WorldWideScience

Sample records for included patient age

  1. Developing a patient and family research advisory panel to include people with significant disease, multimorbidity and advanced age.

    Science.gov (United States)

    Portalupi, Laura B; Lewis, Carmen L; Miller, Carl D; Whiteman-Jones, Kerry L; Sather, Kay A; Nease, Donald E; Matlock, Daniel D

    2017-06-01

    People who have experienced illness due to significant disease, multimorbidity and/or advanced age are high utilizers of the health care system. Yet this population has had little formal opportunity to participate in guiding the health care research agenda, and few mechanisms exist for researchers to engage this population in an efficient way. We describe the process of developing a standing patient and family advisory panel to incorporate this population's voice into research in the USA. The panel was created at the University of Colorado. Preliminary panel development consisted of a needs assessment, information gathering and participant recruitment. We collected feedback from researchers who consulted with the panel and from panel members in order to better understand the experience from the patient and family member perspective. The patient and family research advisory panel consists of eight advisors who have experience with significant disease, multimorbidity and/or advanced age, two physicians and a program manager. The panel meets every other month for 2 hours with the main purpose of advising diverse researchers on health care studies. People with significant disease, multimorbidity and/or advanced age represent a growing demographic in the USA, and their engagement in research is essential as the model of health care delivery moves from volume to value. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Development of a modified prognostic index for patients with aggressive adult T-cell leukemia-lymphoma aged 70 years or younger: possible risk-adapted management strategies including allogeneic transplantation.

    Science.gov (United States)

    Fuji, Shigeo; Yamaguchi, Takuhiro; Inoue, Yoshitaka; Utsunomiya, Atae; Moriuchi, Yukiyoshi; Uchimaru, Kaoru; Owatari, Satsuki; Miyagi, Takashi; Taguchi, Jun; Choi, Ilseung; Otsuka, Eiichi; Nakachi, Sawako; Yamamoto, Hisashi; Kurosawa, Saiko; Tobinai, Kensei; Fukuda, Takahiro

    2017-07-01

    Adult T-cell leukemia-lymphoma is a distinct type of peripheral T-cell lymphoma caused by human T-cell lymphotropic virus type I. Although allogeneic stem cell transplantation after chemotherapy is a recommended treatment option for patients with aggressive adult T-cell leukemia-lymphoma, there is no consensus about indications for allogeneic stem cell transplantation because there is no established risk stratification system for transplant eligible patients. We conducted a nationwide survey of patients with aggressive adult T-cell leukemia-lymphoma in order to construct a new, large database that includes 1,792 patients aged 70 years or younger with aggressive adult T-cell leukemia-lymphoma who were diagnosed between 2000 and 2013 and received intensive first-line chemotherapy. We randomly divided patients into two groups (training and validation sets). Acute type, poor performance status, high soluble interleukin-2 receptor levels (> 5,000 U/mL), high adjusted calcium levels (≥ 12 mg/dL), and high C-reactive protein levels (≥ 2.5 mg/dL) were independent adverse prognostic factors used in the training set. We used these five variables to divide patients into three risk groups. In the validation set, median overall survival for the low-, intermediate-, and high-risk groups was 626 days, 322 days, and 197 days, respectively. In the intermediate- and high-risk groups, transplanted recipients had significantly better overall survival than non-transplanted patients. We developed a promising new risk stratification system to identify patients aged 70 years or younger with aggressive adult T-cell leukemia-lymphoma who may benefit from upfront allogeneic stem cell transplantation. Prospective studies are warranted to confirm the benefit of this treatment strategy. Copyright© 2017 Ferrata Storti Foundation.

  3. Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of inducible paroxysmal supraventricular tachycardia without pre-excitation syndromes: A cohort study of 1960 patients included over 25 years

    Science.gov (United States)

    Brembilla-Perrot, Béatrice; Sellal, Jean Marc; Olivier, Arnaud; Villemin, Thibaut; Beurrier, Daniel; Vincent, Julie; Manenti, Vladimir; de Chillou, Christian; Bozec, Erwan

    2018-01-01

    Aim To investigate the influence of increasing age on clinical presentation, treatment and long-term outcome in patients with inducible paroxysmal supraventricular tachycardia (SVT) without pre-excitation syndromes. Methods Clinical and electrophysiological study (EPS) data, as well as long-term clinical outcome (mean follow-up 2.4±4.0 years) were collected in patients referred for regular tachycardia with inducible SVT during EPS without pre-excitation. Results Among 1960 referred patients, 301 patients (15.4%) were aged ≥70 (70–97). In this subset, anticoagulants were prescribed in 49 patients following an erroneous diagnosis of atrial tachycardia and 14 were previously erroneously diagnosed with ventricular tachycardia because of wide QRS. Ablation was performed more frequently in patients ≥70 despite more frequent failure and complications. During follow-up, higher risks of AF, stroke, pacemaker implantation and death were observed in patients ≥70 whereas SVT recurrences were similar in both age groups. In multivariable analysis, age ≥70 was independently associated with higher risks of SVT-related adverse events prior to ablation (OR = 1.93, 1.41–2.62, pSVT without pre-excitation syndromes are elderly. These patients exhibit higher risks of erroneous tachycardia diagnosis prior to EPS as well as failure and/or complication of ablation, but similar risk of SVT recurrence. These results support performing transesophageal EPS in most patients and intracardiac EPS in selected patients. EPS may furthermore prove useful in elderly patients with regular tachycardia, mainly by avoiding treatment based on an erroneous diagnosis. PMID:29304037

  4. Extending PSA models including ageing and asset management - 15291

    International Nuclear Information System (INIS)

    Martorell, S.; Marton, I.; Carlos, S.; Sanchez, A.I.

    2015-01-01

    This paper proposes a new approach to Ageing Probabilistic Safety Assessment (APSA) modelling, which is intended to be used to support risk-informed decisions on the effectiveness of maintenance management programs and technical specification requirements of critical equipment of Nuclear Power Plants (NPP) within the framework of the Risk Informed Decision Making according to R.G. 1.174 principles. This approach focuses on the incorporation of not only equipment ageing but also effectiveness of maintenance and efficiency of surveillance testing explicitly into APSA models and data. This methodology is applied to a motor-operated valve of the auxiliary feed water system (AFWS) of a PWR. This simple example of application focuses on a critical safety-related equipment of a NPP in order to evaluate the risk impact of considering different approaches to APSA and the combined effect of equipment ageing and maintenance and testing alternatives along NPP design life. The risk impact of several alternatives in maintenance strategy is discussed

  5. Prospective validation of criteria, including age, for safe, nonsurgical management of the ruptured spleen

    International Nuclear Information System (INIS)

    Smith, J.S. Jr.; Wengrovitz, M.A.; DeLong, B.S.

    1992-01-01

    One hundred twelve cases of blunt splenic rupture were prospectively entered (October 1987-October 1991) into surgical or nonsurgical management groups using these criteria for the nonsurgical group: hemodynamic stability-age less than 55 years-CT scan appearance of grade I, II, or III injury-absence of concomitant injuries precluding abdominal assessment+absence of other documented abdominal injuries. All ages were included and AAST injury scaling was used. Patients were grouped from the trauma room. The surgical treatment group included 66 patients (49 splenectomies, 17 splenorraphies). These patients were generally older and more severely injured, required more transfused blood, and a longer ICU stay. The nonsurgical group included 46 patients with 33 older than 14 years. There were 3 patients over the age of 55 years inappropriately included in this group, and nonsurgical therapy failed in all three. Statistical analysis (chi 2) showed that more splenic injuries were observed and more spleens were saved with these criteria applied prospectively compared with a previous retrospective series in the same institution. The series had a success rate of 93%, and validates the criteria used for safe, nonsurgical management of the ruptured spleen and adds a new criterion: a maximum age of 55 years

  6. Prospective validation of criteria, including age, for safe, nonsurgical management of the ruptured spleen

    Energy Technology Data Exchange (ETDEWEB)

    Smith, J.S. Jr.; Wengrovitz, M.A.; DeLong, B.S. (Pennsylvania State University College of Medicine, Hershey (United States))

    1992-09-01

    One hundred twelve cases of blunt splenic rupture were prospectively entered (October 1987-October 1991) into surgical or nonsurgical management groups using these criteria for the nonsurgical group: hemodynamic stability-age less than 55 years-CT scan appearance of grade I, II, or III injury-absence of concomitant injuries precluding abdominal assessment+absence of other documented abdominal injuries. All ages were included and AAST injury scaling was used. Patients were grouped from the trauma room. The surgical treatment group included 66 patients (49 splenectomies, 17 splenorraphies). These patients were generally older and more severely injured, required more transfused blood, and a longer ICU stay. The nonsurgical group included 46 patients with 33 older than 14 years. There were 3 patients over the age of 55 years inappropriately included in this group, and nonsurgical therapy failed in all three. Statistical analysis (chi 2) showed that more splenic injuries were observed and more spleens were saved with these criteria applied prospectively compared with a previous retrospective series in the same institution. The series had a success rate of 93%, and validates the criteria used for safe, nonsurgical management of the ruptured spleen and adds a new criterion: a maximum age of 55 years.

  7. Endodontics and the ageing patient.

    Science.gov (United States)

    Johnstone, M; Parashos, P

    2015-03-01

    Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintaining the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall health and longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain a prosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions from being safely performed. The technical goals of endodontic treatment in the elderly are the same as those for younger patients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for the clinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing, treatment planning and treating the elderly endodontic patient. © 2015 Australian Dental Association.

  8. Appraisal Of Quality Of Life Of Diabetic Patients, Including Life ...

    African Journals Online (AJOL)

    Appraisal Of Quality Of Life Of Diabetic Patients, Including Life Expectancy. ... of long-term complications, development of short-term complications, and physical symptoms and lifestyle changes resulting from the demands of the diabetic ... Key words: Type 2 Diabetes, quality of life, life expectancy, diabetic complications.

  9. Including patients’ perspectives in patient information leaflets: A polyocular approach

    DEFF Research Database (Denmark)

    Fage-Butler, Antoinette Mary

    2013-01-01

    Existing research reveals that patients’ perspectives are missing from mandatory patient information leaflets (PILs). At the same time, there is overwhelming consensus that they should be included in this genre, and a corresponding need for potential approaches to tackle this problem. This paper ...

  10. SPECT of aged backache patients

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Shigehiko; Nishikimi, Junzo; Mizuno, Naokado; Watanabe, Kentaro; Kondo, Masaki; Ozaki, Satoshi; Urasaki, Tetsuya; Muro, Toshiyuki [Prefectural Tajimi Hospital, Gifu (Japan)

    1995-12-01

    Single photon emission computed tomography (SPECT) using {sup 99m}Tc-HMDP was performed on 53 middle-aged or elderly patients (male 20, female, 33; age range, 40-80 years old) with lumbago, i.e., 25 patients with lumbar spondylosis, 15 with lumbar degenerative spondylolisthesis, 4 with spondylolytic spondylolisthesis, 3 with compression fracture, 3 with pulurent spondylitis, 2 with spondylous osteoporosis, and 1 with spinal osteodesmosis. {sup 99m}Tc-HMDP (740 MBq) was intravenously injected and regular SPECT was performed at 3 hours. Gamma camera was performed for about 10 seconds with 5deg intervals, and 36 steps (180deg) of collection was completed after about 6 minutes. The radioisotope accumulation, the presence or absence of sthenia, and its site were evaluated. Forty-seven (88.7%) patients showed excessive accumulation, i.e., 40 (75.5%) in peripheral vertebral osteophyte, 31 (58.5%) in vertebral articulations, and 10 (18.9%) in whole vertebral body. Significantly increased bilateral excessive accumulation was admitted in the vertebral articulations of sliding disc in degenerative spondylolisthesis. SPECT is considered useful in understanding the pathophysiology of degenerative lumber diseases. (S.Y.).

  11. Patient information comes of age.

    Science.gov (United States)

    Murphy, Jeannette

    2017-12-01

    This virtual issue (VI) has been assembled to coincide with the 8th Annual Patient Information Conference 2013 organised by the UK Patient Information Forum (PiF). The conference theme 'Information and support - a service in its own right' is a response to policy documents and initiatives in both Scotland and England which signal the coming of age of patient/consumer information. The VI consists of a collection of open access articles and addresses the question 'What can health science librarians do to ensure that the public are able to find, appraise and use health information?' This material provides research evidence, and examples of the types of initiatives librarians have undertaken to make information a health and care service in its own right. Two recurrent messages are that health science librarians need to form partnerships with healthcare providers and they have a role to play in improving health literacy skills. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

  12. Microscopic age determination of human skeletons including an unknown but calculable variable

    DEFF Research Database (Denmark)

    Wallin, Johan Albert; Tkocz, Izabella; Kristensen, Gustav

    1994-01-01

    estimation, which includes the covariance matrix of four single equation residuals, improves the accuracy of age determination. The standard deviation, however, of age prediction remains 12.58 years. An experimental split of the data was made in order to demonstrate that the use of subgroups gives a false...

  13. Age correction in monitoring audiometry: method to update OSHA age-correction tables to include older workers.

    Science.gov (United States)

    Dobie, Robert A; Wojcik, Nancy C

    2015-07-13

    The US Occupational Safety and Health Administration (OSHA) Noise Standard provides the option for employers to apply age corrections to employee audiograms to consider the contribution of ageing when determining whether a standard threshold shift has occurred. Current OSHA age-correction tables are based on 40-year-old data, with small samples and an upper age limit of 60 years. By comparison, recent data (1999-2006) show that hearing thresholds in the US population have improved. Because hearing thresholds have improved, and because older people are increasingly represented in noisy occupations, the OSHA tables no longer represent the current US workforce. This paper presents 2 options for updating the age-correction tables and extending values to age 75 years using recent population-based hearing survey data from the US National Health and Nutrition Examination Survey (NHANES). Both options provide scientifically derived age-correction values that can be easily adopted by OSHA to expand their regulatory guidance to include older workers. Regression analysis was used to derive new age-correction values using audiometric data from the 1999-2006 US NHANES. Using the NHANES median, better-ear thresholds fit to simple polynomial equations, new age-correction values were generated for both men and women for ages 20-75 years. The new age-correction values are presented as 2 options. The preferred option is to replace the current OSHA tables with the values derived from the NHANES median better-ear thresholds for ages 20-75 years. The alternative option is to retain the current OSHA age-correction values up to age 60 years and use the NHANES-based values for ages 61-75 years. Recent NHANES data offer a simple solution to the need for updated, population-based, age-correction tables for OSHA. The options presented here provide scientifically valid and relevant age-correction values which can be easily adopted by OSHA to expand their regulatory guidance to

  14. Including patient preferences and applying guideline recommendations: a conflict?

    NARCIS (Netherlands)

    Brabers, A.; Esch, T.E.M. van; Groenewegen, P.P.; Hek, K.; Mullenders, P.; Dijk, L. van; Jong, J.D. de

    2017-01-01

    Background: One perceived barrier to adherence to guidelines is the existence of patient preferences which may conflict with them. We examined whether patient preferences influence the prescription of antibiotics in general practice, and how this affects adherence to guidelines. We hypothesised that

  15. [Combined treatment including ozonotherapy of patients with viral hepatitis ].

    Science.gov (United States)

    Chernyshev, A L; Filimonov, R M; Karasev, A V; Neronov, V A; Maksimov, V A

    2008-01-01

    Patients with viral hepatitis have disturbances of biliary tract motor function with the tendency to hypertonus of Oddi's sphincter, changes of physic-colloid properties of bile with increase in density of gall and hepatic bile, pH shift to acid side, microlites formation, disorders in biochemical composition of bile. More than 80% patients have biliar insufficiency. According to our data, with the purpose to correct of disturbances of hepatic exocrine function in patients with viral hepatitis and to prevent stone formation, it is reasonable to use together with antiviral therapy also intravenous injection of ozonated physiological solution and preparations of ursodeoxycholic acid.

  16. Microscopic age determination of human skeletons including an unknown but calculable variable

    DEFF Research Database (Denmark)

    Wallin, Johan Albert; Tkocz, Izabella; Kristensen, Gustav

    1994-01-01

    estimation, which includes the covariance matrix of four single equation residuals, improves the accuracy of age determination. The standard deviation, however, of age prediction remains 12.58 years. An experimental split of the data was made in order to demonstrate that the use of subgroups gives a false...... impression of higher precision of age determination. The present study demonstrates that determination of age at death through microscopic bone morphometry is considerably less precise than generally stated in the literature.......Histomorphometric semi-automatic image analysis of cross-sections of 101 femoral diaphyseal bone sections were performed to reconsider to what degree osteon remodelling in the outer cortex is affected by age. The data were analysed statistically using the generalized least squares method. The model...

  17. Canine cancer patients are included in translational research

    DEFF Research Database (Denmark)

    Børresen, Betina; Clausen, Malene Martini; Hansen, Anders Elias

    2014-01-01

    Cancer bearing dogs represent a unique clinical cancer model with a direct potential for accelerating translation into human patients. A research collaboration between the veterinary and human medical facilities at Copenhagen University and Rigshospitalet has taken offset in this. Canine cancer...

  18. Should metformin be included in fertility treatment of PCOS patients?

    Science.gov (United States)

    Haas, Jigal; Bentov, Yaakov

    2017-03-01

    Metformin, a drug developed for the treatment of patients with type II diabetes, has become commonly prescribed medication for PCOS patients. Initially, metformin was prescribed for patients with impaired glucose tolerance at the pre conception period, however more recently its use was expanded to many of the PCOS patients and for the whole duration of pregnancy. Several studies examining the effects of Metformin during pregnancy reported a lower pregnancy loss, reduced gestational diabetes and no increased risk for birth defects, however, several more recent studies also raised concerns about its safe use. The therapeutic effect of metformin stems from its ability to inhibit the action of the first complex of the electron transport resulting in reduced ATP production. At the initial stages of embryo development, the only source of ATP is the mitochondrial electron transport chain. Lowering ATP production at the critical stage of early embryo development may impair oocyte maturation and embryo development as well as reprogram the metabolic characteristics of the offspring. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Dysphagia in the aging cardiovascular patient.

    Science.gov (United States)

    Mouawad, Nicolas J; Ahluwalia, Guneet S

    2017-11-01

    Dysphagia is not a normal process of aging. Dysphagia aortica refers to external compression of the distal esophagus from an enlarged, ectatic or aneurysmal thoracic aorta leading to mechanical obstruction of the food bolus. It is a rare cause of dysphagia seen in the older population and predisposing risk factors include female gender, short stature, and kyphosis. We selected the case of an octogenarian with a significant cardiovascular history presenting with dysphagia where the diagnosis of dysphagia aortica was delayed but ultimately identified. Although rare, we urge and remind a high index of suspicion for clinicians treating this patient population.

  20. Aging and physiological changes of the kidneys including changes in glomerular filtration rate.

    Science.gov (United States)

    Musso, Carlos G; Oreopoulos, Dimitrios G

    2011-01-01

    In addition to the structural changes in the kidney associated with aging, physiological changes in renal function are also found in older adults, such as decreased glomerular filtration rate, vascular dysautonomia, altered tubular handling of creatinine, reduction in sodium reabsorption and potassium secretion, and diminished renal reserve. These alterations make aged individuals susceptible to the development of clinical conditions in response to usual stimuli that would otherwise be compensated for in younger individuals, including acute kidney injury, volume depletion and overload, disorders of serum sodium and potassium concentration, and toxic reactions to water-soluble drugs excreted by the kidneys. Additionally, the preservation with aging of a normal urinalysis, normal serum urea and creatinine values, erythropoietin synthesis, and normal phosphorus, calcium and magnesium tubular handling distinguishes decreased GFR due to normal aging from that due to chronic kidney disease. Copyright © 2011 S. Karger AG, Basel.

  1. Reassessing the NTCTCS Staging Systems for Differentiated Thyroid Cancer, Including Age at Diagnosis

    Science.gov (United States)

    McLeod, Donald S.A.; Jonklaas, Jacqueline; Brierley, James D.; Ain, Kenneth B.; Cooper, David S.; Fein, Henry G.; Haugen, Bryan R.; Ladenson, Paul W.; Magner, James; Ross, Douglas S.; Skarulis, Monica C.; Steward, David L.; Xing, Mingzhao; Litofsky, Danielle R.; Maxon, Harry R.

    2015-01-01

    Background: Thyroid cancer is unique for having age as a staging variable. Recently, the commonly used age cut-point of 45 years has been questioned. Objective: This study assessed alternate staging systems on the outcome of overall survival, and compared these with current National Thyroid Cancer Treatment Cooperative Study (NTCTCS) staging systems for papillary and follicular thyroid cancer. Methods: A total of 4721 patients with differentiated thyroid cancer were assessed. Five potential alternate staging systems were generated at age cut-points in five-year increments from 35 to 70 years, and tested for model discrimination (Harrell's C-statistic) and calibration (R2). The best five models for papillary and follicular cancer were further tested with bootstrap resampling and significance testing for discrimination. Results: The best five alternate papillary cancer systems had age cut-points of 45–50 years, with the highest scoring model using 50 years. No significant difference in C-statistic was found between the best alternate and current NTCTCS systems (p = 0.200). The best five alternate follicular cancer systems had age cut-points of 50–55 years, with the highest scoring model using 50 years. All five best alternate staging systems performed better compared with the current system (p = 0.003–0.035). There was no significant difference in discrimination between the best alternate system (cut-point age 50 years) and the best system of cut-point age 45 years (p = 0.197). Conclusions: No alternate papillary cancer systems assessed were significantly better than the current system. New alternate staging systems for follicular cancer appear to be better than the current NTCTCS system, although they require external validation. PMID:26203804

  2. Age Estimation for Dental Patients Using Orthopantomographs

    Science.gov (United States)

    Karaarslan, Bekir; Karaarslan, Emine Sirin; Ozsevik, Abdul Semih; Ertas, Ertan

    2010-01-01

    Objectives: The aim of this study was to conduct age estimates for dental patients using orthopantomographs (OPGs). The OPGs were selected by an independent author with respect to criteria and evaluated by two independent dentists. The results were compared to chronologic ages. The reliability of the estimates, concurrently made by the two independent dentists using OPGs, was also evaluated. Methods: In this retrospective study, the OPGs of 238 Turkish individuals of known chronological age, ranging from 1 to 60 years, were measured. Patients were then classified. Radiographs were evaluated by two independent dentists and age estimation was achieved according to the decades. Results: The truest age estimates made by the dentists were in the 1–10 years age range (89.6%), the most inaccurate age estimates were in the 41–50 years age range (41.7%). Results indicate that the accuracy of age estimation diminishes with age. Conclusions: Despite the variations related to the practitioners, in this study, there were no significant differences in age estimations between the two participant practitioners. Age estimation through evaluating OPGs was the most accurate in the first decade and the least in fourth decade. It can be concluded that OPGs are not adequate for accurate age estimation. PMID:20922158

  3. Minimally invasive percutaneous nephrolithotomy in preschool age children with kidney calculi (including stones induced by melamine-contaminated milk powder).

