ANSWERS TO PHOTO QUIZ
Excellent discharge planning should be initiated early on during the road to recovery and should involve all aspects such as caregiver understanding of the diagnosis and why it happened, training (if required for meeting specific needs of the child such as nasogastric tube feeds or the use of home medical equipment), who will be the medical provider post discharge and establishing that connection if possible, and clearly explaining to the caregiver the critical need for close follow up and monitoring after discharge.
Approximately 5% to 10% of all cancers are hereditary. The hereditary cancer panels are detected by NGS (Next Generation Sequencing). Hereditary cancer panels are used in cancer syndromes, colorectal, pancreatic, renal, breast, and ovarian cancer. Somatic mutation cancer panels are by NGS. This will differentiate somatic and germ line mutations, determine the prognosis of patients, screen for therapeutic markers, and determine the sensitivity or resistance to targeted therapy drugs.
The most common peak incidence of this tumor as per available literature was in late sixth and early seventh decades of life with male preponderance. In our case, the age of occurrence was in a much younger male of 42 years age, showing a relatively early onset as compared to the reported peak ages in the literature. It has been noted that the most frequent site is the stomach (52%), followed by the small intestine (25%), large bowel (11%) and oesophagus (5%).
It has been estimated that up to 95% of EPN cases have an underlying uncontrolled diabetes mellitus. Further more, hyperglycemia in association with impaired blood supply to the kidneys from vasculopathy, both of which are prevalent in diabetic patients, facilitates the process of anaerobic metabolism.
Current evidence suggests that females are more susceptible to EPN because they are also more susceptible to urinary tract infections. E. coli is noted to be a very common pathogen in EPN. Klebsiella however is not so common.
The clinical approach to treating patients with EPN has changed over the years. Currently, due to advances in medical imaging, interventional radiology, newer more effective antibiotic therapy, and readily available intensive care integrated with dialytic support, patients with EPN have much better outcomes. Managing EPN more conservatively has thus become the standard of care. In patients with extensive/fulminant disease with hemodynamic compromise, it has been determined that together with fluid resuscitation and antibiotics, immediate nephrectomy should not be delayed for the successful management of EPN.