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Risk Assessment and Risk-Adapted Treatment Selection: A Case-Based Approach for Chronic Lymphocytic Leukemia.

Selected Patient Cases From the APSHO Regional Lecture Series INTRODUCTION As the official publication of the Advanced Practitioner Society for Hematology and Oncology (APSHO), JADPRO is pleased to offer Part 3 of an accredited educational activity based on the recently concluded APSHO Regional Lecture Series. Hosted in collaboration with major cancer centers around the country, the APSHO Regional Lecture Series brought case-based didactic presentations and skills workshops to advanced practitioners. In the spirit of JADPRO, three accredited Grand Rounds articles by Beth Eaby-Sandy, MSN, CRNP,

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… Pretreatment risk assessment is critical to mitigating risks and should include collaboration with co-managing providers such as PCPs and cardiologists to reduce potential drug-drug interactions and optimally manage expected adverse events. … Pretreatment risk assessment is critical to mitigating risks and should include collaboration with co-managing providers such as PCPs and cardiologists to reduce potential drug-drug interactions and optimally manage expected adverse events. …

Clinical Practice Guideline: Nosebleed (Epistaxis) Executive Summary.

OBJECTIVE: Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. … ists, interventional radiologists/neuroradiologists and neurointerventionalists, hematologists, and cardiologists. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, the emergency department, the inpatient hospital, and even remote outpatient encounters with phone calls …

Stress echocardiography with contrast for the diagnosis of coronary artery disease: an evidence-based analysis.

UNLABELLED: In July 2009, the Medical Advisory Secretariat (MAS) began work on Non-Invasive Cardiac Imaging Technologies for the Diagnosis o … h would otherwise appear black on conventional two dimensional ECHO. The enhanced signal then helps cardiologists to determine what parts of the patient's heart muscle are poorly perfused. The first commercially available microsphere contrast agent was Albunex, which received approval by the Food and Drug Administration in the United States in 1994. This origin …

Clinical Practice Guideline: Nosebleed (Epistaxis).

OBJECTIVE: Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. … ists, interventional radiologists/neuroradiologists and neurointerventionalists, hematologists, and cardiologists. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, the emergency department, the inpatient hospital, and even remote outpatient encounters with phone calls …

Lifestyle and Pharmacological Interventions to Prevent Anthracycline-Related Cardiotoxicity in Cancer Patients.

Anthracyclines remain a cornerstone of cancer therapy but are associated with a significant risk of cardiotoxicity, which can lead to overt heart failure. The risk is modulated by cumulative dose, pre-existing cardiovascular disease, and patient-specific factors. As cancer survival improves, the long-term cardiovascular consequences of anthracycline exposure have become a growing concern, underscoring the need for effective preventive strategies. This narrative review examines lifestyle and pharmacological interventions aimed at mitigating anthracycline-induced cardiotoxicity. Evidence suggest

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… These teams typically comprise cardiologists, oncologists, nurses, physiotherapists, nutritionists, and other healthcare professionals working collaboratively to minimize cardiovascular complications while ensuring optimal oncological outcomes. … Use of new and emerging cancer drugs: What the cardiologist needs to know Eur. Heart J. 2024 45 1971 1987 10.1093/eurheartj/ehae161 38591670 6. Balough E. Ariza A. Asnani A. Hoeger C.W. Cardiotoxicity of Anthracyclines Cardiol. Clin. 2025 43 111 127 10.1016/j.ccl.2024.08.002 39551553 7. …

Cardiac Monitoring for Patients Undergoing Treatment With MEK Inhibitor Monotherapy.

PURPOSE OF REVIEW: Aberrant activation of the RAS-RAF-MEK-ERK signaling pathway contributes to numerous malignancies, congenital syndromes, and cardiovascular disorders, establishing MEK inhibitors (MEKi) as crucial therapeutic agents. MEKi demonstrate substantial clinical benefit as monotherapy (e.g., NF1-associated tumors) or combination therapy (e.g., melanoma, glioma, congenital RASopathies). Cardiovascular adverse events, primarily asymptomatic reductions in left ventricular ejection fraction (LVEF), have prompted intensive echocardiographic monitoring. RECENT FINDINGS: Emerging evidence

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… The goal of the above baseline evaluation is to identify patients with significant concerning abnormalities who would benefit from the oversight of a cardiologist. … It is noteworthy that many cardiologists may not be aware of MEKi therapy or the potential cardiac effects, so they may be less comfortable with so-called “permissive cardiotoxicity” approaches. …

Давление может быть серьезно повышено при инъекции детруса ботулиновым токсином А.