    Science.gov (United States)

    Yan, Xiang; Al-Hayek, Samih; Gan, Weidong; Zhu, Wei; Li, Xiaogong; Guo, Hongqian

    2012-10-01

    This study was undertaken to assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mini-PCNL) using ureteroscope and pneumatic intracorporeal lithotripsy in preschool age children with kidney calculi. We studied 27 renal units in 20 patients of preschool age (≤ 6 years) who underwent mini-PCNL at our institute. The mean age was 42.6 months (range 14-68 months). The average stone burden was 1.85 cm (range 0.9-2.8 cm). Eight patients aged 14 to 58 months had been exposed to melamine-tainted powdered formula. The mini-PCNL was performed with an X-ray-guided peripheral puncture. Minimal tract dilatation was undertaken to fit a 14-16 Fr peel-away sheath. Ureteroscope and pneumatic intracorporeal lithotripsy were used to fragment the stones. Complete clearance was achieved in 23 renal units (85.2 %) with mini-PCNL monotherapy. This has increased to 92.6 % after adjunctive ESWL. The average fall in hemoglobin was 1.28 g/dL. None of the patients required blood transfusion. The median length of hospital stay was 8.2 days. Patients were followed up every 6 months for 2 years. There has been only one recurrence of stone and no long-term complications. Mini-PCNL is a effective treatment for pediatric kidney stones refractory to extracorporeal shock wave lithotripsy, including stones induced by melamine-contaminated milk powder. The "mini-PCNL" technique, which uses ureteroscope and pneumatic intracorporeal lithotripsy, is a safe and feasible modality for treating renal calculi in preschool age children.

  4. Age correction in monitoring audiometry: method to update OSHA age-correction tables to include older workers

    OpenAIRE

    Dobie, Robert A; Wojcik, Nancy C

    2015-01-01

    Objectives The US Occupational Safety and Health Administration (OSHA) Noise Standard provides the option for employers to apply age corrections to employee audiograms to consider the contribution of ageing when determining whether a standard threshold shift has occurred. Current OSHA age-correction tables are based on 40-year-old data, with small samples and an upper age limit of 60?years. By comparison, recent data (1999?2006) show that hearing thresholds in the US population have improved....

  5. Retrospective cohort study shows that the risks for retinopathy of prematurity included birth age and weight, medical conditions and treatment.

    Science.gov (United States)

    Ali, Aliaa A; Gomaa, Nancy A S; Awadein, Ahmed R; Al-Hayouti, Huda H; Hegazy, Ahmed I

    2017-12-01

    This study described the characteristics and risk factors of neonates who developed retinopathy of prematurity (ROP) and severe treatable ROP in two Egyptian neonatal intensive care units (NICUs). This retrospective cohort study comprised 108 preterm neonates who were screened for ROP after being admitted to the two NICUs run by Cairo University Hospital from June 2014 to May 2015. Patients were examined using digital fundus photography and indirect ophthalmoscopy was performed if ROP was detected. Retinopathy of prematurity occurred in 75 patients. Late-onset sepsis, ventilation and hypercapnia were independently associated with ROP. Patients who developed severe treatable ROP had a younger gestational age (GA) than patients who did not develop ROP or developed mild or moderate ROP (29 weeks, range 27-33 weeks versus 32 weeks, range 28-36 weeks, p = 0.002) and a lower birthweight (1200 g, range 980-1590 g versus 1460 g, range 770-2475 g, p = 0.029). The risk factors associated with severe treatable ROP included the duration of admission, the duration of incubator oxygen, late-onset sepsis, intraventricular haemorrhage, total parenteral nutrition and the duration of caffeine citrate therapy. This study showed that the risks for ROP were wide-ranging and included GA and weight, medical conditions and treatment. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  6. Gender differences in episodic memory and visual working memory including the effects of age.

    Science.gov (United States)

    Pauls, Franz; Petermann, Franz; Lepach, Anja Christina

    2013-01-01

    Analysing the relationship between gender and memory, and examining the effects of age on the overall memory-related functioning, are the ongoing goals of psychological research. The present study examined gender and age group differences in episodic memory with respect to the type of task. In addition, these subgroup differences were also analysed in visual working memory. A sample of 366 women and 330 men, aged between 16 and 69 years of age, participated in the current study. Results indicate that women outperformed men on auditory memory tasks, whereas male adolescents and older male adults showed higher level performances on visual episodic and visual working memory measures. However, the size of gender-linked effects varied somewhat across age groups. Furthermore, results partly support a declining performance on episodic memory and visual working memory measures with increasing age. Although age-related losses in episodic memory could not be explained by a decreasing verbal and visuospatial ability with age, women's advantage in auditory episodic memory could be explained by their advantage in verbal ability. Men's higher level visual episodic memory performance was found to result from their advantage in visuospatial ability. Finally, possible methodological, biological, and cognitive explanations for the current findings are discussed.

  7. Students' Learning Experiences from Didactic Teaching Sessions Including Patient Case Examples as Either Text or Video

    DEFF Research Database (Denmark)

    Pedersen, Kamilla; Moeller, Martin Holdgaard; Paltved, Charlotte

    2017-01-01

    OBJECTIVES: The aim of this study was to explore medical students' learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students....... Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients. CONCLUSION: The format of patient cases included in teaching may have a substantial impact...

  8. Dental aesthetics and the aging patient.

    Science.gov (United States)

    Davis, Betsy K

    2006-05-01

    Those over the age of 65 years old and the "baby boomers" regard oral health, including oral/dental/facial aesthetics, as part of their overall health and wellness. Over 65% of discretionary wealth in the United States belongs to those over the age of 50. In many instances, they have had to deny their own needs for those of their families and are now at a point where their dental issues can finally be addressed. Aesthetic dentistry offers the opportunity to reverse the signs of aging and restore a youthful appearance. A smile can be the most eye-catching feature of a face and therefore should blend in or harmonize with facial appearance. Advances in aesthetic dentistry, such as porcelain veneers, bonding, periodontal surgery, and dental implants, have shown great efficacy and reliability when used properly. Aesthetic dentistry offers the opportunity for the aged population to have a more youthful, harmonious smile with improved function and optimum oral health.

  9. Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma.

    LENUS (Irish Health Repository)

    Dennedy, Michael Conall

    2012-02-01

    Approximately 7% of women of reproductive age manifest polycystic ovary syndrome (PCOS) and <0.5% have other causes of hyperandrogenism including congenital adrenal hyperplasia (CAH), androgen-secreting tumour of an ovary or an adrenal gland, Cushing\\'s syndrome or hyperthecosis. The presence of features atypical of PCOS should prompt more extensive evaluation than that usually undertaken. Features atypical of PCOS include the onset of symptoms outside the decade of 15-25 years, rapid progression of symptoms, the development of virilization and a serum testosterone concentration in excess of twice the upper limit of the reference range. Ethnic background, family history and specific clinical findings, e.g. Cushingoid appearance, may inform a focused investigation. Otherwise, patients should have measurement of 17-hydroxyprogesterone (17-OHP) under basal conditions ideally in the early morning, and if abnormal, they should have measurement of 17-OHP one hour after the administration of synthetic ACTH, 250 microg i.v., to screen for CAH, which is present in approximately 2% of hyperandrogenic patients. The overnight cortisol suppression test employing 1 mg dexamethasone at midnight is a sensitive test for Cushing\\'s syndrome. Coronal tomographic (CT) scanning of the adrenals and transvaginal ultrasonography of the ovaries are the investigations of choice when screening for tumours in these organs. Less frequently required is catheterization and sampling from both adrenal and ovarian veins, which is a technically demanding procedure with potential complications which may provide definitive diagnostic information not available from other investigations. Illustrative case reports highlight some complexities in the investigation of hyperandrogenic patients presenting with features atypical of PCOS and include only the ninth case report of an androgen-secreting ovarian teratoma.

  10. Tell me your life: including life stories in an adult development and aging course.

    Science.gov (United States)

    Villar, Feliciano; Celdran, Montserrat; Fabà, Josep

    2014-01-01

    The goals of this study were to determine the learning impact of an assignment that consisted of interviewing and analyzing older people's life stories, and to explore how the assignment was evaluated by students. Participants in the study were 122 first-year social education students enrolled in an adult development and aging course. They evaluated the assignment using an eight-adjective questionnaire and were asked about the benefits of the task. Their answers to the questionnaire were then reviewed using content analysis. The results indicated that marks on the life story assignment predicted marks on an exam about basic course concepts. Students considered that the assignment was interesting, useful, and integrated into the course, although most of them also thought that it was very time-consuming. They identified benefits related to the explicit goals of the course (improvement in the learning of developmental concepts, the acquisition of research-related skills, and the deactivation of aging stereotypes) and personal, growth-related benefits. The authors discuss the difficulties posed by the assignment and its usefulness as a complement to more traditional, lecture-based teaching methods in adult development and aging courses.

  11. Enduring effects of severe developmental adversity, including nutritional deprivation, on cortisol metabolism in aging Holocaust survivors.

    Science.gov (United States)

    Yehuda, Rachel; Bierer, Linda M; Andrew, Ruth; Schmeidler, James; Seckl, Jonathan R

    2009-06-01

    In animal models, early life exposure to major environmental challenges such as malnutrition and stress results in persisting cardiometabolic, neuroendocrine and affective effects. While such effects have been associated with pathogenesis, the widespread occurrence of 'developmental programming' suggests it has adaptive function. Glucocorticoids may mediate 'programming' and their metabolism is known to be affected by early life events in rodents. To examine these relationships in humans, cortisol metabolism and cardiometabolic disease manifestations were examined in Holocaust survivors in relation to age at exposure and affective dysfunction, notably lifetime posttraumatic stress disorder (PTSD). Fifty-one Holocaust survivors and 22 controls without Axis I disorder collected 24-h urine samples and were evaluated for psychiatric disorders and cardiometabolic diagnoses. Corticosteroids and their metabolites were assayed by gas chromatography-mass spectroscopy (GC-MS); cortisol was also measured by radioimmunoassay (RIA). Holocaust survivors showed reduced cortisol by RIA, and decreased levels of 5alpha-tetrahydrocortisol (5alpha-THF) and total glucocorticoid production by GC-MS. The latter was associated with lower cortisol metabolism by 5alpha-reductase and 11beta-hydroxysteroid dehydrogenase (11beta-HSD) type-2. The greatest decrements were associated with earliest age of Holocaust exposure and less severe PTSD symptomatology. Cardiometabolic manifestations were associated with decreased 11beta-HSD-2 activity. In controls, 5alpha-reductase was positively associated with trauma-related symptoms (i.e., to traumatic exposures unrelated to the Holocaust). Extreme malnutrition and related stress during development is associated with long-lived alterations in specific pathways of glucocorticoid metabolism. These effects may be adaptive and link with lower risks of cardiometabolic and stress-related disorders in later life.

  12. Prenatal Exposure to Organohalogens, Including Brominated Flame Retardants, Influences Motor, Cognitive, and Behavioral Performance at School Age

    NARCIS (Netherlands)

    Roze, Elise; Meijer, Lisethe; Bakker, Attie; Van Braeckel, Koenraad N. J. A.; Sauer, Pieter J. J.; Bos, Arend F.

    2009-01-01

    BACKGROUND: Organohalogen compounds (OHCs) are known to have neurotoxic effects on the developing brain. OBJECTIVE: We investigated the influence of prenatal exposure to OHCs, including brominated flame retardants, on motor, cognitive, and behavioral outcome in healthy children of school age.

  13. Dementia in middle-aged patients with schizophrenia.

    Science.gov (United States)

    Nicolas, Gaël; Beherec, Laurène; Hannequin, Didier; Opolczynski, Gaëlle; Rothärmel, Maud; Wallon, David; Véra, Pierre; Martinaud, Olivier; Guillin, Olivier; Campion, Dominique

    2014-01-01

    Although numerous studies have assessed cognitive dysfunction in patients with schizophrenia, very few have focused on the diagnosis of dementia. Our objectives were to accurately diagnose dementia in a cohort of middle-aged patients with schizophrenia and to assess the type of dementia. 96 patients with schizophrenia (46 inpatients and 50 outpatients), aged 50 to 70 years, underwent a psychiatric, neurological, and neuropsychological evaluation at baseline and after a 20-month follow-up. We established a 3-step procedure: 1) diagnose dementia according to the DSM-IV criteria, using the Mattis Dementia Rating and Activities of Daily Living scales; 2) characterize dementia using brain imaging, perfusion by 99mTc-ECD-SPECT and laboratory tests including Alzheimer's disease cerebrospinal fluid biomarkers; and 3) search for genetic determinants. Fourteen patients fulfilled the diagnostic criteria of dementia. Four were diagnosed with possible or probable behavioral-variant frontotemporal dementia (bvFTD), two with probable Alzheimer's disease, two with probable vascular dementia (including one due to CADASIL), one with CNS inflammatory disease, and six could not be fully characterized. The diagnosis of dementia in middle-aged patients with schizophrenia is challenging but possible, using a multistep procedure. The most frequent condition, bvFTD, could reflect the presence of an evolutive neurodegenerative process in some patients.

  14. Eleven leaflets for patients and visitors on healthcare associated infections - including accessible formats

    OpenAIRE

    Public Health Agency

    2015-01-01

    The following suite of nine leaflets for patients and visitors to healthcare settings include information on healthcare associated infections, C. difficile, MRSA, norovirus, scabies, ESBL resistant bacteria, multi-drug resistant bacteria and laundry and hand hygiene guidance.

  15. The dosimetric impact of including the patient table in CT dose estimates

    Science.gov (United States)

    Nowik, Patrik; Bujila, Robert; Kull, Love; Andersson, Jonas; Poludniowski, Gavin

    2017-12-01

    The purpose of this study was to evaluate the dosimetric impact of including the patient table in Monte Carlo CT dose estimates for both spiral scans and scan projection radiographs (SPR). CT scan acquisitions were simulated for a Siemens SOMATOM Force scanner (Siemens Healthineers, Forchheim, Germany) with and without a patient table present. An adult male, an adult female and a pediatric female voxelized phantom were simulated. The simulated scans included tube voltages of 80 and 120 kVp. Spiral scans simulated without a patient table resulted in effective doses that were overestimated by approximately 5% compared to the same simulations performed with the patient table present. Doses in selected individual organs (breast, colon, lung, red bone marrow and stomach) were overestimated by up to 8%. Effective doses from SPR acquired with the x-ray tube stationary at 6 o’clock (posterior-anterior) were overestimated by 14-23% when the patient table was not included, with individual organ dose discrepancies (breast, colon, lung red bone marrow and stomach) all exceeding 13%. The reference entrance skin dose to the back were in this situation overestimated by 6-15%. These results highlight the importance of including the patient table in patient dose estimates for such scan situations.

  16. Age

    Science.gov (United States)

    ... Resources About Policymakers Media ASA Member Toolkit Risks Age Explore this page: Age Do anesthesia risks increase ... can you reduce anesthesia risks in older patients? Age Age may bring wisdom but it also brings ...

  17. Colonoscopic evaluation of middle aged patients with altered bowel habits

    International Nuclear Information System (INIS)

    Bhatti, M.A.; Kashif, M.A.; Imran, M.

    2004-01-01

    Objective: To determine the frequency of colorectal carcinoma in-patients above 40 years of age presenting with altered bowel habits by colonoscopy. Patients and Methods: A group of 50 consecutive cases presenting with altered bowel habits meeting the inclusion and exclusion criteria were included in the study. History and physical examination were recorded on a specifically designed proforma. Colonoscopy was done in these patients and any abnormality found was reported and biopsy specimen taken and sent for histopathology. Results: A total number of 17 patients presenting with altered bowel habits were found to be suffering from colorectal carcinoma by colonoscopy. Among these in 30% the lesion was in the rectum , in 9% the lesion was in the sigmoid colon, 6% in the descending colon, 4% at the splenic flexure, 5% in the transverse colon, in 16% the lesion was found at the hepatic flexure and in 30% the lesion was in the ascending colon and caecum. Conclusion: Frequency of colorectal carcinoma is high in-patients above 40 years of age who presenting with altered bowel habits. They should be investigated preferably by means of colonoscopy which is the most complete method of investigation and diagnostic procedure of choice in patients with a clinical suspicion of colorectal carcinoma.(author)

  18. The management of hypogonadism in aging male patients.

    Science.gov (United States)

    Sharma, Vishwamitra; Perros, Petros

    2009-01-01

    This article focuses on the evaluation and management of hypogonadism in aging male patients in the light of recent guidelines. The benefits of treating severe hypogonadism resulting from identifiable pituitary or primary gonadal disease are well established. Milder forms of hypogonadism in the aging male, known as andropause, are common, and constitute an expanding area of clinical interest and research. Several studies indicate that testosterone replacement therapy may produce a wide range of benefits for men with hypogonadism, including improvement in libido, bone density, muscle mass, body composition, mood, and cognition. Currently available data are insufficient to permit a definitive verdict on the balance between risks and benefits of testosterone replacement therapy in aging males.

  19. CHARACTERISTICS OF PATIENTS WITH CEREBRAL STROKE OR TRANSIENT ISCHEMIC ATTACK, INCLUDED INTO THE LIS-2 REGISTER (LYUBERTSY STUDY OF MORTALITY IN PATIENTS AFTER STROKE

    Directory of Open Access Journals (Sweden)

    S. Yu. Martsevich

    2015-01-01

    Full Text Available Aim. To provide final data on the three-year period of the inclusion of patients; to give most accurate "portrait" of patients hospitalized with a brain stroke within the framework of the LIS-2 register (Lyubertsy study of mortality in patients after stroke.Material and methods. All patients (n=960 admitted to the Lyubertsy district hospital №2 with stroke for the period from 01.2009 to 12.2011 were included into the study.Results. Men accounted for 37.5%, women - 62.5%, mean age was 71.1±9.8 years. The history of hypertension was present in 833 patients (86.8%, atrial fibrillation in 252 (26.8% patients, 199 (20.7% patients had previously undergone stroke. In-hospital mortality was 21.6% (207 patients had died; mean age 72.9±9.8 years. Low frequency of the antihypertensive therapy (34.5%, lipid-lowering therapy (0.7%, antiplatelet agents (5.7%, anticoagulation therapy prescription in patients with atrial fibrillation was detected.Conclusion. Insufficient assignment of drugs with a proven effect on the prognosis in patients with risk factors prior to the development of the reference stroke draws attention. High incidence of recurrent strokes indicates an underactive secondary prevention.

  20. Risk Factor Analysis for AKI Including Laboratory Indicators: a Nationwide Multicenter Study of Hospitalized Patients

    Directory of Open Access Journals (Sweden)

    Sasa Nie

    2017-10-01

    Full Text Available Background/Aims: Risk factor studies for acute kidney injury (AKI in China are lacking, especially those regarding non-traditional risk factors, such as laboratory indicators. Methods: All adult patients admitted to 38 tertiary and 22 secondary hospitals in China in any one month between July and December 2014 were surveyed. AKI patients were screened according to the Kidney Disease: Improving Global Outcomes’ definition of AKI. Logistic regression was used to analyze the risk factors for AKI, and Cox regression was used to analyze the risk of in-hospital mortality for AKI patients; additionally, a propensity score analysis was used to reconfirm the risk factors among laboratory indicators for mortality. Results: The morbidity of AKI was 0.97%. Independent risk factors for AKI were advancing age, male gender, hypertension, and chronic kidney disease. All-cause mortality was 16.5%. The predictors of mortality in AKI patients were advancing age, tumor, higher uric acid level and increases in Acute Physiologic Assessment and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. The hazard ratio (HR for mortality with uric acid levels > 9.1 mg/dl compared with ≤ 5.2 mg/dl was 1.78 (95% CI: 1.23 to 2.58 for the AKI patients as a group, and was 1.73 (95% CI: 1.24 to 2.42 for a propensity score-matched set. Conclusion: In addition to traditional risk factors, uric acid level is an independent predictor of all-cause mortality after AKI.

  1. Prenatal Exposure to Organohalogens, Including Brominated Flame Retardants, Influences Motor, Cognitive, and Behavioral Performance at School Age

    OpenAIRE

    Roze, Elise; Meijer, Lisethe; Bakker, Attie; Van Braeckel, Koenraad N.J.A.; Sauer, Pieter J.J.; Bos, Arend F.

    2009-01-01

    Background Organohalogen compounds (OHCs) are known to have neurotoxic effects on the developing brain. Objective We investigated the influence of prenatal exposure to OHCs, including brominated flame retardants, on motor, cognitive, and behavioral outcome in healthy children of school age. Methods This study was part of the prospective Groningen infant COMPARE (Comparison of Exposure-Effect Pathways to Improve the Assessment of Human Health Risks of Complex Environmental Mixtures of Organoha...

