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Neurocysticercosis of the third ventricle: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23769. [PMID: 38588596 PMCID: PMC11007269 DOI: 10.3171/case23769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/06/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Neurocysticercosis is a parasitic infection of the central nervous system. Cysts located in the ventricles, intraventricular neurocysticercosis (IVNCC), can cause symptoms of increased intracranial pressure and, if untreated, can be fatal. Neuroendoscopic removal of IVNCC is recommended as the first-line treatment. OBSERVATIONS The authors present the case of a healthy 30-year-old male originally from Mexico who presented with headaches and vomiting. He was found to have a cyst in the third ventricle on imaging, consistent with IVNCC. The authors successfully performed neuroendoscopic surgery with removal of the cyst en bloc. LESSONS A multidisciplinary team of neurosurgery and infectious disease specialists is recommended for successful management of patients with IVNCC. These patients typically require neuroendoscopic surgical removal for definitive treatment. In this case, the authors show surgery resulted in an effective cure without the need for antiparasitic medication and excellent long-term outcomes.
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Calcified Neurocysticercosis: Demographic, Clinical, and Radiological Characteristics of a Large Hospital-Based Patient Cohort. Pathogens 2023; 13:26. [PMID: 38251334 PMCID: PMC10820744 DOI: 10.3390/pathogens13010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Neurocysticercosis (NCC), the infection of the central nervous system caused by Taenia solium larvae (cysticerci), is a major cause of acquired epilepsy worldwide. Calcification in NCC is the most common neuroimaging finding among individuals with epilepsy in T. solium-endemic areas. We describe the demographic, clinical, and radiological profiles of a large hospital cohort of patients with calcified NCC in Peru (during the period 2012-2022) and compared profiles between patients with and without a previous known diagnosis of viable infection. A total of 524 patients were enrolled (mean age at enrollment: 40.2 ± 15.2 years, mean age at symptom onset: 29.1 ± 16.1 years, 56.3% women). Of those, 415 patients (79.2%) had previous seizures (median time with seizures: 5 years, interquartile range (IQR): 2-13 years; median number of seizures: 7 (IQR: 3-32)), of which 333 (80.2%) had predominantly focal to bilateral tonic-clonic seizures; and 358 (68.3%) used antiseizure medication). Patients had a median number of three calcifications (IQR: 1-7), mostly located in the frontal lobes (79%). In 282 patients (53.8%) there was a previous diagnosis of viable infection, while 242 only had evidence of calcified NCC since their initial neuroimaging. Most patients previously diagnosed with viable infection were male, had previous seizures, had seizures for a longer time, had more calcifications, and had a history of taeniasis more frequently than patients without previously diagnosed viable infection (all p < 0.05). Patients with calcified NCC were heterogeneous regarding burden of infection and clinical manifestations, and individuals who were diagnosed after parasites calcified presented with milder disease manifestations.
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Correction: Epidemiologic and clinical characteristics of infective endocarditis: a single-center retrospective study in the Bronx, New York. Infection 2023:10.1007/s15010-023-02004-z. [PMID: 37072605 DOI: 10.1007/s15010-023-02004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
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2310. Clinical Characteristics of Patients with Calcified Parenchymal Neurocysticercosis and Perilesional Edema in a large non-endemic cohort. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Perilesional edema (PLE) around calcified parenchymal neurocysticercosis (NCC) lesions is a transient inflammatory event that accounts for recurrent symptoms in NCC. Previous reports in endemic regions suggest that 50% of seizures in NCC are due to PLE. Its occurrence in non-endemic regions is largely unexplored.
Methods
A retrospective review of medical records of patients with confirmed NCC followed at Jacobi Medical Center (Bronx, NY) from 1993 to 2021 was performed. Epidemiological, clinical and radiological data were obtained.
Results
180 patients were identified with calcified parenchymal NCC at any time during their course. PLE was documented in 37/180 patients (20.5%). Of these, 27 patients (72.9%) had PLE on presentation; ten patients presented with PLE after a median follow-up of 16.5 (9–36) months. 28 patients (75.6%) with PLE had only calcified parenchymal disease; the remaining 9 patients had mixed forms of NCC concurrently (viable parenchymal, subarachnoid or intraventricular NCC). 8 patients (21.6%) had more than 1 PLE episode with a median number of 3 (2–4) episodes; interval to recurrence was 9 (3.5–11) months. In 6 patients, the recurrence occurred in a calcification different to that of the first PLE episode. 2 patients had multiple calcifications simultaneously displaying PLE. 86.5% of PLE episodes were symptomatic; seizures were the most common symptom (70.3%). Clinical manifestations of PLE often varied during recurrent episodes, with only 2 patients displaying the same symptoms. 10 patients were treated with steroids, and 6 recurrent episodes of PLE occurred during a taper of steroids started for a prior PLE occurrence.
Conclusion
PLE was a frequent phenomenon among NCC patients in our non-endemic cohort. Its clinical course is variable, occurring as a presenting feature in calcified disease. Treatment with steroids may not always be warranted given recurrence during taper periods. Many experts think this may be due to antigens "leaking" from the calcified lesion leading to inflammation, but the true pathophysiology is not known. Further studies are needed to elucidate the etiology and natural history of PLE in NCC patients.
