Foveal vasculature changes and nonperfusion in patients with diabetes types I and II with no evidence of diabetic retinopathy

Graefe's Archive for Clinical and Experimental Ophthalmology - To analyze the foveal avascular zone (FAZ) in patients with diabetes and no retinopathy vs. controls using OCT angiography...     

Primary care perspective and implementation of a multidisciplinary,institutional prostate cancer screening algorithm embedded in the electronic health record

Purpose

In response to controversy regarding prostate cancer (CaP) screening recommendations, a consolidated Duke Cancer Institute (DCI) multidisciplinary algorithm for CaP screening was developed and implemented. We conducted an online survey within the year following its implementation to assess primary care provider (PCP) attitudes and adoption as well as to evaluate how this program affects screening rates.

First-in-Human Phase 1b Trial of Quinacrine Plus Capecitabine in Patients With Refractory Metastatic Colorectal Cancer

BackgroundQuinacrine plus a fluoropyrimidine has in vivo efficacy against metastatic colorectal cancer (mCRC). This phase 1b trial evaluated the combination of quinacrine plus capecitabine in patients with treatment-refractory mCRC.Patients and MethodsUsing a modified Simon accelerated titration design, adults with treatment-refractory mCRC were treated with capecitabine 1000 mg/m² twice daily for 14/21-day cycle, and escalating doses of quinacrine 100 mg daily, 100 mg twice daily, and 200 mg twice daily for 21 days. The primary endpoint was identifying the maximum tolerated dose, determining tolerability and safety. In an expansion cohort, it was overall response rate and time to tumor progression (TTP).ResultsTen patients (median age of 60 years) were treated in phase 1b. The first 2 quinacrine dosing levels were well tolerated. Dose-limiting toxicities were seen in 3 patients treated with quinacrine 200 mg twice daily. Five additional patients tolerated quinacrine 100 mg twice daily without further dose-limiting toxicities, thus establishing the maximum tolerated dose. Seven additional expansion-cohort patients enrolled onto the study before quinacrine manufacturing ceased within the United States. Five patients experienced stable disease, 1 partial response, and 10 disease progression. Median TTP overall was 2.12 months and median overall survival 5.22 months for the 17 patients.ConclusionCapecitabine and quinacrine can be safely administered at the maximum tolerated dose of capecitabine 1000 mg/m² by mouth twice daily on days 1-14 and quinacrine 100 mg by mouth twice daily on days 1-21 of a 21-day cycle in mCRC patients. Although the expansion study was halted early, TTP was in line with other studies of refractory mCRC, suggesting activity of this regimen in heavily pretreated patients.     

Sonographic appearance of uterine lymphoma: Case report and review of the literature

Uterine lymphoma is rare and tends to be misdiagnosed due to lack of specific radiologic features. Few reports have been published on the sonographic characteristics of uterine lymphoma. We present a case report of uterine lymphoma manifested by a fast growing uterus and describe the sonographic findings. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 43 :59–63, 2015     

The role of neuroimaging in the evaluation process of children with isolated sixth nerve palsy

Purpose

The purpose of this study was to assess the role of neuroimaging in identifying the etiology of pediatric isolated sixth nerve palsy (SNP).

Methods

A retrospective cohort study was conducted of all patients younger than 18 years of age with an isolated SNP seen at our medical center between 2003 and 2011.

Results

Sixteen children (nine girls; mean age, 4.5 years) with isolated SNP were identified during an 8-year period. Only cases with normal optic disk appearance and otherwise normal neurological examination were included into this study. Thus, 12 other children with SNP were excluded: ten children with papilledema, one child who developed a SNP following a resection of a brain tumor, and one with hydrocephalus and a shunt malfunction. All cases of isolated SNP were unilateral (ten left eyes). The most common cause for the SNP in these children was a tumor that was found in five patients. Other etiologies encountered in decreasing frequencies were: benign recurrent SNP (in four children), postviral or vaccination (in three children), and one case each of post trauma, Chiari malformation, congenital, and undetermined. Children who were found to have a tumor (9.9?±?5.5 years) were significantly older (P?=?0.019) than children who did not have a tumor (2.1?±?1.8 years).

Conclusions

Isolated SNP can be the presentation of a brain tumor in children, and therefore, early neuroimaging of the brain is recommended, especially in older children.     

Effects of instrumental and psychological support on levels of depressive symptoms for hospitalized older adults

Objectives: To explore the effects of four types of support (psychological support, instrumental support, supervision of instrumental support, and explanation of medical care) on the level of depressive symptoms among hospitalized older adults.

Method: The sample consisted of 468 older adults admitted to the internal medicine units of a large tertiary care medical center in northern Israel. Respondents filled out self-report questionnaires upon admission and discharge. Information regarding severity of illness, chronic health status, and length of hospital stay was gathered from their medical records. Multivariate regression was used to test the association between the four types of caregiving support and depressive symptoms.

Results: Psychological support from informal caregivers was found to be negatively related to depressive symptoms, and instrumental support to be positively related to depressive symptoms among respondents who were more independent in their functioning before the hospitalization. These relationships remained significant after controlling for previously-identified precursors of depressive symptoms: age, gender, education, widowhood, functional and cognitive status, severity of illness, co-morbidities, and length of hospital stay. Supervision of instrumental support and explanation of medical care were not related to depressive symptoms.

Conclusion: Results of this study suggest that functional status, the kind of support, and the setting in which it is given are important in understanding the influence of informal support on the well-being of older adults. The potentially positive as well as negative consequences of various types of support in the hospital setting should be recognized and addressed.     

A novel host-protein assay outperforms routine parameters for distinguishing between bacterial and viral lower respiratory tract infections

Bacterial and viral lower respiratory tract infections (LRTIs) are often clinically indistinguishable, leading to antibiotic overuse. We compared the diagnostic accuracy of a new assay that combines 3 host-biomarkers (TRAIL, IP-10, CRP) with parameters in routine use to distinguish bacterial from viral LRTIs. Study cohort included 184 potentially eligible pediatric and adult patients. Reference standard diagnosis was based on adjudication by an expert panel following comprehensive clinical and laboratory investigation (including respiratory PCRs). Experts were blinded to assay results and assay performers were blinded to reference standard outcomes. Evaluated cohort included 88 bacterial and 36 viral patients (23 did not fulfill inclusion criteria; 37 had indeterminate reference standard outcome). Assay distinguished bacterial from viral LRTI patients with sensitivity of 0.93 ± 0.06 and specificity of 0.91 ± 0.09, outperforming routine parameters, including WBC, CRP and chest x-ray signs. These findings support the assay's potential to help clinicians avoid missing bacterial LRTIs or overusing antibiotics.     

The Politics of Combating the Organ Trade: Lessons From the Israeli and Pakistani Experience

Israel and Pakistan—two major participants in the global organ trade—enacted legislative prohibitions on the trade at roughly the same time. The article highlights three influences that brought about this change of policy in both countries: advocacy by local physicians coupled with media coverage and reinforced by the international medical community. The analysis also explains why the two countries have differed with respect to the enforcement of the organ‐trade prohibition. The insights from the Israeli and Pakistani cases will be of use for the transplant community's efforts against organ trafficking.