  2. Whole body MRI, including diffusion-weighted imaging in follow-up of patients with testicular cancer.

    Science.gov (United States)

    Mosavi, Firas; Laurell, Anna; Ahlström, Håkan

    2015-11-01

    Whole body (WB) magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) has become increasingly utilized in cancer imaging, yet the clinical utility of these techniques in follow-up of testicular cancer patients has not been evaluated. The purpose of this study was to evaluate the feasibility of WB MRI with continuous table movement (CTM) technique, including multistep DWI in follow-up of patients with testicular cancer. WB MRI including DWI was performed in follow-up of 71 consecutive patients (median age, 37 years; range 19-84) with histologically confirmed testicular cancer. WB MRI protocol included axial T1-Dixon and T2-BLADE sequences using CTM technique. Furthermore, multi-step DWI was performed using b-value 50 and 1000 s/mm(2). One criterion for feasibility was patient tolerance and satisfactory image quality. Another criterion was the accuracy in detection of any pathological mass, compared to standard of reference. Signal intensity in DWI was used for evaluation of residual mass activity. Clinical, laboratory and imaging follow-up were applied as standard of reference for the evaluation of WB MRI. WB MRI was tolerated in nearly all patients (69/71 patients, 97%) and the image quality was satisfactory. Metal artifacts deteriorated the image quality in six patients, but it did not influence the overall results. No case of clinical relapse was observed during the follow-up time. There was a good agreement between conventional WB MRI and standard of reference in all patients. Three patients showed residual masses and DWI signal was not restricted in these patients. Furthermore, DWI showed abnormally high signal intensity in a normal-sized retroperitoneal lymph node indicating metastasis. The subsequent (18)F-FDG PET/CT could verify the finding. WB MRI with CTM technique including multi-step DWI is feasible in follow-up of patients with testicular cancer. DWI may contribute to important added-value data to conventional MRI sequences

  3. [Links between life events, traumatism and dementia; an open study including 565 patients with dementia].

    Science.gov (United States)

    Charles, E; Bouby-Serieys, V; Thomas, P; Clément, J-P

    2006-10-01

    Ageing is due to a progressive loss of the person's adaptation capability, whereas during this period environmental aggression increases. In the elderly, life events re-present a psychological traumatism that overwhelms the old person and related family, disrupting and fragilising homeostatic balance. A number of authors have suggested a possible link between life traumatisms and the dementia processes. The aim of this study is to reveal the presence of life traumatisms preceding the apparition of the dementia syndrome. This is a retrospective and comparative work based on the PIXEL study on complaints and demands from the principle informal caregivers of Alzheimer patients. It includes 565 patients presenting the criterion of dementia as defined by the DSM IV, and questionnaires filled out by the principle caregivers. One item of the questionnaire referred to life events which could have played a part in the development of the disorder. In a second stage, the reported events were classified into 4 distinct categories: loss, repeated or prolonged stress, psychotraumatism and depression-inducing events. The statistics were produced using SAS and Stat 10 software. Student's test, ANOVA and chi2-test were used. 372 caregivers answered the first item (65%); 76 of them believed there was no event while 296 related the disorder to one or several life events (79% of responders, 52% of the sample). These results confirm Persson and Clement's study which evidenced a higher frequency of stressing life events for subjects afflicted with dementia as compared with older people without any psychic disorder. Reported events and their respective frequency: spouse death (15.39%), parents' death (15%), familial difficulty (10.08%), anaesthesia (8.49%), child's death (4.42%), somatic disturbance (4%), depression (3.89%), retirement (3.89%), financial problems (2.65%), loneliness (2.65%), removal (1.76%), fall (1%), alcohol (0.8%), traumatism (0.53%), spouse care (0.35%), leaving for

  4. Polypharmacy including falls risk-increasing medications and subsequent falls in community-dwelling middle-aged and older adults.

    Science.gov (United States)

    Richardson, Kathryn; Bennett, Kathleen; Kenny, Rose Anne

    2015-01-01

    polypharmacy is an important risk factor for falls, but recent studies suggest only when including medications associated with increasing the risk of falls. a prospective, population-based cohort study. 6,666 adults aged ≥50 years from The Irish Longitudinal study on Ageing. participants reported regular medication use at baseline. Any subsequent falls, any injurious falls and the number of falls were reported 2 years later. The association between polypharmacy (>4 medications) or fall risk-increasing medications and subsequent falls or injurious falls was assessed using modified Poisson regression. The association with the number of falls was assessed using negative binomial regression. during follow-up, 231 falls per 1,000 person-years were reported. Polypharmacy including antidepressants was associated with a greater risk of any fall (adjusted relative risk (aRR) 1.28, 95% CI 1.06-1.54), of injurious falls (aRR 1.51, 95% CI 1.10-2.07) and a greater number of falls (adjusted incident rate ratio (aIRR) 1.60, 95% CI 1.19-2.15), but antidepressant use without polypharmacy and polypharmacy without antidepressants were not. The use of benzodiazepines was associated with injurious falls when coupled with polypharmacy (aRR 1.40, 95% CI 1.04-1.87), but was associated with a greater number of falls (aIRR 1.32, 95% CI 1.05-1.65), independent of polypharmacy. Other medications assessed, including antihypertensives, diuretics and antipsychotics, were not associated with outcomes. in middle-aged and older adults, polypharmacy, including antidepressant or benzodiazepine use, was associated with injurious falls and a greater number of falls. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Osteonecrosis of the femoral head in lymphoma patients treated with combined chemotherapy including corticosteroids

    International Nuclear Information System (INIS)

    Nikkanen, T.A.V.; Maekinen, E.; Ekfors, T.O.; Hakkarainen, S.; Drysun, B.

    1980-01-01

    Osteonecrosis of the femoral head developed in two patients with malignant lymphoma treated with combined chemotherapy. Pain was the main symptom. It was not possible to radiographically distinguish the necrotic lesions from metastatic tumour growth, and in both cases only histological examination revealed the true nature of bone destruction. The large doses of corticosteroids included in the treatment regiments were most likely of more importance in the etiology of the necrosis than the cytostatic drugs proper. (orig.) [de

  6. Including the online feedback site, Patient Opinion, in the nursing curriculum: Exploratory study.

    Science.gov (United States)

    Jones, Ray; Young, Kim; Munro, James; Miller, Heather; Brelsford, Stephanie; Aronsson, Jennie; Goodman, Benny; Peters, Jane

    2017-10-01

    Globally, universities aim to involve people who use health services to enrich the nursing curriculum for students, but there can be barriers to this involvement. Many also want students to contribute to local communities. Online communication can help connect students to service users to achieve these aims. The online British patient feedback site, Patient Opinion, gathers comments from service users about services and encourages service responses to the comments. To explore the feasibility and acceptability of five ways of including Patient Opinion in the undergraduate nursing curriculum. Five case studies using mixed data collection methods. British University with nursing students across two campuses, accustomed to using webinars, video presentations and social media. Students from different years participated in the five approaches of making use of Patient Opinion in the curriculum; 18 students took part in an online forum to discuss Patient Opinion in the curriculum. We trialled timetabled webinars, video-linked lectures, optional enhanced access for self-study, optional audit of service user comments for two local hospitals, and optional Twitter and Tweetchat. Students discussed the aims and approaches in an online forum. Of the five approaches trialled, webinars seemed effective in ensuring that all nursing students engaged with the topic. Video-linked lectures provided an alternative when timetabling did not allow webinars, but were less interactive. The three optional approaches (Tweetchats, audit exercise, self-directed study) provided opportunities for some students to enhance their learning but students needed guidance. Sending a summary of student reviews of patients' feedback to local hospitals illustrated how students might be agents of change in local health services. Experience from these case studies suggests that webinars followed by use of Patient Opinion preparing for placements may be a sustainable way of embedding feedback sites in the

  7. Sexual Health questions included in the Health Behaviour in School-aged Children (HBSC) Study: an international methodological pilot investigation.

    Science.gov (United States)

    Young, Honor; Költő, András; Reis, Marta; Saewyc, Elizabeth M; Moreau, Nathalie; Burke, Lorraine; Cosma, Alina; Windlin, Béat; Gabhainn, Saoirse Nic; Godeau, Emmanuelle

    2016-12-05

    This paper describes the methodological developments of the sexual health items included in the Health Behaviour in School-aged Children (HBSC) study since their mandatory inclusion in the study in 2002. The current methodological, ethical and pedagogical challenges in measuring young people's sexual health behaviours are discussed along with the issues associated with the sexual health items introduced to the HBSC study in 2002. The development and piloting of new cross-national items for use in the 2013/14 HBSC data collection are presented and discussed. An international pilot study was undertaken to determine the impact of these proposed changes. Questionnaires and classroom discussion groups were conducted in five pilot countries in 2012/2013 (France, Hungary, Ireland, Portugal and Romania) with a total of 612 school-aged children (age M = 15.55 years, SD = 0.95). The majority of participants in each country provided positive feedback about the appropriateness of the questions. Some small cross-national differences were found in the self-reported quantitative data relating to the appropriateness of the questions (χ 2  = 22.831, df = 9, p = .007, V = .117). Qualitative feedback suggests that for the vast majority of students the phrasing and age-targeting of the questions were considered appropriate. With the exception of a small number of respondents who commented on the clarity and/or personal nature of the content, no specific issues with the questions were identified. These findings provide guidance on the answerability (including the extent of missing and inconsistent data), understandability, acceptability (including in different cultures) and relevance of questions to potential participants. The findings from the pilot study suggest that in general, the questions are understandable, acceptable, and of a high priority to the target population, and that the simplification has significantly reduced the proportion of missing data

  8. Sexual Health questions included in the Health Behaviour in School-aged Children (HBSC Study: an international methodological pilot investigation

    Directory of Open Access Journals (Sweden)

    Honor Young

    2016-12-01

    Full Text Available Abstract Background This paper describes the methodological developments of the sexual health items included in the Health Behaviour in School-aged Children (HBSC study since their mandatory inclusion in the study in 2002. The current methodological, ethical and pedagogical challenges in measuring young people’s sexual health behaviours are discussed along with the issues associated with the sexual health items introduced to the HBSC study in 2002. The development and piloting of new cross-national items for use in the 2013/14 HBSC data collection are presented and discussed. Methods An international pilot study was undertaken to determine the impact of these proposed changes. Questionnaires and classroom discussion groups were conducted in five pilot countries in 2012/2013 (France, Hungary, Ireland, Portugal and Romania with a total of 612 school-aged children (age M = 15.55 years, SD = 0.95. Results The majority of participants in each country provided positive feedback about the appropriateness of the questions. Some small cross-national differences were found in the self-reported quantitative data relating to the appropriateness of the questions (χ2 = 22.831, df = 9, p = .007, V = .117. Qualitative feedback suggests that for the vast majority of students the phrasing and age-targeting of the questions were considered appropriate. With the exception of a small number of respondents who commented on the clarity and/or personal nature of the content, no specific issues with the questions were identified. Conclusions These findings provide guidance on the answerability (including the extent of missing and inconsistent data, understandability, acceptability (including in different cultures and relevance of questions to potential participants. The findings from the pilot study suggest that in general, the questions are understandable, acceptable, and of a high priority to the target population, and that the

  9. [Echocardiographic indices of the right heart in patients with coronary artery disease in different age groups].

    Science.gov (United States)

    Gajfulin, R A; Sumin, A N; Arhipov, O G

    2016-01-01

    The aim of study was to examine echocardiographic indices of right heart chambers in patients with coronary artery disease in different age groups. On 678 patients aged 38-85 years, who underwent echocardiography, are including with the use of spectral tissue Doppler. Obtained 2 age groups: 1st - patients up to 60 years (n=282) and group 2nd - patients 60 years and older (n=396). In the analysis the obtained results in patients with coronary heart disease in older age groups showed an increase in right ventricular wall thickness, systolic and average pressure in the pulmonary artery. These changes were accompanied by deterioration in left ventricular diastolic function, while the systolic function of the left and right ventricle were independent of age. Thus, the results can be recommended for assessment of right ventricular dysfunction in patients of older age groups.

  10. Influence of Age on Critically Ill Patients with Cirrhosis

    Directory of Open Access Journals (Sweden)

    Cheng-Yi Chen

    2015-12-01

    Conclusion: During ICU stays, old age does not have adverse effects on ICU mortality, ventilator-free days, ICU days, or ICU-free days in cirrhotic patients (either compensated or decompensated cirrhosis. After ICU discharge, age ≥ 75 years is an independent prognostic factor for in-hospital mortality and 6-month mortality in patients with decompensated cirrhosis.

  11. PRISE EN CHARGE DES PATIENTS DIABETIQUES AGES

    Directory of Open Access Journals (Sweden)

    Bernard BAUDUCEAU

    2017-05-01

    Full Text Available La prise en charge des patients diabétiques âgés est devenue aujourd’hui un véritable problème de santé publique du fait de l’augmentation du nombre des malades. Dans cette population, les complications du diabète sont plus graves et s’intriquent avec les manifestations plus spécifiquement gérontologiques. L’évaluation gériatrique standardisée est indispensable pour définir la situation de chaque malade selon son degré d’autonomie et de dénutrition, ses fonctions cognitives et son environnement social. Les objectifs thérapeutiques doivent être individualisés en fonction de la présentation clinique du patient. L’insulinothérapie est fréquemment incontournable et nécessite l’éducation du patient ou de son entourage. La prise en charge des patients diabétiques âgés doit éviter un trop grand laxisme chez une personne restée en bonne santé mais aussi un activisme déraisonnable chez les sujets fragiles en raison du risque hypoglycémique.

  12. Experience of aging in patients with rheumatic disease: a comparison with the general population.

    Science.gov (United States)

    Bode, Christina; Taal, Erik; Westerhof, Gerben J; van Gessel, Lidewij; van de Laar, Mart V

    2012-01-01

    Self-perceptions of aging have been shown to predict mental and physical health and even longevity. This study examined the aging perceptions of patients with rheumatic disease and compared them with the general Dutch population. Consecutive patients visiting a rheumatology clinic completed the Personal Experience of Aging Scale (PEAS) subscales: physical decline, social loss, continuous growth, and two sentence stems from the SELE instrument (What I like/do not like about getting older ...) as qualitative measures of the subjective experience of aging. A representative sample from the general Dutch population between 40 and 85 years was used as a comparison group. Participants included in this study were 208 patients with a rheumatic disease and 975 persons from the Dutch Aging Survey (DAS). Both quantitative and qualitative data showed that patients perceived aging more strongly as physical decline. These negative experiences did not extend to social and psychological domains of aging. Age-group comparisons revealed that patients in middle adulthood experienced physical aging similar to older people without a rheumatic disease. The negative experience of aging in patients is limited to the physical domain and does not extend to other domains of life. The negative experience of physical aging even in middle-aged groups warrants further studies on its effects on mental and physical health outcomes and health behavior in patients with rheumatic disease.

  13. Psychological Frailty in the Aging Patient.

    Science.gov (United States)

    Fitten, L Jaime

    2015-01-01

    There is little written in the geriatric literature about the concept of psychological frailty which encompasses cognitive, mood, and motivational components. The concept is intended to consider brain changes that are beyond normal aging, but not necessarily inclusive of disease, that result in decreased cognitive or mood resilience in the presence of modest stressors, and may eventually lead to negative health outcomes in a manner parallel to physical frailty, an entity well known to clinicians. Most work exploring the interface between cognition, mood, and physical frailty has demonstrated a bidirectional association between the two domains. Psychological symptoms or deficits have been described as either worsening the degree of physical frailty, or physical frailty has been viewed as a risk to a worsening cognition or depression. However, psychological frailty, a consequence of age-altered brain function, has not been studied for itself. By what possible mechanism does the brain reveal its loss of resiliency under modest stress and how can this be visualized? Are there markers that predate a psychological decline that might permit a preventive intervention which could delay the appearance of negative health outcomes such as reduced functional capacity or increased dependency? The present review will explore these concepts and possibilities. © 2015 Nestec Ltd., Vevey/S. Karger AG, Basel.

  14. VSNL1 Co-expression networks in aging include calcium signaling, synaptic plasticity, and Alzheimer’s disease pathways

    Directory of Open Access Journals (Sweden)

    C W Lin

    2015-03-01

    Full Text Available The Visinin-like 1 (VSNL1 gene encodes Visinin-like protein 1, a peripheral biomarker for Alzheimer disease (AD. Little is known, however, about normal VSNL1 expression in brain and the biologic networks in which it participates. Frontal cortex gray matter from 209 subjects without neurodegenerative or psychiatric illness, ranging in age from 16–91, were processed on Affymetrix GeneChip 1.1 ST and Human SNP Array 6.0. VSNL1 expression was unaffected by age and sex, and not significantly associated with SNPs in cis or trans. VSNL1 was significantly co-expressed with genes in pathways for Calcium Signaling, AD, Long Term Potentiation, Long Term Depression, and Trafficking of AMPA Receptors. The association with AD was driven, in part, by correlation with amyloid precursor protein (APP expression. These findings provide an unbiased link between VSNL1 and molecular mechanisms of AD, including pathways implicated in synaptic pathology in AD. Whether APP may drive increased VSNL1 expression, VSNL1 drives increased APP expression, or both are downstream of common pathogenic regulators will need to be evaluated in model systems.

  15. Identification of mutations including de novo mutations in Korean patients with hypokalaemic periodic paralysis.

    Science.gov (United States)

    Kim, S H; Kim, U K; Chae, J J; Kim, D J; Oh, H Y; Kim, B J; Lee, C C

    2001-05-01

    Hypokalaemic periodic paralysis (hypoPP) is an autosomal dominant disorder involving the abnormal function of ion channels and it is characterized by paralysis attacks of varying severity, accompanied by a fall in blood potassium levels. Linkage analysis showed that the candidate locus responsible for hypoPP was localized to chromosome 1q31-32, and this locus encoded the muscle dihydropyridine-sensitive calcium channel alpha(1)-subunit (CACNA1S). So far, three different mutations in CACNA1S gene have been identified in patients with hypoPP: Arg528His, Arg1239His and Arg1239Gly in Caucasian patients. However, there are few reports about the mutations of CACNA1S gene in other races. In this study, four Korean families with five hypoPP patients were screened for mutations of CACNA1S gene with polymerase chain reaction-based restriction analysis and single-strand conformation polymorphism analysis. To determine the mode of inheritance, haplotype analysis was done with three microsatellite markers (D1S1726, CACNL1A3, and D1S1723). Arg528His mutation was detected in three families, and one family had no known mutations. Moreover, for the first time, we detected de novo Arg528His mutations in two out of three families with hypoPP. Haplotype analysis using three microsatellite markers (D1S1726, CACNL1A3, and D1S1723) suggested the occurrence of de novo Arg528His mutations in two of the three families with Arg528His mutation. Arg528His mutations of CACNA1S, including de novo Arg528His mutations, were found in Korean patients with hypoPP. These results imply that de novo mutation, in addition to non-penetrance, is one of the genetic mechanisms that can explain the previous clinical observation that hypoPP occurs sporadically without family history.

  16. The utility of including pathology reports in improving the computational identification of patients

    Directory of Open Access Journals (Sweden)

    Wei Chen

    2016-01-01

    Full Text Available Background: Celiac disease (CD is a common autoimmune disorder. Efficient identification of patients may improve chronic management of the disease. Prior studies have shown searching International Classification of Diseases-9 (ICD-9 codes alone is inaccurate for identifying patients with CD. In this study, we developed automated classification algorithms leveraging pathology reports and other clinical data in Electronic Health Records (EHRs to refine the subset population preselected using ICD-9 code (579.0. Materials and Methods: EHRs were searched for established ICD-9 code (579.0 suggesting CD, based on which an initial identification of cases was obtained. In addition, laboratory results for tissue transglutaminse were extracted. Using natural language processing we analyzed pathology reports from upper endoscopy. Twelve machine learning classifiers using different combinations of variables related to ICD-9 CD status, laboratory result status, and pathology reports were experimented to find the best possible CD classifier. Ten-fold cross-validation was used to assess the results. Results: A total of 1498 patient records were used including 363 confirmed cases and 1135 false positive cases that served as controls. Logistic model based on both clinical and pathology report features produced the best results: Kappa of 0.78, F1 of 0.92, and area under the curve (AUC of 0.94, whereas in contrast using ICD-9 only generated poor results: Kappa of 0.28, F1 of 0.75, and AUC of 0.63. Conclusion: Our automated classification system presented an efficient and reliable way to improve the performance of CD patient identification.

  17. Supportive and palliative care for patients with chronic mental illness including dementia.

    Science.gov (United States)

    Lloyd-Williams, Mari; Abba, Katharine; Crowther, Jacqueline

    2014-09-01

    People with preexisting mental illness are known to have difficulty accessing healthcare services including palliative care and people with dementia have similar issues accessing palliative care. The review addressed the time period from January 2013 to March 2014. There were few articles addressing issues for palliative and supportive care for patients with preexisting mental health issues. The main factor that would improve care is interdisciplinary working between mental healthcare teams and palliative care teams. In contrast, there were many published articles on the palliative and supportive care needs for people with dementia. These articles included consensus statements, models of care; studies of why models of care, for example Advanced Care Planning were not being implemented; and carer reports of care in the last year of life. Urgent research is required as to how support for people with preexisting mental illness who require palliative care can be improved--excellent liaison between mental health and palliative care teams is essential. There is much research on palliative care needs for people with dementia but an apparent lack of innovative approaches to care including care of people within their family home.

  18. Age-related racial disparities in prostate cancer patients: A systematic review.

    Science.gov (United States)

    He, Ting; Mullins, C Daniel

    2017-04-01

    Prostate cancer mortality rates have decreased over recent decades, but racial disparities in prostate cancer survival still present as a serious challenge. These disparities may be impacted by age; in fact, African-American men younger than age 65 have prostate cancer mortality rates nearly three times greater than that of White men. Therefore, a systematic literature review was conducted in Medline and EMBASE databases focusing on articles comparing survival and mortality rates for prostate cancer patients across age and race. Articles included were based on the following criteria: (1) included African-American and White prostate cancer patients residing in the US; (2) measured racial disparities across distinct age categories with at least one category below and one above age 65; and (3) addressed racial disparities in terms of overall survival or mortality. Twenty eight articles compared survival and mortality disparities between African-American and White prostate cancer patients across different age categories. Of the 28 articles, 19 articles (68%) showed disparities decreased with age, 8 articles (29%) showed disparities constant with age, and 1 article (3%) showed disparities increased with age. More often the survival and mortality gap between African-American and White prostate cancer patients decreases with age. Additional studies are needed to elucidate other factors that may influence racial disparities in prostate cancer patients. These results provide insight into the racial disparities in prostate cancer and suggest more resources should be directed towards decreasing the disparity gap in younger prostate cancer patients.