Disclosures
All Authors: No reported disclosures.
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1028. Clinical and radiologic characteristics of calcified parenchymal neurocysticercosis: A large series of a non-endemic region. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system and a common cause of seizures. Approximately, one-third of patients with epilepsy in endemic regions have NCC. Calcified parenchymal cysticercosis (CaNCC) was previously referred to as an inactive form of NCC, however, recent data suggests that the antigenic parasitic material within this lesion can intermittently elicit a host inflammatory response. The clinical and radiologic characteristics associated with calcified lesions have not yet been well characterized.
Methods
We describe the clinical, radiologic, and serologic characteristics of a large series of patients with calcified parenchymal NCC who presented to Jacobi Medical Center, New York.
Results
Of 302 cases of NCC, 87 patients (32.5%) had exclusively CaNCC. Most individuals were female (50.7%) and born in Mexico (32.2%); the mean age was 38.4 ± 15.3 years and the median time from migration was 12 years [IQR 4-20 years]. The most common presentation was seizures (52.9%); among these patients, 23 individuals (53.5%) had perilesional edema on imaging which was always associated with enhancement on MR T1 image after gadolinium injection. Thirty-seven patients (42.5%) presented with headaches; among these, only 6 patients (16.2%) had perilesional edema at presentation. Nine patients (10.3%) were diagnosed incidentally. The Western blot was positive in 19 patients (21.8%) and the cysticercosis antigen in serum was negative in all cases.
Conclusion
This large series of patients with CaNCC in a non-endemic area highlights the clinical spectrum of this form of NCC. Seizures were the most common symptom. Perilesional edema around calcified lesions was seen in 50% of individuals presenting with seizures, similar to findings in endemic regions. Headaches also were frequent; the pathophysiology is yet not well understood. Unlike extraparenchymal disease, serum antigen is not positive in CaNCC. Enhancement of the corresponding calcifications after gadolinium was frequently seen on MRI. More research on individuals with CaNCC is needed to better understand why certain calcified lesions develop perilesional edema. It is clear that CaNCC is not inactive and the etiology of both headaches and seizures is probably multifactorial.
Disclosures
All Authors: No reported disclosures.
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1185. Taking care of migrants: The approach to eosinophilia. Open Forum Infect Dis 2022. [PMCID: PMC9751919 DOI: 10.1093/ofid/ofac492.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Eosinophilia in immigrant patients is a common finding in the outpatient setting. While screening guidelines for refugee populations exist, there are no guidelines to the approach to eosinophilia in immigrants. Etiologic diagnosis and laboratory investigation in migrant patients requires attention to the epidemiological risk factors. Serodiagnosis is an important tool in the diagnosis of chronic parasitic diseases affecting migrant patients. Methods We describe the demographic, laboratory and diagnosis characteristics of migrant patients with eosinophilia (absolute eosinophil count ≥ 500 cells/mm3) who were referred to the Tropical Medicine clinic of Jacobi Medical Center, New York. Results A total of 104 cases of eosinophilia were seen. Most individuals were female (54.8%) and born in The Caribbean (27.9%), followed by Asia (23.1%) and Central America (15.4%). The mean age of the patients was 50.7 ± 14.4 years and the median time from migration was 18 years [IQR 6-28 years]. The mean of the peak of eosinophils in the past 3 months was 1300 ± 600 cel/mm3. Serology for Strongyloides was positive in 24 patients (23.1%). The proportion of seroprevalence for Strongyloides by country was higher in Central America (7 patients; 43.8%), Africa (3 patients; 37.5%) and The Caribbean (8 patients; 27.6%). Patients with bathroom and plumbing outdoors were more likely to be seropositive for Strongyloides (p=0.04). Chagas serology was positive in 6 out of 10 patients tested and Schistosoma antibodies were positive in 3 out of 8 patients tested. Of note, both results were only tested in patients with epidemiological risk factors. Conclusion Strongyloidiasis was common in our migrant population. Individuals without water supply and bathroom inside the house were more likely to have a positive serology. Many of these patients can develop disseminated infection if receiving corticosteroids. Screening in at-risk asymptomatic patients allows to identify and treat this latent disease and avoid potential morbidity and mortality. Patients were also screened for other latent parasitic infections based on epidemiology risk factors that do not result in eosinophilia such as Chagas disease and schistosomiasis. Further studies are needed to help inform guidelines on screening immigrant populations. Disclosures All Authors: No reported disclosures.
