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11.
Fahad A. Almugbel Narhari Timilshina Naser AlQurini Allison Loucks Rana Jin Arielle Berger Lindy Romanovsky Martine Puts Shabbir M.H. Alibhai 《Journal of Geriatric Oncology》2021,12(5):786-792
Background: The Vulnerable Elders Survey (VES-13) is commonly used to identify older patients who may benefit from Comprehensive Geriatric Assessment (CGA) prior to cancer treatment. The optimal cut point of the VES-13 to identify those whose final oncologic treatment plan would change after CGA is unclear. We hypothesized that patients with high positive VES-13 scores (7–10)have a higher likelihood of a change in treatment compared to low positive scores (3–6).Methods: Retrospective review of a customized database of all patients seen for pre-treatment assessment in an academic geriatric oncology clinic from June 2015 to June 2019. Various VES-13 cut points were analyzed to identify those individuals whose treatment was modified after CGA. Area under the curve (AUC) was calculated and subgroups of patients treated locally or systemically were also examined to determine if performance varied by treatment modality.Results: We included 386 patients with mean age 81, 58% males. Gastrointestinal cancer was the most common site (31%) and 60% were planned to receive curative treatment. The final treatment plan was modified in 59% overall, with 52.7% modified with VES-13 scores 7–10, 50.8% with scores 3–6 and 28.1% with scores <3 (P = 0.002). VES-13 performance in predicting treatment modification was similar for cut points 3 (AUC 0.58), 4 (0.59), 5 (0.59), and 6 (0.59) and in those considering local treatment vs. chemotherapy.Conclusions: A positive VES-13 score was associated with final oncologic treatment plan modification. A high positive score was not superior to the conventional cut point of ≥3. 相似文献
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A rare complication of mechanical aortic valve replacement: Separation in the region of the mitral‐aortic intervalvular fibrosa 下载免费PDF全文
Mehmet Celik MD Ahmet Güner MD Alev Kılıçgedik MD Sabahattin Gunduz MD Abdulrahman Naser MD Elif Eroglu Büyüköner MD Muzaffer Kahyaoglu MD Cagatay Onal MD Gokhan Kahveci MD 《Echocardiography (Mount Kisco, N.Y.)》2017,34(8):1232-1233
A 28‐year‐old man was admitted to our emergency service with a shortness of breath and palpitation. On admission, his blood pressure was high and he was in hypertensive pulmonary edema. His physical examination showed rales in both lungs and pansystolic murmur at mitral focus. His medical history included aortic valve replacement (AVR) because of native aortic valve infective endocarditis. Transthoracic echocardiography (TTE) showed normal functional aortic valve. Color flow imaging demonstrated severe mitral regurgitation with posterior eccentric jet. To examine in detail, transesophageal echocardiography (TEE) and three‐dimensional (3D) echocardiography were performed. TEE disclosed a separation in the subaortic curtain leading to severe mitral regurgitation from the left ventricle to the left atrium. In addition to severe mitral regurgitation with posterior eccentric jet, 26‐mm‐long pouch was seen in mitral‐aortic intervalvular fibrosa (MAIVF) at 120° TEE view. This pouch was separated from the mitral anterior leaflet junction releasing the mitral anterior leaflet and causing prolapse and chorda rupture in the A2 scallop of the mitral anterior leaflet. The MAIVF connects the anterior mitral leaflet to the posterior portion of the aortic annulus. The separation of the MAIVF represents a complication of the aortic valve replacement. 相似文献
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Background
There are limited studies about optimal duration and benefits of breastfeeding—and in particular, exclusive breastfeeding—on infant health and growth in the occupied Palestinian territory. This study aimed to evaluate the effect of exclusive breastfeeding on the health of infants in the Gaza Strip (at age 9 months), in terms of anthropometric measurements, growth, and morbidity.Methods