  19. Improvement in Detection of Wrong-Patient Errors When Radiologists Include Patient Photographs in Their Interpretation of Portable Chest Radiographs.

    Science.gov (United States)

    Tridandapani, Srini; Olsen, Kevin; Bhatti, Pamela

    2015-12-01

    This study was conducted to determine whether facial photographs obtained simultaneously with radiographs improve radiologists' detection rate of wrong-patient errors, when they are explicitly asked to include the photographs in their evaluation. Radiograph-photograph combinations were obtained from 28 patients at the time of portable chest radiography imaging. From these, pairs of radiographs were generated. Each unique pair consisted of one new and one old (comparison) radiograph. Twelve pairs of mismatched radiographs (i.e., pairs containing radiographs of different patients) were also generated. In phase 1 of the study, 5 blinded radiologist observers were asked to interpret 20 pairs of radiographs without the photographs. In phase 2, each radiologist interpreted another 20 pairs of radiographs with the photographs. Radiologist observers were not instructed about the purpose of the photographs but were asked to include the photographs in their review. The detection rate of mismatched errors was recorded along with the interpretation time for each session for each observer. The two-tailed Fisher exact test was used to evaluate differences in mismatch detection rates between the two phases. A p value of error detection rates without (0/20 = 0%) and with (17/18 = 94.4%) photographs were different (p = 0.0001). The average interpretation times for the set of 20 radiographs were 26.45 (SD 8.69) and 20.55 (SD 3.40) min, for phase 1 and phase 2, respectively (two-tailed Student t test, p = 0.1911). When radiologists include simultaneously obtained photographs in their review of portable chest radiographs, there is a significant improvement in the detection of labeling errors. No statistically significant difference in interpretation time was observed. This may lead to improved patient safety without affecting radiologists' throughput.

  20. Antibody isotypes, including IgG subclasses, in Ecuadorian patients with pulmonary Paragonimiasis

    Directory of Open Access Journals (Sweden)

    Angel Guevara E.

    1995-08-01

    Full Text Available An ELISA test was developed to detect Paragonimus-specific antibodies, including IgG subclasses, using P. mexicanus crude water-soluble antigens. The test was standardized to detect antibodies in sera of Ecuadorian patients with pulmonary paragonimiasis and negative controls from the endemic area. The detected mean levels of IgG (0.753, SEM: 0.074 and IgM (0.303, SEM: 0.033 were significantly elevated (P<0.05. Within the IgG subclasses, IgG4 showed the highest detected mean level (0.365, SEM: 0.116 and the other three subclasses showed considerably lower mean levels (IgG1, 0.186 SEM: 0.06; IgG2, 0.046 SEM: 0.01; IgG3, 0.123 SEM: 0.047. The number of P. mexicanus eggs found in sputum of infected individuals showed a positive correlation with the level of antibodies detected for IgM, IgG and its subclasses (P<0.001. The relevance of these findings in Ecuadorian patients suffering from pulmonary paragonimiasis is discussed.

  1. [Baseline clinical characteristics and management of patients included in IBERICAN study].

    Science.gov (United States)

    Barrios, V; Escobar, C; Llisterri, J L; Rodríguez Roca, G; Badimón, J J; Vergara, J; Prieto, M Á; Serrano, A; Cinza, S; Murillo, C

    2015-01-01

    To determine the prevalence and incidence of cardiovascular risk factors and cardiovascular events in Spain, as well as the quality of the follow-up in clinical practice. In this study the baseline data of the first interim analysis of IBERICAN are shown (n=830). IBERICAN is a multicenter, longitudinal and observational population-based study of patients daily attended in primary care setting according to clinical practice in Spain. Subjects between 18 and 85 years daily attended in primary care setting are being included consecutively. Treatment of patients will be performed according only to clinical criteria of investigators. Blood pressure control was defined according to 2013 European guidelines of hypertension; LDL-cholesterol control was defined according to 2012 European guidelines of cardiovascular prevention; diabetes control was defined as HbA1ccardiovascular risk factors with a poor control. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  2. Periictal and interictal headache including migraine in Dutch patients with epilepsy: a cross-sectional study.

    Science.gov (United States)

    Hofstra, W A; Hageman, G; de Weerd, A W

    2015-03-01

    As early as in 1898, it was noted that there was a need to find "a plausible explanation of the long recognized affinities of migraine and epilepsy". However, results of recent studies are clearly conflicting on this matter. In this cross-sectional study, we aimed to define the prevalence and characteristics of both seizure-related and interictal headaches in patients with epilepsy (5-75years) seeking help in the tertiary epilepsy clinic SEIN in Zwolle. Using a questionnaire, subjects were surveyed on the existence of headaches including characteristics, duration, severity, and accompanying symptoms. Furthermore, details on epilepsy were retrieved from medical records (e.g., syndrome, seizure frequency, and use of drugs). Diagnoses of migraine, tension-type headache, or unclassifiable headache were made based on criteria of the International Classification of Headache Disorders. Between March and December 2013, 29 children and 226 adults were evaluated, 73% of whom indicated having current headaches, which is significantly more often when compared with the general population (pheadache, while 29% had solely seizure-related headaches and 22% had both. Migraine occurs significantly more often in people with epilepsy in comparison with the general population (pheadaches conforms to results in the general population. These results show that current headaches are a significantly more frequent problem amongst people with epilepsy than in people without epilepsy. When comparing migraine prevalence, this is significantly higher in the population of patients with epilepsy. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Characterization of Patients With Lupus Nephritis Included in a Large Cohort From the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER).

    Science.gov (United States)

    Galindo-Izquierdo, María; Rodriguez-Almaraz, Esther; Pego-Reigosa, José M; López-Longo, Francisco J; Calvo-Alén, Jaime; Olivé, Alejandro; Fernández-Nebro, Antonio; Martinez-Taboada, Víctor; Vela-Casasempere, Paloma; Freire, Mercedes; Narváez, Francisco J; Rosas, José; Ibáñez-Barceló, Mónica; Uriarte, Esther; Tomero, Eva; Zea, Antonio; Horcada, Loreto; Torrente, Vicenç; Castellvi, Iván; Calvet, Joan; Menor-Almagro, Raúl; Zamorano, María A Aguirre; Raya, Enrique; Díez-Álvarez, Elvira; Vázquez-Rodríguez, Tomás; García de la Peña, Paloma; Movasat, Atusa; Andreu, José L; Richi, Patricia; Marras, Carlos; Montilla-Morales, Carlos; Hernández-Cruz, Blanca; Marenco de la Fuente, José L; Gantes, María; Úcar, Eduardo; Alegre-Sancho, Juan J; Manero, Javier; Ibáñez-Ruán, Jesús; Rodríguez-Gómez, Manuel; Quevedo, Víctor; Hernández-Beriaín, José; Silva-Fernández, Lucía; Alonso, Fernando; Pérez, Sabina; Rúa-Figueroa, Iñigo

    2016-03-01

    The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ± 12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P lupus activity at the time of the last visit (P treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.

  4. Analysis of adult patients with epilepsy in the age continuum

    Directory of Open Access Journals (Sweden)

    V. A. Karlov

    2016-01-01

    Full Text Available Objective: to study the presence of comorbidities and to investigate quality of life in patients with main types of epilepsy in relation to age.Patients and methods. The investigation enrolled 150 patients aged 17 to 64 years with idiopathic, cryptogenic, and symptomatic types of epilepsy. The investigators studied the presence of sleep disorders using the questionnaires designed by the Somnology Center, Ministry of Health of Russia, and that of daytime sleepiness by the Epworth Sleepiness Scale, determined the level of anxiety and depression by the Hospital Anxiety and Depression Scale, and assessed the severity of seizures by the National Hospital Seizure Severity Scale. Quality of life was investigated using the QOLIE-89 questionnaire. A cluster analysis was carried out to divide all the patients into three age groups (mean age, 27.3; 30.7; and 37.7 years.Results and discussion. A positive relationship was obtained between some indicators of sleep disorders, level of anxiety, and age. There were significant differences between the above three age groups in the following indicators: sleep disorders; daytime sleepiness; level of anxiety, severity of seizures, and scores of the QOLIE-89 questionnaire (p<0.001. Since the patients suffer from different basic types of epilepsy (cryptogenic, idiopathic, and symptomatic, the findings testify to age as an independent factor that modifies quality of life in epileptic patients.

  5. Effectiveness of maximal safe resection for glioblastoma including elderly and low karnofsky performance status patients. Retrospective review at a single institute

    International Nuclear Information System (INIS)

    Uzuka, Takeo; Takahashi, Hideaki; Aoki, Hiroshi; Natsumeda, Manabu; Fujii, Yukihiko

    2012-01-01

    Elderly and low Karnofsky performance status (KPS) patients have been excluded from most prospective trials. This retrospective study investigated glioblastoma treatment outcomes, including those of elderly and low KPS patients, and analyzed the prognostic factors using the medical records of 107 consecutive patients, 59 men and 48 women aged from 21 to 85 years (median 65 years), with newly diagnosed glioblastoma treated at our institute. There were 71 high-risk patients with age >70 years and/or KPS 6 -methylguanine-deoxyribonucleic acid methyltransferase-negative (p=0.027), and more than subtotal removal (p=0.003) were significant prognostic factors. The median postoperative KPS score tended to be better than the preoperative score, even in the high-risk group. We recommend maximal safe resection for glioblastoma patients, even those with advanced age and/or with low KPS scores. (author)

  6. Effectiveness of incentive spirometry in patients following thoracotomy and lung resection including those at high risk for developing pulmonary complications.

    Science.gov (United States)

    Agostini, Paula; Naidu, Babu; Cieslik, Hayley; Steyn, Richard; Rajesh, Pala Babu; Bishay, Ehab; Kalkat, Maninder Singh; Singh, Sally

    2013-06-01

    Following thoracotomy, patients frequently receive routine respiratory physiotherapy which may include incentive spirometry, a breathing technique characterised by deep breathing performed through a device offering visual feedback. This type of physiotherapy is recommended and considered important in the care of thoracic surgery patients, but high quality evidence for specific interventions such as incentive spirometry remains lacking. 180 patients undergoing thoracotomy and lung resection participated in a prospective single-blind randomised controlled trial. All patients received postoperative breathing exercises, airway clearance and early mobilisation; the control group performed thoracic expansion exercises and the intervention group performed incentive spirometry. No difference was observed between the intervention and control groups in the mean drop in forced expiratory volume in 1 s on postoperative day 4 (40% vs 41%, 95% CI -5.3% to 4.2%, p=0.817), the frequency of postoperative pulmonary complications (PPC) (12.5% vs 15%, 95% CI -7.9% to 12.9%, p=0.803) or in any other secondary outcome measure. A high-risk subgroup (defined by ≥2 independent risk factors; age ≥75 years, American Society of Anaesthesiologists score ≥3, chronic obstructive pulmonary disease (COPD), smoking status, body mass index ≥30) also demonstrated no difference in outcomes, although a larger difference in the frequency of PPC was observed (14% vs 23%) with 95% CIs indicating possible benefit of intervention (-7.4% to 2.6%). Incentive spirometry did not improve overall recovery of lung function, frequency of PPC or length of stay. For patients at higher risk for the development of PPC, in particular those with COPD or current/recent ex-smokers, there were larger observed actual differences in the frequency of PPC in favour of the intervention, indicating that investigations regarding the physiotherapy management of these patients need to be developed further.

  7. Outcome of Triple Antiplatelet Therapy Including Cilostazol in Elderly Patients with ST-Elevation Myocardial Infarction who Underwent Primary Percutaneous Coronary Intervention: Results from the INTERSTELLAR Registry.

    Science.gov (United States)

    Jang, Ho-Jun; Park, Sang-Don; Park, Hyun Woo; Suh, Jon; Oh, Pyung Chun; Moon, Jeonggeun; Lee, Kyounghoon; Kang, Woong Chol; Kwon, Sung Woo; Kim, Tae-Hoon

    2017-06-01

    Compared with dual antiplatelet therapy including aspirin and clopidogrel, triple antiplatelet therapy including cilostazol has a mortality benefit in patients with ST-segment elevation myocardial infarction. However, whether the mortality benefit persists in elderly patients is not clear. From 2007 to 2014, 1278 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were retrospectively analyzed. The patients were divided into four groups by age (elderly, respectively) and antiplatelet strategy (triple or dual antiplatelet therapy). We compared the mortality rates between the triple and dual antiplatelet therapy groups. There were 1052 (male, 85%; mean age, 56.3 ± 10.4 years) patients in the young group and 241 (male, 52.7%; mean age, 80.3 ± 4.5 years) patients in the elderly group. In the young and elderly groups, 220 (20.9%) and 28 (12.3%) patients were treated with triple antiplatelet therapy. During a 1-year follow-up period, 80 patients died (4.2% in the young group vs. 15.5% in the elderly group). Kaplan-Meier survival analysis revealed that triple antiplatelet therapy was associated with a lower mortality rate in the young group (log-rank, p = 0.005). Although there were more angiographic high-risk patients in the elderly group, similar mortality rates were reported (log-rank, p = 0.803) without increased bleeding rates (1 vs. 3.6% in the elderly group, p = 0.217). Triple antiplatelet therapy might be a better antiplatelet regimen than dual antiplatelet therapy for patients with ST-segment elevation myocardial infarction. Although this benefit was strong in patients aged elderly patients (aged ≥75 years).

  8. Effect of Age on the Hemostatic Function in Patients with Degenerative Diseases of the Large Joints

    Directory of Open Access Journals (Sweden)

    Igor L. Shlykov, PhD¹, ScD¹

    2013-06-01

    Full Text Available Background: Aging is associated with an increased hypercoagulable state. Degenerative diseases of the large joints are also accompanied by increased coagulation activity. We investigated the effect of age on the hemostatic function in patients with osteoarthritis. Material and Methods: The study included 192 patients with osteoarthritis admitted to the clinic for primary hip or knee arthroplasty. The patients were categorized into 5 age groups: the age group under 40 years, the 41–to-50 -year age group, the 51–to-60-year age group, the 61-to-70- year age group, and the age group over 70 years. The general blood clotting tests, platelet number, fibrinogen, antithrombin, protein C, TAT, D-dimer, vonWillebrand factor (vWF, PAI-1, ß-thromboglobulin were determined. Results: Among patients with osteoarthritis, the antithrombin III level significantly decreased by the age of 50; however, above the age of 60 there was a distinct decrease in platelet count, and over the age of 70 the activity of the extrinsic coagulation pathway and the plasminogen level dropped significantly. TAT and D-dimer levels were elevated in most of the patients. Conclusion: The decrease in platelet count coupled with the activity of the extrinsic coagulation pathway in elderly osteoarthritic patients may increase blood loss during total arthroplasty; also, the drop in the anticoagulant and fibrinolytic potential may play a negative role in strengthening the prothrombotic state during the postoperative period.

  9. Age and Fertility: A Study on Patient Awareness

    OpenAIRE

    Deatsman, Sara; Vasilopoulos, Terrie; Rhoton-Vlasak, Alice

    2016-01-01

    Objective Fertility declines as women age. Advancing maternal age increases pregnancy risks such as diabetes or hypertension. Studies suggest women are not aware of the risks of aging on fertility and pregnancy. The study objective was to assess women's knowledge of fertility and reproductive outcomes affected by aging. Methods Prospective IRB approved survey of women (n=94) attending an obstetrics and gynecology (OB/GYN) clinic. Data collected included demographics, pregnancy history, and kn...

  10. Application of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis.

    Science.gov (United States)

    Xu, Mao; Li, Xiaoxi; Wang, Jun; Guo, Xiangyang

    2014-01-01

    Airway management is crucial in clinical anesthesia. Many complications associated with airway management result from unexpected difficult airway, but predicting a difficult airway is a major challenge. We investigated the efficacy of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis, a population with a high incidence of difficult airway. We randomly enrolled 303 patients scheduled for elective surgery for cervical spondylosis at Peking University Third Hospital between August 2012 and March 2013. Preoperatively, patients were evaluated for difficult airway according to a clinical index and parameters on lateral cervical radiographs and magnetic resonance images. Difficult airway was defined as Cormack-Lehane grades III-IV. Logistic regression was used to identify a combined (clinical and radiological) model for difficult airway. A receiver operating characteristic (ROC) curve was used to describe the effectiveness of prediction. We identified three clinical predictive factors using the ROC curve: mouth opening, sternomental distance, and neck mobility. We created a clinical model using three factors: gender, age, and mouth opening, with odds ratios (OR) of 0.370, 1.034, and 0.358, respectively. Using the clinical and radiological parameters, we formulated a combined model with five risk factors: gender, mouth opening, atlanto-occipital gap, the angle from the second to sixth cervical vertebraes in the neutral position, and the angle difference of d (the angle between the laryngeal axis and the epiglottic axis) from the neutral position to extension (OR: 0.107, 0.355, 0.846, 1.057, and 0.952, respectively). The sensitivity and specificity of the combined model were 80.0% and 65.7%, respectively, and the ROC curve confirmed that the combined model was better than any single clinical predictor and the clinical model. The efficacy of the combined model including both clinical and

  11. Prevalence of dental fluorosis in children taking part in an oral health programme including fluoride tablet supplements from the age of 2 years

    DEFF Research Database (Denmark)

    Eckersten, Charlotte; Pylvänen, Lena; Schröder, Ulla

    2010-01-01

    To investigate the prevalence of dental fluorosis in children who had participated in an oral health programme between the ages 2-5 years, including fluoride tablets from the age of 2 years.......To investigate the prevalence of dental fluorosis in children who had participated in an oral health programme between the ages 2-5 years, including fluoride tablets from the age of 2 years....

  12. [The assessment of the dependence between antigen CA 125 and nicotinism in patients with benign ovarian tumors including endometrial cysts].

    Science.gov (United States)

    Posadzka, Ewa; Jach, Robert; Babczyk, Dorota; Knafel, Anna; Pityński, Kazimierz

    2014-01-01

    Cancer antigen CA-125 is a marker that is primarily used to differentiate benign from malignant tumors as well as to monitor response to ovarian cancer treatment. Taken as a separate marker, it displays low sensitivity and specificity in ovarian cancer diagnosis; however, in combination with other markers it may be successfully applied especially in postmenopausal women. Elevated CA-125 levels in blood serum indicate cancerous as well as non-cancerous diseases. Research aiming to determine environmental factors that may have influence on antigen CA-125 level, and thus on the assessment of this marker's application in gynecological and oncological diseases continues. the aim of the present research is an attempt to estimate the influence of nicotinism on antigen CA-125 in blood serum in patients with diagnosed benign ovarian tumors including endometrial cysts. 174 women aged 16-85 years with diagnosed benign ovarian tumor were qualified for the study. In all patients level of antigen CA-125 in blood serum was assessed preoperatively and nicotinism history was taken. Also transvaginal ultrasound was performed to obtain preliminary diagnosis. Smoking and non-smoking patients were classified into two groups, namely of those with histopathologically confirmed cysts of endometrial type and those with non-endometrial benign ovarian tumors. statistical analysis did not prove any dependence between the CS-125 antigen level and nicotinism in any of these groups. Also additional analysis with division into premenopausal and postmenopausal patients did not determine any statistically significant dependence. Nicotinism does not significantly influence the CA-125 antigen level in patients with benign However, the connection between the addiction severity and its influence on antigen CA-125 in blood serum cannot be excluded. ovarian tumors or endometrial cysts.

  13. Age as a prognostic variable in patients undergoing transurethral prostatectomy

    DEFF Research Database (Denmark)

    Krogh, J; Jensen, J S; Iversen, H G

    1993-01-01

    In a retrospective study the outcome of transurethral prostatectomy (TURP) for benign prostatic hyperplasia (BPH) in patients more than 80 years old was compared to a control group of patients with a mean age ten years younger. The elderly had significantly more tissue resected and presented...

  14. Nutritional problems and blood dyscrasias in aging patients.

    Science.gov (United States)

    MARLOW, A A

    1956-10-01

    Accurate solution of the problems of aging awaits better understanding and definition of senescence. However, adequate nutrition ranks high on the list of causes of increased longevity and happiness in old age. Optimum diets for aging people differ from other age groups only in some reduction in total calories. The digestive apparatus of older people is adequate except when influenced by pathological conditions. Hematologic standards are essentially unchanged in aging persons. Proper management of hematological problems in all age groups depends on accurate diagnosis. Aged patients tolerate diagnostic procedures very well under gentle management. Pure nutritional anemia is rare but poor nutrition is an important complicating factor in the management of blood dyscrasias in older people.

  15. Esophageal replacement in patients under 3 months of age.

    Science.gov (United States)

    Vargas Gomez, M

    1994-04-01

    From 1985 to 1991, esophageal replacement was performed in seven patients with esophageal atresia without fistula. In four, the operation was performed in the neonatal period; three of these patients are alive. The other three patients were operated on between 2 and 3 months of age; two of them are alive. Six of the patients had colonic interposition, and the other had gastric interposition. Of the two patients who died, one had multiple associated malformations; the other one had a massive barium bronchoaspiration before the esophageal replacement.

