1
|
Reddy KT, Syeda H, Stenberg D, Bakhshaei S, Reddy S, Alkhero M, Razzack AA, Gounder S. Spontaneous Isolated Superior Mesenteric Artery Dissection With Thrombosis: A Case Report of a Rare Presentation of Acute Abdominal Pain. CJC Open 2022; 4:1090-1092. [PMID: 36562018 PMCID: PMC9764121 DOI: 10.1016/j.cjco.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 08/12/2022] [Indexed: 02/01/2023] Open
Abstract
Spontaneous isolated superior mesenteric artery dissection is a very rare vascular disease that involves the superior mesenteric artery or its branches, with an incidence as low as 0.08%. The majority of cases occur in patients of Asian descent. Due to advances in imaging modalities, particularly abdominal computed tomography angiography, the diagnosis of this disease has been increasing. Herein, we present a rare case of spontaneous isolated superior mesenteric artery dissection with thrombosis in a young male patient with no past medical history. The importance of this disease as a differential diagnosis for acute abdominal pain is emphasized.
Collapse
Affiliation(s)
- Krishna Theja Reddy
- Cardiovascular Fellowship Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
| | - Humera Syeda
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
| | - Daniel Stenberg
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
| | - Sina Bakhshaei
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
- Corresponding author: Dr Sina Bakhshaei, Temecula Valley Hospital, 31700 Temecula Pkwy, Temecula, California 92592, USA. Tel.: +1-213-949-6412.
| | - Srivaibhav Reddy
- Internal Medicine Department, Karwar Institute of Medical Sciences, Karwar, India
| | - Mohammed Alkhero
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
| | - Aminah Abdul Razzack
- Internal Medicine Department, Dr N.T.R University of Health Sciences, Vijayawada, India
| | - Sivaraman Gounder
- Internal Medicine Residency Program, UHS Southern California Medical Education Consortium, Temecula, California, USA
| |
Collapse
|
2
|
Gounder S, Strudwick M. Multimodality imaging review for suspected ovarian torsion cases in children. Radiography (Lond) 2020; 27:236-242. [PMID: 32713824 DOI: 10.1016/j.radi.2020.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Ovarian torsion (OT), although rare, can be described as a complete or partial twist of the ovary with impairment of blood flow. Although occurring at any age, it is more common in children and during pregnancy. Presenting symptoms are non-specific but include either persistent or intermittent acute abdominal pain, making early diagnosis difficult. Delayed diagnosis is associated with an increased need for oophorectomy. The aim of this literature review is to establish the safest and most efficacious imaging strategy for OT by comparing and contrasting evidence for current imaging modalities found in the literature. KEY FINDINGS Characteristically, OT can be identified through a combination of findings some of which includes an enlarged ovary, multiple follicles at the periphery and a "whirlpool" sign. Currently, ultrasound is the preferred primary imaging modality; although computed tomography (CT) and magnetic resonance imaging (MRI) may also be used when findings are equivocal; with MRI being the safer option. CONCLUSION Ultimately, while it is true that ovarian torsion is not a common cause of acute abdominal pain in children, it should always be considered in the differential diagnosis. Prior to selecting an imaging modality; the clinical presentation, age group, possible radiation dose and availability of the modality needs to be considered to ensure the appropriate imaging strategy. IMPLICATIONS FOR PRACTICE With new tools such as scoring systems, B-flow imaging (BFI), diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) currently being explored for possible use in the future, early diagnosis of OT may be attainable. Thus, reducing the likelihood of adverse complications and consequently the need for oophorectomy.
Collapse
Affiliation(s)
- S Gounder
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia.
| | - M Strudwick
- Centre for Advanced Imaging, University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
3
|
Harries AD, Marais B, Kool B, Ram S, Kumar AMV, Gounder S, Viney K, Brostrom R, Roseveare C, Bissell K, Reid AJ, Zachariah R, Hill PC. Mentorship for operational research capacity building: hands-on or hands-off? Public Health Action 2015; 4:S56-8. [PMID: 26477290 DOI: 10.5588/pha.13.0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/19/2013] [Indexed: 11/10/2022] Open
Abstract
Mentorship is a key feature of operational research training courses run by the International Union Against Tuberculosis and Lung Disease and Médecins Sans Frontières. During the recent South Pacific paper writing module, the faculty discussed 'hands-on' mentorship (direct technical assistance) vs. 'hands-off' mentorship (technical advice). This article explores the advantages and disadvantages of each approach. Our collective experience indicates that 'hands-on' mentorship is a valuable learning experience for the participant and a rewarding experience for the mentor. This approach increases the likelihood of successful course completion, including publishing a well written paper. However, mentors must allow participants to lead and take ownership of the paper, in keeping with a first author position.
