Modeling Survival in Patients With Brain Stroke in the Presence of Competing Risks

ObjectivesAfter heart disease, brain stroke (BS) is the second most common cause of death worldwide, underscoring the importance of understanding preventable and treatable risk factors for the outcomes of BS. This study aimed to model the survival of patients with BS in the presence of competing risks.MethodsThis longitudinal study was conducted on 332 patients with a definitive diagnosis of BS. Demographic characteristics and risk factors were collected by a validated checklist. Patients’ mortality status was investigated by telephone follow-up to identify deaths that may be have been caused by stroke or other factors (heart disease, diabetes, high cholesterol, etc.). Data were analyzed by the Lunn-McNeil approach at alpha=0.1.ResultsOlder age at diagnosis (59–68 years: adjusted hazard ratio [aHR], 2.19; 90% confidence interval [CI], 1.38 to 3.48; 69–75 years: aHR, 5.04; 90% CI, 3.25 to 7.80; ≥76 years: aHR, 5.30; 90% CI, 3.40 to 8.44), having heart disease (aHR, 1.65; 90% CI, 1.23 to 2.23), oral contraceptive pill use (women only) (aHR, 0.44; 90% CI, 0.24 to 0.78) and ischemic stroke (aHR, 0.52; 90% CI, 0.36 to 0.74) were directly related to death from BS. Older age at diagnosis (59–68 years: aHR, 21.42; 90% CI, 3.52 to 130.39; 75–69 years: aHR, 16.48; 90% CI, 2.75 to 98.69; ≥76 years: aHR, 26.03; 90% CI, 4.06 to 166.93) and rural residence (aHR, 2.30; 90% CI, 1.15 to 4.60) were directly related to death from other causes. Significant risk factors were found for both causes of death.ConclusionsBS-specific and non-BS-specific mortality had different risk factors. These findings could be utilized to prescribe optimal and specific treatment.     

Aloysia citriodora Palau (lemon verbena) for insomnia patients: A randomized,double‐blind,placebo‐controlled clinical trial of efficacy and safety

Aloysia citriodora (A. citriodora) has a long history of traditional use for sedation and treatment of insomnia in different societies. This study was carried out to assess the efficacy of A. citriodora in patients with insomnia. One hundred patients were randomly divided into two groups of A. citriodora (total essential oil 1.66 mg/10 ml and total amount of flavonoid in terms of quercetin 3.22 mg/10 ml of the syrup) and placebo. They were advised to use 10 cc of the syrups; an hour before the bedtime for a period of 4 weeks. Participants were assessed using Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) questionnaires at the baseline and then 2 and 4 weeks after the enrollment. Mean scores of global PSQI and its four components including sleep latency, habitual sleep efficiency, daytime dysfunction, and subjective sleep quality and also ISI score in the A. citriodora group improved significantly after 4 weeks of treatment when compared with the placebo group (p < 0.001, for all of them). Also, improvement of global score of PSQI and ISI was observed in the intervention group as compared with the placebo group, 2 weeks after the enrollment (p < 0.001). The results of this study showed that oral intake of A. citriodora can be suggested as a complementary treatment for patients with insomnia.     

Furosemide Inhalation in Dyspnea of Mustard Gas-Exposed Patients: A Triple-Blind Randomized Study

Dyspnea is the hallmark symptom of some respiratory diseases such as chronic obstructive pulmonary disease and bronchiolitis and is a major reason for which these patients seek medical attention. We performed a randomized triple-blind controlled crossover clinical trial in which we compared the efficacy of inhaled furosemide (4 ml equal to 40 mg in 10 min) with placebo (4 ml of 0.9% saline solution) in 41 mustard gas-exposed patients. Dyspnea index, visual analog scale (VAS), and pulmonary function test results were obtained before and 4 h after treatments. Results showed that both furosemide and placebo significantly decreased VAS and dyspnea index and increased FEV₁, FVC, and FEV₁/FVC, while there was no difference between the two drugs in these effects (p values.23, .61, .81, .36, and.27, respectively). Our results failed to address the previously reported effects of inhaled furosemide on dyspnea. In fact, we suggest that patients with a previous exposure to sulfur mustard, in which chronic bronchitis and bronchiolitis are the most suggested underlying mechanisms, may not benefit from furosemide to alleviate their dyspnea.     

