Evaluation of the bioequivalence and food effect on the bioavailability of CC-486 (oral azacitidine) tablets in adult patients with cancer

Cancer Chemotherapy and Pharmacology - CC-486 is an oral formulation of azacitidine that allows for extended dosing schedules to prolong azacitidine exposure to malignant cells and maximize...     

The impact of age on prognosis in patients with gastric cancer: experience in a tertiary care centre

BackgroundGastric cancer (GC) is a leading cause of cancer-related death in the world and most patients have advanced disease upon presentation. The effect of age on prognosis in GC is controversial. We aimed to determine the impact of age on survival in patients with GC.MethodsThis was a retrospective study of the medical records of Lebanese patients diagnosed with GC at the American University of Beirut Medical Center (AUBMC) between 2005 and 2014. Patients were divided into young (<65 years) and older groups (≥65 years). A multivariate analysis was done to determine the independent predictors of survival. Kaplan-Meier method was used for analysis of long-term survival outcomes.ResultsThe sample consisted of 156 patients. The mean age was 62.15 (SD 13.54). Most patients presented with stage 4 disease (62.2%) and poorly differentiated histology (66.4%). The most common symptoms were abdominal pain and weight loss. On bivariate analysis, advanced stage (P=0.02) and higher grade (P=0.04) were associated with increased mortality. Patients <65 years of age were significantly more likely to have poorly differentiated tumours, while patients ≥65 years had more comorbidities (P=0.001). The 5-year DFS were 35% and 37% for patients <65 years of age and ≥65 years of age, respectively (P=0.15).ConclusionsHigher grade and advanced stage are associated with worse survival in patients with GC, but age did not seem to have an impact. Screening high risk patients and early diagnosis are necessary to improve survival.     

Biological effects of rAAV-caAlk2 coating on structural allograft healing.

Structural bone allografts often fracture due to their lack of osteogenic and remodeling potential. To overcome these limitations, we utilized allografts coated with recombinant adeno-associated virus (rAAV) that mediate in vivo gene transfer. Using beta-galactosidase as a reporter gene, we show that 4-mm murine femoral allografts coated with rAAV-LacZ are capable of transducing adjacent inflammatory cells and osteoblasts in the fracture callus following transplantation. While this LacZ vector had no effect on allograft healing, bone morphogenetic protein signals delivered via rAAV-caAlk2 coating induced endochondral bone formation directly on the cortical surface of the allograft by day 14. By day 28 there was evidence of remodeling of the new woven bone and massive osteoclastic resorption of the cortical surface of the rAAV-caAlk2-coated allografts only. Micro-CT analysis of rAAV-LacZ- vs rAAV-caAlk2-coated allografts after 42 days of healing demonstrated a significant increase in new bone formation (0.67 +/- 0.21 vs 2.49 +/- 0.40 mm(3); P < 0.005). Furthermore, the 3D micro-CT images of femurs grafted with rAAV-Alk2-coated allografts provided the first evidence that complete bridging of bone around a cortical allograft is possible. These results indicate that cell-free, rAAV-coated allografts have the potential to revitalize in vivo following transplantation.     

Peer review improves psychometric characteristics of multiple choice questions

Abstract

Purpose: For new and emerging medical schools, developing a system to peer-review and evaluate the assessment processes through faculty development programs can be a challenge. This study evaluates the impact of peer-review practices on item analysis, reliability, and the standard error of measurement of multiple-choice questions for summative final examinations.

Methods: This study used a retrospective cohort design of two consecutive academic years in 2012 and in 2013. Psychometric analyses of multiple-choice questions of three summative final examinations in Medicine, Pediatrics, and Surgery for sixth year medical students at the College of Medicine Taif University were used. Formal peer review of multiple-choice questions began in 2013, using guidelines from the National Board of Medical Examiners. Psychometric analyses of multiple-choice questions included item analysis (item difficulty and item discrimination) and calculation of internal-consistency reliability and the standard error of measurement. Data analyses were conducted using Stata.

Results: Results showed significant improvement in psychometric indices, particularly item discrimination and reliability by .14 and .12 points, respectively, following the implementation of the peer review process across the three exams. Item difficulty remained unchanged for Pediatrics and Surgery.

Conclusion: Peer-review practices of multiple-choice questions using guidelines can lead to improved psychometric characteristics of items; these findings have implications for faculty development programs in improving item quality, particularly for medical schools in early stages of transforming assessment practices.     

Smoking patterns among Jordanian health professionals: A study about the impediments to tobacco control in Jordan

Background

Little is known about Arab health professionals' smoking practices.

Aim

This is the first study to examine smoking practices among Arab health professionals.

Methods

Background: Little is known about Arab nurses and physicians' smoking patterns.

Aim

This study aims to examine smoking patterns among Arab nurses and physicians.

Methods

A total of 918 nurses and physicians participated in this study. Data were collected using the Global Professional Health Survey.

Results

About 38.8% are current smokers. The smoking percentages for male nurses and male physicians were high (83.8%, 94.6% respectively) compared to female nurses and female physicians (16.2%, 5.4% respectively). Approximately 53.8% wanted to quit and 60.6% had made previous quit attempts that lasted for more than two days. About 64.1% believed that nurses and physicians who smoke were less likely to advise patients to stop smoking. The predictors of smoking were: age when tried first cigarettes OR = 6.36, 95% CI = 4.48, 9.04; father smokes OR = 1.95, 95% CI = 1.40, 2.72; mother smokes OR = 1.99, 95% CI = 1.18, 3.39; shift work OR = 1.45, 95% CI = 1.04, 2.03; and the interaction (gender and profession) OR = 1.82, 95% CI = 1.55, 2.14.