Collapse
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - B Marais
- The Sydney Emerging Infections and Biosecurity Institute, University of Sydney, Sydney, NSW, Australia
| | - B Kool
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - A M V Kumar
- The Union South-East Asia Regional Office, New Delhi, India
| | - S Gounder
- National Tuberculosis Programme, Ministry of Health, Suva, Fiji
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - R Brostrom
- Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, Georgia, USA
| | - C Roseveare
- Department of Statistics, Regional Public Health, Lower Hutt, New Zealand
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - A J Reid
- Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - R Zachariah
- Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - P C Hill
- Centre for International Health, The University of Otago, Dunedin, New Zealand
| |
Collapse
|
4
|
Itogo N, Hill PC, Bissell K, Harries AD, Viney K, Gounder S. Tuberculosis notifications, characteristics and treatment outcomes: urban vs. rural Solomon Islands, 2000-2011. Public Health Action 2015; 4:S25-8. [PMID: 26477283 DOI: 10.5588/pha.13.0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING All provincial tuberculosis (TB) management units in the Solomon Islands. OBJECTIVE To compare TB notifications, characteristics and treatment outcomes in urban vs. rural areas. DESIGN A retrospective descriptive cohort study involving record review and data extraction from provincial TB and laboratory registers and treatment charts from 2000 to 2011. RESULTS Of 4137 TB cases notified, 1364 (33%) were from urban and 3227 (67%) from rural areas. Notification rates per year of study were consistently higher in urban areas (104-150 per 100 000 population) than in rural areas (49-70/100 000). Cases in rural areas were more likely to have smear-negative pulmonary TB and less likely to have extra-pulmonary TB (P < 0.001). TB cases in rural areas were more likely to die from TB than those from urban areas (3.2% vs. 5.9%). In contrast, TB cases in rural areas were less likely to default (2.8% vs. 1.8%). CONCLUSION TB notification rates were much higher in urban than in rural areas in the Solomon Islands. Rural patients are more likely to die from the disease but are slightly less likely to default. Further research is required to explore the possibility of under-reporting in rural areas and to improve treatment outcomes.
Collapse
Affiliation(s)
- N Itogo
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - P C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - K Viney
- Secretariat of the Pacific Community, Nouméa, New Caledonia
| | | |
Collapse
|
5
|
Bissell K, Viney K, Brostrom R, Gounder S, Khogali M, Kishore K, Kool B, Kumar AMV, Manzi M, Marais B, Marks G, Linh NN, Ram S, Reid S, Roseveare C, Tayler-Smith K, Van den Bergh R, Harries AD. Building operational research capacity in the Pacific. Public Health Action 2015; 4:S2-S13. [PMID: 26477282 DOI: 10.5588/pha.13.0091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.
