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Jenab-Wolcott J, Tan K, Heitjan DF, Giantonio BJ, Garin M, Powers J, Stopfer J, Hoops T, Rustgi A. Evaluation of physician knowledge and referral practices for colorectal cancer (CRC) genetic risk assessment: The experience at the Hospital of University of Pennsylvania (HUP). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
379 Background: 3-5% of CRCs are due to inherited genetic mutations. We surveyed knowledge and practices of academic physicians for identification and care of individuals at risk for inherited CRC. Methods: 264 physicians (oncologists (ON), gastroenterologists (GA), surgeons, internists, gynecologists, and radiation oncologists) at HUP were invited to participate in a web-based 9-min survey. The ability to obtain appropriate medical history and to make referral to genetic services was evaluated. Knowledge of hereditary CRC syndromes was examined both pre and post viewing of an educational web-page on inherited CRCs. Mantel-Haenszel, Fisher exact, and McNemar statistical tests were applied. Results: Response rate was 33.3%; and of those, 97.4% accessed the educational webpage. In the cohort, 98.9 % obtained a medical history very frequently (VF), 88.6% obtained cancer history in 1st and 45.5% in the 2nd degree relatives VF, and 63.9% asked about the relatives' age at time of cancer diagnosis VF. Of those most likely to care for patients with CRC, the GA more frequently asked about relatives' age at cancer diagnosis (p=0.014) and family history of polyps (p< 0.001) than ON. GA were more likely than ON to refer patients for genetic counseling (73.9% vs. 36.8%, p=0.008). GA had superior knowledge of the availability of genetic testing for Lynch syndrome (LS) (95.6% GA vs. 63.2% ON, p=0.005) and for familial adenomatous polyposis (FAP) (100.0% GA vs. 65.8% ON, p<0.001). For the entire cohort, the educational intervention raised awareness of genetic testing for LS (64.5% pre vs. 94.7% post, p<0.001), FAP (69.7% pre vs. 97.4% post, p<0.001), and Peutz-Jeghers Syndrome (31.6% pre vs. 84.2% post, p<0.001); and it significantly improved recognition of LS family pedigrees and selection of appropriate surveillance. Conclusions: Of the respondents, GA are more likely to obtain a detailed family history, utilize genetic services, and have a greater awareness of the availability of genetic testing, than ON. A simple educational intervention improves physician knowledge on inherited CRC risk recognition and surveillance recommendations. No significant financial relationships to disclose.
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Tan K. New year, New Challenges [Editor's Remarks. IEEE COMPUT INTELL M 2010. [DOI: 10.1109/mci.2009.935313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pua U, Tan K, Lindsay T, Rajan D, Oreopoulos G. Abstract No. 210: Use of iliac branch grafts in the treatment of aorto-iliac aneurysms, a single institution experience. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kranokpiraksa P, Kachura J, Beecroft R, Tan K, Rajan D, Jaskolka J. Abstract No. 27: Do the RECIST Amendment for Tumor Response Evaluation criteria correlate better with patient outcomes than the RECIST 1.1 criteria after conventional transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC)? J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pua U, Tan K, Lindsay T, Rajan D, Oreopoulos G. Abstract No. 211: Fenestrated and branched endovascular aortic repair in the treatment of complex aortic aneurysms, a single institution experience. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tan K, Li H, Yang M, Hepburn H, Radloff S. Wasp hawking induces endothermic heat production in guard bees. JOURNAL OF INSECT SCIENCE (ONLINE) 2010; 10:142. [PMID: 21073346 PMCID: PMC3016720 DOI: 10.1673/031.010.14102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 03/01/2010] [Indexed: 05/30/2023]
Abstract
When vespine wasps, Vespa velutina Lepeletier (Hymenoptera: Vespidae), hawk (capture) bees at their nest entrances alerted and poised guards of Apis cerana cerana F. and Apis mellifera ligustica Spinola (Hymenoptera: Apidae) have average thoracic temperatures slightly above 24° C. Many additional worker bees of A. cerana, but not A. mellifera, are recruited to augment the guard bee cohort and begin wing-shimmering and body-rocking, and the average thoracic temperature rises to 29.8 ± 1.6° C. If the wasps persist hawking, about 30 guard bees of A. cerana that have raised their thoracic temperatures to 31.4 ± 0.9° C strike out at a wasp and form a ball around it. Within about three minutes the core temperature of the heat-balling A. cerana guard bees reaches about 46° C, which is above the lethal limit of the wasps, which are therefore killed. Although guard bees of A. mellifera do not exhibit the serial behavioural and physiological changes of A. cerana, they may also heat-ball hawking wasps. Here, the differences in the sequence of changes in the behaviour and temperature during "resting" and "heat-balling" by A. cerana and A. mellifera are reported.
