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Unusual involvement of postrenal transplantation kaposi's sarcoma: Two case reports
No full text6NOV-DEC644-6453
A joint convolutional-recurrent neural network with an attention mechanism for detecting intracranial hemorrhage on noncontrast head CT
No full textTo investigate the performance of a joint convolutional neural networks-recurrent neural networks (CNN-RNN) using an attention mechanism in identifying and classifying intracranial hemorrhage (ICH) on a large multi-center datasetto test its performance in a prospective independent sample consisting of consecutive real-world patients. All consecutive patients who underwent emergency non-contrast-enhanced head CT in five different centers were retrospectively gathered. Five neuroradiologists created the ground-truth labels. The development dataset was divided into the training and validation set. After the development phase, we integrated the deep learning model into an independent center's PACS environment for over six months for assessing the performance in a real clinical setting. Three radiologists created the ground-truth labels of the testing set with a majority voting. A total of 55,179 head CT scans of 48,070 patients, 28,253 men (58.77\%), with a mean age of 53.84 +/- 17.64 years (range 18-89) were enrolled in the study. The validation sample comprised 5211 head CT scans, with 991 being annotated as ICH-positive. The model's binary accuracy, sensitivity, and specificity on the validation set were 99.41\%, 99.70\%, and 98.91, respectively. During the prospective implementation, the model yielded an accuracy of 96.02\% on 452 head CT scans with an average prediction time of 45 +/- 8 s. The joint CNN-RNN model with an attention mechanism yielded excellent diagnostic accuracy in assessing ICH and its subtypes on a large-scale sample. The model was seamlessly integrated into the radiology workflow. Though slightly decreased performance, it provided decisions on the sample of consecutive real-world patients within a minute.1FEB 81
Information theory approaches to improve glioma diagnostic workflows in surgical neuropathology
No full textAims Resource-strained healthcare ecosystems often struggle with the adoption of the World Health Organization (WHO) recommendations for the classification of central nervous system (CNS) tumors. The generation of robust clinical diagnostic aids and the advancement of simple solutions to inform investment strategies in surgical neuropathology would improve patient care in these settings. Methods We used simple information theory calculations on a brain cancer simulation model and real-world data sets to compare contributions of clinical, histologic, immunohistochemical, and molecular information. An image noise assay was generated to compare the efficiencies of different image segmentation methods in H\&E and Olig2 stained images obtained from digital slides. An auto-adjustable image analysis workflow was generated and compared with neuropathologists for p53 positivity quantification. Finally, the density of extracted features of the nuclei, p53 positivity quantification, and combined ATRX/age feature was used to generate a predictive model for 1p/19q codeletion in IDH-mutant tumors. Results Information theory calculations can be performed on open access platforms and provide significant insight into linear and nonlinear associations between diagnostic biomarkers. Age, p53, and ATRX status have significant information for the diagnosis of IDH-mutant tumors. The predictive models may facilitate the reduction of false-positive 1p/19q codeletion by fluorescence in situ hybridization (FISH) testing. Conclusions We posit that this approach provides an improvement on the cIMPACT-NOW workflow recommendations for IDH-mutant tumors and a framework for future resource and testing allocation.5SEP3
The Efficacy of Low-Dose Enoxaparin in Psoriasis
No full textABSTRACT
Psoriasis is a frequently encountered inflammatory skin disease with unclear etiology and no curative
therapy. Enoxaparin is a low-molecular weight heparin analogue. Heparin and its analogues in low doses have
antiproliferative and immunomodulatory effects. Low-dose enoxaparin has inhibitory effects on T cell-mediated
immune reactions. T lymphocytes play a key role in the immunopathogenesis of psoriasis. The aim of this study was
to evaluate the efficacy of low-dose enoxaparin in the treatment of psoriasis. Twenty-three patients with chronic
plaque and guttate psoriasis were enrolled in an open study. Patients were given subcutaneous injections of 5 mg
enoxaparin once weekly for a total of 6 weeks. There was a statistically significant difference between the PASI
(Psoriasis Area and Severity Index) scores at the beginning and at the 6th week follow up (p=0.008). Four out
of 23 patients (17%) showed marked improvement (≥50% reduction in PASI score), 8 patients (35%) showed
moderate improvement (25-49% reduction in PASI score), 5 patients (22%) were unchanged (<25% reduction in
PASI score). Six patients (26%) experienced worsening with a corresponding increase in the PASI scores. Based on
these findings, 52% of patients were considered to get benefit from enoxaparin treatment. No systemic side-effects
due to enoxaparin were observed. The only local side-effect recorded in 7 patients (30%) was ecchymosis at the
injection site. Low-dose enoxaparin, which appears to be safe, is a candidate to become a future alternative in the
treatment of psoriasis. Further studies assessing the optimum dose and duration of treatment, as well as patient
subgroups that will benefit most from enoxaparin treatment are warranted. In addition, efficacy of enoxaparin in
psoriasis should be compared to those of standard therapeutic modalities
Do prognosis and clinicopathological features differ in young early-stage breast cancer?