Collapse
Affiliation(s)
- K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, the University of Auckland, Auckland, New Zealand
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - R Brostrom
- Division of TB Elimination, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Gounder
- National Tuberculosis Programme, Fiji Ministry of Health, Suva, Fiji
| | - M Khogali
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - K Kishore
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - B Kool
- School of Population Health, the University of Auckland, Auckland, New Zealand
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - M Manzi
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - B Marais
- Marie Bashir Institute for Emerging Infections and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - G Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - N N Linh
- Global TB Programme, World Health Organization, Geneva, Switzerland ; Division of Pacific Technical Support, WHO Representative Office in the South Pacific, Suva, Fiji
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - S Reid
- Australian Centre for International and Tropical Health, School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - C Roseveare
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - K Tayler-Smith
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - R Van den Bergh
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
6
|
Tamani T, Bissell K, Tayler-Smith K, Gounder S, Linh NN, Graham SM. The trend of tuberculosis cases over 60 years in Fiji's largest treatment centre: 1950-2010. Public Health Action 2015; 4:42-6. [PMID: 26423760 DOI: 10.5588/pha.13.0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/21/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING P J Twomey Hospital, National Tuberculosis Programme, Fiji. OBJECTIVES To review the trend in numbers of tuberculosis (TB) cases registered each year from 1950 to 2010 at P J Twomey Hospital, Fiji's largest TB treatment centre and central TB unit, and to consider trends in the context of key TB control events in Fiji. DESIGN Descriptive study of data from medical records and TB registers, including age, sex, ethnicity, TB diagnosis and smear result. RESULTS Between 1950 and 2010, 14 616 cases were registered at P J Twomey Hospital. Of these, 58% were male, 70% were indigenous Fijians (i-taukei) and 64% were aged 15-49 years. The caseload dropped sharply in the 1960s, and has fallen steadily since 1990. Smear results were available for the majority of cases (91%). Between 1950 and 1985, smear-positive cases accounted for 19% of cases overall; this increased to 41% after 1985 following laboratory training. The numbers of sputum smear-positive cases recorded each year has been increasing in the last decade. CONCLUSION There have been marked changes in TB caseload over the last 60 years at Fiji's largest TB treatment centre. The recent increase in smear-positive cases while total TB cases have been falling needs further evaluation.
Collapse
Affiliation(s)
- T Tamani
- Health Information Unit, Ministry of Health, Suva, Fiji
| | - K Bissell
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France ; The University of Auckland, Auckland, New Zealand
| | - K Tayler-Smith
- Operational Centre Brussels, Operational Research Unit, Médecins Sans Frontières, Luxembourg
| | - S Gounder
- National Tuberculosis Programme, Suva, Fiji
| | - N N Linh
- Global TB Programme, World Health Organization, Geneva, Switzerland ; Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - S M Graham
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France ; Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Prasad P, Gounder S, Varman S, Viney K. Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji. Public Health Action 2015; 4:159-63. [PMID: 26400803 DOI: 10.5588/pha.14.0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/19/2014] [Indexed: 11/10/2022] Open
Abstract
SETTINGS Three tuberculosis (TB) treatment centres under the Fiji National Tuberculosis Programme. OBJECTIVES To determine the prevalence of diabetes mellitus (DM) among TB patients for the period 2010-2012, and to evaluate sputum smear conversion and anti-tuberculosis treatment outcomes, comparing patients with and without DM. DESIGN A retrospective descriptive study using routinely collected data from the TB register and in-patient folders. RESULTS Of 577 TB patients identified, information on DM was available for 567 (98%), of whom 68 (12%) had DM. Smear status at 2 months was available for 254 (82%) patients with sputum smear-positive pulmonary TB. The sputum smear conversion rate (from positive to negative) was equivalent in TB patients with and without DM (78% vs. 80%, P = 0.66). Anti-tuberculosis treatment outcome information was available for 462 patients; the difference in outcome comparing successfully treated patients with those unsuccessfully treated was not statistically significant (91% in TB patients with DM vs. 84% in TB patients without DM, P = 0.06). CONCLUSION DM is common among TB patients in Fiji. Sputum smear conversion rates were not different in TB patients with and without DM; no difference in treatment success between the two groups was observed.