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Epidemiologic and clinical characteristics of infective endocarditis: a single-center retrospective study in the Bronx, New York. Infection 2022; 50:1349-1361. [PMID: 35614176 DOI: 10.1007/s15010-022-01846-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is paucity of data on the epidemiological, microbiological, and clinical characteristics of patients admitted with infective endocarditis (IE) in the Bronx, New York. PATIENT AND METHODS We conducted a retrospective study at Jacobi Medical Center, a tertiary care hospital in the Bronx. All adult patients who were hospitalized with a primary diagnosis of new-onset IE between January 1st, 2010 and September 30th, 2020 were included. The primary outcome was in-hospital mortality. A logistic regression model was used to identify baseline variables associated with in-hospital mortality. RESULTS 182 patients were included in this analysis (female sex: 38.5%, median age: 54 years). 46 patients (25.3%) reported intravenous drug use. 153 patients (84.1%) had positive blood cultures. Staphylococcus aureus (S. aureus) was the most common isolated pathogen (45.1% of monomicrobial IE). Nearly half of the cases secondary to S. aureus were methicillin resistant Staphylococcus aureus (MRSA) (34/69). 164 patients (90.1%) were diagnosed with native valve IE. The mitral valve was involved in 32.4% of patients followed by the aortic valve (19.8%). The in-hospital mortality was 18.1%. The mortality was higher in the cohort 2010-2015 compared to the cohort 2016-2020 (22.1% vs 14.6%). Increasing age, MRSA IE, and active malignancy were the only variables found to have significant association with in-hospital death. CONCLUSION S. aureus was the most common causative agent and MRSA accounted for about half of the S. aureus IE cases. The incidence of IE in patients with intravenous drug use increased over time, while the median age decreased. The in-hospital death rate was higher in 2010-2015 compared to 2016-2020.
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Recommendations for Screening and Diagnosis of Chagas Disease in the United States. J Infect Dis 2022; 225:1601-1610. [PMID: 34623435 PMCID: PMC9071346 DOI: 10.1093/infdis/jiab513] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chagas disease affects an estimated 326 000-347 000 people in the United States and is severely underdiagnosed. Lack of awareness and clarity regarding screening and diagnosis is a key barrier. This article provides straightforward recommendations, with the goal of simplifying identification and testing of people at risk for US healthcare providers. METHODS A multidisciplinary working group of clinicians and researchers with expertise in Chagas disease agreed on 6 main questions, and developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, after reviewing the relevant literature on Chagas disease in the United States. RESULTS Individuals who were born or resided for prolonged time periods in endemic countries of Mexico and Central and South America should be tested for Trypanosoma cruzi infection, and family members of people who test positive should be screened. Women of childbearing age with risk factors and infants born to seropositive mothers deserve special consideration due to the risk of vertical transmission. Diagnostic testing for chronic T. cruzi infection should be conducted using 2 distinct assays. CONCLUSIONS Increasing provider-directed screening for T. cruzi infection is key to addressing this neglected public health challenge in the United States.
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The COVID-19 Pandemic – A Cause for Late Presentation of Sarcoma Patients? Clin Oncol (R Coll Radiol) 2022. [PMCID: PMC8924333 DOI: 10.1016/j.clon.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Background Over 300,000 people in the United States are infected with Trypanosoma cruzi, the protozoan parasite that causes Chagas disease (CD). Only about 1% of estimated U.S. cases have been identified, usually through blood donor screening, and most people are unaware they have the infection. Screening is critical for increasing case detection and ensuring patients receive appropriate and timely care, but awareness of CD management strategies among healthcare providers is low. Diagnostic guidelines for CD in the United States are needed to increase provider-directed screening and diagnosis. Methods Screening recommendations were prepared by the U.S. Chagas Diagnostic Working Group, which consists of clinicians, researchers, and public health experts involved in CD programs. The group agreed on six main questions based on the PICO method (Population, Intervention, Comparison, and Outcome). Subgroups discussed each and proposed initial recommendations, which were then shared and validated within the larger group. The recommendations used the GRADE methodology, assigning two sets of ratings: 1) strength of the recommendation, and 2) quality of the evidence. Results The group recommended screening anyone who was born or lived for >6 months in South America, Central America and Mexico (Figure 1). Recent community-based studies found a prevalence of 1-3.8% in this population. Within this population, having a family member with CD, or having clinical conditions suggestive of CD, including electrocardiographic abnormalities, suggest an elevated risk. Screening women of childbearing age and infants born to seropositive women is important for preventing congenital transmission. Test performance may vary depending on several factors, including whether patients are from South America, Central America or Mexico. Confirmation therefore requires positive results on at least two serological tests based on different antigens or formats, in line with Pan American Health Organization (PAHO) recommendations. Once CD is confirmed, patients should receive an electrocardiogram and echocardiogram to monitor for development of cardiac complications. Conclusion These CD screening recommendations are meant to be a resource for U.S. healthcare providers to simplify testing of at-risk patients. Disclosures Jen Manne-Goehler, MD, DSc, Regeneron (Individual(s) Involved: Self): Scientific Research Study Investigator Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)
