This document discusses urine cytology and urinary markers for detecting bladder cancer. It notes that urine cytology has high specificity but low sensitivity for both high and low grade tumors. Several urinary markers are discussed, including BTA, ImmunoCyt, NMP-22, UroVysion, microsatellite analysis, Lewis antigen X, CK20, CYFRA 21.1, survivin, hyaluronic acid and TRAP, along with their reported sensitivities and specificities. However, none meet the 90% sensitivity threshold needed to replace cystoscopy, so the conclusion is that a combination of cystoscopy and urine markers is currently the best approach for bladder cancer surveillance.
Biomarkers have a diversified role in diagnosis, prognostication and risk stratification. This presentation aims to compile the basic information and new literature on various biomarkers pertaining to cancer care.
Tumor Biomarkers For Screening, Progression and Prognosis Vivek Misra
Tumor markers are substances that can be found in the body (usually in the blood or urine) when cancer is present. Along with other tests, tumor markers can be used to help show if cancer is present, to determine the type of cancer, and in some cases to help show if treatment is working. Some of the more common tumor markers are discussed here.
Biomarkers have a diversified role in diagnosis, prognostication and risk stratification. This presentation aims to compile the basic information and new literature on various biomarkers pertaining to cancer care.
Tumor Biomarkers For Screening, Progression and Prognosis Vivek Misra
Tumor markers are substances that can be found in the body (usually in the blood or urine) when cancer is present. Along with other tests, tumor markers can be used to help show if cancer is present, to determine the type of cancer, and in some cases to help show if treatment is working. Some of the more common tumor markers are discussed here.
Tumor markers
Many cancers are associated with the abnormal production of some molecules which can be measured in plasma. These molecules are known as tumor markers.
A good tumor maker should have those properties:
1. A tumor marker should be present in or produced by tumor itself.
2. A tumor marker should not be present in healthy tissues.
3. Plasma level of a tumor marker should be at a minimum level in healthy subjects and in benign conditions.
4. A tumor marker should be specific for a tissue, it should have different immunological properties when it is synthesized in other tissues.
5. Plasma level of the tumor marker should be in proportion to the both size of the tumor and the activity of the tumor.
6. Half-life of a tumor should not be very long
7. A tumor marker should be present in plasma at a detectable level, even though tumor size is very small
Slides for 3rd and 4th year medical students in Obstetrics and Gynecology- to not overlook the possibility as a diagnosis- still present. Slides highlighting diagnostic and management challenges
Bladder cancer is a disease of urinary bladder in which cells grow abnormally and have the potential to spread to other parts of the body. This is one of four parts of presentations on Bladder cancer. Please do go through the rest of the presentations too.
Non-Muscle Invasive Carcinoma Bladder Management Protocol.
CT (chest, pelvis)/MRI for muscle invasive disease only
Before TURBT if MI suspected
CT/MRI overstaged local tumor
80% accurate for local staging
80% accuracy for LN disease (>1cm)
PET no additional value
Urinary Bladder Cancer is diagnosed with cystoscopy and biopsy. Treatment is done as per the type of cancer and its stage. If the cancer is of first stage and / or low grade it is managed with surgery and intra vesical therapy. Surgery includes Trans Urethral Resection of Bladder Tumour. Intravesical therapy includes BCG, Mitomycin C and Gemcitabine. HIVEC is a latest technology in which Heated chemotherapy is circulated in Urinary Bladder .
Tumor markers
Many cancers are associated with the abnormal production of some molecules which can be measured in plasma. These molecules are known as tumor markers.
A good tumor maker should have those properties:
1. A tumor marker should be present in or produced by tumor itself.
2. A tumor marker should not be present in healthy tissues.
3. Plasma level of a tumor marker should be at a minimum level in healthy subjects and in benign conditions.
4. A tumor marker should be specific for a tissue, it should have different immunological properties when it is synthesized in other tissues.
5. Plasma level of the tumor marker should be in proportion to the both size of the tumor and the activity of the tumor.
6. Half-life of a tumor should not be very long
7. A tumor marker should be present in plasma at a detectable level, even though tumor size is very small
Slides for 3rd and 4th year medical students in Obstetrics and Gynecology- to not overlook the possibility as a diagnosis- still present. Slides highlighting diagnostic and management challenges
Bladder cancer is a disease of urinary bladder in which cells grow abnormally and have the potential to spread to other parts of the body. This is one of four parts of presentations on Bladder cancer. Please do go through the rest of the presentations too.
Non-Muscle Invasive Carcinoma Bladder Management Protocol.
CT (chest, pelvis)/MRI for muscle invasive disease only
Before TURBT if MI suspected
CT/MRI overstaged local tumor
80% accurate for local staging
80% accuracy for LN disease (>1cm)
PET no additional value
Urinary Bladder Cancer is diagnosed with cystoscopy and biopsy. Treatment is done as per the type of cancer and its stage. If the cancer is of first stage and / or low grade it is managed with surgery and intra vesical therapy. Surgery includes Trans Urethral Resection of Bladder Tumour. Intravesical therapy includes BCG, Mitomycin C and Gemcitabine. HIVEC is a latest technology in which Heated chemotherapy is circulated in Urinary Bladder .
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
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/
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
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Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
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CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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2. URINE CYTOLOGY
• Urine cytology, first introduced
by Papanicolaou in 1945
• Evaluates the morphologic
changes associated with bladder
cancer
• It is the gold standard urinary
marker against which other
markers are held
• Sensitivity 40% to 62%
3. • Positive urine cytology is virtually
diagnostic of a bladder tumor, though
the tumor is not endoscopically visible.