  16. SPM analysis of cerebral blood flow changes related to age in patients with schizophrenia

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ho Chun; Kim, Sung Wan; Lee, Byeong II; Min, Jung Joon; Bom, Hee Seung [Chonnam National University Medical School, Gwangju (Korea, Republic of)

    2007-07-01

    The goal of this study was to explore neural activities of schizophrenic patients related to current age including the age of onset and also we examined the correlation patterns between age and neural correlates. 21 patients with schizophrenia (female/male; 10/11, mean age; 36.1 11.2) participated in this study and all patients were evaluated by criteria of DSM-IV as a schizophrenia patient. Exclusion criteria included inability to give informed consent and a history of significant neurological illness. 99mTc-ECD brain perfusion SPECT images were obtained from 21 schizophrenic patients. Using SPM (statistical parametric mapping), all images were normalized to a SPECT template (MNI template) and then smoothed. We performed an ANCOVA analysis with current age (covariate variable) and the age of onset (nuisance variable). The correlation was analyzed into positive and negative patterns. Findings are reported as a Z scores with a significance threshold of p < 0.005 (uncorrected) and a minimum cluster size of 10. Significant difference was found between current age and premorbid age (p < 0.05). Cerebral regions that were positively correlated with current age were observed in the middle frontal gyrus and the superior frontal gyrus bilaterally, the left precentral gyrus (Brodmann's area; BA 9) and the right inferior frontal gyrus (BA 46). Also, in relation to negative correlations, there were many regions in the right posterior cingulate gyrus (BA 30) and the left cuneus (BA 30), middle temporal gyrus (BA 21) and superior temporal gyrus (BA 13, 39). Additionally, the occipital regions were found in the right cuneus (BA 18) including the right middle occipital gyrus (BA 18) and right lingual gyrus (BA 19). Age effect in schizophrenic patients was observed in the dorsolateral prefrontal cortex with positive correlation. We suggest that the dorsolateral prefrontal cortex activity which is important for cognitive task performance is related to an increase of patients

  17. SPM analysis of cerebral blood flow changes related to age in patients with schizophrenia

    International Nuclear Information System (INIS)

    Song, Ho Chun; Kim, Sung Wan; Lee, Byeong II; Min, Jung Joon; Bom, Hee Seung

    2007-01-01

    The goal of this study was to explore neural activities of schizophrenic patients related to current age including the age of onset and also we examined the correlation patterns between age and neural correlates. 21 patients with schizophrenia (female/male; 10/11, mean age; 36.1 11.2) participated in this study and all patients were evaluated by criteria of DSM-IV as a schizophrenia patient. Exclusion criteria included inability to give informed consent and a history of significant neurological illness. 99mTc-ECD brain perfusion SPECT images were obtained from 21 schizophrenic patients. Using SPM (statistical parametric mapping), all images were normalized to a SPECT template (MNI template) and then smoothed. We performed an ANCOVA analysis with current age (covariate variable) and the age of onset (nuisance variable). The correlation was analyzed into positive and negative patterns. Findings are reported as a Z scores with a significance threshold of p < 0.005 (uncorrected) and a minimum cluster size of 10. Significant difference was found between current age and premorbid age (p < 0.05). Cerebral regions that were positively correlated with current age were observed in the middle frontal gyrus and the superior frontal gyrus bilaterally, the left precentral gyrus (Brodmann's area; BA 9) and the right inferior frontal gyrus (BA 46). Also, in relation to negative correlations, there were many regions in the right posterior cingulate gyrus (BA 30) and the left cuneus (BA 30), middle temporal gyrus (BA 21) and superior temporal gyrus (BA 13, 39). Additionally, the occipital regions were found in the right cuneus (BA 18) including the right middle occipital gyrus (BA 18) and right lingual gyrus (BA 19). Age effect in schizophrenic patients was observed in the dorsolateral prefrontal cortex with positive correlation. We suggest that the dorsolateral prefrontal cortex activity which is important for cognitive task performance is related to an increase of patients age

  18. A multimethod investigation including direct observation of 3751 patient visits to 120 dental offices

    Directory of Open Access Journals (Sweden)

    Stephen Wotman

    2010-05-01

    Full Text Available Stephen Wotman1, Catherine A Demko1, Kristin Victoroff1, Joseph J Sudano2, James A Lalumandier11Department of Community Dentistry, Case Western Reserve University, School of Dental Medicine, Cleveland, OH, USA; 2Center of Health Care Research and Policy, Case Western Reserve University, School of Medicine, Cleveland, OH, USAAbstract: This report defines verbal interactions between practitioners and patients as core activities of dental practice. Trained teams spent four days in 120 Ohio dental practices observing 3751 patient encounters with dentists and hygienists. Direct observation of practice characteristics, procedures performed, and how procedure and nonprocedure time was utilized during patient visits was recorded using a modified Davis Observation Code that classified patient contact time into 24 behavioral categories. Dentist, hygienist, and patient characteristics were gathered by questionnaire. The most common nonprocedure behaviors observed for dentists were chatting, evaluation feedback, history taking, and answering patient questions. Hygienists added preventive counseling. We distinguish between preventive procedures and counseling in actual dental offices that are members of a practice-based research network. Almost a third of the dentist’s and half of the hygienist’s patient contact time is utilized for nonprocedure behaviors during patient encounters. These interactions may be linked to patient and practitioner satisfaction and effectiveness of self-care instruction.Keywords: dental practice, dental practice core activities, direct observation of dental practice, Dental Davis Observation Code, dentist, hygienist patient behaviors

  19. Yearly Data for Spoken Language Preferences of Supplemental Security Income Aged Applicants (FY 2016, including 53rd week)

    Data.gov (United States)

    Social Security Administration — This dataset provides annual volume of SSI Aged initial claims at the national level from federal fiscal year 2016 shown two ways—we base one on a 52-week reporting...

  20. Quarterly Data for Asian & Pacific Islander Languages, Supplemental Security Income Initial Claims (Aged) (FY 2016, including 53rd week)

    Data.gov (United States)

    Social Security Administration — This dataset provides quarterly volumes of SSI Aged initial claims at the national level from federal fiscal year 2016 with quarter 4 shown two ways—we base one on a...

  1. Theory of mind and schizophrenia in young and middle-aged patients: Influence of executive functions.

    Science.gov (United States)

    Croca, Marta; Lagodka, Aurèlie; Gadel, Remi; Bourdel, Marie Chantal; Bendjemaa, Narjes; Gaillard, Raphael; Olié, Jean Pierre; Champagne-Lavau, M; Krebs, Marie Odile; Amado, Isabelle

    2018-01-01

    Theory of Mind (ToM) is compromised in schizophrenia, and responsible for social disability. We aim to study the correlation between ToM deficits and Executive Functions (EF), using the Faux Pas Test (FPT) for ToM evaluation, Behavioral Assessment of the Dysexecutive Syndrome (BADS) and Wisconsin Card Sorting Test (WCST) for EF assessment. Two groups of patients with schizophrenia were included: 22 young (18-35 years-old) and 18 middle-aged (>50 years-old) Patients, compared to age-matched Controls. We found worst FPT performances in both groups of patients, but with a more generalized pattern of dysfunction in the middle-aged patient group. This group had worse EF scores than both controls and younger patients. The association of EF with FPT items was uneven. In young patients only empathy (Q6) remained significant after controlling for EF and level of education, while in middle-aged patients faux pas explanation (Q4), false belief (Q5) and total scores remained significant. In young patients only affective TOM was impaired. No correlation was found with clinical symptoms, nor age at onset of the disease. We conclude that ToM deficit arises early during the course of the illness (already present in young patients), increases in middle-aged patients, and relates only partially with EF. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Age-related rehabilitation outcome in stroke patients.

    Science.gov (United States)

    Manimmanakorn, Nuttaset; Arrayawichanon, Preeda; Wattanapun, Pattra; Nuntharuksa, Chompilai; Kuptniratsaikul, Vilai

    2008-03-01

    Patients who survive a stroke usually have residual neurological deficits. Consequently, a rehabilitation program is valuable for improving their quality of life (QOL). However, age is a known factor that needs qualification vis-à-vis rehabilitation outcomes among Thai patients. To study the functional and psychological outcomes and the QOL before and after rehabilitation program among three age groups of Thai stroke patients ( or = 65 years of age). Prospective, analytical study. Three hundred and twenty seven stroke patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO QOL BREF questionnaire before and after undergoing an in-patient rehabilitation program. Data were collected from nine sites around Thailand. Functional and psychological outcomes and the quality of life score improved after the rehabilitation program. The youngest group of stroke victims showed the greatest improvement in functional outcome and QOL score in both the physical and social domains. No significant difference was found regarding anxiety and depression among the three groups. An in-patient rehabilitation program was of benefit to Thai stroke patients but age significantly determined rehabilitation outcomes.

  3. Preoperative Serum Interleukin-6 Is a Potential Prognostic Factor for Colorectal Cancer, including Stage II Patients

    Directory of Open Access Journals (Sweden)

    Kazuyoshi Shiga

    2016-01-01

    Full Text Available Aims. To evaluate the prognostic significance of serum interleukin-6 (IL-6 in colorectal cancer (CRC. Patients and Methods. Preoperative serum IL-6 was measured in 233 CRC patients and 13 healthy controls. Relationships between IL-6 and various clinicopathological factors were evaluated, and the overall survival (OS and disease-free survival (DFS rates according to IL-6 status were calculated for all patients and according to disease stage. Results. The mean IL-6 level was 6.6 pg/mL in CRC patients and 2.6 pg/mL in healthy controls. Using a cutoff of 6.3 pg/mL, obtained using receiver operating characteristic curve analysis, 57 patients had a high IL-6 level. The mean value was higher for stage II disease than for stage III disease. IL-6 status correlated with C-reactive protein (CRP and carcinoembryonic antigen levels, obstruction, and pT4 disease. The OS differed according to the IL-6 status for all patients, whereas the DFS differed for all patients and for those with stage II disease. The Cox proportional hazards model showed that pT4 disease was an independent risk factor for recurrence in all CRC patients; IL-6, CRP, and pT4 were significant risk factors in stage II patients. Conclusions. The preoperative IL-6 level influences the risk of CRC recurrence.

  4. Non-vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Fosbøl, Emil Loldrup; Gadsbøll, Kasper

    2016-01-01

    Among atrial fibrillation (AF) patients, Danish nationwide registries (2011-2015) were used to examine temporal trends of initiation patterns of oral anticoagulation (OAC) treatment according to age. Overall, 43,299 AF patients initiating vitamin K antagonists (VKA) (42%), dabigatran (29......%), rivaroxaban (13%), or apixaban (16%) were included with mean age (SD) 72.1 (11.3), 71.5 (11.0), 74.3 (11.1), and 75.3 (11.1) years, respectively. Patients aged ≥85 years comprised 15%. Trend tests showed increase in patients ≥85 years initiating OAC (p ....0001). This decrease was independent of age. Dabigatran was the most common non-VKA OAC (NOAC) (40% users), but usage decreased from 2014 until study end (6%) (p aged

  5. Age group analysis of psychological, physical and functional deterioration in patients hospitalized for pneumonia.

    Science.gov (United States)

    Martín-Salvador, Adelina; Torres-Sánchez, Irene; Sáez-Roca, Germán; López-Torres, Isabel; Rodríguez-Alzueta, Elisabeth; Valenza, Marie Carmen

    2015-10-01

    Hospital admissions due to pneumonia range from 1.1 to 4 per 1,000 patients and this figure increases with age. Hospitalization causes a decline in functional status. Physical impairment impedes recovery and constitutes a higher risk of disability and mortality in elderly people. The objective of this study is to assess the impact of hospital stay in patients with pneumonia related with age. A total of 116 patients with pneumonia were included in this study, and divided into two age groups:psychological and emotional profile were evaluated. Pneumonia severity, nutritional status, independence and comorbidities were also assessed. Statistical analyses revealed significant differences between both age groups in pneumonia severity and comorbidities. Significant improvements between admission and discharge were found in lung function in both groups (pgroup. Hospitalization leads to a significant physical impairment in patients admitted for pneumonia. This deterioration increases with age. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  6. FKRP mutations, including a founder mutation, cause phenotype variability in Chinese patients with dystroglycanopathies.

    Science.gov (United States)

    Fu, Xiaona; Yang, Haipo; Wei, Cuijie; Jiao, Hui; Wang, Shuo; Yang, Yanling; Han, Chunxi; Wu, Xiru; Xiong, Hui

    2016-12-01

    Mutations in the fukutin-related protein (FKRP) gene have been associated with dystroglycanopathies, which are common in Europe but rare in Asia. Our study aimed to retrospectively analyze and characterize the clinical, myopathological and genetic features of 12 Chinese patients with FKRP mutations. Three patients were diagnosed with congenital muscular dystrophy type 1C (MDC1C) and nine patients were diagnosed with limb girdle muscular dystrophy type 2I (LGMD2I). Three muscle biopsy specimens had dystrophic changes and reduced glycosylated α-dystroglycan staining, and two showed reduced expression of laminin α2. Two known and 13 novel mutations were identified in our single center cohort. Interestingly, the c.545A>G mutation was found in eight of the nine LGMD2I patients as a founder mutation and this founder mutation in Chinese patients differs from the one seen in European patients. Moreover, patients homozygous for the c.545A>G mutation were clinically asymptomatic, a less severe phenotype than in compound heterozygous patients with the c.545A>G mutation. The 13 novel mutations of FKRP significantly expanded the mutation spectrum of MDC1C and LGMD2I, and the different founder mutations indicate the ethnic difference in FKRP mutations.

  7. Survival of chronic hemodialysis patients over 80 years of age

    Directory of Open Access Journals (Sweden)

    Sladoje-Martinovic B

    2014-04-01

    Full Text Available Branka Sladoje-Martinovic, Ivana Mikolasevic, Ivan Bubic, Sanjin Racki, Lidija OrlicDepartment of Nephrology and Dialysis, Division of Internal Medicine, University Hospital Center Rijeka, Rijeka, CroatiaBackground/aim: The number of elderly patients with chronic kidney disease (CKD stage 5 management with hemodialysis (HD is steadily increasing. Therefore we analyzed the number of new CKD patients ≥80 years managed with HD and their survival through the study period. We aimed also, to identify which of several key variables might be independently associated with survival in this very elderly population of patients.Patients and methods: This was a single-center, retrospective cohort study that took place during the period from January 1987 to September 2012. The study consisted of 78 (50 male and 28 women very elderly patients (≥80 years of age; the mean age at which HD was initiated was 83.2±2.5 years. Survival and factors associated with mortality were studied. Survival was defined as the time from start of HD treatment to death (or end of study, if still alive.Results: In the period from 1987 to 2002, patients ≥80 years of age were only sporadically treated with HD, but since 2003, the number of new patients has been steadily increasing. The mean survival for our group of patients was 25.1±22.4 months (range 1–115 months. Furthermore, 30.8% patients survived <12 months, 29.5% patients survived 12–24 months, 30.8% patients survived 24–60 months, and 9% patients survived >60 months on HD treatment. Older patients were less likely to have diabetes, and primary renal disease did not influence survival. Patients with high C-reactive protein levels and poor nutritional status, as well as those who did not have pre-HD nephrology care and those that had a catheter as vascular access for HD had poor survival. In about half of our patients, the cause of death was cardiovascular disease.Conclusion: Among patients who were ≥80 years of

  8. Permanent atrial fibrillation ablation surgery in patients with advanced age

    Directory of Open Access Journals (Sweden)

    Stephan Geidel

    2005-10-01

    Full Text Available Background: Even if permanent atrial fibrillation (pAF is a frequent concomitant problem in patients undergoing open heart surgery and particularly in those with advanced age, data of pAF ablation surgery in older aged patients are scarce. This study was performed to assess early and late results of combined open heart surgery and pAF ablation procedures in patients with advanced aged, compared to young patients. Material and Methods: A selective group of 126 patients (Group A: age ≥70 [76.4±4.8] years, n=70; Group B: age <70 [62.0±6.2] years: n=56 with pAF (≥6 months underwent either monopolar (Group A, B: n=51 vs. n=44 or bipolar (Group A, B: n=19 vs. n=12 radiofrequency (RF ablation procedures concomitant to open heart surgery. Regular follow-up was performed 3 to 36 months after surgery to assess survival, New York Heart Association (NYHA class and conversion rate to stable sinus rhythm (SR. Results: Early mortality (<30 days was 2.9% in Group A (Group B: 0%, cumulative survival at long-term follow up was 0.78 vs. 0.98 (p=0.03 and NYHA-class improved significantly in both groups, particularly in cases with stable SR. At 12-months follow-up 73% of Group A patients were in stable SR (Group B 78%. Conclusions: Concomitant mono- and bipolar RF ablation surgery represents a safe option to cure pAF during open heart surgery with a very low risk, even in patients with advanced age.

  9. High performance of a risk calculator that includes renal function in predicting mortality of hypertensive patients in clinical application.

    Science.gov (United States)

    Ravera, Maura; Cannavò, Rossella; Noberasco, Giuseppe; Guasconi, Alessandro; Cabib, Ursula; Pieracci, Laura; Pegoraro, Valeria; Brignoli, Ovidio; Cricelli, Claudio; Deferrari, Giacomo; Paoletti, Ernesto

    2014-06-01

    The aim of this study was to assess the accuracy of a risk calculator that includes renal function as compared with that of the traditional Framingham Risk Score (FRS) in predicting the risk of mortality of hypertensive individuals managed in primary care. From the databases of British and Italian General Practitioners, we retrieved demographic and clinical data for 35 101 UK and 27 818 Italian individuals aged 35-74 years with a diagnosis of hypertension. Then, the 5-year incidence of cardiovascular events as well as all-cause and cardiovascular mortality were recorded for both samples. A comparison analysis of the performance of the Individual Data Analysis of Antihypertensive Intervention Trials (INDANA) calculator with that of FRS in predicting 5-year all-cause and cardiovascular mortality risk was made. The INDANA calculator was more accurate than the FRS in predicting all-cause [Δc 0.038, 95% confidence interval (CI) 0.026-0.051 for United Kingdom, and 0.018, 95% CI 0.010-0.027 for Italy, both P calculator, 20% of the UK and 10% of the Italian patients were reclassified to higher risk classes for all-cause mortality, and 25 and 28%, respectively were reclassified when cardiovascular mortality was assessed (P calculator proved to be more accurate than the FRS in predicting the risk of mortality in hypertensive patients and should be considered for systematic adoption for risk stratification of hypertensive individuals managed in primary care.

  10. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators

    DEFF Research Database (Denmark)

    van Walraven, Carl; Hart, Robert G; Connolly, Stuart

    2009-01-01

    . Outcomes included ischemic stroke, serious bleeding (intracranial hemorrhage or systemic bleeding requiring hospitalization, transfusion, or surgery), and cardiovascular events (ischemic stroke, myocardial infarction, systemic embolism, or vascular death). RESULTS: The analysis included 8932 patients......BACKGROUND AND PURPOSE: Stroke risk increases with age in patients who have nonvalvular atrial fibrillation. It is uncertain whether the efficacy of stroke prevention therapies in atrial fibrillation changes as patients age. The objective of this study was to determine the effect of age...... on the relative efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and vascular events in patients with atrial fibrillation. METHODS: This is an analysis of the Atrial Fibrillation Investigators database, which...

  11. Age as a prognostic variable in patients undergoing transurethral prostatectomy

    DEFF Research Database (Denmark)

    Krogh, J; Jensen, J S; Iversen, H G

    1993-01-01

    In a retrospective study the outcome of transurethral prostatectomy (TURP) for benign prostatic hyperplasia (BPH) in patients more than 80 years old was compared to a control group of patients with a mean age ten years younger. The elderly had significantly more tissue resected and presented...... with a higher rate of preoperative urinary tract infection. More urological complications were seen among the elderly but these were generally short lived and had no influence on the morbidity, mortality and symptomatic outcome. The perioperative mortality was 3.2% among elderly and 0% in the younger age group....... A cardiorespiratory risk score could not predict patients at risk. In conclusion the age per se had no major influence on the outcome of TURP....

  12. [Depression in Patients with Age-Related Macular Degeneration].

    Science.gov (United States)

    Narváez, Yamile Reveiz; Gómez-Restrepo, Carlos

    2012-09-01

    Age-related macular degeneration is a cause for disability in the elderly since it greatly affects their quality of life and increases depression likelihood. This article discusses the negative effect depression has on patients with age-related macular degeneration and summarizes the interventions available for decreasing their depression index. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  13. Negative impact of asthma on patients in different age groups.

    Science.gov (United States)

    Alith, Marcela Batan; Gazzotti, Mariana Rodrigues; Montealegre, Federico; Fish, James; Nascimento, Oliver Augusto; Jardim, José Roberto

    2015-01-01

    To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years). From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador). The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012); "Have you been absent from school/work in the last 12 months?" (p age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups), whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups). In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance.

  14. Age and Fertility: A Study on Patient Awareness.

    Science.gov (United States)

    Deatsman, Sara; Vasilopoulos, Terrie; Rhoton-Vlasak, Alice

    2016-08-01

    Fertility declines as women age. Advancing maternal age increases pregnancy risks such as diabetes or hypertension. Studies suggest women are not aware of the risks of aging on fertility and pregnancy. The study objective was to assess women's knowledge of fertility and reproductive outcomes affected by aging. Prospective IRB approved survey of women (n=94) attending an obstetrics and gynecology (OB/GYN) clinic. Data collected included demographics, pregnancy history, and knowledge of age-related fertility decline and pregnancy risks. Statistical analysis performed using JMP Pro11.0. Ages ranged from 18 to 67. One third (30.5%) were aware fertility begins to decline at age 35, however this varied among groups depending on prior history of infertility or requiring fertility treatment. Nulliparous women were more unaware of the health risks of pregnancy over age 35 (1.4% vs 13.6%, P 0.02). African Americans (AA) women were less likely to think obesity (76% Caucasian vs 47.8% AA vs 66.7% other, P fertility. Knowledge regarding fertility and reproduction related to aging was variable and differed by age and race. Difficulty conceiving appears to be associated with higher knowledge levels. Public education will increase awareness of age-related fertility declines. Increased contact during pregnancy is an excellent opportunity to educate women in a nondirective way.

  15. From rhetoric to reality: including patient voices in supportive cancer care planning

    Science.gov (United States)

    Gold, Sara K. Tedford; Abelson, Julia; Charles, Cathy A.