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PO-1415 Association of radiomic features with aggressive phenotypes in soft tissue sarcomas. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07866-x] [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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PO-1338 Does frailty influence treatment intent in men with non-metastatic prostate cancer? Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis: A meta-analysis and expert group-based consensus recommendations. PLoS Negl Trop Dis 2021; 15:e0009193. [PMID: 33788843 PMCID: PMC8057605 DOI: 10.1371/journal.pntd.0009193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/20/2021] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Single brain enhancing lesions (SEL) are the most common presentation of neurocysticercosis (NCC) observed on neuroimaging in people presenting with epileptic seizures not only on the Indian sub-continent and in travelers returning from cysticercosis-endemic regions, but are also present in other parts of the world. The aim of this study, which consisted of a systematic review (CRD42019087665), a meta-analysis and an expert group consultation, was to reach consensus on the best anti-seizure medication and anti-inflammatory treatment for individuals with SEL NCC. Standard literature review methods were used. The Cochrane risk of bias tool was used and random effects model meta-analyses were performed. The quality of the body of evidence was rated using GRADE tables. The expert committee included 12 gender and geographically balanced members and recommendations were reached by applying the GRADE framework for guideline development. The 1-1.5-year cumulative incidence of seizure recurrence, cyst resolution or calcification following anti-seizure medication (ASM) withdrawal was not statistically different between ASM of 6, 12 or 24 months. In contrast, in persons whose cyst calcified post treatment, longer ASM decreased seizure recurrence. The cumulative incidence ratio (CIR) 1-1.5 years after stopping ASM was 1.79 95% CI: (1.00, 3.20) for patients given 6 versus 24 months treatment. Anti-inflammatory treatment with corticosteroids in patients treated with ASM compared to patients treated with ASM only showed a statistically significant beneficial effect on seizure reduction (CIR 0.44, 95% CI 0.23, 0.85) and cyst resolution (CIR 1.37, 95%CI: 1.07, 1.75). Our results indicate that ASM in patients with SEL NCC whose cysts resolved can be withdrawn, while patients whose cysts calcified seem to benefit from prolonged anti-seizure medication. Additional corticosteroid treatment was found to have a beneficial effect both on seizure reduction and cyst resolution.
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Abstract
Background Neurocysticercosis (NCC) is associated with significant morbidity and a variety of clinical presentations We describe our experience with NCC at a New York City hospital. Methods A retrospective review of consecutive patients with a confirmed diagnosis of neurocysticercosis who attended to Jacobi Medical Center in New York City was done. Demographic data, symptoms at presentation, and cysticercosis serology were retrieved from the medical records. The cases were classified according to the location of the cysts. Demographic and clinic variables were compared to assess for differences according to the cyst location. Results A total of 260 cases of NCC were included. Of these cases, 163 (62.7%) were male, and the median age was 36.7 ± 13.7 years. A total of 245 patients (94.2%) were immigrants from 22 different countries. The most common countries of origin were Mexico (28.8%) and Ecuador (24.2%). Parenchymal NCC alone was seen in 139 patients (53.5%); of these, 31 patients had viable cysts. Forty patients (15.4%) were diagnosed with subarachnoid NCC (SANCC) alone and 19 patients (7.3%) had intraventricular NCC alone. Sixty-two patients (23.8%) had parenchymal and extra parenchymal NCC. Additionally, 24.7% of SANCC cases had concomitant spinal NCC. The median time from immigration to presentation was 9.5 years. SANCC cases had significantly longer time from immigration than parenchymal disease. The most common symptom among patients with only parenchymal NCC was seizures (68.4%). Among patients with only SANCC, 28 patients (70.0%) reported headache. Fifteen patients (37.5%) had intracranial hypertension and 12 required shunt placement. Eight patients (20.0%) of the SANCC group presented as an ischemic event. Cysticercus antigen was measured in 172 patients and was positive in 38 patients (14.6%); all but one with a positive antigen had extra-parenchymal NCC. Conclusion This is the largest series of NCC reported in the US and highlights the importance of SANCC disease, a more severe form of NCC. Our data suggests that those with SANCC present with intracranial hypertension and have longer latency than other forms. The NCC recombinant antigen was more likely to be positive in extra-parenchymal disease. This is a complex disease and ID physicians should be aware of the many presentations. Disclosures All Authors: No reported disclosures
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Immunomodulatory Therapy for the Management of Loiasis. Clin Infect Dis 2020; 73:e1632-e1633. [PMID: 33326992 DOI: 10.1093/cid/ciaa1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/07/2020] [Indexed: 11/12/2022] Open
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805O ICON8: Overall survival results in a GCIG phase III randomised controlled trial of weekly dose-dense chemotherapy in first line epithelial ovarian, fallopian tube or primary peritoneal carcinoma treatment. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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P-113 Supportive medication in advanced biliary tract cancers with ABC-02 regimen. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices. PLoS One 2020; 15:e0229565. [PMID: 32163426 PMCID: PMC7067457 DOI: 10.1371/journal.pone.0229565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRs-travelers to the same destinations with other purpose for travel-but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. METHODS AND FINDINGS Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health department; members of the general VFR population (community); and VFR and non-VFR travelers presenting to a travel health clinic, both before their pretravel consultation and again, after return from travel. A Community Advisory Board of African immigrants and prior qualitative research informed survey development and dissemination. Across the three groups, 489 travelers completed surveys: 351 VFRs and 138 non-VFRs. VFRs who reported taking antimalarials on their last trip rated their concern about malaria higher than those who did not. Having taken five or more trips to SSA was reported more commonly among VFRs diagnosed with malaria than community VFRs (44.0% versus 20.4%; p = 0.008). Among travel health clinic patients surveyed before and after travel, VFR travelers were less successful than non-VFRs in adhering to their planned use of antimalarials (82.2% versus 98.7%; p = 0.001) and employing mosquito bite avoidance techniques (e.g., using bed nets: 56.8% versus 81.8%; p = 0.009). VFRs who visited the travel health clinic were more likely than VFR respondents from the community to report taking an antimalarial (83.0% versus 61.9%; p = 0.009), or to report bite avoidance behaviors (e.g., staying indoors when mosquitoes were out: 80.9% versus 59.5%; p = 0.009). CONCLUSIONS We observed heterogeneity in malaria prevention behaviors among VFRs and between VFR and non-VFR traveler populations. Although VFRs attending the travel health clinic appear to demonstrate better adherence to malaria prevention measures than VFR counterparts surveyed in the community, specialized pretravel care is not sufficient to ensure chemoprophylaxis use and bite avoidance behaviors among VFRs. Even when seeking specialized pretravel care, VFRs experience greater barriers to the use of malaria prevention than non-VFRs. Addressing access to health care and upstream barrier reduction strategies that make intended prevention more achievable, affordable, easier, and resonant among VFRs may improve malaria prevention intervention effectiveness.