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Yang S, Guo LJ, Tang XF, Tan K, Gong RG, Li A, Yu T, Gao QH, Xuan M, Wen YM, Wang CM, Wang XY. The alteration of Id-1 and TSP-1 expression in mucoepidermoid carcinoma associated with its clinical features and prognosis. Int J Oral Maxillofac Surg 2009; 39:29-35. [PMID: 19906510 DOI: 10.1016/j.ijom.2009.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 08/17/2009] [Accepted: 10/13/2009] [Indexed: 10/20/2022]
Abstract
Expression of Id-1 (inhibitors of DNA binding/differentiation protein 1) and TSP-1 (thrombospondin-1) in mucoepidermoid carcinoma and their relationship to pathological features and prognosis was studied. Moderately and poorly differentiated groups had significantly higher Id-1 positive expression rate (p<0.05) than well differentiated carcinoma. Stages III-IV showed significant increase of Id-1 positive expression rate (p<0.05) compared with stages I and II. Id-1 positive expression was significantly higher in patients with cervical lymph node metastasis or relapse at 5 years (p<0.05). After that, patients with negative Id-1 expression had significantly higher tumor-free survival than patients with positive expression (p<0.05). Correlation between the expression of Id-1 and TSP-1 in mucoepidermoid carcinoma was negative (p<0.05). Poorly differentiated groups show significantly lower TSP-1 positive expression rate than well differentiated groups (p<0.05). No significant differences of TSP-1 positive expression were detected with clinical stage. TSP-1 positive expression was significantly lower in patients with cervical lymph node metastasis or relapse at 5 years (p<0.05). After 5 years, patients with positive TSP-1 expression had significantly higher tumor-free survival than patients with negative TSP-1. Positive Id-1 expression is associated with high malignancy/poor prognosis; positive TSP-1 expression is associated with low malignancy/good prognosis. Protein expression status may help assess tumor malignancy and patient prognosis.
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Tan K, Umapathi T, Lim S, Sitoh Y, Lok S, Goh K. PO27-TH-01 Neuroimmunology database and tissue repository: a Singapore initiative. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)71171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tan K. O919 Birth, maternal and perinatal mortality trends in Singapore. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lin C, Tan K. PO10-TU-43 Treatment of neuromyelitis optica spectrum disorders with azathioprine. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rajasekaran T, Tan K. P361 Physiologic skin changes in pregnancy. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61852-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Tan K, Adie K, Tan R, McNabb A, Tang P. P197 Molecular detection and monitoring of disseminated Adenovirus infection in a hematopoietic stem cell transplant recipient by real-time PCR. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tan K, Anderson M, Krajden M, Petric M, Mak A, Naus M. O13 Mumps virus detection by PCR and culture during an outbreak in a highly unvaccinated population. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mirza H, Tan K. P249 Comparison, optimization and validation of high throughput in-vitro drug susceptibility microassays for the emerging protozoan pathogen Blastocystis. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70468-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tam X, Shiu S, Chow WS, Wong Y, Betteridge J, Tan K. Abstract: P1203 ATORVASTATIN INDUCES THE EXPRESSION OF SOLUBLE RECEPTOR FOR ADVANCED GLYCATION END PRODUCTS. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
High-density lipoprotein (HDL) plays an important protective role against atherosclerosis, and the anti-atherogenic properties of HDL include the promotion of cellular cholesterol efflux and reverse cholesterol transport (RCT), as well as antioxidant, anti-inflammatory and anticoagulant effects. RCT is a complex pathway, which transports cholesterol from peripheral cells and tissues to the liver for its metabolism and biliary excretion. The major steps in the RCT pathway include the efflux of free cholesterol mediated by cholesterol transporters from cells to the main extracellular acceptor HDL, the conversion of free cholesterol to cholesteryl esters and the subsequent removal of cholesteryl ester in HDL by the liver. The efficiency of RCT is influenced by the mobilization of cellular lipids for efflux and the intravascular remodelling and kinetics of HDL metabolism. Despite the increased cardiovascular risk in people with type 2 diabetes, current knowledge on RCT in diabetes is limited. In this article, abnormalities in RCT in type 2 diabetes mellitus and therapeutic strategies targeting HDL and RCT will be reviewed.