    2005-01-01

    Abstract Objective  To explore the extent and manner of patient participation in the planning of regional supportive care networks throughout the province of Ontario. We consider the disconnect between the rhetoric and reality of patient involvement in network planning and co‐ordination. Context  In 1997, the Province of Ontario, Canada, established a new, regionalized cancer care system. By transferring responsibility to the regional level and to networks, the architects of the new provincial system hoped to broaden participation in decision making and to enhance the responsiveness of decisions to communities. Research approach  Through a qualitative, multiple case study approach we evaluated the processes of involving patients in network development. In‐depth, semi‐structured interviews and document analysis were complemented by observations of provincial meetings, regional council and network meetings. Results  The network development processes in the three case study regions reveal a significant gap between intentions to involve patients in health planning and their actual involvement. This gap can be explained by: (i) a lack of clear direction regarding networks and patient participation in these networks; (ii) the dominance of regional cancer centres in network planning activities; and, (iii) the emergence of competing provincial priorities. Discussion  These three trends expose the complexity of the notion of public participation and how it is embedded in social and political contexts. The failed attempt at involving patients in health planning efforts is the result of benign neglect of public participation intents and the social and political contexts in which public and patient participation is meant to occur. PMID:16098150

  16. Does age affect prognosis in salivary gland carcinoma patients?

    DEFF Research Database (Denmark)

    Bjørndal, Kristine; Larsen, Stine R; Therkildsen, Marianne H

    2016-01-01

    in the young group were WHO performance status 0 and in disease stage I + II, and they presented with significantly more histological low grade tumors. In multivariate analysis, chronological age seemed to be of no prognostic significance to salivary gland carcinoma patients as opposed to performance status......, disease stage and histological grade. CONCLUSIONS: Salivary gland carcinoma patients over the age of 70 years have a poor prognosis compared to younger patients, which can be explained by higher disease stages, more histological high grade subtypes and a poorer performance status at the time of diagnosis.......AIM: To compare incidence, histology, treatment modalities, disease stages, and outcome in elderly patients (≥70 years) compared to younger (

  17. Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey.

    Science.gov (United States)

    Burt, Jenni; Lloyd, Cathy; Campbell, John; Roland, Martin; Abel, Gary

    2016-01-01

    Doctor-patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor-patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. To determine how reported GP-patient communication varies between patients from different ethnic groups, stratified by age and gender. Analysis of data from the English GP Patient Survey from 2012-2013 and 2013-2014, including 1,599,801 responders. A composite score was created for doctor-patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group. There was strong evidence (Pgender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP-patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor-patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as 'Any other white'. The identification of groups with particularly marked differences in experience of GP-patient communication--older, female, Asian patients and younger 'Any other white' patients--underlines the need for a renewed focus on quality of care for these groups. © British Journal of General Practice 2016.

  18. Cervical vertebral maturation and dental age in coeliac patients.

    Science.gov (United States)

    Costacurta, M; Condò, R; Sicuro, L; Perugia, C; Docimo, R

    2011-07-01

    The aim of the study was to evaluate the cervical vertebral maturation and dental age, in group of patients with coelic disease (CD), in comparison with a control group of healthy subjects. At the Paediatric Dentistry Unit of PTV Hospital, "Tor Vergata" University of Rome, 120 female patients, age range 12.0-12.9 years were recruited. Among them, 60 subjects (Group 1) were affected by CD, while the control group (Group 2) consisted of 60 healthy subjects, sex and age-matched. The Group 1 was subdivided, according to the period of CD diagnosis, in Group A (early diagnosis) and Group B (late diagnosis). The skeletal age was determined by assessing the cervical vertebral maturation, while the dental age has been determined using the method codified by Demirjiyan. STATISTICS.: The analyses were performed using the SPSS software (version 16; SPSS Inc., Chicago IL, USA). In all the assessments a significant level of alpha = 0.05 was considered. There are no statistically significant differences between Group 1 and Group 2 as for chronological age (p=0.122). Instead, from the assessment of skeletal-dental age, there are statistically significant differences between Group 1 - Group 2 (pcervical vertebral maturity can be assessed with a low cost, non invasive, easy to perform exam carried out through the routine radiographic examinations such as orthopanoramic and lateral teleradiography.

  19. Age Disparity in Palliative Radiation Therapy Among Patients With Advanced Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Jonathan [University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii (United States); Xu, Beibei [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Yeung, Heidi N.; Roeland, Eric J. [Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Division of Palliative Medicine, Department of Internal Medicine, University of California San Diego, La Jolla, California (United States); Martinez, Maria Elena [Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California (United States); Le, Quynh-Thu [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Mell, Loren K. [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Murphy, James D., E-mail: j2murphy@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States)

    2014-09-01

    Purpose/Objective: Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population. Methods and Materials: We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy. Results: The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001). Conclusions: Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end

  20. Maxillofacial intervention in trauma patients aged 60 years and older

    Directory of Open Access Journals (Sweden)

    Subhashraj K

    2008-01-01

    Full Text Available The purpose of this study was to evaluate the incidence of trauma victims of age 60 years and older who required maxillofacial intervention. The study analyses the pattern of injuries and the various factors that predict the treatment plan of these patients. A retrospective study was carried out in 1820 trauma patients who reported to the Sri. Ramachandra Dental College and Hospital and required maxillofacial intervention, over a period of 5 years (October 2000 and September 2005. Of the total trauma victims, 185 patients were found to be aged 60 years more. In the majority of the patients, the injury was due to road traffic accidents (79.4%. Males (72.4% sustained more injuries than females (27.6%. Soft tissue injuries were seen in 49.1% of the patients, while 14% had mandibular fractures. People in their early 60s were injured more often than their older counterparts. The findings of this study highlight the present situation with regard to maxillofacial trauma in patients aged 60 years and older and its management in this part of the country.

  1. Urticaria and Prodromal Symptoms Including Erythema Marginatum in Danish Patients with Hereditary Angioedema

    DEFF Research Database (Denmark)

    Rasmussen, Eva R; Valente de Freitas, Priscila; Bygum, Anette

    2016-01-01

    Erythema marginatum is a characteristic skin rash seen in patients with hereditary angioedema (HAE); however, it can be confused with urticaria, leading to delay in correct diagnosis. The aim of this study was to clarify how often erythema marginatum is misinterpreted as urticaria, potentially...

  2. Contraceptive failure of etonogestrel implant in patients treated with antiretrovirals including efavirenz.

    Science.gov (United States)

    Leticee, Nadia; Viard, Jean-Paul; Yamgnane, Amina; Karmochkine, Marina; Benachi, Alexandra

    2012-04-01

    Contraception for HIV-positive women is a complex issue. Although the use of condoms is recommended, complementary methods of contraception are often prescribed. Antiretroviral therapy can lead to drug interactions and modify the efficacy of hormonal contraception. Two unintended pregnancies suggest that etonogestrel implants should be used with caution in patients on efavirenz. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Vitrectomy in patients over 90 years of age

    Directory of Open Access Journals (Sweden)

    Muto T

    2016-01-01

    Full Text Available Tetsuya Muto, Tomoyuki Ide, Makoto Chikuda, Shigeki Machida Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan Purpose: The aim of this study was to evaluate vitrectomy procedures performed in patients over 90 years of age at the Dokkyo Medical University Koshigaya Hospital (Koshigaya, Japan.Patients and methods: Vitrectomies were performed in nine eyes of nine patients who were over 90 years of age between May 2010 and March 2015. Factors such as the underlying vitreoretinal disease, preoperative and postoperative best-corrected visual acuity (BCVA, surgical time, postoperative body position, need for a second surgery, systemic disease, and intraoperative changes in systemic conditions have been evaluated.Results: The most common cause of the underlying vitreoretinal disease was vitreous hemorrhage derived from age-related macular degeneration and posterior dislocation of the lens secondary to a posterior capsular rupture (two cases each. The mean values for the logarithm of the minimum angle of resolution BCVA were 2.15 preoperatively and 1.46 postoperatively (P=0.020, Wilcoxon signed-rank test. The mean surgical time was 109 minutes. Prone position was needed in two cases, and no second surgeries were needed. The most common cause of systemic disease was hypertension, which was found in six cases. Transient hypertension was found in two cases during surgery, and these patients were treated using intravenous calcium blocker injections.Conclusion: Patients over 90 years of age who underwent vitrectomy procedures did not have serious problems, except transient hypertension during surgery. The BCVA significantly improved. These results indicated that vitrectomies could be performed successfully in patients over 90 years of age. Keywords: vitrectomy, underlying vitreoretinal disease, transient hypertension

  4. Age-related in-hospital mortality among patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Abid, A.R.; Rafique, S.; Ahmed, R.Z.; Anjum, A.H.; Tarin, S.M.A.

    2004-01-01

    Objective: To evaluate the in-hospital mortality of acute myocardial infarction among different age groups. Subjects and Methods: The subjects were 460 admitted patients of acute myocardial infarction who fulfilled our inclusion criteria. Patients were divided into four age groups. Group-I included patients in 20-40 years, group-II (41-50 years), group-III (51-60 years) and group-IV (>60 years). Mortality was compared between different age groups by Chi-square and linear-regression models. Results: The total in-hospital mortality was 16.7%. It gradually increased from 5.6% in group-I (20-40 years) patients to 21% in group-IV (>60 years) patients. While mortality in groups group-II (41-50 years) and group-III (51-60 years) patients was 16.7% and 18.6% respectively. A marked increase in mortality was noted with increase in age. Group- IV (>60 years) patients presented 2 hours late to the hospital than the group-I (20-40 years) patients. There was no statistical difference in site of infarction in different age groups. Old age (group-IV i.e. >60 years old) was more associated with heart failure (higher Killip class) on presentation. Lesser number of patients in group-IV received thrombolytic therapy than group-I. Only 31.09% patients in group-IV and 62.5% patients in group-I received streptokinase therapy respectively. Conclusion: In patients with acute myocardial infarction age was a powerful independent predictor of in-hospital mortality and complications. (author)

  5. The Comparison of Sagittal Spinopelvic Parameters between Young Adult Patients with L5 Spondylolysis and Age-Matched Control Group

    OpenAIRE

    Oh, Young Min; Choi, Ha Young; Eun, Jong Pil

    2013-01-01

    Objective To compare spinopelvic parameters in young adult patients with spondylolysis to those in age-matched patients without spondylolysis and investigate the clinical impact of sagittal spinopelvic parameters in patients with L5 spondylolysis. Methods From 2009 to 2012, a total of 198 young adult male patients with spondylolysis were identified. Eighty age-matched patients without spondylolysis were also selected. Standing lateral films that included both hip joints were obtained for each...

  6. Resveratrol Enhances Neuroplastic Changes, Including Hippocampal Neurogenesis, and Memory in Balb/C Mice at Six Months of Age

    Science.gov (United States)

    Torres-Pérez, Mario; Tellez-Ballesteros, Ruth Ivonne; Ortiz-López, Leonardo; Ichwan, Muhammad; Vega-Rivera, Nelly Maritza; Castro-García, Mario; Gómez-Sánchez, Ariadna; Kempermann, Gerd; Ramirez-Rodriguez, Gerardo Bernabe

    2015-01-01

    Resveratrol (RVTL) is a flavonoid found in red wine and has been publicized heavily as an anti-aging compound. Indeed, basic research confirms that although there is much hype in the promotion of RVTL, flavonoids such as RVTL have a wide range of biological effects. We here investigated the effects of RVTL treatment on hippocampal plasticity and memory performance in female Balb/C mice, a strain with low baseline levels of adult neurogenesis. Two weeks of treatment with RVTL (40 mg/kg) induced the production of new neurons in vivo by increasing cell survival and possibly precursor cell proliferation. In addition, RVTL decreased the number of apoptotic cells. The number of doublecortin (DCX)-expressing intermediate cells was increased. RVTL stimulated neuronal differentiation in vitro without effects on proliferation. In the dentate gyrus, RVTL promoted the formation and maturation of spines on granule cell dendrites. RVTL also improved performance in the step down passive avoidance test. The RVTL-treated mice showed increase in the levels of two key signaling proteins, phospho-Akt and phospho-PKC, suggesting the involvement of these signaling pathways. Our results support the vision that flavonoids such as resveratrol deserve further examination as plasticity-inducing compounds in the context of successful cognitive aging. PMID:26695764

  7. Resveratrol Enhances Neuroplastic Changes, Including Hippocampal Neurogenesis, and Memory in Balb/C Mice at Six Months of Age.

    Science.gov (United States)

    Torres-Pérez, Mario; Tellez-Ballesteros, Ruth Ivonne; Ortiz-López, Leonardo; Ichwan, Muhammad; Vega-Rivera, Nelly Maritza; Castro-García, Mario; Gómez-Sánchez, Ariadna; Kempermann, Gerd; Ramirez-Rodriguez, Gerardo Bernabe

    2015-01-01

    Resveratrol (RVTL) is a flavonoid found in red wine and has been publicized heavily as an anti-aging compound. Indeed, basic research confirms that although there is much hype in the promotion of RVTL, flavonoids such as RVTL have a wide range of biological effects. We here investigated the effects of RVTL treatment on hippocampal plasticity and memory performance in female Balb/C mice, a strain with low baseline levels of adult neurogenesis. Two weeks of treatment with RVTL (40 mg/kg) induced the production of new neurons in vivo by increasing cell survival and possibly precursor cell proliferation. In addition, RVTL decreased the number of apoptotic cells. The number of doublecortin (DCX)-expressing intermediate cells was increased. RVTL stimulated neuronal differentiation in vitro without effects on proliferation. In the dentate gyrus, RVTL promoted the formation and maturation of spines on granule cell dendrites. RVTL also improved performance in the step down passive avoidance test. The RVTL-treated mice showed increase in the levels of two key signaling proteins, phospho-Akt and phospho-PKC, suggesting the involvement of these signaling pathways. Our results support the vision that flavonoids such as resveratrol deserve further examination as plasticity-inducing compounds in the context of successful cognitive aging.

  8. Resveratrol Enhances Neuroplastic Changes, Including Hippocampal Neurogenesis, and Memory in Balb/C Mice at Six Months of Age.

    Directory of Open Access Journals (Sweden)

    Mario Torres-Pérez

    Full Text Available Resveratrol (RVTL is a flavonoid found in red wine and has been publicized heavily as an anti-aging compound. Indeed, basic research confirms that although there is much hype in the promotion of RVTL, flavonoids such as RVTL have a wide range of biological effects. We here investigated the effects of RVTL treatment on hippocampal plasticity and memory performance in female Balb/C mice, a strain with low baseline levels of adult neurogenesis. Two weeks of treatment with RVTL (40 mg/kg induced the production of new neurons in vivo by increasing cell survival and possibly precursor cell proliferation. In addition, RVTL decreased the number of apoptotic cells. The number of doublecortin (DCX-expressing intermediate cells was increased. RVTL stimulated neuronal differentiation in vitro without effects on proliferation. In the dentate gyrus, RVTL promoted the formation and maturation of spines on granule cell dendrites. RVTL also improved performance in the step down passive avoidance test. The RVTL-treated mice showed increase in the levels of two key signaling proteins, phospho-Akt and phospho-PKC, suggesting the involvement of these signaling pathways. Our results support the vision that flavonoids such as resveratrol deserve further examination as plasticity-inducing compounds in the context of successful cognitive aging.

  9. Age-related changes in trunk neuromuscular activation patterns during a controlled functional transfer task include amplitude and temporal synergies.

    Science.gov (United States)

    Quirk, D Adam; Hubley-Kozey, Cheryl L

    2014-12-01

    While healthy aging is associated with physiological changes that can impair control of trunk motion, few studies examine how spinal muscle responses change with increasing age. This study examined whether older (over 65 years) compared to younger (20-45 years) adults had higher overall amplitude and altered temporal recruitment patterns of trunk musculature when performing a functional transfer task. Surface electromyograms from twelve bilateral trunk muscle (24) sites were analyzed using principal component analysis, extracting amplitude and temporal features (PCs) from electromyographic waveforms. Two PCs explained 96% of the waveform variance. Three factor ANOVA models tested main effects (group, muscle and reach) and interactions for PC scores. Significant (pactivity, demonstrated continuous activation levels in specific muscle sites despite changing external moments, and had altered temporal synergies within abdominal and back musculature. In summary both older and younger adults recruit highly organized activation patterns in response to changing external moments. Differences in temporal trunk musculature recruitment patterns suggest that older adults experience different dynamic spinal stiffness and loading compared to younger adults during a functional lifting task. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Patient-related factors and circumstances surrounding decisions to forego life-sustaining treatment, including intensive care unit admission refusal.

    Science.gov (United States)

    Reignier, Jean; Dumont, Romain; Katsahian, Sandrine; Martin-Lefevre, Laurent; Renard, Benoit; Fiancette, Maud; Lebert, Christine; Clementi, Eva; Bontemps, Frederic

    2008-07-01

    To assess decisions to forego life-sustaining treatment (LST) in patients too sick for intensive care unit (ICU) admission, comparatively to patients admitted to the ICU. Prospective observational cohort study. A medical-surgical ICU. Consecutive patients referred to the ICU during a one-yr period. None. Of 898 triaged patients, 147 were deemed too well to benefit from ICU admission. Decisions to forego LST were made in 148 of 666 (22.2%) admitted patients and in all 85 patients deemed too sick for ICU admission. Independent predictors of decisions to forego LST at ICU refusal rather than after ICU admission were: age; underlying disease; living in an institution; preexisting cognitive impairment; admission for medical reasons; and acute cardiac failure, acute central neurologic illness, or sepsis. Hospital mortality after decisions to forego LST was not significantly different in refused and admitted patients (77.5% vs. 86.5%; p = .1). Decisions to forego LST were made via telephone in 58.8% of refused patients and none of the admitted patients. Nurses caring for the patient had no direct contact with the ICU physicians for 62.3% of the decisions in refused patients, whereas meetings between nurses and physicians occurred in 70.3% of decisions to forego LST in the ICU. Patients or relatives were involved in 28.2% of decisions to forego LST at ICU refusal compared with 78.4% of decisions to forego LST in ICU patients (p refused patients (vs. none of admitted patients) and were associated with less involvement of nurses and relatives compared with decisions in admitted patients. Further work is needed to improve decisions to forego LST made under the distinctive circumstances of triage.

  11. Broadening the Reach of Standardized Patients in Nurse Practitioner Education to Include the Distance Learner.

    Science.gov (United States)

    Ballman, Kathleen; Garritano, Nicole; Beery, Theresa

    2016-01-01

    Using standardized patients (SP) presenting with a specific complaint has been a mainstay in health care education. Increased use of technology has facilitated the move of instruction from the on-campus classroom to distance learning for many nurse practitioner programs. Using interactive case studies provides distance learners SP encounters. This technologically facilitated encounter gives the distance learner the opportunity for integrative thinking and development of problem solving and clinical reasoning skills.

  12. Radiation doses to patients in computed tomography including a ready reckoner for dose estimation

    International Nuclear Information System (INIS)

    Szendroe, G.; Axelsson, B.; Leitz, W.

    1995-11-01

    The radiation burden from CT-examinations is still growing in most countries and has reached a considerable part of the total from medical diagnostic x-ray procedures. Efforts for avoiding excess radiation doses are therefore especially well motivated within this field. A survey of CT-examination techniques practised in Sweden showed that standard settings for the exposure variables are used for the vast majority of examinations. Virtually no adjustments to the patient's differences in anatomy have been performed - even for infants and children on average the same settings have been used. The adjustment of the exposure variables to the individual anatomy offers a large potential of dose savings. Amongst the imaging parameters, a change of the radiation dose will primarily influence the noise. As a starting point it is assumed that, irrespective of the patient's anatomy, the same level of noise can be accepted for a certain diagnostic task. To a large extent the noise level is determined by the number of photons that are registered in the detector. Hence, for different patient size and anatomy, the exposure should be adjusted so that the same transmitted photon fluence is achieved. An appendix with a ready reckoner for dose estimation for CT-scanners used in Sweden is attached. 7 refs, 5 figs, 8 tabs

  13. Phase 2 study of the JAK kinase inhibitor ruxolitinib in patients with refractory leukemias, including postmyeloproliferative neoplasm acute myeloid leukemia.

    Science.gov (United States)

    Eghtedar, Alireza; Verstovsek, Srdan; Estrov, Zeev; Burger, Jan; Cortes, Jorge; Bivins, Carol; Faderl, Stefan; Ferrajoli, Alessandra; Borthakur, Gautam; George, Solly; Scherle, Peggy A; Newton, Robert C; Kantarjian, Hagop M; Ravandi, Farhad

    2012-05-17

    We conducted a phase 2 study of ruxolitinib in patients with relapsed/refractory leukemias. Patients with acceptable performance status (0-2), adequate organ function, and no active infection, received ruxolitinib 25 mg orally twice a day for 4 weeks (1 cycle). Response was assessed after every 2 cycles of treatment, and patients who completed 2 cycles were allowed to continue treatment until disease progression. Dose escalation to 50 mg twice daily was permitted in patients demonstrating a benefit. Thirty-eight patients, with a median age of 69 years (range, 45-88), were treated. The median number of prior therapies was 2 (range, 1-6). Twelve patients had JAK2V617F mutation. Patients received a median of 2 cycles of therapy (range, 1-22). Three of 18 patients with postmyeloproliferative neoplasm (MPN) acute myeloid leukemia (AML) showed a significant response; 2 achieved complete remission (CR) and one achieved a CR with insufficient recovery of blood counts (CRi). The responding patients with palpable spleens also had significant reductions in spleen size. Overall, ruxolitinib was very well tolerated with only 4 patients having grade 3 or higher toxicity. Ruxolitinib has modest antileukemic activity as a single agent, particularly in patients with post-MPN AML. The study was registered at www.clinicaltrials.gov as NCT00674479.

  14. Revised stratigraphy of Area 123, Koobi Fora, Kenya, and new age estimates of its fossil mammals, including hominins.