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M272 WHEN AGRANULOCYTOSIS BECOMES BLASTS: A CASE OF ACUTE LEUKEMIA IN THE SETTING OF IMMUNE DYSREGULATION. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Clinical Pearls in travellers and migrants. J Travel Med 2019; 26:5237753. [PMID: 30535197 DOI: 10.1093/jtm/tay147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/07/2018] [Indexed: 11/14/2022]
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Community-based participatory research in travel medicine to identify barriers to preventing malaria in VFR travellers. J Travel Med 2019; 26:5238695. [PMID: 30535124 PMCID: PMC6628254 DOI: 10.1093/jtm/tay148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 11/14/2022]
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In memorium Herbert B. Tanowitz, MD, FIDSA, FACP, FRSTMH 6 September 1941 - 17 July 2018. Parasitol Res 2018; 118:353-354. [PMID: 30430237 DOI: 10.1007/s00436-018-6140-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/06/2018] [Indexed: 11/25/2022]
Abstract
With deep regret and sadness, we report the death of Professor Herbert B. Tanowitz, Professor of Pathology, Division of Parasitology and Professor of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York. He is survived by his children Pam, Meredith, and Jill, and their families.
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ENGAGING OLDER RESIDENTS THROUGH A CIVIC ACADEMY IN AGE-FRIENDLY BOSTON. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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BARRIERS TO EMPLOYMENT AMONG OLDER ADULTS: AN ACTION ITEM OF THE AGE-FRIENDLY BOSTON INITIATIVE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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EP-1586: Docetaxel – Mitigating the high price of success. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31895-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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ICON8: A GCIG phase III randomised trial evaluating weekly dose- dense chemotherapy integration in first-line epithelial ovarian/fallopian tube/primary peritoneal carcinoma (EOC) treatment: Results of primary progression- free survival (PFS) analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Co-enrolment of Participants into Multiple Cancer Trials: Benefits and Challenges. Clin Oncol (R Coll Radiol) 2017; 29:e126-e133. [PMID: 28314597 PMCID: PMC5479364 DOI: 10.1016/j.clon.2017.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 11/17/2022]
Abstract
Opportunities to enter patients into more than one clinical trial are not routinely considered in cancer research and experiences with co-enrolment are rarely reported. Potential benefits of allowing appropriate co-enrolment have been identified in other settings but there is a lack of evidence base or guidance to inform these decisions in oncology. Here, we discuss the benefits and challenges associated with co-enrolment based on experiences in the Add-Aspirin trial - a large, multicentre trial recruiting across a number of tumour types, where opportunities to co-enrol patients have been proactively explored and managed. The potential benefits of co-enrolment include: improving recruitment feasibility; increased opportunities for patients to participate in trials; and collection of robust data on combinations of interventions, which will ensure the ongoing relevance of individual trials and provide more cohesive evidence to guide the management of future patients. There are a number of perceived barriers to co-enrolment in terms of scientific, safety and ethical issues, which warrant consideration on a trial-by-trial basis. In many cases, any potential effect on the results of the trials will be negligible - limited by a number of factors, including the overlap in trial cohorts. Participant representatives stress the importance of autonomy to decide about trial enrolment, providing a compelling argument for offering co-enrolment where there are multiple trials that are relevant to a patient and no concerns regarding safety or the integrity of the trials. A number of measures are proposed for managing and monitoring co-enrolment. Ensuring acceptability to (potential) participants is paramount. Opportunities to enter patients into more than one cancer trial should be considered more routinely. Where planned and managed appropriately, co-enrolment can offer a number of benefits in terms of both scientific value and efficiency of study conduct, and will increase the opportunities for patients to participate in, and benefit from, clinical research.