Collapse
Affiliation(s)
- P Prasad
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - S Gounder
- National Tuberculosis Programme, Fiji Ministry of Health, Suva, Fiji
| | - S Varman
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - K Viney
- Public Health Division, Secretariat of the Pacific Community, Nouméa, New Caledonia ; National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
8
|
Reddy M, Gounder S, Reid SA. Tuberculosis diagnostics in Fiji: how reliable is culture? Public Health Action 2015; 4:184-8. [PMID: 26400808 DOI: 10.5588/pha.14.0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022] Open
Abstract
SETTINGS Acid-fast bacilli (AFB) smear microscopy and Mycobacterium tuberculosis culture are the first-line diagnostic tests for tuberculosis (TB). The contamination of TB cultures significantly reduces the reliability of TB diagnosis. OBJECTIVE To investigate factors associated with TB culture contamination in Fiji, and the relative diagnostic performance of culture compared to microscopy. DESIGN All tests performed at the Daulakao Mycobacterium Reference Laboratory (DMRL) in Fiji from 2010 to 2012 were reviewed. Study variables included AFB smear and TB culture results, age and type of specimen, referring TB testing centre and patient age. RESULTS Of 5708 specimens reviewed, 70% had both AFB smear and culture results recorded; 421 specimens were contaminated; 2.7% of specimens were either degraded or had no result recorded. There was moderate agreement (κ = 0.577) between the two tests. Culture was more likely to be positive at higher AFB smear scores. Culture contamination was associated with distance from the DMRL, sample age and operator-associated factors. CONCLUSION Increases in the speed of referral from TB testing centres or the addition of preservatives to sputum specimens may results in less culture contamination. The planned introduction of liquid culture techniques in combination with culture on Ogawa media is likely to increase the sensitivity of TB diagnosis in Fiji.
Collapse
Affiliation(s)
- M Reddy
- National Tuberculosis Programme, Ministry of Health, Lautoka, Fiji
| | - S Gounder
- National Tuberculosis Programme, Ministry of Health, Lautoka, Fiji
| | - S A Reid
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Mahadeo R, Gounder S, Graham SM. Changing from single-drug to fixed-dose combinations: experience from Fiji. Public Health Action 2015; 4:169-73. [PMID: 26400805 DOI: 10.5588/pha.14.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fixed-dose combinations (FDCs) of first-line anti-tuberculosis drugs were introduced in Fiji in 2011, and there have been concerns about treatment response. OBJECTIVE To evaluate the treatment response to FDCs among tuberculosis (TB) patients. METHODS A retrospective cohort study was undertaken of treatment outcomes of new TB cases registered from January 2010 to April 2013 and weighing ⩾30 kg. Sputum smear conversion of new sputum smear-positive cases and end-of-treatment outcomes of all cases were evaluated for those receiving FDCs and compared to outcomes with previous use of single-drug preparations. RESULTS Among new TB patients, 240 received single-drug preparations and 259 received FDCs for the full duration of treatment. The groups were similar in terms of demographic and clinical characteristics. Treatment outcomes were available for 95% of cases. Unknown outcomes were more common in those receiving FDCs. When known, end-of-treatment outcome was the same in the two treatment groups and did not differ between TB types. Sputum smear conversion after the 2-month intensive phase of treatment was similar in the two treatment groups: 95% and 97%, respectively. CONCLUSION The introduction of FDCs in Fiji for the treatment of TB cases has not been associated with changes in treatment response.
Collapse
Affiliation(s)
- R Mahadeo
- National Tuberculosis Programme, Ministry of Health, Suva, Fiji
| | - S Gounder
- National Tuberculosis Programme, Ministry of Health, Suva, Fiji
| | - S M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia ; International Union Against Tuberculosis and Lung Disease, Paris, France
| |
Collapse
|
10
|
Gounder A, Gounder S, Reid SA. Evaluation of the implementation of the Xpert® MTB/RIF assay in Fiji. Public Health Action 2015; 4:179-83. [PMID: 26400807 DOI: 10.5588/pha.14.0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/28/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING All Xpert® MTB/RIF tests performed in the three TB (tuberculosis) treatment centres in Fiji from June 2012 to February 2013. OBJECTIVES To determine 1) the number of Xpert tests performed in each centre, 2) the association between sputum quality and Xpert results, 3) the agreement of Xpert with acid-fast bacilli (AFB) smear microscopy and TB culture and 4) error rates. DESIGN Retrospective review of records. RESULTS A total of 415 Xpert tests were performed in the study period. Mycobacterium tuberculosis was detected in 69 (16.6%) samples. No rifampicin resistance was detected. M. tuberculosis was detected from 60 (18.7%) good-quality sputum samples. A total of 43 (10.4%) errors occurred during this period. M. tuberculosis was detected in 10 (2.9%) smear-negative specimens. There was a substantial and an almost perfect agreement between Xpert and AFB microscopy (κ = 0.793) and culture results (κ = 0.818), respectively. CONCLUSION Although a good correlation between Xpert and the two tests were shown in the study, Xpert should not replace the routine first-line TB diagnostic tests used in Fiji for reasons related to logistics and sustainability. A further evaluation of the assay's performance is required over a longer time period to gauge its diagnostic value in detecting smear-negative, Xpert-positive cases in Fiji.