Discussion

Effective interventions often begin with and/or depend on nurses and physicians being committed to smoking cessation. Given the very high smoking rates among nurses and physicians a key priority must be to provide quit smoking programs and to enable them to become effective champions of smoking cessation nationwide.     

整形外科研究的循证医学证据水平

目的 近年来,医学、外科类文献有向循证医学方向发展的趋势.本研究旨在检测已发表的整形外科类文章的证据水平.方法 回顾性分析<整形再造外科杂志(Plastic and Reconstructive Surgery,PRS)><整形外科年鉴(Annals of Plastic Surgery,Annals)><整形再造与美容外科杂志(Journal of Plastic,Reconstructive,and Aesthetic Surgery,JPRAS)><美国美容外科杂志(American Journal of Aesthetic Surgery,Aesthetic)>4本主要的整形外科类杂志2009年1～12月刊载论文利用证据的水平.结果 在1759篇文献中,共有726篇(41%)纳入本研究标准(排除动物实验、尸体研究、基础医学、文献复习、继续教育和信函等方面文献).将选中的文献根据其证据水平进行分级(Ⅰ～Ⅳ级;Ⅰ级,证据水平最高,如随机对照研究;Ⅳ级,证据水平最低,如病例报告).4本杂志的平均证据水平分别为:PRS=3.05,Aesthetic=3.11,JPRAS=3.35,Annals=3.31.4本杂志的平均证据水平,除了JPRAS与Aesthetic的差异无统计学意义外,余者差异均有统计学意义(P<0.05).本研究纳入标准的文献,只有2.2%的证据水平为Ⅰ级.结论 4本杂志的平均证据水平为3.2(Ⅲ级水平).为了使整形外科专业加入到高水平循证医学行列,我们应当在今后的工作中着重强调随机对照研究的应用.     

The outcomes of mycophenolate mofetil therapy combined with systemic corticosteroids in acute uveitis associated with Vogt–Koyanagi–Harada disease

Purpose: To study the effectiveness of mycophenolate mofetil (MMF) as first‐line therapy combined with systemic corticosteroids in acute uveitis associated with Vogt–Koyanagi–Harada (VKH) disease. The outcomes in this group were compared with those of another group of patients with VKH disease who were treated with corticosteroid monotherapy or with delayed addition of immunomodulatory therapy. Methods: This prospective study included 19 patients (38 eyes) diagnosed with acute uveitis associated with VKH disease. Results: The mean follow‐up period was 27.0 ± 11.1 months (range 16–54 months). Corticosteroid‐sparing effect was achieved in all patients. The mean interval between starting treatment and tapering prednisone to 10 mg or less daily was 5.1 ± 1.2 months (range 3–7 months). Ten (53%) patients discontinued treatment without relapse of inflammation. The mean time observed of treatment was 17.3 ± 11.9 months (range 3–41.5 months). Visual acuity of 20/20 was achieved by 38% of the eyes in the corticosteroid group and by 74% in the corticosteroid + MMF group (p < 0.001). Recurrent inflammation of ≥3 times was reduced significantly (p = 0.0383) in the corticosteroid + MMF group (3%) as compared to corticosteroid group (18%). Development of all complications was significantly higher in the corticosteroid group (43%) compared with the corticosteroid + MMF group (8%) (p < 0.001). None of the eyes in the corticosteroid + MMF group developed ‘sunset glow fundus’. Conclusions: Addition of MMF as first‐line therapy to corticosteroids in patients with acute uveitis associated with VKH disease leads to significant reduction in recurrences of uveitis and development of late complications and significantly improves visual outcome.     

Poncet’s disease (reactive arthritis associated with tuberculosis): retrospective case series and review of literature

The primary objective of this study is to describe the demographics and clinical characteristics of patients with Poncet’s disease (PD) in the Makkah region in Saudi Arabia, where tuberculosis is on the rise. The secondary objective is conducting a PD systematic literature review to compare our findings. We studied seven patients who presented with arthritis within the first 3?years from diagnosis of active tuberculosis in two centers in the Makkah region: King Faisal Specialist Hospital and King Fahad Hospital in Jeddah from January 2005 to December 2011. We conducted a literature review on PD in multiple biomedical/pharmaceutical databases up to December 2011. We detected a new pattern of reactive arthritis associated with tuberculosis (TB). We identified this as PD or tuberculous rheumatism, which is a sterile reactive arthritis that can emerge during any stage of acute TB infection. Seven cases of Poncet’s disease were identified in our study. The most common presentation was extrapulmonary with involvement of multiple sites. Six out of seven patients developed arthritis after initiation of anti-TB drugs; one patient developed polyarthritis after completion of anti-TB medication. Asymmetrical polyarthritis was the most common presentation and the resolution of the arthritis was with symptomatic treatment and continuation of anti-TB drugs except in one case. PD may manifest in a variable pattern during the course of active tuberculous infection. Physicians should be aware of this rare complication associated with a common disease to prevent delay in diagnosis and initiation of appropriate treatment.