Survival after first recurrence of breast cancer. The Miami experience.

BACKGROUND. Four hundred thirty-three patients with recurrent breast cancer were treated by the authors at a large medical breast oncology facility from 1976-1982. The median survival time from first relapse (MSFR) for the 193 patients whose survival experience was not confounded by lead-time bias was 26 months. This MSFR is similar to that of most series published in the 1970s and 1980s and is approximately double that of series published in the 1960s. METHODS. In this series, regression analysis identified disease-free interval (DFI), estrogen receptor (ER) status, and dominant disease site as significant prognostic variables, similar to other published series. RESULTS. In 113 patients with known ER values, DFI, and dominant metastatic sites, a prognostic spectrum of MSFR patterns was identified among combinations of these three variables. The MSFR ranged from 15 months for poor risk patients with negative ER values, visceral dominant sites, and DFI of less than 24 months, to more than 90 months for good risk patients with positive ER values, soft tissue dominant sites, and DFI of more than 24 months. Although menopausal status alone was not a significant prognostic variable in regression analysis, 66% of premenopausal patients had a constellation of "poor" prognostic variables. CONCLUSIONS. This type of prognostic factor analysis at first relapse could help identify subsets of patients who might be considered for aggressive investigational therapies such as high-dose chemotherapy with autologous bone marrow reconstitution.     

Central auditory processing and word discrimination in patients with multiple sclerosis

Many multiple sclerosis (MS) patients with normal pure tone threshold suffer from difficulties in their hearing especially speech perception in background noise, which is possibly because of incompetence of central auditory processing in this group. Three audiologic tests including gap in noise test (GIN), duration pattern sequence test (DPST) and word discrimination score (WDS) were used for comparing a number of aspects of central auditory processing between patients with MS and normal subjects. Approximate threshold and percent of correct answers in GIN test, percent of correct answers in DPST test and monosyllabic discrimination in WDS test were obtained through cross-sectional non-invasive study conducted on 26 subjects with relapsing-remitting multiple sclerosis who had mean age of 28.9 (SD 4.1) years, and 26 18–40-year-old ones with normal hearing and mean age of 27.7 (SD 5.2). Results of this study demonstrate increased approximate threshold and reduction of percent of correct answers obtained from GIN test in patients with multiple sclerosis (Pv = 0.0001). Furthermore in patients with MS, the average of correct answers in DPST was lower than normal subjects and finally performance of MS subjects in WDS test in quiet environment was correlated with GIN threshold (r = ?/624, Pr = /003). Results of the present study showed that patients with MS had defect in aspects of central auditory processing consisting of temporal resolution, auditory pattern and the memory for auditory task and difficulty in discrimination of speech in noisy environment that are related to the involvement of central nervous system.     

Knowledge and self-care practice regarding diabetes among type 2diabetics: experience from a non-profit hospital chain in Bangladesh

Diabetes mellitus (DM) is generally being perceived as a problem of the developed world, but currently, people from developing countries like Bangladesh are suffering from chronic diseases of which diabetes is a major one. The aim of the study was to assess knowledge and self-care practice regarding diabetes among type 2 diabetes mellitus (T2DM) subjects. A cross-sectional study was conducted among 11,917 (age ≥?18 years, 4418 males and 7499 females) T2DM subjects attending the health care centers and hospitals in Dhaka (Capital) and also in the northern part of Bangladesh operated by the local diabetic association. Data were collected through interviewer-administered questionnaire. The levels of knowledge and self-care practice were measured by predefined scores, categorized as poor (<mean – 1 SD), average (mean?±?1 SD), and good (>mean?+?1 SD). Independent samples t test, ANOVA, and Pearson’s correlation were used to determine the association between different variables considering p value <?0.05. The mean (± SD) age (years) of the T2DM was 50?±?12. The proportion of “poor,” “average,” and “good” score for knowledge were 34%, 51%, and 15% and for that practice were 16%, 72%, and 12%, respectively. Knowledge was significantly associated with practice (r?=?0.299, p?=?0.001). The study reveals a difference between knowledge and self-care practice related to T2DM. T2DM health literacy program needs to be developed for better health promotion.