Collapse
Affiliation(s)
- A Gounder
- National Tuberculosis Program, Ministry of Health, Suva, Fiji
| | - S Gounder
- National Tuberculosis Program, Ministry of Health, Suva, Fiji
| | - S A Reid
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
11
|
Alo A, Gounder S, Graham SM. Clinical characteristics and treatment outcomes of tuberculosis cases hospitalised in the intensive phase in Fiji. Public Health Action 2015; 4:164-8. [PMID: 26400804 DOI: 10.5588/pha.14.0022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/28/2014] [Indexed: 11/10/2022] Open
Abstract
SETTINGS Tuberculosis (TB) is an ongoing public health challenge in Fiji. Clinical case detection and management are critical for effective TB control. Most TB cases in Fiji are hospitalised for the intensive phase of treatment. OBJECTIVES To describe the demographic and clinical characteristics, comorbidities and final treatment outcomes of TB patients hospitalised for the intensive phase of treatment in Fiji. DESIGN A retrospective, descriptive study of all TB cases hospitalised during the intensive phase over a 3-year period (2010-2012). RESULTS A total of 395 TB hospitalised cases were included, of whom 61% were sputum smear-positive. The largest proportions of cases were among young adults (15-34 years) and the unemployed, respectively 43% and 71%. Diabetes (13%) and smoking (22%) were common comorbidities. Final anti-tuberculosis treatment outcomes were available for 96% of cases; 81% were cured or completed treatment. Default was more common in those with current employment. Death was the final treatment outcome in 4%, and was more common (11%) in the oldest group aged 355 years (OR 5.7, 95%CI 1.9-17). CONCLUSION This study provides original and comprehensive descriptive data on TB cases in Fiji and identifies characteristics associated with poor treatment outcomes.
Collapse
Affiliation(s)
- A Alo
- National Tuberculosis Program, Ministry of Health, Suva, Fiji
| | - S Gounder
- National Tuberculosis Program, Ministry of Health, Suva, Fiji
| | - S M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia ; International Union Against Tuberculosis and Lung Disease, Paris, France
| |
Collapse
|
12
|
Delai MY, Gounder S, Tayler-Smith K, Van den Bergh R, Harries AD. Relationship between education and training activities and tuberculosis case detection in Fiji, 2008-2011. Public Health Action 2015; 2:142-4. [PMID: 26392973 DOI: 10.5588/pha.12.0064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/20/2012] [Indexed: 11/10/2022] Open
Abstract
Due to concerns about under-reporting of the tuberculosis (TB) case burden in Fiji, efforts have been put into national training, education and awareness activities in the formal health sector and among village health workers, health volunteers and the community since 2010. There has been an absolute increase in TB registrations, and TB case notification rates during the period of training activities in 2010 (21.3 per 100 000 population) and 2011 (23.6/100 000) were significantly increased compared with TB case notification rates in 2008 (12.4/100 000) and 2009 (14.6/100 000), when no training activities took place (P < 0.01). These findings support the use of ongoing training efforts.