• The sensitivity and specificity of urine
cytology is dependent on the:
Cytopathologist
number of samples evaluated
stage and grade of the tumor
Associated inflammation, infection, intra-
vesical instillations
4. • Instrumented urine during cystoscopy
has improved sensitivity and specificity,
but an invasive procedure is required
• 15% of patients with atypical cytology
that is not diagnostic of cancer will have
an underlying malignancy
• Thus patients with an atypical cytology
need more frequent evaluation or repeat
random bladder biopsies.
5. • Even in the setting of UC patients with a
negative workup (cystoscopy and upper
tract imaging) with a persistently positive
cytology;
40% were found to have genitourinary
cancer within 24 months, with a mean
time to diagnosis of 5.6 months
6. • Although cytology has traditionally been
believed to have high sensitivity for high-
grade cancer and low sensitivity for low
grade cancer, recent studies do not
support this
• Thus cytology has high specificity but
low sensitivity for both high-grade and
low-grade tumors including CIS
8. • BTA stat(qualitative) & BTA TRAK
(quantitative)
• detect human complement factor H–
related protein
• sensitivity 50% to 80%
specificity 50% and 75%
• These tests are more sensitive than
cytology but can be falsely positive in
patients with inflammation, infection, or
hematuria
9. • ImmunoCyt:
• A hybrid of cytology and an
immunofluorescent assay
• Three fluorescent labeled monoclonal
antibodies are targeted at a UC variant
of carcinoembryonic antigen and two
bladder mucins.
10. • Sensitivity 86%
Specificity 79%
• not been shown to be affected by benign
conditions, but interpretation is complex
and operator dependent
11. • NMP-22 Bladder Check Test
• Based on the detection of nuclear matrix
protein 22, part of the mitotic apparatus
released from urothelial nuclei upon
cellular apoptosis.
• The protein is elevated in UC, but it is
also released from dead and dying
urothelial cells.
12. • Benign conditions of the urinary tract
such as stones, infection, inflammation,
hematuria, and cystoscopy can cause a
false-positive reading.
• Both a laboratory-based, quantitative
immunoassay and a qualitative point-of-
care test are available.
13. • UroVysion (FISH):
• Fluorescence in-situ hybridization
identifies fluorescently labeled DNA
probes that bind to intranuclear
chromosomes.
• The current commercially available
probes evaluate aneuploidy for chr 3, 7,
and 17 and homozygous loss of 9p 21
14. Sensitivity 79%
Specificity 98%
• UroVysion has the highest specificity of
the available tumor markers
• Detects chromosomal changes before
the development of phenotypic
expression of malignancy, so it leads to
an “anticipatory positive” reading in
some patients
15. • Patients testing negative are unlikely to
experience tumor recurrence in less than
1 year
• This may allow identification of patients
at risk of recurrence versus those
unlikely to recur in order to individualize
surveillance protocols
16. • clarify equivocal findings in patients with
atypical or negative cytology
• Not affected by hematuria, inflammation,
or other factors that can cause false-
positive readings with some tumor
markers, so it appears to be useful as a
marker of BCG response
17. • Microsatellite analysis
• Amplifies repeats in the genome that are
highly polymorphic, and PCR
amplification can detect tumor-
associated loss of heterozygosity by
comparing the peak ratio of the two
alleles in tumor DNA in the urine sample
with the presence of the alleles in a
blood sample from the same individual
18. • Interestingly, if the microsatellite
analysis:
persistently positive-83% 2-year
recurrence rate
persistently negative-22% of patients
had recurrent tumors
• standardization of the test will allow
analysis without a blood sample, and
this will significantly improve the patient’s
acceptance
19. • The Lewis blood group antigen X
• Usually absent from urothelial cells in
adults except for occasional umbrella
cells
• There is increased Lewis X expression
in bladder cancers
• It is independent of secretor status,
grade, and stage.
21. • CK 20 and CYFRA 21.1
• Fragments of cytoskeletal proteins that
can be detected in the urine of bladder
cancer patients by either protein or
mRNA detection
• CK 20: sensitivity 85%
specificity 76%
22. • CYFRA 21.1: with a cutoff value of 4
ng/mL,
sensitivity 43%
specificity 68%
23. • CpG dinucleotide:
• CpG Islands cluster around promoters
in an unmethylated state to allow gene
expression
• Methylation of the CpG islands shuts
down the promoter, and if the promoter
in question is part of a tumor suppressor
gene then cancer can form.
24. • Survivin:
• An antiapoptotic protein that has a high
expression in urothelial cancer
• Found in 10% to 30% of bladder
cancers and is readily shed into the
urine.
• Sensitivity 64% to 100%
specificity 87% to 93%
25. • This test may be useful in predicting
which patients will respond to
intravesical therapy
• Survivin was relatively poor at detecting
advanced-stage or high-grade tumors
26. • Hylauronic acid:
• Controls intercellular communications
and cell replication.
• Urothelial cancer induces hylauronic
acid production from fibroblasts, and the
amount correlates with the stage of the
disease.
• sensitivity 91% to 100%
• specificity 84% to 90%
27. • TRAP:
• Telomerase resides at the terminal ends
of the chromosomes and duplicates
random DNA repeats to prevent cell
death
• Telomerase activity is measured in
telomeric repeat application protocol
(TRAP) and is detected in 80% of urine
from patients with bladder cancer with
no grade differential.
29. • Virtually all patients complain of pain and
discomfort with an office cystoscopy
• Urine markers studies could forgo this
pain in select situations as described
above.
• However, patients reported that a urine
marker study would need 90% sensitivity
in order to replace office cystoscopy
30. • None of the currently available urinary
markers meet this 90% sensitivity on a
reliable basis
• Therefore a combination of cystoscopy
with urine markers, in select situations,
is appropriate for surveillance of patients
with non–muscle-invasive bladder
cancer