This study targeted mothers with infants attending primary health centres for vaccination at 9 months of age. Eight primary health centres were randomly selected from United Nation for Relief and Work Agency and Ministry of Health primary health centres in four regions of the Gaza Strip. Of 343 mother–infant pairs, in the first 6 months of life 251 infants received mixed feeding and 92 were exclusively breastfed.Findings
There were significant differences between the head circumferences of infants who were exclusively breastfed and those who received mixed feeding (44·1 cm [SD 1·39] and 43·7 cm [SD 1·15], respectively; p=0·007). There were no significant differences in the length and weight of infants between the two groups. Infants who were exclusively breastfed had a significantly lower frequency of gastrointestinal infections than infants who received mixed feeding (48% and 80%, respectively; p=0·001), as well as greater protection against respiratory tract infection (47% and 83%, respectively; p=0·001), lower incidence of otitis media (18% and 38%, respectively), and a significantly lower risk of urinary tract infection (5% and 65% respectively; p=0·001).Interpretation
Human milk is unique, and breastfeeding is the healthiest practice for healthy term infants for approximately the first 6 months after birth, providing ideal nutrition and supporting optimal growth and development. It also provides reasonable protection against infectious diseases. Thus, breastfeeding is the reference model against which all alternative feeding methods must be measured, with respect to growth, and short-term and long-term health outcomes. Infants should be introduced to nutrient-rich, solid foods (with particular attention to iron) at 6 months, with continued breastfeeding for up to 2 years. Every effort should be made to maintain breastfeeding rather than using formula or other milk substitute.Funding
None. 相似文献17.
Indika Gawarammana Fahim Mohamed Kamal Naser K. Jeganathan P. L. Ariyananada 《Clinical toxicology (Philadelphia, Pa.)》2018,56(7):633-639
Context: Intentional self-poisoning with the herbicide paraquat has a very high case-fatality and is a major problem in rural Asia and Pacific.Objectives: We aimed to determine whether the addition of immunosuppression to supportive care offers benefit in resource poor Asian district hospitals.Materials and methods: We performed a randomised placebo-controlled trial comparing immunosuppression (intravenous cyclophosphamide up to 1?g/day for two days and methylprednisolone 1?g/day for three days, and then oral dexamethasone 8?mg three-times-a-day for 14 days) with saline and placebo tablets, in addition to standard care, in patients with acute paraquat self-poisoning admitted to six Sri Lankan hospitals between 1st March 2007 and 15th November 2010. The primary outcome was in-hospital mortality.Results: 299 patients were randomised to receive immunosuppression (147) or saline/placebo (152). There was no significant difference in in-hospital mortality rates between the groups (immunosuppression 78 [53%] vs. placebo 94 [62%] (Chi squared test 2.4, p?=?.12). There was no difference in mortality at three months between the immunosuppression (101/147 [69%]) and placebo groups (108/152 [71%]); (mortality reduction 2%, 95% CI: ?8 to +12%). A Cox model did not support benefit from high-dose immunosuppression but suggested potential benefit from the subsequent two weeks of dexamethasone.Conclusions: We found no evidence that high dose immunosuppression improves survival in paraquat-poisoned patients. The continuing high mortality means further research on the use of dexamethasone and other potential treatments is urgently needed. 相似文献
18.
Al-Herz Adeeba Saleh Khuloud Al-Awadhi Adel Al-Kandari Waleed Hasan Eman Ghanem Aqeel Hussain Mohammed Ali Yaser Nahar Ebrahim Alenizi Ahmad Hayat Sawsan Abutiban Fatemah Aldei Ali Alhajeri Hebah Alhadhood Naser Bahbahani Husain Tarakmeh Hoda Mokaddem Khaled Khadrawy Ahmad Fazal Ammad Zaman Agaz Mazloum Ghada Bartella Youssef Hamed Sally Alsouk Ramia Al-Saber Ahmed 《Clinical rheumatology》2021,40(5):1759-1765
Clinical Rheumatology - Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or... 相似文献
19.