No full textBackgroundBreast cancer is the most frequently detected cancer and the leading cause of cancer-related death in women. Although it is mostly seen in older patients, breast cancer affects women aged 24 to >70 years, with poorer prognosis in young patients. Young age remains a controversial topic in the literature. This study aimed to identify subtype differences and the effect of age on early-stage breast cancer outcomes. MethodsA total of 300 consecutive patients underwent surgery between 2011 and 2015 for early-stage breast cancer. Of these, 248 were eligible for this study and were divided into three groups: group Y (aged 35 and 45 years). The clinical and pathological features and data related to recurrence, metastasis, and death were recorded. ResultsNo statistical differences were found between groups regarding histopathological features except for higher histological grade and Ki-67 levels in group M. Additionally, group Y recorded no progression (recurrence or metastasis) or death. Disease-free survival was 117.8 months (95\% CI 111.8-123.8) for group M, which was significantly shorter than that for group E (p < 0.001). Additionally, the hazard ratio (HR) for progression from group M to group E was 10.21 with significant difference (p = 0.003, 95\% CI 2.26-46.08). However, the HR of group Y to group E was 0.04, without significance (p = 0.788, 95\% CI 0.18-345 x 10(6)). The overall 5-year survival was 100\% in group Y, 98.8\% in group M, and 99.3\% in group E, without significance. ConclusionA very young age cannot be considered an independent risk factor for poor prognosis. Rather than age, histological grade and Ki-67 index are more important factors in early-stage breast cancer.OCT 19
Importance of Informed Consent in Clinical Practice
No full textIntroduction: This study aims to determine the experiences and opinions of physicians on informed consent practices, to research their awareness of their legal responsibilities, and to provide solutions to the problems encountered in practice. Methods: This research is a descriptive field study. One hundred and eighty-four physicians working in a state hospital in Istanbul participated in this study between January 15 and February 15, 2018. The questionnaire form was used as a data collection tool. After the participants were informed about the purpose and method of the research, their consent was obtained, and they were asked to fill in the questionnaire forms. The analysis of the data was performed using the SPSS 18.00 program. The significance level was accepted as p<0.05. Results: One hundred and eighty-four physicians working in a state hospital in Istanbul participated in this study. 69\% (n=127) of the physicians participating in the study were male and 31\% (n=57) were female. 35.3\% (n=65) of the participants were from the 3039 years old age group. 96.7\% (n=178) of the physicians in the study stated that they personally informed their patients before the surgical interventions. 83.7\% (n=154) of the physicians think that the lawsuits filed against the physicians due to medical malpractice affect the health services provided by the physicians to their patients.61.4\% of the participants (n=113) think that they have not received enough education in their medical education processes regarding the rights and obligations of the physicians. Conclusion: Considering the current situation in Turkey, the informed consent process is not yet at the level it should be. Since human rights are in the process of development in the world, informed consent and many more patient rights will gain importance with studies on this subject. Therefore, training, and studies should be increased to inform physicians and patients about informed consent and to make them a behavioral model physicians.2MAY139-1432
Optimizing the Personalized Care for the Management of Rectal Cancer: A Consensus Statement
No full textColorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acibadem Mehmet Ali Aydinlar and Koc Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.8AUG627+3
Towards Development of a Standard Terminology of the World Health Organization Classification of Tumors of the Central Nervous System in the Turkish Language, and a Perspective on the Practical Implications of the WHO Classification for Low and Middle Income Countries
No full textIn our manuscript, we propose a common terminology in the Turkish language for the newly adopted WHO classification of the CNS tumors, also known as the WHO CNS 5th edition. We also comment on the applicability of this new scheme in low and middle income countries, and warn about further deepening disparities between the global north and the global south. This division, augmented by the recent COVID-19 pandemic, threatens our ability to coordinate efforts worldwide and may create significant disparities in the diagnosis and treatment of cancers between the ``haves{''} and the ``have nots{''}.3SEP185-2043
Pharmacokinetic characterization of favipiravir in patients with COVID-19
No full textThis prospective observational study describes the pharmacokinetic characteristics of favipiravir in adult patients hospitalized for mild to moderate COVID-19 with a positive RT-PCR test. Favipiravir was administered for 5 days, with a loading dose of 3200 mg and a maintenance dose of 1200 mg/day. Serial blood samples were collected on Day 2 and Day 4 of the therapy. Laboratory findings of the patients (n = 21) and in-hospital mortality were recorded. Favipiravir concentrations exhibited substantial variability and a significant decrease during the treatment of COVID-19. The median favipiravir trough concentration (C0-trough) on Day 2 was 21.26 (interquartile range {[}IQR], 8.37-30.78) mu g/mL, whereas it decreased significantly to 1.61 (IQR, 0.00-6.41) mu g/mL on Day 4, the area under the concentration-time curve decreased by 68.5\%. Day 2 C0-trough of female patients was higher than male patients. Our findings indicate that favipiravir concentrations show significant variability during the treatment of COVID-19 and therapeutic drug monitoring may be necessary to maintain targeted concentrations.7JUL3516-35228