Panminerva medica
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Multicenter Study
Predictors of endoscopic intervention in upper gastrointestinal bleeding patients hospitalized for another illness: a multi-center retrospective study.
To characterize variables that may predict the need for endoscopic intervention in inpatients admitted for several causes who during the hospitalization developed acute non-variceal upper gastrointestinal bleeding (NVUGIB). ⋯ In hospitalized patients, in case of de novo NVUGIB, the number of PRBC units transfused and RS are predictive of significant endoscopic findings.
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Fertility represents a biological and psychological requirement for women. Some genetic diseases represent a rare cause of infertility, being responsible for 10% of cases of premature ovarian insufficiency. Among these, the most frequent and also those most studied by researchers are Turner Syndrome - due to a karyotype abnormality of the X chromosome pair - and the presence of fragile X premutation (FMR1). ⋯ Mutations of BRCA 1 and 2 genes, make patients at genetically determined high risk of developing early ovarian or breast cancer and of getting POIs for the treatments they must undergo to prevent it (prophylactic bilateral oophorectomy) or treat it (chemotherapy). The management of impaired fertility is not less important than that of other syndromic manifestations for the quality of life of patients. Few data are available regarding the efficiency of cryopreservation of reproductive material (oocytes, embryos or ovarian tissue) in order to preserve fertility in this particular subgroup of patients, but certainly it represents a promising chance and a hope for the future.
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The treatment of patients with multiple myeloma has changed in the last decades, with an improved median survival of 8-10 years. The current treatment for newly diagnosed multiple myeloma patients eligible for autologous transplantation consists of 4 phases: pretransplant, induction, transplant, post-transplant consolidation and maintenance. Even today, a long-term disease control is the goal of multiple myeloma treatment in current clinical practice. ⋯ Careful patient selection based on overall health status is crucial to ensure a balance between risks and benefits. In the era of induction regimens with new agents, upfront autologous transplantation remains the standard of care for young patients with newly diagnosed multiple myeloma due to the longer progression-free survival showed in randomized clinical studies. With the currently available data, the tandem transplantation in multiple myeloma may be considered in patients with high-risk cytogenetics, in particular, those who did not receive a new triplet combination or those with a lower response than very good partial response following their first transplantation.
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Multiple myeloma (MM) accounts for about 1.8% of all cancers and slightly over 17% of hematologic malignancies. Despite improvements in outcomes in recent years, currently, there is still no cure for this disease. Although allogeneic stem cell transplantation (Allo-SCT) is a potentially curative treatment, given the armamentarium of highly effective therapeutic options and a pipeline of novel agents, many opinion leaders sustain that there is no longer a role for this approach. ⋯ However, there are no current data supporting upfront Allo-SCT. Prospective trials combining the so-called "graft-versus-myeloma" effect and new drugs are an unmet medical need in high-risk patients. Early relapse after first-line treatment, which identifies patients with poor prognosis independently of other prognostic factors, could become a clinical indication.