Impact of an aggressive stenting strategy on initial and one-year follow-up costs in patients undergoing coronary angioplasty

Background: Although stents have been shown in randomised trials to reduce restenosis rates compared with balloon angioplasty, there are concerns regarding the cost-effectiveness of an aggressive stenting strategy. Stents were shown to increase medical costs over 12 months in the early trials.
Aim: Our aim was to determine the economic impact of an aggressive stenting strategy using current stenting techniques compared with a conservative stenting strategy.
Methods: Initial and one year follow-up costs were determined in all patients who underwent successful revascularisation during June to December 1996 (aggressive stenting, n =401), and compared to all patients treated in the corresponding months in 1995 (conservative stenting, n =347). All patients had clinical follow-up for one year.
Results: The proportion of patients receiving a stent increased from 22.5% in 1995 to 66.1% in 1996 (p <0.0001). Requirement for repeat procedures in the 1995 group compared with 1996 was coronary angiography in 31% vs 16% (p <0.0001), coronary angioplasty in 11% vs 6% (p =0.0044) and bypass surgery in 4.8% vs 2.5% (p =0.054). The mean initial cost of the procedure was higher in the aggressive stenting group ($4319±1276 in 1995 vs $5131±1491 in 1996, p <0.0001), but after 12 months follow-up, total medical costs were equivalent ($5975±4143 in 1995 vs $5994±3476 in 1996, p =NS).
Conclusion: An aggressive coronary stenting strategy is associated with higher initial costs compared with a conservative strategy, but lower costs during follow-up due to reduced need for repeat procedures, resulting in equivalent one year total medical costs.     

The efficacy of bone marrow mononuclear stem cell transplantation in patients with non-ischemic dilated cardiomyopathy—a meta analysis

Heart Failure Reviews - Cardiomyopathy refers to a wide spectrum of heart pathologies that interfere with normal heart function. Management options of patients with cardiomyopathy depended mainly...     

Experiences of family caregivers of patients with bipolar disorder

Introduction: Attention to caregiving consequences has been mainly restricted to bipolar disorder, although studies suggest that relatives of bipolar patients also experience considerable distress. The purpose of this study was to explore the lived experiences of family member caregivers of bipolar disorder patients. Methods: In a qualitative research of phenomenological methodology, family member caregivers of bipolar disorder patients in Farshchian Psychiatric Hospital in Hamedan (Iran) were selected by purposive sampling in the year 2010. By reaching data saturation, the number of participants was 12. Data were gathered through in‐depth interviews and analyzed by van Manen method. Results: Analysis of the interviews revealed six major themes: fears and anxiety for the future, psychosomatic impact, feeling isolated and loneliness, financial impact, change in lifestyle and family functioning, and lack of support and knowledge. Discussion: This study highlights the need for family‐oriented mental health services to be developed and for further research to identify the specific nursing interventions that are effective in helping to sustain family caregiving.     

Squamous cell carcinoma at an ileostomy site—Fifty-four years following colectomy for ulcerative colitis: A case report and literature review

INTRODUCTIONCarcinoma arising at an ileostomy site is an extremely rare occurrence. The rate of malignancy arising at an ileostomy site is reported as being 2–4 of every 1000 cases. The development of squamous cell carcinoma at the mucocutaneous junction of an ileostomy is extremely rare.PRESENTATION OF CASEWe present a case of a 76-year-old male who developed squamous cell carcinoma at an ileostomy site fifty-four years after total colectomy as management for ulcerative colitis.DISCUSSIONOur literature review has identified only four similar cases previously published in English literature. All cases of squamous cell carcinoma developing in ileostomy have occurred after a minimum of twenty-six years following ileostomy. This suggests that the etiology may be due to chronic factors.CONCLUSIONPatients with chronic stomal inflammation, bleeding or persistent induration and/or mass formation should be followed up closely and investigated for recurrence or development of a new malignancy. There should be a low threshold to obtain an early definitive tissue diagnosis by taking biopsies to prevent local or systemic invasion.