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Beecroft R, Mujoomdar A, Patry G, Lo K, Kachura J, Jarvi K, Rajan D, Tan K, Sniderman K. Abstract No. 235: Short-Term Outcomes After Varicocele Repair by Embolization and Microsurgical Varicocelectomy: Implications for IVF Planning. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Bent C, Rajan D, Simons M, Tan K, Beecroft R, Jaskolka J, Kachura J, Sniderman K. Abstract No. 122: Efficacy of Stent-Graft Placement for Salvage of Dysfunctional Arteriovenous Hemodialysis Fistulas. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tan K, Sniderman K, Rajan D, Kachura J, Jaskolka J, Simons M, Beecroft R. Abstract No. 363 EE: Endovascular Strategies in Difficult and Challenging Iliac Access During Aortic Stent Graft. Tips and Tricks with Current Non-Custom Devices. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Xiong W, Lim JH, Ong SH, Tung NN, Liu J, Racoceanu D, Tan K, Chong A, Foong K. Automatic working area classification in peripheral blood smears without cell central zone extraction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:4074-7. [PMID: 19163607 DOI: 10.1109/iembs.2008.4650104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this paper we study automatic classification of working areas in peripheral blood smears using image analysis and recognition methods. Such automatic classification can provide objective and reproducible quality control for the evaluation of smears and smear maker devices. However, research in this filed has drawn little attention. Existing methods either can not differentiate correctly different cell distributions or rely on the extraction of the central pallor zones in cells for counting, which are not always observable. In contrast, we do not rely on the pallor zone extraction thus on more general basis. We introduce two generic parameters to measure the goodness of working areas, one for the degree of overlap, and the other for the spatial occupancy. We also propose a cascading classification network for the classification of different areas. The effectiveness of our method has been tested on over 150 labeled images acquired from three malaria-infected Giemsa-stained blood smears using an oil immersion 100 x objective.
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Tan K, Roda R, Ostrow L, McArthur J, Nath A. PML-IRIS in patients with HIV infection: clinical manifestations and treatment with steroids. Neurology 2009; 72:1458-64. [PMID: 19129505 DOI: 10.1212/01.wnl.0000343510.08643.74] [Citation(s) in RCA: 247] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection that develops in immunosuppressed patients with HIV infection. Paradoxically, some of these patients may develop PML during combined antiretroviral therapy in the setting of immune reconstitution. We describe the types of PML in relation to immune reconstitution inflammatory syndrome (IRIS) and the effects of steroid use in these patients. METHODS We performed a retrospective review of the literature (1998 to 2007) and of all HIV-infected patients diagnosed with PML-IRIS at Johns Hopkins Hospital (2004 to 2007). We recorded information on clinical features, microbiologic and virological analysis, neuroimaging, pathology, treatment, and outcome. RESULTS Of 54 patients with PML-IRIS, 36 developed PML and IRIS simultaneously (PML-s-IRIS) and 18 had worsening of preexisting PML (PML-d-IRIS) after the initiation of combined antiretroviral therapy. PML-IRIS developed between 1 week and 26 months after initiation of antiretroviral therapy. PML-d-IRIS patients developed IRIS earlier, had higher lesion loads on MRI of the brain, had shorter durations of survival, and had higher mortality rate compared to PML-s-IRIS patients. Twelve patients received treatment with steroids, of which five died and seven showed good neurologic recovery. Patients who survived had received steroids early after IRIS diagnosis for longer durations and had contrast enhancement on IRIS neuroimaging. CONCLUSIONS Immune reconstitution following initiation of combined antiretroviral therapy may lead to activation of an inflammatory response to detectable or latent JC virus infection. Early and prolonged treatment with steroids may be useful in these patients but requires further investigation.