Collapse
Affiliation(s)
- M Y Delai
- National Health Research Office, Ministry of Health, Suva, Fiji
| | - S Gounder
- National Tuberculosis Control Programme, Suva, Fiji
| | - K Tayler-Smith
- Medical Department, Operational Research Unit, Médecins Sans Frontières (MSF), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - R Van den Bergh
- Medical Department, Operational Research Unit, Médecins Sans Frontières (MSF), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
13
|
Tairea K, Kool B, Harries AD, Bissell K, Gounder S, Hill PC, Avare T, Fariu R. Characteristics of government workers and association with diabetes and hypertension in the Cook Islands. Public Health Action 2014; 4:S34-8. [PMID: 26477285 DOI: 10.5588/pha.13.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Twenty government departments in Rarotonga, Cook Islands. OBJECTIVE To determine the characteristics, presence of selected non-communicable disease (NCD) risk factors and prevalence of diabetes mellitus (DM) and hypertension among government workers who participated in 'wellness checks' in 2012. DESIGN Cross-sectional study involving analysis of survey data. RESULTS Of 598 employees, 70% were aged 25-54 years and 55% were female. Two thirds were obese (body mass index ⩾30 kg/m(2)), and 76% had low levels of fruit and vegetable consumption. Of 50 (8.4%) participants diagnosed with DM (random blood glucose ⩾11 mmol/l, fasting ⩾7 mmol/l), 30 were self-reported and 20 were based on blood glucose. Of the 206 (34.4%) diagnosed with hypertension (systolic ⩾140 and/or diastolic ⩾90), 71 were self-reported and 135 were based on blood pressure measurements. Obesity was associated with hypertension (OR 2.79, 95%CI 1.4-5.4), but not with DM. No relationship was observed between fruit and vegetable consumption and presence or absence of DM or hypertension. CONCLUSION This study identified a high prevalence of obesity and hypertension among government employees in the Cook Islands, risk factors that are associated with NCDs such as DM and cardiovascular disease. 'Wellness checks' pave the way for interventions in workplace settings to prevent and better manage these diseases through early diagnosis, risk management, treatment and supportive public health policies.
Collapse
Affiliation(s)
- K Tairea
- Ministry of Health, Rarotonga, Cook Islands
| | - B Kool
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - K Bissell
- School of Population Health, The University of Auckland, Auckland, New Zealand ; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S Gounder
- National Tuberculosis Programme, Ministry of Health, Suva, Fiji
| | - P C Hill
- Centre for International Health, The University of Otago, Dunedin, New Zealand
| | - T Avare
- Ministry of Health, Rarotonga, Cook Islands
| | - R Fariu
- Ministry of Health, Rarotonga, Cook Islands
| |
Collapse
|
14
|
Fonua L, Bissell K, Vivili P, Gounder S, Hill PC. Sputum smear microscopy referral rates and turnaround time in the Tonga Islands. Public Health Action 2014; 4:S29-33. [PMID: 26477284 DOI: 10.5588/pha.13.0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 11/08/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING The National Tuberculosis Programme and the National Reference Laboratory, located on the main island of Tonga, Tongatapu, and three district hospital laboratories located on the outer islands. OBJECTIVES To compare Tongatapu with Tonga's outer islands with respect to sputum referral rates, numbers of samples per patient, sample quality, test results and time from sending sample to obtaining results and from obtaining results to treatment initiation. DESIGN Retrospective study involving record review of laboratory and TB treatment registers in Tonga's four hospitals from 2003 to 2012. RESULTS Of 3078 sputum samples submitted, 71.7% were of good quality. Sputum referral rates on Tongatupu were nearly twice as high as those on the outer islands (353 vs. 180 per 100 000 population). The mean smear turnaround times on Tongatapu and the outer islands were respectively 4.02 and 4.11 days. Of 83 positive cases, 91.2% were treated within a day in Tongatapu compared with 80% in the outer islands. CONCLUSIONS Referral rates for sputum smear testing differed in the main and the outer islands in Tonga, but turnaround times did not. Records of sputum quality and dates had limitations, necessitating interventions with TB-specific laboratory guidelines and registers. Further research is required to understand the differences in referral rates.
Collapse
Affiliation(s)
- L Fonua
- Ministry of Health, Nuku'alofa, Tonga
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, University of Auckland, Auckland, New Zealand
| | - P Vivili
- Ministry of Health, Nuku'alofa, Tonga
| | | | - P C Hill
- Centre for International Health, Faculty of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
15
|
Gounder S, Harries AD. Screening tuberculosis patients for diabetes mellitus in Fiji: notes from the field. Public Health Action 2012; 2:145-7. [PMID: 26392974 DOI: 10.5588/pha.12.0058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 11/15/2012] [Indexed: 12/17/2022] Open
Abstract
Diabetes (DM) is a problem in Fiji and threatens tuberculosis (TB) control efforts. A review was conducted of all TB patients registered in Fiji in 2011 to assess routine practices of screening for DM. Of 221 TB patients, 138 (62%) had their DM status recorded in their case folders; 18 (13%) had a known history of DM. Random blood glucose (RBG) was performed in 91 (76%) of the remaining 120 patients: 47(52%) had RBG ≥ 6.1 mmol/l, but only three were further investigated, of whom one was diagnosed with DM. There are deficiencies in screening TB patients for DM in Fiji, and improvements are needed.