ВВЕДЕНИЕ: Токсин ботулинового токсина А (BONT/A-DI) используется у пациентов с избыточным мочевым пузырем (OAB) или нейрогеническим мочевым пузырем в результате множественных склерозов (MS) или повреждения спинного мозга. Эта процедура, как правило, проводится под местной анестезией. Мы изучили влияние BONT/A-DI на кровяное давление, наиболее важный автономный параметр для бодрых пациентов, в качестве потенциального фактора риска сердечно-сосудистых заболеваний.МАТЕРИАЛ & МЕТОДЫ: Пациенты с OAB или спонтанно опустошающие с нейрогенной детрозной активностью (NDO) из-за MS, в которых BONT/A-DI п

Assessment of adherence to the guidelines for the management of nausea and vomiting induced by chemotherapy.

ObjectiveTo assess adherence of the prescribing physicians in a private cancer care center to the American Society of Clinical Oncology guideline for antiemetic prophylaxis, in the first cycle of antineoplastic chemotherapy.MethodsA total of 139 chemotherapy regimens, of 105 patients, were evaluated retrospectively from 2011 to 2013.ResultsWe observed 78% of non-adherence to the guideline rate. The main disagreements with the directive were the prescription of higher doses of dexamethasone and excessive use of 5-HT3 antagonist for low risk emetogenic chemotherapy regimens. On univariate analys

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… Other studies showed adherence rates to antiemetic guidelines ranging from 3-42%. ( 8 – 12 ) Guideline adherence rates generally also vary within each medical specialty. ( 13 ) According to a British study, 70% of cardiologists and 25% of orthopedic surgeons adhere to protocols. …

Risk mitigation in divers with persistent (patent) foramen ovale.

In this issue, Anderson and colleagues report follow-up of divers who were found to have a persistent (patent) foramen ovale (PFO) or, in eleven cases, an atrial septal defect (ASD). In most divers diagnosis followed an episode of decompression illness (DCI). The efficacy of closure of the PFO/ASD in preventing future DCI was compared with conservative diving. They reported that in the closure group the occurrence of confirmed DCI decreased significantly compared with pre-closure, but in the conservative group this reduction was not significant. It is believed there are three requirements for

Percutaneous coronary intervention and 30-day unplanned readmission with chest pain in the United States (Nationwide Readmissions Database).

Percutaneous coronary intervention (PCI) improves anginal chest pain in most, but not all, treated patients. PCI is associated with unplanned readmission for angina and non-specific chest pain within 30-days of index PCI. Patients with an index hospitalization for PCI between January-November in each of the years 2010-2014 were included from the United States Nationwide Readmissions Database. Of 2 723 455 included patients, the 30-day unplanned readmission rate was 7.2% (n = 196 581, 42.3% female). This included 9.8% (n = 19 183) with angina and 11.1% (n = 21 714) with non-specific chest pain.

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… In addition, a formal clinic review with a cardiology fellow and a computerized alert system for re‐presentations facilitated early cardiologist review. This package of interventions reduced 30‐day hospital readmission from 9.6% to 5.3% over the 4‐year study period. … Early post‐percutaneous coronary intervention chest pain: a Nationwide survey on interventional Cardiologists' perspective . Cardiovasc Revasc Med . 2020 ; 21 ( 12 ): 1517 ‐ 1522 . 32563712 10.1016/j.carrev.2020.05.011 24 Demiryoguran NS , Karcioglu O , Topacoglu H , et al. …

A lost race against time-a rare case of AL amyloidosis.