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van der Leest K, Bogaard J, Rudolphus A, Tan K, van Tilburg A, Mannaerts G, Aerts J. Paraesophageal Hiatal Hernia-Induced Dyspnea. Respiration 2009; 78:105. [PMID: 17284893 DOI: 10.1159/000099333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Indexed: 11/19/2022] Open
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Tan K, Hammond ER, Kerr D, Nath A. Fibrocartilaginous embolism: a cause of acute ischemic myelopathy. Spinal Cord 2008; 47:643-5. [DOI: 10.1038/sc.2008.135] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hankey GJ, Algra A, Chen C, Wong MC, Cheung R, Wong L, Divjak I, Ferro J, de Freitas G, Gommans J, Groppa S, Hill M, Spence D, Lees K, Lisheng L, Navarro J, Ranawaka U, Ricci S, Schmidt R, Slivka A, Tan K, Tsiskaridze A, Uddin W, Vanhooren G, Xavier D, Armitage J, Hobbs M, Le M, Sudlow C, Wheatley K, Yi Q, Bulder M, Eikelboom JW, Hankey GJ, Ho WK, Jamrozik K, Klijn K, Koedam E, Langton P, Nijboer E, Tuch P, Pizzi J, Tang M, Antenucci M, Chew Y, Chinnery D, Cockayne C, Loh K, McMullin L, Smith F, Schmidt R, Chen C, Wong MC, de Freitas G, Hankey GJ, Loh K, Song S. VITATOPS, the VITAmins TO prevent stroke trial: rationale and design of a randomised trial of B-vitamin therapy in patients with recent transient ischaemic attack or stroke (NCT00097669) (ISRCTN74743444). Int J Stroke 2008; 2:144-50. [PMID: 18705976 DOI: 10.1111/j.1747-4949.2007.00111.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epidemiological studies suggest that raised plasma concentrations of total homocysteine (tHcy) may be a common, causal and treatable risk factor for atherothromboembolic ischaemic stroke, dementia and depression. Although tHcy can be lowered effectively with small doses of folic acid, vitamin B(12) and vitamin B(6), it is not known whether lowering tHcy, by means of B vitamin therapy, can prevent stroke and other major atherothromboembolic vascular events. AIM To determine whether the addition of B-vitamin supplements (folic acid 2 mg, B(6) 25 mg, B(12) 500 microg) to best medical and surgical management will reduce the combined incidence of stroke, myocardial infarction (MI) and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. DESIGN A prospective, international, multicentre, randomised, double blind, placebo-controlled clinical trial. SETTING One hundred and four medical centres in 20 countries on five continents. SUBJECTS Eight thousand (6600 recruited as of 5 January, 2006) patients with recent (<7 months) stroke (ischaemic or haemorrhagic) or TIA (brain or eye). RANDOMISATION Randomisation and data collection are performed by means of a central telephone service or secure internet site. INTERVENTION One tablet daily of either placebo or B vitamins (folic acid 2 mg, B(6) 25 mg, B(12) 500 mug). PRIMARY OUTCOME The composite of stroke, MI or death from any vascular cause, whichever occurs first. Outcome and serious adverse events are adjudicated blinded to treatment allocation. SECONDARY OUTCOMES TIA, unstable angina, revascularisation procedures, dementia, depression. STATISTICAL POWER: With 8000 patients followed up for a median of 2 years and an annual incidence of the primary outcome of 8% among patients assigned placebo, the study will have at least 80% power to detect a relative reduction of 15% in the incidence of the primary outcome among patients assigned B vitamins (to 6.8%/year), applying a two-tailed level of significance of 5%. CONCLUSION VITATOPS aims to recruit and follow-up 8000 patients between 1998 and 2008, and provide a reliable estimate of the safety and effectiveness of folic acid, vitamin B(12), and vitamin B(6) supplementation in reducing recurrent serious vascular events among a wide range of patients with TIA and stroke throughout the world.
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Tan K, Patel S, Gandhi N, Chow F, Rumbaugh J, Nath A. Burden of neuroinfectious diseases on the neurology service in a tertiary care center. Neurology 2008; 71:1160-6. [PMID: 18838663 DOI: 10.1212/01.wnl.0000327526.71683.b7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Neurologic infections have the potential to cause death and suffering. These disorders often go unrecognized or are misdiagnosed. There has yet not been a census of neurologic infections conducted in a hospital setting. We aimed to determine the burden of neurologic infections on the neurology service in a tertiary care center and identify challenges in the diagnosis and treatment of these infections. METHODS We reviewed retrospectively all inpatients diagnosed with any neuroinfectious disease evaluated at Johns Hopkins Medical Institutions between October 2004 and December 2005. We recorded information on hospital admission, clinical features, microbiologic analysis, neuroimaging, EEG, pathology, treatment, and outcome. RESULTS A total of 116 of 4,225 patients admitted to or consulted on by the neurology service were identified. Eighty percent of patients were aged between 18 and 65 years. Fifty-two patients were immunocompromised, of which 28 patients had HIV infection. Overall, 86 microbiologic agents were identified in 80 patients. The commonest causes were viral, followed by bacterial and fungal infections. However, 31% of patients remained without an identifiable microbiologic etiology. Hospitalization periods were long, with 43% of patients staying beyond 2 weeks. There was significant morbidity: 28% of patients required rehabilitation or long-term care, and 12% died. CONCLUSIONS Neurologic infections have a major socioeconomic impact because they result in prolonged hospitalizations, expensive diagnostic tests and treatments, and long-term debilitation or death in young patients. Though potentially curable conditions, the burden of undiagnosed infections remains high.
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