Collapse
Affiliation(s)
- S Gounder
- Fiji National Tuberculosis Programme, Suva, Fiji
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
16
|
Gerecitano J, Gounder S, Teruya-Feldstein J, Arcila M, Ogilvie S, Gonzalez C, Lin D, Zheng J, Zhang Z, McDonald A, Mulligan G, O'Connor OA. Tissue microarray analysis reveals protein expression patterns and potential biomarkers of clinical benefit to bortezomib in relapsed/refractory non-Hodgkin lymphoma. Br J Haematol 2012; 158:290-292. [PMID: 22533368 DOI: 10.1111/j.1365-2141.2012.09137.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- John Gerecitano
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill-Cornell Medical College, New York, NY, USA
| | | | | | - Maria Arcila
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Shahiba Ogilvie
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Camille Gonzalez
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Dorothy Lin
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill-Cornell Medical College, New York, NY, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alice McDonald
- Millennium Pharmaceuticals, The Takeda Oncology Company, Cambridge, MA, USA
| | - George Mulligan
- Millennium Pharmaceuticals, The Takeda Oncology Company, Cambridge, MA, USA
| | - Owen A O'Connor
- NYU Langone Medical Center, NYU Cancer Institute, New York, NY, USA
| |
Collapse
|
17
|
Kasimis B, Chang V, Gounder S, Gonzalez M, Finch-Cruz C, Blumenfrucht M, Srinivas S, Cogswell J, Morales E, Ahmed S. Prediction of survival by immunohistochemical stains (IHC) in stage D2 prostate cancer patients (pts): The importance of pTEN overexpression. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16019 Background: Several signal transduction pathways,important for apoptosis and angiogenesis were idendified and their expression and correlation with survival was studied by IHC in archival prostate cancer biopsies. All pts has androgen deprivation for stage D2 disease and were followed at 3 month intervals. Methods: In an IRB approved study,42 pts had adequate tissue preserved between 1992 and 2006 and their charts were reviewed retrospectively.IHC stains to detect tumor expression of S6(ribosomal),p70s6,pTEN,AKT-1,BCL-1(Cyclin D1),VEGF,c-KIT,PDGFR-alpha and PDGFR-beta were performed by US Labs(Irvine,CA).All results were independently evaluated by two pathologists.Immunoreactivity was scored using a semiquantitative system combining intensity of staining(0–3+) and percentage of cells staining positive(0–3+).The total score was obtained by adding the scores for indensity and the percentage of positive cells,then averaging the resuts obtained by each reader.For the purpose of this study, stain intensity of 0–1+ was considered negative and the intensity of 2–3+ was considered positive.A Cox regression survival model for each stain was developed with variables known to predict survival :Gleason score,Hemoglobin(Hgb),Alkaline Phosphatase(Alk Phos),Prostate Specific Antigen(PSA),Lactate Dehydrogenase(LDH) levels. Results: The median values were: age 70yrs(56–92),Gleason score 8(6–10), LDH 171 IU/L(97–350),Hgb 12.9gm/dl (6.8–16.3), PSA 188ng/ml(2–5677),Alk Phos 139U/L(60–1756),survival 851 days(163- 6102).In univariate analysis,VEGF staining was predictive of survival (p<0.037) but not in multivariate analysis.The pTEN staining correlated with survival (p<0.0367) and a hazard ratio of 0.040 in multivariate analysis. Conclusions: In this small sample of pts, overexpression of S6,p70s6,AKT-1,BCL-1,VEGF,c-KIT,PDGFR-alpha and PDGFR-beta by IHC staining did not predict survival independently.The pTEN staining,however was strong predictor of survival in the multivariate analysis. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- B. Kasimis
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| | - V. Chang
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| | - S. Gounder
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| | - M. Gonzalez
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| | - C. Finch-Cruz
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| | - M. Blumenfrucht
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| | - S. Srinivas
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| | - J. Cogswell
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| | - E. Morales