INTRODUCTION: Amyloidosis is a rare multi-system disease that can affect the heart. Recent advances have been made in finding successful treatments for these patients. Nonetheless, cardiac amyloidosis continues to carry high morbidity and mortality. CASE PRESENTATION: This case refers to a 52-year-old man presenting with signs and symptoms of heart failure. Electrocardiogram showed q waves in V1-V3 and T wave inversion in the inferior and lateral leads. Echocardiography revealed moderate concentric left ventricular hypertrophy, with preserved biventricular systolic function and no other chang

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… Improved recognition of AL amyloidosis by cardiologists allows for earlier treatment and improved outcomes. Conclusion This case highlights the diagnostic challenges and underscores the crucial role of EMB in selected cases. …

Atypical Presentation of Systemic Amyloid Light Chain (AL) Amyloidosis.

Light chain (AL) amyloidosis is caused by a plasma cell clone that produces a dysfunctional, monoclonal light chain. This light chain misfolds and aggregates, resulting in catastrophic organ damage and eventual death. Due to the multiple organs affected by the disease, symptoms can be vague, such as lethargy, fatigue, weight loss, and peripheral edema. This case presentation follows a 66-year-old female patient who presented to our emergency department complaining of progressive shortness of breath (SOB). The patient denied any other associated symptoms and denied any past significant medical

Оценка лечения множественных склерозов и его воздействия на здоровье мозга: опыт Объединенного центра Арабских Эмиратов.

Множественный склероз является хроническим, сложным неврологическим заболеванием, которое часто вызывает как видимые, так и невидимые симптомы, которые существенно влияют на повседневное функционирование. Комплексный подход к многоплановому склерозовому уходу имеет важное значение для благополучия пациентов, особенно в уникальном социокультурном контексте Объединенных Арабских Эмиратов, где такие факторы, как страхование и наличие специалистов, могут создавать дополнительные проблемы. МЕТОДОЛОГИЯ: В одном из специализированных центров Объединенных Арабских Эмиратов было проведено ретроспективн

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… There is access to MS specialized physical therapists and other specialties like urologists, gastroenterologists, internal medicine, and cardiologists. During this study, there was limited access to in-house psychologists or trained psychiatrists. …

State of oral mucosa as an additional symptom in the course of primary amyloidosis and multiple myeloma disease.

Multiple myeloma (myeloma multiplex (MM)) is a malignant non-Hodgkin's lymphoma derived from B cell. Its essence is a malignant clone of plasma cells synthesizing growth of monoclonal immunoglobulin, which infiltrate the bone marrow, destroy the bone structure, and prevent the proper production of blood cells components. The paper presents a case of 62-year-old patient who developed symptoms in addition to neurological and haematological changes in the oral mucosa in the course of multiple myeloma. The treatment resulted in partial improvement. The authors wish to draw attention not only to no

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… Discussion The described case stresses the necessity for various speciality physicians to cooperate, not only for a haematologist and a periodontist, but also for other highly specialised representatives of different fields of medicine such as cardiologists, internists, dermatologists, gastrologists …

Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies: JACC: CardioOncology State-of-the-Art Review.

Invasive cardiac interventions are recommended to treat ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. These recommendations are based on randomized controlled trials that historically included few individuals with active, advanced malignancies. Advanced malignancies represent a significant competing risk for mortality, and there is limited evidence to inform the risks and benefits of invasive cardiac interventions in affected patients. We review the benefit con

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… In addition to patients and their social support, key stakeholders include interventional cardiologists, cardiac surgeons, and oncologists/hematologists. Cardio-oncology is important in bringing together these specialists. … Conclusions Patients with advanced cardiac conditions and cancers should be involved in shared decision making with their health care team (eg, cardiologist/oncologist) when considering the role of invasive cardiac interventions. …

Safety and Efficacy of the Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells in Patients With Heart Failure: A Phase 1/2 Randomized Controlled Trial (RIMECARD Trial [Randomized Clinical Trial of Intravenous Infusion Umbilical Cord Mesenchymal Stem Cells on Cardiopathy]).