    Science.gov (United States)

    Gathogo, Patrick N; Brown, Francis H

    2006-11-01

    Recent geologic study shows that all hominins and nearly all other published mammalian fossils from Paleontological Collection Area 123, Koobi Fora, Kenya, derive from levels between the KBS Tuff (1.87+/-0.02 Ma) and the Lower Ileret Tuff (1.53+/-0.01 Ma). More specifically, the fossils derive from 53 m of section below the Lower Ileret Tuff, an interval in which beds vary markedly laterally, especially those units containing molluscs and algal stromatolites. The upper Burgi Member (approximately 2.00-1.87 Ma) crops out only in the southwestern part of Area 123. Adjacent Area 110 contains larger exposures of the member, and there the KBS Tuff is preserved as an airfall ash in lacustrine deposits and also as a fluvially redeposited ash. We observed no mammalian fossils in situ in this member in Area 123, but surface specimens have been documented in some monographic treatments. Fossil hominins from Area 123 were attributed to strata above the KBS Tuff in the 1970s, but later they were assigned to strata below the KBS Tuff (now called the upper Burgi Member). This study definitively places the Area 123 hominins in the KBS Member. Most of these hominins are between 1.60 and 1.65 myr in age, but the youngest may date to only 1.53 Ma, and the oldest, to 1.75 Ma. All are 0.15-0.30 myr younger than previously estimated. The new age estimates, in conjunction with published taxonomic attributions of fossils, suggest that at least two species of Homo coexisted in the region along with A. boisei until at least 1.65 Ma. Comparison of crania KNM-ER 1813 and KNM-ER 1470, which were believed to be of comparable age, is at the focus of the debate over whether Homo habilis sensu lato is in fact composed of two species: Homo habilis and Homo rudolfensis. These two crania are separated in time by approximately 0.25 myr, and therefore, arguments for their conspecificity no longer need to confront the issue of unusually high contemporaneous variation within a single species.

  15. Patients' age as a determinant of care received following acute stroke: A systematic review

    Directory of Open Access Journals (Sweden)

    Bernhardt Julie

    2011-07-01

    Full Text Available Abstract Background Evidence-based care should improve acute stroke outcomes with the same magnitude of effect for stroke patients of all ages. However, there is evidence to suggest that, in some instances, older stroke patients may receive poorer quality care than younger patients. Our aim was to systematically review evidence of the quality of care provided to patients with acute stroke related to their age. Quality of care was determined by compliance with recommended care processes. Methods We systematically searched MEDLINE, CINAHL, ISI Web of Knowledge, Ageline and the Cochrane Library databases to identify publications (1995-2009 that reported data on acute stroke care process indicators by patient age. Data extracted included patient demographics and process indicator compliance. Included publications were critically appraised by two independent reviewers using the Critical Appraisal Skills Programme tool, and a comparison was made of the risk of bias according to studies' findings. The evidence base for reported process indicators was determined, and meta-analysis was undertaken for studies with sufficient similarity. Results Nine from 163 potential studies met the inclusion criteria. Of the 56 process indicators reported, eleven indicators were evidence-based. Seven of these indicators (64% showed significantly poorer care for older patients compared to younger ones, while younger patients received comparatively inferior care for only antihypertensive therapy at discharge. Our findings are limited by the variable methodological quality of included studies. Conclusion Patients' age may be a factor in the care they receive after an acute stroke. However, the possible influence of patients' age on clinicians' decision-making must be considered in terms of the many complex issues that surround the provision of optimal care for older patients with acute stroke.

  16. The financial burden of HIV care, including antiretroviral therapy, on patients in three sites in Indonesia.

    Science.gov (United States)

    Riyarto, Sigit; Hidayat, Budi; Johns, Benjamin; Probandari, Ari; Mahendradhata, Yodi; Utarini, Adi; Trisnantoro, Laksono; Flessenkaemper, Sabine

    2010-07-01

    This paper assesses the extent of the financial burden due to out-of-pocket payments for health care incurred by people living with HIV (PLHIV) and the effect of this burden on their financial capacity. Data were collected in a cross-sectional survey of 353 PLHIV from three cities in Indonesia (Jakarta, Jogjakarta and Merauke). Respondents in Jakarta were sampled from one hospital and one non-governmental organization working with PLHIV. In Jogjakarta and Merauke, all HIV patients on antiretroviral therapy (ART) who came to selected hospitals during the interview period were asked to participate in the survey. The survey collected data on the frequency and extent of payments for HIV-related care, with answers cross-checked against medical records. Results show that PLHIV had different burdens of payments in the different geographical areas. On average, respondents in Jogjakarta spent 68%, and PLHIV on ART in Jakarta spent 96%, of monthly expenditure for HIV-related care, indicating a substantial financial burden for many ART patients. These patients depended on several sources of finance to cover the costs of their care, with donations from their immediate family being the most common method, selling assets and payments from personal income being the second most common method in Jakarta and Jogjakarta, respectively. Most PLHIV in these two areas did not have insurance. In Merauke, there were little observed out-of-pocket payments because the government covers medical costs via the local budget and health insurance for the poor. The results of this study confirm previous findings that providing subsidized ART drugs alone does not ensure financial accessibility to HIV care. Thus, the government of Indonesia at central and local levels should consider covering HIV care additional to providing antiretroviral drugs free of charge. Social health insurance should also be encouraged.

  17. Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications.

    Science.gov (United States)

    Bordeaux, Jeremy S; Martires, Kathryn J; Goldberg, Dori; Pattee, Sean F; Fu, Pingfu; Maloney, Mary E

    2011-09-01

    Few prospective studies have evaluated the safety of dermatologic surgery. We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use. Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded. Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were on two or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR] = 5.80), graft repair (OR = 7.58), flap repair (OR = 11.93), and partial repair (OR = 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P = .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae. The study was limited to one academic dermatology practice. The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  18. Varied autopsy findings in five treated patients with Gaucher disease and parkinsonism include the absence of Gaucher cells.

    Science.gov (United States)

    Monestime, Gianina; Borger, Daniel K; Kim, Jenny; Lopez, Grisel; Allgaeuer, Michael; Jain, Dhanpat; Vortmeyer, Alexander; Wang, Hao-Wei; Sidransky, Ellen

    2016-05-01

    Enzyme replacement therapy is standard of care for patients with Gaucher disease, as it significantly improves skeletal, visceral, and hematological symptoms. Few pathological studies have documented the extent of pathological findings in treated patients. Autopsy findings in five treated patients, who ultimately developed parkinsonism, ranged from the complete absence of Gaucher pathology to extensive involvement of multiple tissues, without correlation to age, genotype, spleen status, or dose/duration of therapy. Additional autopsies may elucidate modifiers and biomarkers contributing to disease burden and response to therapy. Published by Elsevier Inc.

  19. Metabolic syndrome and aerobic fitness in patients with first-episode schizophrenia, including a 1-year follow-up

    DEFF Research Database (Denmark)

    Nyboe, L.; Vestergaard, C. H.; Moeller, M. K.

    2015-01-01

    OBJECTIVE: To compare the prevalence of metabolic syndrome (MetS) and metabolic abnormalities in patients with first-episode schizophrenia (FES) with sex- and age-matched healthy controls; to investigate changes in MetS during 1year of treatment; and to investigate predictors of MetS. METHODS...

  20. Radiotherapy for cancer patients aged 80 and older: a study of effectiveness and side effects

    International Nuclear Information System (INIS)

    Zachariah, Babu; Balducci, Lodovico; Venkattaramanabalaji, G.V.; Casey, Linda; Greenberg, Harvey M.; Del Regato, Juan A.

    1997-01-01

    Purpose: To profile cancer patients aged 80 and older undergoing radiotherapy and to study the tumor response and side effects of therapy. Methods and Materials: We retrospectively analyzed the records of patients aged 80 and older who received radiation therapy at James A. Haley Veterans Hospital and H. Lee Moffitt Cancer Center between 1988 and 1995. A total of 203 patients aged 80-94 received radiotherapy during this period. Treatment sites included head and neck [50], breast [16], chest [37], pelvis [53], and miscellaneous [39]. Age, treatment site, field size, total dose, response to treatment, treatment interruptions, incidence and severity of weight loss, myelosuppression, diarrhea, mucositis, dermatitis, and follow-up status are assessed using our departmental records and hospital tumor registry. Results: Of 191 patients evaluated, 179 (94%) completed the treatment without serious complications. A total of 195 sites were irradiated. Twelve patients (6%) required interruption of the treatment. Therapeutic responses were seen in 86 out of 112 patients (77%) treated with curative intent (with 67% complete response) and in 67 out of 83 patients (81%) treated with palliative intent. The causes of treatment interruptions included weight loss from diarrhea, dysphagia, and progressive disease. Treatment interruptions were more likely in patients treated with large treatment fields. In patients treated for upper aero-digestive tract cancer, Grade 3 and 4 mucositis was noted in 20 and 2% of patients, respectively. Grade 1 and 2 enteritis was noted in 43% of patients treated for pelvic malignancies. Grade 3 dermatitis was noted only in 2% of patients. Conclusion: Radiotherapy is highly effective and well tolerated by the oldest old. Age is not a contraindication to aggressive radiotherapy

  1. Modeling radiation dosimetry to predict cognitive outcomes in pediatric patients with CNS embryonal tumors including medulloblastoma

    International Nuclear Information System (INIS)

    Merchant, Thomas E.; Kiehna, Erin N.; Li Chenghong; Shukla, Hemant; Sengupta, Saikat; Xiong Xiaoping; Gajjar, Amar; Mulhern, Raymond K.

    2006-01-01

    Purpose: Model the effects of radiation dosimetry on IQ among pediatric patients with central nervous system (CNS) tumors. Methods and Materials: Pediatric patients with CNS embryonal tumors (n = 39) were prospectively evaluated with serial cognitive testing, before and after treatment with postoperative, risk-adapted craniospinal irradiation (CSI) and conformal primary-site irradiation, followed by chemotherapy. Differential dose-volume data for 5 brain volumes (total brain, supratentorial brain, infratentorial brain, and left and right temporal lobes) were correlated with IQ after surgery and at follow-up by use of linear regression. Results: When the dose distribution was partitioned into 2 levels, both had a significantly negative effect on longitudinal IQ across all 5 brain volumes. When the dose distribution was partitioned into 3 levels (low, medium, and high), exposure to the supratentorial brain appeared to have the most significant impact. For most models, each Gy of exposure had a similar effect on IQ decline, regardless of dose level. Conclusions: Our results suggest that radiation dosimetry data from 5 brain volumes can be used to predict decline in longitudinal IQ. Despite measures to reduce radiation dose and treatment volume, the volume that receives the highest dose continues to have the greatest effect, which supports current volume-reduction efforts

  2. Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management

    International Nuclear Information System (INIS)

    1993-11-01

    This standard presents program criteria and implementation guidance for an operational configuration management program for DOE nuclear and non-nuclear facilities in the operational phase. Portions of this standard are also useful for other DOE processes, activities, and programs. This Part 1 contains foreword, glossary, acronyms, bibliography, and Chapter 1 on operational configuration management program principles. Appendices are included on configuration management program interfaces, and background material and concepts for operational configuration management

  3. Goiter in adult patients aged 55 years and older: etiology and clinical features in 634 patients.

    Science.gov (United States)

    Díez, Juan J

    2005-07-01

    Goiter is common in older people, although the frequency of the different causes of goiter has not been well defined. Our aim has been to assess the frequency of the diverse etiologies of goiter in adult patients aged 55 years and older, and evaluate the relationships between etiology and age, sex, and goiter features. We performed a descriptive, cross-sectional study in ambulatory patients in the setting of an endocrinology clinic. Six hundred thirty-four patients (544 women, 85.8%) with goiter, aged 55-91 years, were studied. Causes of goiter were nontoxic multinodular goiter (325 patients, 51.3%); toxic multinodular goiter (151 patients, 23.8%); solitary thyroid nodule (62 patients, 9.8%); toxic adenoma (32 patients, 5.0%); Graves' disease (27 patients, 4.3%); Hashimoto's thyroiditis (25 patients, 3.9%); simple goiter (8 patients, 1.3%); thyroiditis (3 patients, 0.5%); and thyroid-stimulating hormone-secreting pituitary adenoma (1 patient, 0.2%). Patients with multinodular goiter had greater thyroid size and longer time of evolution than those patients with uninodular disease. Most of the symptoms and signs associated with goiter were dependent on thyroid size and time of evolution. Age and sex conditioned the presence of retrosternal goiter and tracheal deviation, and previous therapy was related to retrosternal goiter and local symptoms. However, etiology was not associated with the presence of any symptom. Nontoxic and toxic multinodular goiter are the main etiologies of goiter in patients aged 55 years and older. Thyroid size is the main factor influencing the appearance of signs and symptoms, although age and sex are related with the presence of retrosternal goiter and tracheal deviation.

  4. Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome

    DEFF Research Database (Denmark)

    Reiman, M P; Thorborg, K; Covington, K

    2017-01-01

    for diagnosis and assessment of FAIS. Diagnostic imaging was the domain with the highest level of agreement. Domains such as patient-reported outcome measures (PRO's) and physical examination were identified as non-diagnostic measures (rather as assessments of disease impact). CONCLUSION: Although it also had...... the greatest level of variability in description of examination domains, diagnostic imaging continues to be the preeminent diagnostic measure for FAIS. No single domain should be utilized as the sole diagnostic or assessment parameter for FAIS. While not all investigated domains provide diagnostic capability...... for FAIS, those that do not are able to serve purpose as a measure of disease impact (e.g., impairments and activity limitations). The clinical relevance of this Delphi survey is the understanding that a comprehensive assessment measuring both diagnostic capability and disease impact most accurately...

  5. Prevalence of pain medication prescriptions in France, Germany, and the UK - a cross-sectional study including 4,270,142 patients.

    Science.gov (United States)

    Jacob, Louis; Kostev, Karel

    2018-01-01

    The goal of the present study was to analyze the prevalence of pain medication prescriptions in general practices in France, Germany, and the UK. This study included all patients aged ≥18 years followed in 2016 in general practitioner practices in France, Germany and the UK. The primary outcome was the prevalence of patients receiving prescriptions for pain medications in France, Germany, and the UK in 2016. The following drugs were included in the analysis: anti-inflammatory and antirheumatic products, non-steroids and analgesics including opioids, antimigraine preparations, and other analgesics and antipyretics. Demographic variables included age and gender. This study included 4,270,142 patients. The prevalences of pain medication prescriptions were 57.3% in France, 29.6% in Germany, and 21.7% in the UK. Although this prevalence generally remained consistent between age groups in France (54.3%-60.3%), it increased with age in Germany (18-30 years: 23.8%; >70 years: 35.8%) and in the UK (18-30 years: 9.3%; >70 years: 43.8%). Finally, the prevalence of pain medication prescriptions was higher in women than in men in all three countries. Paracetamol was prescribed to 82.3% and 60.1% of patients receiving pain medication in France and the UK, respectively, whereas ibuprofen was prescribed to 46.5% of individuals in Germany. The prevalence of pain medication prescriptions was higher in France than in Germany and the UK. Further research is needed to gain a better understanding of the differences in the prescription patterns between these three European countries.

  6. Accumulation of advanced glycation end (AGEs products in intensive care patients: an observational, prospective study

    Directory of Open Access Journals (Sweden)

    Rommes Johannes H

    2010-05-01

    Full Text Available Abstract Background Oxidative stress plays an important role in the course and eventual outcome in a majority of patients admitted to the intensive care unit (ICU. Markers to estimate oxidative stress are not readily available in a clinical setting. AGEs accumulation has been merely described in chronic conditions, but can also occur acutely due to oxidative stress. Since AGEs have emerged to be stable end products, these can be a marker of oxidative stress. Skin autofluorescence (AF is a validated marker of tissue content of AGEs. We hypothesized that AGEs accumulate acutely in ICU patients. Methods We performed an observational prospective study in a medical surgical ICU in a university affiliated teaching hospital. All consecutively admitted ICU patients in a 2 month period were included. Skin AF was measured using an AGE reader in 35 consecutive ICU patients > 18 yrs. As a comparison, historical data of a control group (n = 231 were used. These were also used to calculate age-adjusted AF-levels (AFadj. Values are expressed as median and interquartile range [P25-P75]. Differences between groups were tested by non parametric tests. P Results AFadj values were higher in ICU patients (0.33 [0.00 - 0.68] than in controls (-0.07 [-0.29 - 0.24]; P adj were observed between acute or planned admissions, or presence of sepsis, nor was skin AFadj related to severity of disease as estimated by APACHE-II score, length of ICU, hospital stay or mortality. Conclusion Acute AGE accumulation in ICU patients was shown in this study, although group size was small. This can possibly reflect oxidative stress in ICU patients. Further studies should reveal whether AGE-accumulation will be a useful parameter in ICU patients and whether skin AF has a predictive value for outcome, which was not shown in this small study.

  7. Radiotherapy for prostatic cancer in patients aged 75 or older

    Energy Technology Data Exchange (ETDEWEB)

    Hisada, Tomohiro; Kataoka, Masaaki; Mogami, Hiroshi; Inoue, Takeshi; Uemura, Masahiko; Sumiyoshi, Yoshiteru [Shikoku Cancer Center Hospital, Matsuyama (Japan); Nagao, Shuji

    2000-10-01

    Thirty-eight patients with prostatic cancer treated with radiotherapy giving a mean dose of 60.7 Gy between 1992 and 1997 at Shikoku Cancer Center Hospital were reviewed and the treatment outcomes were investigated retrospectively. About two-third of the patients were treated with radiation by linear accelerator with 40 to 46 Gy to the whole pelvis and with 20 to 26 Gy boost to the prostate area and the other one-third were treated only to the prostate area. For almost patients, external beam radiotherapy in combination with endocrine therapy was used. The median duration of follow-up was 36 months. Overall 5-year survival and 5-year relapse-free survival rate were 65.8%, and 88.9%, respectively. Severe rectal late morbidity (over grade 3) according to RTOG grading system were seen in one (2.6%). Although the number of cases was rather small and the follow-up duration was rather short, conventional external beam radiotherapy in combination with endocrine therapy may contribute to the survival benefit of patients with prostatic cancer in aged 75 or older. Radiotherapy for elderly prostatic cancer patients should be treated with an effort to decrease the late morbidity and not to deteriorate the QOL of the patients, because many patients were died of other causes than cancer. (author)

  8. Mortality and recurrence rates among systemically untreated high risk breast cancer patients included in the DBCG 77 trials

    DEFF Research Database (Denmark)

    Jensen, Maj Britt; Nielsen, Torsten O.; Knoop, Ann S.

    2018-01-01

    Background: Following loco-regional treatment for early breast cancer accurate prognostication is essential for communicating benefits of systemic treatment. The aim of this study was to determine time to recurrence and long-term mortality rates in high risk patients according to patient characte......Background: Following loco-regional treatment for early breast cancer accurate prognostication is essential for communicating benefits of systemic treatment. The aim of this study was to determine time to recurrence and long-term mortality rates in high risk patients according to patient...... and EGFR positive. Multivariate categorical and fractional polynomials (MFP) models were used to construct prognostic subsets by clinicopathologic characteristics. Results: In a multivariate model, mortality rate was significantly associated with age, tumor size, nodal status, invasion, histological type...

  9. Effects of vitamins, including vitamin A, on HIV/AIDS patients.

    Science.gov (United States)

    Mehta, Saurabh; Fawzi, Wafaie

    2007-01-01

    increase lymphoid cell differentiation, which leads to an increase in CCR5 receptors. These receptors are essential for attachment of HIV to the lymphocytes and therefore, an increase in their number is likely to increase HIV replication. Vitamin A supplementation in HIV-infected children, on the other hand, has been associated with protective effects against mortality and morbidity, similar to that seen in HIV-negative children. The risk for lower respiratory tract infection and severe watery diarrhea has been shown to be lower in HIV-infected children supplemented with vitamin A. All-cause mortality and AIDS-related deaths have also been found to be lower in vitamin A-supplemented HIV-infected children. The benefits of multivitamin supplementation, particularly vitamins B, C, and E, have been more consistent across studies. Multivitamin supplementation in HIV-infected pregnant mothers has been shown to reduce the incidence of adverse pregnancy outcomes such as fetal loss and low birth weight. It also has been shown to decrease rates of MTCT among women who have poor nutritional or immunologic status. Further, multivitamin supplementation reduces the rate of HIV disease progression among patients in early stage of disease, thus delaying the need for ART by prolonging the pre-ART stage. In brief, there is no evidence to recommend vitamin A supplementation of HIV-infected pregnant women; however, periodic vitamin A supplementation of HIV-infected infants and children is beneficial in reducing all-cause mortality and morbidity and is recommended. Similarly, multivitamin supplementation of people infected with HIV, particularly pregnant women, is strongly suggested.

  10. Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: retrospective physician surveys including chart reviews at numerous centers.

    Science.gov (United States)

    Gossman, Michael S; Wilkinson, Jeffrey D; Mallick, Avishek

    2014-01-01

    In a 2-part study, we first examined the results of 71 surveyed physicians who provided responses on how they address the management of patients who maintained either a pacemaker or a defibrillator during radiation treatment. Second, a case review study is presented involving 112 medical records reviewed at 18 institutions to determine whether there was a change in the radiation prescription for the treatment of the target cancer, the method of radiation delivery, or the method of radiation image acquisition. Statistics are provided to illustrate the level of administrative policy; the level of communication between radiation oncologists and heart specialists; American Joint Committee on Cancer (AJCC) staging and classification; National Comprehensive Cancer Network (NCCN) guidelines; tumor site; patient׳s sex; patient׳s age; device type; manufacturer; live monitoring; and the reported decisions for planning, delivery, and imaging. This survey revealed that 37% of patient treatments were considered for some sort of change in this regard, whereas 59% of patients were treated without regard to these alternatives when available. Only 3% of all patients were identified with an observable change in the functionality of the device or patient status in comparison with 96% of patients with normal behavior and operating devices. Documented changes in the patient׳s medical record included 1 device exhibiting failure at 0.3-Gy dose, 1 device exhibiting increased sensor rate during dose delivery, 1 patient having an irregular heartbeat leading to device reprogramming, and 1 patient complained of twinging in the chest wall that resulted in a respiratory arrest. Although policies and procedures should directly involve the qualified medical physicist for technical supervision, their sufficient involvement was typically not requested by most respondents. No treatment options were denied to any patient based on AJCC staging, classification, or NCCN practice standards. Copyright

  11. Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes

    Directory of Open Access Journals (Sweden)

    Graeme Kohler

    2017-11-01

    Full Text Available n a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs at decision-making points in primary healthcare (PHC based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability.