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THE EVOLVING ROLE OF SENIOR CENTERS IN AN ERA OF THE AGE-FRIENDLY COMMUNITY MOVEMENT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Editorial: refractory GERD-good drug, wrong patients? Authors' reply. Aliment Pharmacol Ther 2017. [PMID: 28621071 DOI: 10.1111/apt.14151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Randomised clinical trial: addition of alginate-antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms. Aliment Pharmacol Ther 2017; 45:1524-1533. [PMID: 28464343 DOI: 10.1111/apt.14064] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/09/2017] [Accepted: 03/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Symptomatic breakthrough in proton pump inhibitor (PPI)-treated gastro-oesophageal reflux disease (GERD) patients is a common problem with a range of underlying causes. The nonsystemic, raft-forming action of alginates may help resolve symptoms. AIM To assess alginate-antacid (Gaviscon Double Action, RB, Slough, UK) as add-on therapy to once-daily PPI for suppression of breakthrough reflux symptoms. METHODS In two randomised, double-blind studies (exploratory, n=52; confirmatory, n=262), patients taking standard-dose PPI who had breakthrough symptoms, assessed by Heartburn Reflux Dyspepsia Questionnaire (HRDQ), were randomised to add-on Gaviscon or placebo (20 mL after meals and bedtime). The exploratory study endpoint was change in HRDQ score during treatment vs run-in. The confirmatory study endpoint was "response" defined as ≥3 days reduction in the number of "bad" days (HRDQ [heartburn/regurgitation] >0.70) during treatment vs run-in. RESULTS In the exploratory study, significantly greater reductions in HRDQ scores (heartburn/regurgitation) were observed in the Gaviscon vs placebo (least squares mean difference [95% CI] -2.10 [-3.71 to -0.48]; P=.012). Post hoc "responder" analysis of the exploratory study also revealed significantly more Gaviscon patients (75%) achieved ≥3 days reduction in "bad" days vs placebo patients (36%), P=.005. In the confirmatory study, symptomatic improvement was observed with add-on Gaviscon (51%) but there was no significant difference in response vs placebo (48%) (OR (95% CI) 1.15 (0.69-1.91), P=.5939). CONCLUSIONS Adding Gaviscon to PPI reduced breakthrough GERD symptoms but a nearly equal response was observed for placebo. Response to intervention may vary according to whether symptoms are functional in origin.
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A national survey of current practices of preparation and management of radical prostate radiotherapy patients during treatment. Radiography (Lond) 2017; 23:87-93. [DOI: 10.1016/j.radi.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/18/2016] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
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The Rapid Access Palliative Ambulatory Radiotherapy Clinic as an Educational Tool – Experience of Leeds Cancer Centre. Clin Oncol (R Coll Radiol) 2017; 29:e93. [DOI: 10.1016/j.clon.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
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Metformin as an adjuvant treatment for cancer: a systematic review and meta-analysis. Ann Oncol 2016; 27:2184-2195. [PMID: 27681864 PMCID: PMC5178140 DOI: 10.1093/annonc/mdw410] [Citation(s) in RCA: 278] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Metformin use has been associated with a reduced risk of developing cancer and an improvement in overall cancer survival rates in meta-analyses, but, to date, evidence to support the use of metformin as an adjuvant therapy in individual cancer types has not been presented. PATIENTS AND METHODS We systematically searched research databases, conference abstracts and trial registries for any studies reporting cancer outcomes for individual tumour types in metformin users compared with non-users, and extracted data on patients with early-stage cancer. Studies were assessed for design and quality, and a meta-analysis was conducted to quantify the adjuvant effect of metformin on recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS), to inform future trial design. RESULTS Of 7670 articles screened, 27 eligible studies were identified comprising 24 178 participants, all enrolled in observational studies. In those with early-stage colorectal cancer, metformin use was associated with a significant benefit in all outcomes [RFS hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.47-0.85; OS HR 0.69, CI 0.58-0.83; CSS HR 0.58, CI 0.39-0.86]. For men with early-stage prostate cancer, metformin was associated with significant, or borderline significant, benefits in all outcomes (RFS HR 0.83, CI 0.69-1.00; OS HR 0.82, CI 0.73-0.93; CSS HR 0.58, CI 0.37-0.93); however, there was significant heterogeneity between studies. The data suggest that prostate cancer patients treated with radical radiotherapy may benefit more from metformin (RFS HR 0.45, CI 0.29-0.70). In breast and urothelial cancer, no significant benefits were identified. Sufficient data were not available to conduct analyses on the impact of metformin dose and duration. CONCLUSIONS Our findings suggest that metformin could be a useful adjuvant agent, with the greatest benefits seen in colorectal and prostate cancer, particularly in those receiving radical radiotherapy, and randomised, controlled trials which investigate dose and duration, alongside efficacy, are advocated.