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| | - S. Ahmed
- New Jersey Medical School/VANJHCS, East Orange, NJ; New Jersey Medical School/VANJHCS, Newark, NJ; VANJHCS, East Orange, NJ
| |
Collapse
|
18
|
Kasimis BS, Chang V, Gounder S, Hoover D, Finch-Cruz C, Cogswell J, Gonzalez ML, Morales E, Srinivas S, Blumenfrucht M. Correlation between prostate cancer immunohistochemical stains (IHC) and survival in stage D2 patients(pts). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
19
|
Chang VT, Bhatty MU, Hoover D, Sikder MA, Gounder S, Gonzalez ML, McPherson M, Zhong F, Nazha NT, Kasimis BS. End-of-life quality-of-care indicators for medical oncology patients at a VA medical center. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
20
|
Kasimis B, Chang VT, Hoover D, Sikder M, Gounder S, Finch Cruz C, Gonzalez ML, Cogswell J, Srinivas S, Blumenfrucht M. VEGF, PDGF alpha, PDGF beta, and C-Kit expression are not independent survival predictors in stage D 2 prostate cancer (PC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15623 Background: In PC, overexpression of VEGF, PDGF alpha, PDGF beta, and C-Kit has been reported in over 50% of biopsy samples and may be important predictors of survival. Methods: In an ongoing project, we reviewed the records of 26 patients (pts) with stage D2 PC and stained their archival tissue specimens for VEGF, PDGF alpha, PDGF beta, and C-Kit expression. Immunohistochemistry was performed at US LABS (Irvine CA). All immunostains were evaluated by two pathologists. Immunoreactivity was scored using a semiquantitative system for intensity of staining (0–3+) and % of tumor cells (0–3+). The total score was obtained by averaging the scores between the two readers. All pts had androgen deprivation and were followed at 3 months intervals with physical examination, CBC, chemistry profile and PSA levels. A stepwise Cox model was used with variables: Gleason score, Hemoglobin (Hgb), Alkaline Phosphatase (Alk Phos), PSA, LDH levels, and C-Kit positive or negative staining. Results: Median values were as follows: age 69 years (56–91), Alk Phos 139 U/L(60–1298), PSA 178 ng/ml (1.8–5677), LDH 169 IU/L (100–350), Hgb 12.8 gm/dl (6.8–16.3), Gleason score 8 (5–10), Survival 26 mos (8.3–144.1). The median value for C-Kit staining was 3 on a scale of 0–6. 18 pts were grouped into low staining group (0–4) and 8 pts in a high staining group (4.5–5). The Kappa Coefficient for C-Kit was 0.83, and ranged from 0.78–0.91 for the other 3 stains. In univariate survival analyses, C-Kit staining was a predictor for survival (p=0.037) but not PDGF alfa, PDGF beta, or VEGF. In the stepwise Cox model, independent survival predictors in order of significance were the Gleason score, Hgb, and PSA levels. Conclusions: In this sample, VEGF, PDGF alpha, PDGF beta, and C-Kit overexpression by immunohistochemistry in archival tissue are not independent predictors of survival. The C-Kit, however, has a small association with survival but may have collinearity with known predictors of survival. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- B. Kasimis
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| | - V. T. Chang
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| | - D. Hoover
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| | - M. Sikder
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| | - S. Gounder
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| | - C. Finch Cruz
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| | - M. L. Gonzalez
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| | - J. Cogswell
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| | - S. Srinivas
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| | - M. Blumenfrucht
- University of Medicine and Dentistry of New Jersey, Newark, NJ; VA New Jersey Health Care System, East Orange, NJ; Rutgers University, New Brunswick, NJ
| |
Collapse
|
21
|
Affiliation(s)
- Stephen J Nervi
- University of Medicine and Dentistry at New Jersey Medical School, Newark, USA
| | | | | | | |
Collapse
|
22
|
Gounder S, Patenaude V, Popescu C, Beckham W, Olivotto I, Hintz B. A Comparison of Modified Wide Tangent, Direct Internal Mammary and Intensity Modulated Radiation Therapy Plans in the Treatment of Left-Sided Breast Cancer. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|