Veldtman GR Connolly HM Grogan M Ammash NM Warnes CA 《Journal of the American College of Cardiology》2004,44(1):174-180
OBJECTIVES: We sought to determine pregnancy outcomes in patients with tetralogy of Fallot (TOF). BACKGROUND: Pregnancy outcomes in patients with TOF are incompletely defined. METHODS: Clinical, hemodynamic, and obstetric data were reviewed for women with TOF and prior pregnancy. RESULTS: Of 72 respondents, 43 (mean age, 26 years) had 112 pregnancies (range, 1 to 5); 82 pregnancies were successful. Eight women had unrepaired TOF at the time of their 20 successful pregnancies. At first assessment (age > or =18 years), six patients had pulmonary hypertension, three had moderate or severe right ventricular (RV) systolic dysfunction, and 13 had severe RV dilation due to pulmonic regurgitation. Sixteen patients had 30 miscarriages (27%) and one term stillbirth. Mean overall birth weight was 3.2 kg (range, 2.1 to 4.2 kg). Unrepaired TOF (p = 0.05) and morphologic pulmonary artery abnormality (p = 0.03) were independently predictive of infant birth weight. Six patients had cardiovascular complications during pregnancy: supraventricular tachycardia in two, heart failure in two, pulmonary embolism in a patient with pulmonary hypertension, and progressive RV dilation in a patient with severe pulmonic regurgitation. Five infants (6%) had congenital anomalies. CONCLUSIONS: Patients with TOF have an increased risk of fetal loss, and their offspring are more likely to have congenital anomalies than offspring in the general population. Adverse maternal events, although rare, may be associated with left ventricular dysfunction, severe pulmonary hypertension, and severe pulmonic regurgitation with RV dysfunction. 相似文献
20.
I. Shafran L. Kugler F. A. X. Kl-Zaatari S. A. Naser J. Sandoval 《Digestive and liver disease》2002,34(1):22-28
BACKGROUND: Crohn's disease, an inflammatory bowel disease in humans, has a suspected aetiology of Mycobacterium avium subsp. Paratuberculosis. AIMS: To evaluate the role of rifabutin and clarithromycin anti-Mycobacterium avium subsp. Paratuberculosis treatment in Crohn's disease patients using an open clinical trial. METHODS:. A total of 36 patients with acute presentations of Crohn's disease, whose sera tested positive against p35 and p36 antigens (two recombinant proteins of Mycobacterium avium subsp. Paratuberculosis), were selected for treatment with rifabutin and macrolide antibiotic therapy Rifabutin and macrolide antibiotic therapy medications included 250 mg 1 po bid clarithromycin and 150 mg 1 po bid Ri-fabutin accompanied with a probiotic. Crohn's disease patients' response to rifabutin and macrolide antibiotic therapy was monitored over a period ranging from 4 to 17 months. RESULTS: Seven patients (19.4%) withdrew from the study since they were unable to tolerate medications. Of the remaining 29 patients, 21 (58.3%) reached a sustained state of improvement, traditionally defined as a decrease of 70 points between their entrance and exit Crohn's disease activity index scores together with the absence of the need of all other Crohn's medications, such as immunosuppressants and corticosteroids. Three Crohn's disease patients [8. 3%) noticed significant improvements, but required other Crohn's medications, concurrently with rifabutin and macrolide antibiotic therapy, to achieve and sustain improvement. Only 5 Crohn's disease patients (13.8%) were non-responders, noticing no marked improvement while on rifabutin and macrolide antibiotic therapy. CONCLUSION: The data add further evidence to support the role of rifabutin and macrolide antibiotic therapy in the treatment of Crohn's disease specifically in those patients with evidence of Mycobacterium avium subsp. Paratuberculosis infection. A large multi-centre clinical trial is needed to further explore these findings. 相似文献