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Anticholinergic burden in schizophrenia and ability to benefit from psychosocial treatment programmes: a 3-year prospective cohort study. Psychol Med 2016; 46:3199-3211. [PMID: 27576609 DOI: 10.1017/s0033291716002154] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Many medications administered to patients with schizophrenia possess anticholinergic properties. When aggregated, pharmacological treatments may result in a considerable anticholinergic burden. The extent to which anticholinergic burden has a deleterious effect on cognition and impairs ability to participate in and benefit from psychosocial treatments is unknown. METHOD Seventy patients were followed for approximately 3 years. The MATRICS consensus cognitive battery (MCCB) was administered at baseline. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden (ACB) scale. Ability to benefit from psychosocial programmes was measured using the DUNDRUM-3 Programme Completion Scale (D-3) at baseline and follow-up. Psychiatric symptoms were measured using the PANSS. Total antipsychotic dose was measured using chlorpromazine equivalents. Functioning was measured using the Social and Occupational Functioning Assessment Scale (SOFAS). RESULTS Mediation analysis found that the influence of anticholinergic burden on ability to participate and benefit from psychosocial programmes was completely mediated by the MCCB. For every 1-unit increase on the ACB scale, change scores for DUNDRUM-3 decreased by -0.27 points. This relationship appears specific to anticholinergic burden and not total antipsychotic dose. Moreover, mediation appears to be specific to cognition and not psychopathology. Baseline functioning also acted as mediator but only when MCCB was not controlled for. CONCLUSIONS Anticholinergic burden has a significant impact on patients' ability to participate in and benefit from psychosocial treatment programmes. Physicians need to be mindful of the cumulative effect that medications can have on patient cognition, functional capacity and ability to benefit from psychosocial treatments.
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ICON8 Stage 1A and 1B analysis: safety and feasibility of weekly carboplatin and paclitaxel regimens in first-line ovarian cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Early Real Life Experience of Radium 223 (Ra223) in Castrate Resistant Prostate Cancer (CRPC). Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2015.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Repurposing Vitamin D as an Anticancer Drug. Clin Oncol (R Coll Radiol) 2015; 28:36-41. [PMID: 26520788 DOI: 10.1016/j.clon.2015.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 12/20/2022]
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EP-1223: Endorectal balloons in prostate cancer radiotherapy: effects on seminal vesicle positioning. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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1489Fulminant and Fatal: Two Strongyloidiasis Cases in HTLV-1 Patients. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Early Corticosteroid Treatment in Severe Pulmonary Hemorrhagic Syndrome From Leptospirosis: Is Immunomodulation the Key to Survival? Chest 2014. [DOI: 10.1378/chest.1988226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Simultaneous Cone Beam Computed Tomography (CBCT) Acquisition During Arc Radiation Therapy (SCART): A Comparison of Volume Delineation on Simultaneous and Standard CBCT in Prostate Radiation Therapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Are the Benefits of Aspirin in Colorectal Cancer Limited to PIK3CA Mutated Cancers? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Reaching Our Goal of Zero Catheter Associated Urinary Tract Infections (CAUTI). Am J Infect Control 2014. [DOI: 10.1016/j.ajic.2014.03.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Do women who intermittently attend breast screening differ from those who attend every invitation and those who never attend? J Med Screen 2014; 21:98-103. [DOI: 10.1177/0969141314533677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Analysis of screening uptake usually dichotomizes women into attenders and non-attenders, though many women respond positively to some but not all invitations. This paper studies these intermittent attenders. Methods A cohort of 8,571 women invited for consecutive breast screens in the Northern Ireland Breast Screening Programme were followed in a study linking screening and census records. Multivariate logistic analysis was used to analyze the characteristics of those who attended both times (consistent), once (intermittent or ‘one-time only’), or not at all (non-attenders). Results Overall, 15.5% of women attended once and 13.4% were non-attenders. Non-attenders were characteristically disadvantaged (as measured by social renting, car access, and employment status), less likely to be married, and more likely to be healthy. One-time attenders were younger, and suffering poor health, though there was no association with either social renting or employment status. Privately rented accommodation and city living was associated with both one-time attendance and non-attendance. Conclusions One-time attenders are an important and distinct subgroup of screening invitees in this analysis. Their distinct characteristics suggest that transitory factors, such as change in marital status, ill-health, or addressing difficulties through change of residence are important. These distinct characteristics suggest the need for different approaches to increase attendance, among both intermittent attenders and those not attending at all.
