMTB) hosted by West Cancer Center, a member of the Caris Centers of Excellence for Precision Medicine Network. VMTB reviews cases where the cancer patient’s tumor was sent for molecular profiling and how those results were used to help guide therapy. Personal information has been removed to protect patient privacy.
Caris Centers of Excellence Virtual Molecular Tumor Board - October 15, 2015 ...Caris Life Sciences
Slide deck (no audio) from Caris Life Sciences' Virtual Molecular Tumor Board hosted by COE member MedStar Washington Cancer Institute (Dr. Avani S. Mohapatra)
Tyler Lonergan, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
1. Medullary Thyroid Cancer: From
Diagnosis to Surveillance
JASON LEPSE, MS4
UNIVERSITY OF KANSAS SCHOOL OF MEDICINE
2. Objectives
• Case Presentation
• Overview of medullary thyroid cancer including workup, treatment and surveillance guidelines
• Ms. G’s course
• References
3. H&P
• 49 yo female with previously discovered right thyroid nodule and multiple abnormal appearing
lymph nodes on ultrasound
• CC: neck pain
• HPI
• Nodule discovered by PCP; became painful 3-4 weeks ago
• Endorses occasional odynophagia but denies dyspnea, dysphagia or voice change
• No aggravating factors; pain medication helpful
4. H&P
• PMH: cholelithiasis , hypothyroidism, iron deficiency anemia, menorrhagia, fibroid uterus
• Medications: sennokot
• Allergies: aspirin
• PSH: tubal ligation, laparoscopic cholecystectomy, C-section, D&C
• FH: diabetes in mother; no hx of thyroid or parathyroid disease, pheochromocytoma or mucosal
neuromas
• SH: single; no cigarettes or EtOH
• ROS: denies fever, chills, night sweats, chest pain, shortness of breath, fainting or joint pain
5. H&P
• Physical Exam
GEN: Alert and awake. No acute distress. Responds
appropriately.
VOICE: Strong voice without hoarseness.
HEAD/FACE: Normocephalic, atraumatic. Face
symmetric.
EYES: EOMI. Conjunctiva pink and moist
EARS: Able to hear at conversational levels. Normal
pinna bilaterally.
NOSE: Midline dorsum and septum.
OC/OP: No mucosal lesions. Hard and soft palate
normal. Tongue and FOM soft and clear. Oropharynx
clear without erythema or exudate.
NECK: Supple, palpable right cervical LAD; palpable
right thyroid nodule, tenderness to palpation near
lower border/insertion of right SCM/level 4. No
fluctuance or overlying erythema
CARDIOVASCULAR: Pulses intact
RESPIRATORY: Chest with normal symmetry, excursion,
and respiratory effort.
NEURO: Affect and mood normal. Alert and Oriented to
Person, Place, Time, & Situation
CN3-6, 7 (HB 1/6 BL), 9-12 grossly intact BL
EXTREMITIES: Moving all extremities.
6. H&P
• Physical Exam
• Flexible Laryngoscopy: True Vocal Cords (TVCs) visualized without masses, symmetrically abduction-
adduction, and no persistent glottic gap noted
• DDX: Thyroid malignancy vs thyroiditis vs lymphoma
• CT Neck Soft Tissue w/ IV Contrast had been performed in ED prior to admission and ENT consult
18. Workup
• FNA
• “Atypia of undetermined significance”
• Large atypical cells in a lymphoid background
• Excisional biopsy recommended
• Core biopsy of R lower cervical lymph node
• Medullary thyroid cancer
• Calcitonin stain: Positive
1
19. Overview
• First characterized by Hazard and associates in 1959
• Cell of origin: Neural crest derived parafollicular C-cells
• Calcitonin and CEA serum concentrations are directly related to C-
cell mass
• 1-2% of all thyroid malignancies
• Lower than previous estimates due to rise in number of PTC cases
• Associated with mutations in RET proto-oncogene
• 50% of sporadic cases have RET mutation
• All MEN2A, MEN2B and FMTC cases have RET mutation
20. Prognosis
• Ten-year survival rates 2
• Stage I: 100%
• Stage II: 93%
• Stage III: 71%
• Stage IV: 21%
• 70% patients who present with palpable thyroid nodule have cervical metastases and 10% have
distant metastases
• Presenting with T1: 14% central neck disease, 11% lateral neck disease
• Presenting with T4: 86% central neck disease, 93% had lateral neck disease 3
•Stage and age at diagnosis were found to be prognostic on multivariate analysis
• Post-operative calcitonin doubling time is independent predictor of survival
21. Workup Guidelines
• All patients with FNA consistent with MTC should undergo: 4
• Physical Exam
• Neck ultrasound
• Calcitonin measurement
• CEA measurement
• RET genetic testing
• Systemic imaging indicated when calcitonin > 500 or patient has extensive neck disease
• Octreoscan appears more sensitive than (18)FDG-PET for well-differentiated NETs, whereas (18)FDG-PET
demonstrates superior sensitivity for poorly-differentiated NETs 5
22. Further Workup
• Calcitonin: 15,678 pg/mL
• CEA: 337.7 ng/mL
