The COVID-19 pandemic has tremendously affected higher education institutions, that started, as a result of the pandemic to transition into more convenient options for teaching and assessment. 1 While medical schools around the globe are putting all their efforts to ensure readiness of students and faculty to efficiently use digital facilities and technology in their learning and teaching, the assessment of clinical competencies remains a difficult area that needs innovative solutions and adaptations. 2,3 Technology-enhanced learning is more than just a necessary transition in the COVID-19 era. It has been a target for years. This pursuit, however, has been persistently met by a great deal of resistance. Faculty have felt for years that they were not ready to fully use the available technologies. 4 With the transition that was mandated by the COVID-19 pandemic, all faculty were urged by the school administration to transform to using technology in the absence of any other available alternative. We need to capitalize on this achievement. Assessment, however, remains a problem that requires much more than the introduction of technology. Many
Photodynamic therapy (PDT) is an established treatment for the ablation of dysplastic Barrett's epithelium and early esophageal carcinoma, but no data have been published on curative 5-aminolevulinic acid (5-ALA)-PDT for long-segment early esophageal cancer with infiltration of the upper sphincter. We describe successful curative treatment of an unusual early long-segment squamous cell carcinoma (uT1a,N0) of the proximal esophagus (18 - 28 cm aborally), with three sessions of 5-ALA-PDT. Endoscopic and endosonographic follow-up macroscopically showed a complete remission of the tumor, proven by biopsy showing total histological ablation. After a follow-up period of 23 months, there has been no indication of tumor recurrence. Early superficial (< 3 mm) squamous cell carcinomas of the esophagus can be ablated completely by 5-ALA-PDT. However, long-term follow-up is required in order to prove the effectiveness of endoscopic ablation therapy for early esophageal cancer.
Although it is an invasive and unpleasant procedure, esophagogastroduodenoscopy (EGD) is still the gold standard for esophageal varices (EV) detection. The aim of this study was to investigate liver stiffness measurement (LSM) and spleen diameter as simple noninvasive tools for EV prediction in chronic hepatitis C patients (CHC).A total of 123 Egyptian patients with CHC have been included and were classified based on screening EGD result into 2 groups; group A (without EV) and group B (with EV). Group (B) was subclassified according to EV grade into 4 subgroups: (B1, grade I), (B2, grade II), (B3, grade III), and (B4, grade IV). LSM was taken for each patient on the next day by an independent Fibroscan operator and correlated to the EGD result. Demographic, clinical, and biochemical data were recorded and analyzed using advanced data-mining computational technology.Mean LSM was 9.94 ± 6 kPa for group A and 33.32 ± 14 kPa for group B, whereas it was 21.22 ± 3, 25.72 ± 6, 33.82 ± 8, and 46.1 ± 15 kPa for subgroups B1, B2, B3, and B4, respectively. Mean spleen diameter was 11.09 ± 1.7 cm for group A and 16.58 ± 1.6 cm for group B. However, LSM ≥17 kPa was the only independent factor for EV prediction; splenic longitudinal span ≥15 cm was a complementary predictor when LSM was <17 kPa. The overall accuracy was 98.33 ± 3.33, Mikro = 98.26%.LSM ≥17 kPa and spleen diameter ≥15 cm is a simple noninvasive algorithm that could be used for prediction of EV and discrimination among its different grades.
Introduction and aims Nonalcoholic fatty liver disease (NAFLD) is increasing globally with an estimated prevalence of approximately 25 %. Nonalcoholic steatohepatitis as the progressive disease entity often leads to fibrosis and end-stage disease. The magnitude of NAFLD patients are not diagnosed and have no access to further clinical assessment. Diagnostic pathways for individual risk evaluation fitting with available resources are of utmost importance in real-world clinical practice.
Methods Retrospective analysis of 1346 anonymized outpatient datasets at Würzburg University Hospital, Germany. Transient elastography (TE) with controlled attenuation parameter and laboratory-based risk scores (NFS, FIB-4) were the main diagnostic workup tools for risk stratification.
Results After preselection based on questionnaire information NAFLD still accounts for one-fifth of patients in the liver outpatient service. More than 80 % of NAFLD patients receive their first-time diagnosis in our unit. Laboratory-based risk scores and TE are valuable tools for second-step risk assessment as shown in our clinical data analysis. Moreover, 65 % of NAFLD patients use inpatient services for at least 1 day. The policy to perform liver biopsy in high-risk patients above the recommended threshold of 9.6 kPa if any clinical doubt exists regarding the diagnosis of cirrhosis leads to a histological down staging in almost 80 %.
Conclusion Questionnaire-based referral from primary care followed by broadly available fast-track TE and eventually liver biopsy for selected patients is the standard practice in our unit. This approach represents a feasible model to handle the large gap between availability and clinical need for TE facilities.
Thrombocytopenia is a well-known relative contraindication for the initiation of antiviral therapy in HCV-infected patients and may also result in the postponement of many invasive procedures that chronic liver disease (CLD) patients may need to undergo, such as percutaneous, transjugular, or laparoscopic liver biopsy; paracentesis; thoracentesis; radiofrequency ablation; or partial hepatectomy for hepatocellular carcinoma. The latter group of patients may also need to undergo splenectomy, especially if the platelet counts are ,50,000/mm3(Cacoub et al.,2000). Different therapeutic strategies have been suggested and tried for the treatment of HCV-related thrombocytopenia in different studies with variable success (generally disappointing). However, the recent introduction of second-generation thrombopoietinreceptor agonists (TPO-RAs) has opened up a novel way to treat thrombocytopenia. In 2008, the US Food and Drug Administration approved two TPO-RAseltrombopag and romiplostim for use in chronic immune thrombocytopenic purpura(CITP) patients refractory to at least one standard treatment (Nurden et al.,2009). Background: Thrombocytopenia is a common hematological abnormality observed in patients infected with hepatitis C virus (HCV). Thrombocytopenia is a well-known relative contraindication for the initiation of antiviral therapy in HCV-infected patients and may also result in the postponement of many invasive procedures that chronic liver disease (CLD) patients may need to undergo. This study aiming to determine the platelet response to eltrombopag and side effects of eltrombopag therapy in patients with HCV-associated thrombocytopenia. Patients and methods: This prospective study was carried out on 30 patients with chronic HCVassociated thrombocytopenia (<50,000×109/L) thatprecludes the initiation of HCV therapy. Eltrombopag was initiated at a dose of 25 mg once daily; the dose was adjusted with 25 mg increments every 2 weeks to achieve the target platelet count. The primary end point was to achieve stable target platelet count(>100,000×109/L) required to initiate antiviral therapy and any surgical intervention. Results: Treatment response was achieved in 29 (96.7%) patients. This prospective study showed That when the dependent variable was the increased platelet count at second week of treatment while the independent variables are: age, albumin level, gender, platelet count before treatment, AST, and WBC count. The only significant positive predictive factor was the platelet count before treatment. Conclusion:Eltrombopag causes significant elevation of platelet count in patients with HCV related thrombocytopenia, so that Eltrombopag could be used prior to and during treatment with antiviral therapy when thrombocytopenia become confronting problem as well as before surgical interventions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.