RationaleUmbilical cord-derived mesenchymal stem cells (UC-MSC) are easily accessible and expanded in vitro, possess distinct properties, and improve myocardial remodeling and function in experimental models of cardiovascular disease. Although bone marrow-derived mesenchymal stem cells have been previously assessed for their therapeutic potential in individuals with heart failure and reduced ejection fraction, no clinical trial has evaluated intravenous infusion of UC-MSCs in these patients.ObjectiveEvaluate the safety and efficacy of the intravenous infusion of UC-MSC in patients with chronic

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… Transthoracic Echocardiography Transthoracic echocardiography was performed by 2 experienced cardiologists, blind from treatment allocation, from both participating centers. Studies were performed in Vivid 7 Dimension Cardiovascular Ultrasound System (General Electric Healthcare). … Acknowledgments We thank all participants of this trial and cardiologists who referred patients for the study and technicians from the Laboratory of Nano-Regenerative Medicine and the radiology departments from Clínica Dávila and Universidad de Chile for their technical support. …

Anticoagulation challenges in cancer patients: prevention, detection, and treatment strategies.

Cancer-associated thrombosis is one of the most common and serious complications in oncology patients, contributing significantly to morbidity and mortality. This prothrombotic state is driven by cancer-related factors, systemic inflammation, and treatment-induced endothelial injury. Anticoagulation management in these patients is challenging, as both thrombotic and bleeding risks must be carefully balanced, particularly in those with cardiovascular comorbidities. This review examines the complexities of anticoagulation in cancer-associated thrombosis through three clinical cases. Case 1 focus

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… Multidisciplinary collaboration among oncologists, cardiologists, and hematologists is essential to navigate the complexities of CAT management. … The interplay of cancer treatments and thrombotic risks necessitates a multidisciplinary approach, emphasizing collaboration between oncologists, cardiologists, and hematologists to navigate the complexities of CAT. …

Pulmonary hypertension in patients with multiple myeloma: A comprehensive review.

Multiple myeloma (MM) is a common hematological malignancy resulting from clonal proliferation of plasma cells and is defined by criteria set forth by the international myeloma working group. Pulmonary hypertension (PH) is defined by an elevated mean pulmonary artery pressure >20 mmHg measured during right heart catheterization. Echocardiography-diagnosed PH is relatively common in patients with MM and has been associated with increased mortality, morbidity, and poor stem cell transplant outcomes. PH in patients with MM (PH-MM) is usually multifactorial in origin. MM disease-specific factors,

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… A high index of suspicion and early screening for PH is prudent, and should be contemplated by all providers involved in the care of patients with MM, including oncologists, cardiologists, pulmonologists and primary care physicians. … Etiology and pathophysiology of PH‐MM is complex and a detailed workup with a multidisciplinary approach between hematology‐oncology, cardiologists, and PH specialists would help appropriate classification and management. …

Babesia microti-induced fulminant sepsis in an immunocompromised host: A case report and the case-specific literature review.

Babesia microti is an obligate intra-erythrocytic parasite transmitted by infected ticks. B. microti is a eukaryote much larger than prokaryotic microbes and more similar to human hosts in their biochemistry and metabolism. Moreover, Babesia spp. possess various immune evasion mechanisms leading to persistent and sometimes life-threatening diseases in immunocompromised hosts. Chronic lymphocytic leukemia (CLL) is the most prevalent adult B-cell malignancy, and a small percentage of CLL transforms into aggressive lymphomas. CLL also causes immune dysfunction due to the over-expansion of immatur

Improvement of the left atrial systolic function after a surgical reduction of the high flow arteriovenous fistula.

BACKGROUND: High-output heart failure (HOHF) is a distinct cardiac complication in end-stage kidney disease (ESKD) patients with high-flow arteriovenous fistulae (AVFs). While AVF flow reduction improves hemodynamics and left atrial (LA) volume, its effect on LA systolic function remains unclear. OBJECTIVE: To evaluate changes in left atrial systolic function and left ventricular (LV) filling pressures following surgical AVF flow reduction in haemodialysis patients with high-flow fistulae. METHODS: In this prospective, single-centre interventional study, 28 ESKD patients (mean age 63 ± 15 ye

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… Although often considered a passive chamber by non-cardiologists, the left atrium plays a crucial role in cardiac function. …