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Patterns of Failure After Intensity Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chemoradiotherapy for N2 head and neck squamous cell carcinoma - outcomes without a planned neck dissection: Our experience in two hundred and seven patients. Clin Otolaryngol 2013; 38:347-51. [DOI: 10.1111/coa.12133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 01/03/2023]
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Breast cancer in older patients: national cancer registry data. Int J Clin Pract 2013; 67:698-700. [PMID: 23758449 DOI: 10.1111/ijcp.12117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 12/27/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The population in developed countries is ageing. Cancer is a disease of ageing, and this is likely to lead to an increase in the number of older patients diagnosed with cancer with significant implications for resource allocation and research priorities. Breast Cancer in older women presents a number of challenges. AIMS This paper describes the trends in number of new breast cancer registrations in older patients over the last 38 years. MATERIALS AND METHODS Data were extracted from the Office for National Statistics describing new registrations of breast cancer for patients aged 65 or over, from 1971 to 2009. RESULTS The number of diagnoses of breast cancer across all age groups increased from 17,694 in 1971 to 40,260 in 2009. The proportion of diagnoses of breast cancer made in women aged 65 and over increased from 42% in 1971 to 45% in 2009. The proportion of diagnoses of breast cancer made in women aged 70 and over increased from 30% in 1971 to 33% in 2009. The number of cases of breast cancer registered in patients aged 65 and over has increased from 7376 in 1971 to 17,934 in 2009. DISCUSSION The reasons for the large increases in the number of older women diagnosed with breast cancer, and older women represent an increasing proportion of those diagnosed are multi-factorial. These include the ageing of the population, obesity, alcohol consumption, use of hormone replacement therapy and reproductive factors, improved breast cancer awareness and the UK National Screening Programme. Clinician attitudes and behaviours and also cancer registries striving to increase their levels are other causes. The effective management of these women will present constraints to service delivery and should therefore influence research priorities. CONCLUSION This short communication reports on the increasing registration of breast cancer in the older age group which will present a number of challenges for the future.
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Abstract
BACKGROUND Clostridium difficile colitis is associated with increased age, antibiotic usage, and hospitalization. Severe C. difficile colitis refractory to medical therapy may require surgical intervention including subtotal colectomy. We initiated an adjuvant intracolonic vancomycin (ICV) enema protocol for inpatients with severe C. difficile colitis and compared the response to this therapy in patients from the community and nursing homes. METHODS A single-hospital, retrospective chart review was done on 47 consecutive patients with C. difficile colitis treated with ICV (1 g/500 mL normal saline q6h) from January 2007 through October 2009. The proportions of patients with the outcomes of response to the ICV protocol, need for subtotal colectomy, and death were described. Associations of patient characteristics with these outcomes were examined with bivariate tests and multivariable logistic models with adjustment for age, hypoalbuminemia, acidosis, and nursing-home status. RESULTS Thirty-three of 47 patients (70%) with severe C. difficile colitis responded to adjunct ICV with complete resolution without surgery. Incomplete responders who had surgery were more likely to survive than those patients who did not undergo subtotal colectomy (p<0.01). Seven of nine patients who underwent surgery survived >90 d, and overall, 37 of 47 patients (79%) survived after ICV therapy. Nursing-home residence, acidosis, and hypoalbuminemia were significantly associated with the non-resolution of colitis in bivariate analyses (all p<0.01), whereas nursing-home residence and hypoalbuminemia showed non-significant trends toward association with death (p=0.07 and p=0.06, respectively). Multivariate logistic-regression models showed significant associations of acidosis with an incomplete response to ICV (p=0.02), of older age with death (p=0.04), and of hypoalbuminemia with both an incomplete response to ICV and death (both p=0.04). No complications were attributable to ICV. CONCLUSION Complete resolution without surgery was achieved in 70% in this series of patients with severe C. difficile colitis who received adjunct ICV therapy. A clinical trial will be needed to determine whether ICV as compared with standard therapy alone can reduce the need for surgery with non-inferior or superior outcomes.
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Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997-2009, part 2: migrants resettled internationally and evaluated for specific health concerns. Clin Infect Dis 2012; 56:925-33. [PMID: 23223602 DOI: 10.1093/cid/cis1016] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Increasing international migration may challenge healthcare providers unfamiliar with acute and long latency infections and diseases common in this population. This study defines health conditions encountered in a large heterogenous group of migrants. METHODS Migrants seen at GeoSentinel clinics for any reason, other than those seen at clinics only providing comprehensive protocol-based health screening soon after arrival, were included. Proportionate morbidity for syndromes and diagnoses by country or region of origin were determined and compared. RESULTS A total of 7629 migrants from 153 countries were seen at 41 GeoSentinel clinics in 19 countries. Most (59%) were adults aged 19-39 years; 11% were children. Most (58%) were seen >1 year after arrival; 27% were seen after >5 years. The most common diagnoses were latent tuberculosis (22%), viral hepatitis (17%), active tuberculosis (10%), human immunodeficiency virus (HIV)/AIDS (7%), malaria (7%), schistosomiasis (6%), and strongyloidiasis (5%); 5% were reported healthy. Twenty percent were hospitalized (24% for active tuberculosis and 21% for febrile illness [83% due to malaria]), and 13 died. Tuberculosis diagnoses and HIV/AIDS were reported from all regions, strongyloidiasis from most regions, and chronic hepatitis B virus (HBV) particularly in Asian immigrants. Regional diagnoses included schistosomiasis (Africa) and Chagas disease (Americas). CONCLUSIONS Eliciting a migration history is important at every encounter; migrant patients may have acute illness or chronic conditions related to exposure in their country of origin. Early detection and treatment, particularly for diagnoses related to tuberculosis, HBV, Strongyloides, and schistosomiasis, may improve outcomes. Policy makers should consider expansion of refugee screening programs to include all migrants.
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Cancer in older patients: New registrations of prostate, breast, colorectal and lung cancer in patients aged 65 and over in England, 1971–2009. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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