• Calcium and PTH within normal limits
• Plasma-free metanephrines within normal limits
• CT Chest:
• Linear opacity in right middle lobe could be due to
atelectasis or mucoid impaction
• Nonspecific 12 mm right hepatic hypodensity
• Presented at Tumor Board: T2N1bMx Medullary
Thyroid Carcinoma
• Recommendations: PET vs octreotide scan and surgery
• Octreotide scan: No avid lesions in chest or liver
23. Treatment Guidelines
• Total thyroidectomy
• No neck disease
• Level 6 neck dissection
• Levels 2-5 neck dissection may be considered based on calcitonin level
• Neck disease
• Level 6 neck dissection
• Ipsilateral neck dissection levels 2-5
• Contralateral neck dissection levels 2-5 if CTN>200
• Adjuvant EBRT should be considered in patients with residual disease, extra-thyroidal extension
or extensive lymph node metastases
• Less aggressive surgery to preserve speech and swallow may be preferred in extensive regional
or metastatic disease
• EBRT or systemic chemotherapy should be considered
24. Treatment Guidelines
• Vandetanib or cabozantinib can be used as single-agent first line chemotherapy in
patients with advanced progressive MTC
• Not without side effects
• Vandetanib trial: 12% dropped out and 35% required dose reduction
• Cabozantinib trial: 16% dropped out and 79% required dose reduction
6 7
25. Surveillance
• Key is serial physical exams,
ultrasounds and labs
• Draw first post-op calcitonin
and CEA 3 months after
surgery
4
26. Surveillance
• Doubling Times: should be calculated every 6 months for CEA and calcitonin
• 4 data points over minimum of two years required
• One retrospective study showed significant difference in 5 and 10 year survival in patients with doubling
times greater or less than 6 months 8
http://www.thyroid.org/professionals
/calculators/thyroid-cancer-
carcinoma/
27. Treatment
• Total thyroidectomy with bilateral central and lateral compartment neck dissections
• Final pathology: pT2N1b medullary thyroid carcinoma
• (+) extranodal extension
• (-) angio-invasion or perineural spread
• ENT follow-up scheduled
• No adjuvant radiation per tumor board recommendations
28. References
1: Litzky, L. Pulmonary Neuroendocrine Tumors. Surgical Pathology Clinics, 2010-03-01, Volume 3, Issue 1, Pages 27-59
2: Modigliani, Elisabeth, Regis Cohen, Jose-Marie Campos, Bernard Conte-Devolx, Beatrice Maes, Andree Boneu, Martin Schlumberger, Jean-
Claude Bigorgne, Philippe Dumontier, Laurence Leclerc, Bernard Corcuff, and Isabelle Guilhem. "Prognostic Factors for Survival and for Biochemical
Cure in Medullary Thyroid Carcinoma: Results in 899 Patients." Clin Endocrinol Clinical Endocrinology 48.3 (1998): 265-73.
3: Quayle, Frank Jay, and Jeffrey Moley F. "Medullary Thyroid Carcinoma: Management of Lymph Node Metastases." Current Treatment Options in
Oncology Curr. Treat. Options in Oncol. 6.4 (2005): 347-54.
4:Wells, Samuel A., Sylvia Asa L., Henning Dralle, Rossella Elisei, Douglas Evans B., Robert Gagel F., Nancy Lee, Andreas Machens, Jeffrey Moley F.,
Furio Pacini, Friedhelm Raue, Karin Frank-Raue, Bruce Robinson, M. Rosenthal Sara, Massimo Santoro, Martin Schlumberger, Manisha Shah, and
Steven Waguespack G. "Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma." Thyroid 25.6
(2015): 567-610.
5: Squires, Malcolm H., N. Adsay Volkan, David Schuster M., Maria Russell C., Kenneth Cardona, Keith Delman A., Joshua Winer H., Deniz Altinel,
Juan Sarmiento M., Bassel El-Rayes, Natalyn Hawk, Charles Staley A., Shishir Maithel K., and David Kooby A. "Octreoscan Versus FDG-PET for
Neuroendocrine Tumor Staging: A Biological Approach." Annals of Surgical Oncology Ann Surg Oncol 22.7 (2015): 2295-301.
6: Wells, S. A., B. Robinson G., R. Gagel F., H. Dralle, J. Fagin A., M. Santoro, E. Baudin, R. Elisei, B. Jarzab, J. Vasselli R., J. Read, P. Langmuir, A. Ryan
J., and M. Schlumberger J. "Vandetanib in Patients With Locally Advanced or Metastatic Medullary Thyroid Cancer: A Randomized, Double-Blind
Phase III Trial." Journal of Clinical Oncology 30.2 (2011): 134-41. Web.
7: Elisei, R., M. Schlumberger J., S. Muller P., P. Schoffski, M. Brose S., M. Shah H., L. Licitra, B. Jarzab, V. Medvedev, M. Kreissl C., B. Niederle, E.
Cohen E. W., L. Wirth J., H. Ali, C. Hessel, Y. Yaron, D. Ball, B. Nelkin, and S. Sherman I. "Cabozantinib in Progressive Medullary Thyroid Cancer."
Journal of Clinical Oncology 31.29 (2013): 3639-646.
8: Barbet, Jacques, Loïc Campion, Françoise Kraeber-Bodéré, and Jean-François Chatal. "Prognostic Impact of Serum Calcitonin and
Carcinoembryonic Antigen Doubling-Times in Patients with Medullary Thyroid Carcinoma." The Journal of Clinical Endocrinology & Metabolism
90.11 (2005): 6077-084.