  12. Clinical Features and Gene Mutations of Lung Cancer Patients 30 Years of Age or Younger.

    Directory of Open Access Journals (Sweden)

    Yuehong Wang

    Full Text Available Few studies examining the clinical features and gene mutations in lung cancer patients 30 years of age or younger have been published. A trend towards increasing morbidity has been noted in young patients; thus, an urgent need exists to explore this subgroup of patients.Patients aged ≤30 years with pathologically diagnosed lung cancer were retrospectively evaluated. We reviewed the clinical features, gene mutations and prognosis of each patient.Forty-one patients were included in this study. The mean age was 26.4±3.5 years. Cough, tightness/dyspnea and chest pain were common symptoms, and 58.5% of patients presented with advanced stages of lung cancer. Adenocarcinoma was the predominant histologic type noted in these young patients. Masses and nodules were the dominant imaging features observed upon lung computed tomography (CT. Thoracic lymphadenopathy occurred very frequently in these patients. Five of 6 patients with echinoderm microtubule-associated protein-like 4 (EML4-anaplastic lymphoma kinase (ALK gene fusions presented solid masses with no ground-glass opacity (GGO and thoracic multifocal lymphadenopathy. Six of 22 (27.2% cases contained EML4-ALK gene fusions. In addition, 5 of 22 (22.7% patients harbored epidermal growth factor receptor (EGFR mutations, and 2 of 17 patients exhibited KRAS and ROS1 gene mutations. The median survival times were 44.2 months for patients with early stage disease and 8 months for patients with advanced NSCLC disease. The one-year and 5-year survival rates were 56.6% and 38.6%, respectively.Increased gene mutation frequencies are noted in these very young lung cancer patients. This finding indicates that the detection of gene mutations in these patients is important and will help to determine the appropriate targeted therapy.

  13. Depression, anxiety, and somatic symptoms in older cancer patients: a comparison across age groups.

    Science.gov (United States)

    Cohen, Miri

    2014-02-01

    Previous studies have reported that older cancer patients experience lower psychological distress than younger patients, but most prior studies do not differentiate between age groups within the 'older' category. The aim of this study was to assess the intensity of the symptoms of depression, anxiety, and somatic symptoms among different age groups of older cancer patients. Participants were composed of 321 cancer patients 60 years and older, who were divided into three age groups: 60-69, 70-79, and 80+ years. The participants answered the Brief Symptom Inventory-18, which included subscales for depression, anxiety, and somatic symptoms and the cancer-related problem list, in addition to providing personal and cancer-related details. Depressive, anxiety, and somatic symptoms and cancer-related problems were lowest in the 70-79 years age group and highest in the 80+ years age group. Comparisons between pairs of groups showed significant differences between each of the groups in Brief Symptom Inventory total scores and between the 80+ years age group and the other two groups in regard to depressive symptoms and cancer-related problems. Differences, related to anxiety and somatic symptoms, were significant for the 70-79 year olds, in comparison with the youngest and oldest groups. Intensity of symptoms was explained by older age, higher number of cancer-related problems, female gender, and lower income. Nonlinear relations exist between age and psychological symptoms, which is in line with the postponement of age-related health and functional decline in the modern era. These results suggest that the study of psychological reactions to cancer should examine differences between age groups among older cancer patients. Copyright © 2013 John Wiley & Sons, Ltd.

  14. Psychosocial, demographic, and treatment-seeking strategic behavior, including faith healing practices, among patients with epilepsy in northwest India.

    Science.gov (United States)

    Pal, Surender Kumar; Sharma, Krishan; Prabhakar, Sudesh; Pathak, Ashis

    2008-08-01

    The data on sociocultural, demographic, and psychosocial aspects and types of treatment strategies adopted by families of patients with epilepsy in northwestern India were collected by the interview schedule method from 400 patients (200 idiopathic and 200 symptomatic) at the outpatient department of the Neurology and Epilepsy Clinic of the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Epilepsy was classified as idiopathic or symptomatic on the basis of clinical tests (EEG, CT scan, and MRI). It was observed that socioeconomic factors had no bearing on epilepsy in the present sample. Early onset, that is, before 20 years of age, reduced the chances of patients' finding a spouse among those who disclosed the disease information, thereby impacting the nuptial and fertility rates of patients with epilepsy. The present sample of patients was well informed about and sensitized to the efficacy of the modern system of medicine, as 80% of patients sought medical treatment on the very same day as or within a week of onset of seizures. The data were compatible with the framed hypothesis that well-being and safety of the patient would override the stigma burden factor, as 94% of the affected families made no attempt to hide the disease from their neighbors, friends, and colleagues, and teachers of the affected patients. Surprisingly, only 7.5% of the families admitted that they consulted a faith healer. Families did adopt some culturally prevalent methods to control involuntary movements during seizures. It can be concluded that trust in faith healers exists strongly as an undercurrent, but is not overtly admitted by the majority of patients. Some families concurrently visited modern hospitals and occult healers seeking a cure for the disease. The fear of having a child with epilepsy or other abnormalities discouraged married patients from becoming pregnant after developing epilepsy.

  15. Nutritional status and feeding-tube placement in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy-based larynx preservation program.

    Science.gov (United States)

    Bozec, Alexandre; Benezery, Karen; Chamorey, Emmanuel; Ettaiche, Marc; Vandersteen, Clair; Dassonville, Olivier; Poissonnet, Gilles; Riss, Jean-Christophe; Hannoun-Lévi, Jean-Michel; Chand, Marie-Eve; Leysalle, Axel; Saada, Esma; Sudaka, Anne; Haudebourg, Juliette; Hebert, Christophe; Falewee, Marie-Noelle; Demard, François; Santini, José; Peyrade, Frédéric

    2016-09-01

    The objective of the study is to evaluate the nutritional status and determine its impact on clinical outcomes in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy (ICT)-based larynx preservation program without prophylactic feeding-tube placement. All patients with locally advanced (T3/4, N0-3, M0) hypopharyngeal squamous cell carcinoma, technically suitable for total pharyngolaryngectomy, treated by docetaxel, cisplatin and 5-fluorouracil (TPF)-ICT for larynx preservation at our institution between 2004 and 2013, were included in this retrospective study. Patients' nutritional status was closely monitored. Enteral nutrition was used if and when a patient was unable to sustain per-oral nutrition and hydration. The impact of nutritional status on clinical outcomes was investigated in univariate and multivariate analysis. A total of 53 patients (42 men and 11 women, mean age = 58.6 ± 8.2 years) were included in this study. Six (11.3 %) patients had lost more than 10 % of their usual body weight before therapy. Compared with patients' usual weight, the mean maximum patient weight loss during therapeutic management was 8.7 ± 4.5 kg. Enteral nutrition was required in 17 patients (32 %). We found no influence of the tested nutritional status-related factors on response to ICT, toxicity of ICT, overall, cause-specific and recurrence-free survival, and on post-therapeutic swallowing outcome. Maximum weight loss was significantly associated with a higher risk of enteral tube feeding during therapy (p = 0.03) and of complications (grade ≥3, p = 0.006) during RT. Without prophylactic feeding-tube placement, approximately one-third of the patients required enteral nutrition. There was no significant impact of nutritional status on oncologic or functional outcomes.

  16. ASSESSMENT OF THE SPECIFIC LOCAL HUMORAL IMMUNITY IN PATIENTS WITH INFERTILITY INCLUDING CASES ASSOCIATED WITH GENITAL TUBERCULOSIS

    Directory of Open Access Journals (Sweden)

    A. V. Mordyk

    2013-01-01

    Full Text Available Abstract. In order to optimize the detection and diagnosis of genital tuberculosis evaluation of the specific local antituberculosis immunity in 39 patients with infertility entered to the Department of Gynecology for the implementation of therapeutic and diagnostic laparoscopy has been carried out. All patients were divided into 3 groups: the 1st one included patients with tubal-peritoneal infertility, the group 2 included patients with infertility not associated with the defeat of the fallopian tubes, the third group was presented by patients with tubal-peritoneal infertility associated with genital tuberculosis who completed the basic course of anti-tuberculosis treatment. It was established that in case of the tubal-peritoneal infertility the local humoral immunity was characterised by increasing of IgM in the whole peritoneal fluid. Among women who recovered from genital tuberculosis increasing of IgA and IgG to M. tuberculosis was revealed in contrast to patients with infertility not associated with damage of fallopian tubes (p < 0.05. In 25% of patients of the 1st group genital tuberculosis was diagnosed. The diagnostic criteria for early detection of genital tuberculosis were determined and the algorithm of genital tuberculosis identification have been proposed.

  17. Processes in healthcare teams that include nurse practitioners: what do patients and families perceive to be effective?

    Science.gov (United States)

    Kilpatrick, Kelley; Jabbour, Mira; Fortin, Chantal

    2016-03-01

    To explore patient and family perceptions of team effectiveness of teams those include nurse practitioners in acute and primary care. Nurse practitioners provide safe and effective care. Patients are satisfied with the care provided by nurse practitioners. Research examining patient and family perceptions of team effectiveness following the implementation of nurse practitioners in teams is lacking. A descriptive qualitative design was used. We used purposeful sampling to identify participants in four clinical specialties. We collected data from March 2014-January 2015 using semi-structured interviews and demographic questionnaires. Content analysis was used. Descriptive statistics were generated. Participants (n = 49) believed that the teams were more effective after the implementation of a nurse practitioner and this was important to them. They described processes that teams with nurse practitioners used to effectively provide care. These processes included improved communication, involvement in decision-making, cohesion, care coordination, problem-solving, and a focus on the needs of patients and families. Participants highlighted the importance of interpersonal team dynamics. A human approach, trust, being open to discussion, listening to patient and family concerns and respect were particularly valued by participants. Different processes emerged as priorities when data were examined by speciality. However, communication, trust and taking the time to provide care were the most important processes. The study provides new insights into the views of patients and families and micro-level processes in teams with nurse practitioners. The relative importance of each process varied according to the patient's health condition. Patients and providers identified similar team processes. Future research is needed to identify how team processes influence care outcomes. The findings can support patients, clinicians and decision-makers to determine the processes to focus on to

  18. Patient and program costs, and outcomes, of including gender-sensitive services in intensive inpatient programs for substance use.

    Science.gov (United States)

    Hornack, Sarah E; Yates, Brian T

    2017-12-01

    Gender-sensitive services (GSS) attempt to make substance use treatment better for women, but at what cost and with what results? We sought answers to these questions in a federally-funded study by measuring separately the patient and provider costs of adding GSS, outcomes, and cost-outcome relationships for 12 mixed-gender intensive inpatient programs (IIP) that varied in amounts and types of GSS. GSS costs to female inpatients included time devoted to GSS and expenses for care of dependents while in the IIP. GSS costs to providers included time spent with patients, indirect services, treatment facilities, equipment, and materials. Offering more GSS was expected to consume more patient and provider resources. Offering more GSS also was expected to enhance outcomes and cost-outcome relationships. We found that average GSS costs to patients at the IIPs were $585 ($515-$656) per patient. Average GSS costs to providers at the IIPs were $344 ($42-$544) per patient. GSS costs to patients significantly exceeded GSS costs to providers. Contrary to previous research, offering more GSS services to patients did not result in significantly higher costs to patients or providers. IIPs offering more GSS may have delivered fewer traditional services, but this did not significantly affect outcomes, i.e., days until returning to another substance use treatment. In fact, median cost-outcome for these IIPs was a promising 35 treatment-free days, i.e., over a month, per $100 of GSS resources used by patients and providers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Including patients in core outcome set development: issues to consider based on three workshops with around 100 international delegates.

    Science.gov (United States)

    Young, Bridget; Bagley, Heather

    2016-01-01

    This commentary article describes three interactive workshops that explored how patients can contribute to decisions about what outcomes are measured in clinical trials across the world. Outcomes like quality of life, side-effects and pain are used in trials to measure whether a treatment is effective. Here, we outline how research groups are increasingly coming together to develop 'core outcomes sets' for particular conditions. Core outcome sets are lists of agreed outcomes. Their use will help in identifying which treatments are effective by enabling people to compare the findings of different clinical trials in the same condition. Currently, it is often very difficult to make these comparisons because different studies often measure different outcomes. Delegates attending the workshops included patients, clinicians and researchers. They discussed ways of making core outcome set development more meaningful and accessible for patients, and ensuring that they have a genuine say in the development process. This article summarises these discussions and concludes by identifying three distinctive challenges in securing patient input to core outcome set development: the process and objectives can seem far removed from the immediate concerns of patients, difficulties can arise in securing patient input on an international scale, and difficulties can also arise in bringing multiple stakeholder groups together to achieve consensus. While patient participation, involvement and engagement in core outcome set development can draw on lessons from other research areas, these distinctive challenges point to the need for distinctive solutions to enable meaningful patient input to core outcome set development. Background This article describes three workshops that explored how patients can contribute to decisions about what outcomes are measured in clinical trials. People need evidence about what treatments are best for particular health conditions. The strongest evidence comes

  20. Body composition changes in male patients with chronic obstructive pulmonary disease: Aging or disease process?

    Science.gov (United States)

    Lee, Li-Wen; Lin, Chieh-Mo; Li, Hung-Chou; Hsiao, Pei-Lin; Chung, An-Chi; Hsieh, Chu-Jung; Wu, Pi-Chi; Hsu, Shu-Feng

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) mainly affects middle-age and elderly adults. It is unclear if the presence of muscle wasting and fat accumulation in patients with COPD is age or disease-related. This study investigated the effect of age and COPD disease severity on body composition with the aim of identifying a biomarker(s) for COPD. Healthy subjects and patients with COPD of different severity were recruited. Dual-energy X-ray absorptiometry was used to analyze total and segmental body composition. Subjects included in the analysis were classified into four groups: healthy young (aged 20-45 years) (n = 35), healthy old (aged ≥ 60 years) (n = 37), moderate COPD (n = 40), and severe COPD (n = 14). In healthy old adults, leg and limb lean masses were lower by 10.6% and 8.5%, respectively, compared with healthy young adults (P changes in total and segmental body composition with aging and COPD severity. It found that aging and COPD altered the body composition differently, and the effect was most pronounced in leg lean mass. Remarkably, differences in appendicular lean masses were seen in mild COPD although no changes in body weight or BMI were apparent compared with healthy young adults. In contrast, fat depot changes were only observed in severe COPD. Aging and COPD processes are multifactorial and additional longitudinal studies are required to explore both the quantitative and qualitative changes in body composition with aging and disease process.

  1. B12 deficiency increases with age in hospitalized patients: a study on 14,904 samples.

    Science.gov (United States)

    Mézière, Anthony; Audureau, Etienne; Vairelles, Stéphane; Krypciak, Sébastien; Dicko, Michèle; Monié, Marguerite; Giraudier, Stéphane

    2014-12-01

    Cobalamin deficiency is responsible for hematological, neurological, neurocognitive, and neuropsychiatric impairments and is a risk factor for cardiovascular diseases, particularly in the elderly people. In order to determine B12 status in old inpatients, a total number of 14,904 hospitalized patients in whom B12 measurements were performed in five hospitals in the Paris metropolitan area were included from January 1, 2011 to December 31, 2011. The aims of the study were to determine whether age had an impact on B12 and folate deficiencies and to evaluate correlations between B12 and biological parameters-folate, hemoglobin, mean cell volume, homocystein (tHcy)-and age. Patients were aged 70.3±19.5 years. Low B12 concentration ( 17 µmol/L), 20.4% had low folate concentration (folate 17 µmol/L), and 4.7% of patients were both functional B12 and folate deficient. The B12 or folate deficient patients had lower mean cell volume level than nondeficient patients. Increase in mean cell volume and tHcy concentrations with age and decrease in B12, folate, and hemoglobin levels with age were observed. Frequency of functional B12 deficiency was 9.6% in patients aged 30-60 years and 14.2% in patients over 90 years. Frequency of functional folate deficiency was 9.5% in 30-60 years and 12.1% in >90 years. In inpatients, functional B12 deficiency and functional folate deficiency increase with age and are not associated with anemia or macrocytosis. False vitamin B deficiencies are frequent. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes.

    Science.gov (United States)

    Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

    2017-03-06

    Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to

  3. Patients as team members: opportunities, challenges and paradoxes of including patients in multi-professional healthcare teams.

    Science.gov (United States)

    Martin, Graham P; Finn, Rachael

    2011-11-01

    Current healthcare policy emphasises the need for more collaborative, team-based approaches to providing care, and for a greater voice for service users in the management and delivery of care. Increasingly, policy encourages 'partnerships' between users and professionals so that users, too, effectively become team members. In examining this phenomenon, this paper draws on insights from the organisational-sociological literature on team work, which highlights the challenges of bringing together diverse professional groups, but which has not, to date, been applied in contexts where users, too, are included in teams. Using data from a qualitative study of five pilot cancer-genetics projects, in which service users were included in teams responsible for managing and developing new services, it highlights the difficulties involved in making teams of such heterogeneous members-and the paradoxes that arise when this task is achieved. It reveals how the tension between integration and specialisation of team members, highlighted in the literature on teams in general, is especially acute for service users, the distinctiveness of whose contribution is more fragile, and open to blurring. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  4. Specific balance training included in an endurance-resistance exercise program improves postural balance in elderly patients undergoing haemodialysis.

    Science.gov (United States)

    Frih, Bechir; Mkacher, Wajdi; Jaafar, Hamdi; Frih, Ameur; Ben Salah, Zohra; El May, Mezry; Hammami, Mohamed

    2018-04-01

    The purpose of this study was to evaluate the effects of 6 months of specific balance training included in endurance-resistance program on postural balance in haemodialysis (HD) patients. Forty-nine male patients undergoing HD were randomly assigned to an intervention group (balance training included in an endurance-resistance training, n = 26) or a control group (resistance-endurance training only, n = 23). Postural control was assessed using six clinical tests; Timed Up and Go test, Tinetti Mobility Test, Berg Balance Scale, Unipodal Stance test, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scale. All balance measures increased significantly after the period of rehabilitation training in the intervention group. Only the Timed Up and Go, Berg Balance Scale, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scores were improved in the control group. The ranges of change in these tests were greater in the balance training group. In HD patients, specific balance training included in a usual endurance-resistance training program improves static and dynamic balance better than endurance-resistance training only. Implications for rehabilitation Rehabilitation using exercise in haemodialysis patients improved global mobility and functional abilities. Specific balance training included in usual endurance resistance training program could lead to improved static and dynamic balance.

  5. Comparison of the prognosis among different age groups in elderly patients with hip fracture

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2008-01-01

    patients even in the elderly. There were two in-hospital deaths in group B, 11 in group C, and two in group D. Five of the 15 deaths were inoperable cases due to poor performance status at admission. Conclusion: Walking ability at discharge and survival prognosis worsened as age advanced. On the other hand, since surgical cases achieved better walking ability than conservatively treated cases, efforts should be made to achieve better functional prognosis even in the old-olds, including surgery together with early ambulation and rehabilitation.

  6. Cystic fibrosis - Comparison between patients in paediatric and adult age.

    Science.gov (United States)

    Santos, V; Cardoso, A V; Lopes, C; Azevedo, P; Gamboa, F; Amorim, A

    Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians. Although most cases are diagnosed in childhood, diagnosis in adults is apparently increasing. Evaluate the adult population with CF, comparing patients who were diagnosed before and after 18 years of age. Retrospective analysis of patients followed in three main medical centres in Portugal in 2012. Comparison of two groups: G1 - patients diagnosed at <18 years and G2 - patients diagnosed at ≥18 years. 89 adults were identified: 61.8% in G1, 38.2% in G2. Gender distribution was similar in both groups. Average age in G2 was higher (38.3±8.4 vs. 26.8±6.1 years, p<0.001). Respiratory symptoms most frequently led to CF diagnosis in all patients, mainly in adulthood. There was a greater percentage of patients homozygous for the mutation delF508 in G1 (43.6 vs. 8.8%, p=0.02). Respiratory and pancreatic function, and body mass index (BMI) showed a higher severity in G1 (G1 vs. G2: FEV1: 54.6±27.3 vs. 29.9±64.6%, p=0.177; pancreatic insufficiency 72.7 vs. 26.5%, p<0.001; BMI 20.2±3.4 vs. 22.2±4.8, p=0.018). Pseudomonas aeruginosa and methicillin-sensitive Staphylococcus aureus were the most frequently isolated microorganisms. Lung transplantation rate was higher in G2 (20.6 vs. 10.9%, p=0.231) while mortality rate was higher in G1 (0 vs. 3.6%, p=0.261). Hospital admission rate was higher in G1 as well as mortality rate. The results suggest that patients with CF diagnosed in childhood have characteristics that distinguish them from those diagnosed in adulthood, and these differences may have implications for diagnosis, prognosis and life expectancy. Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  7. Shift, Interrupted: Strategies for Managing Difficult Patients Including Those with Personality Disorders and Somatic Symptoms in the Emergency Department.

    Science.gov (United States)

    Moukaddam, Nidal; AufderHeide, Erin; Flores, Araceli; Tucci, Veronica

    2015-11-01

    Difficult patients are often those who present with a mix of physical and psychiatric symptoms, and seem refractory to usual treatments or reassurance. such patients can include those with personality disorders, those with somatization symptoms; they can come across as entitled, drug-seeking, manipulative, or simply draining to the provider. Such patients are often frequent visitors to Emergency Departments. Other reasons for difficult encounters could be rooted in provider bias or countertransference, rather than sole patient factors. Emergency providers need to have high awareness of these possibilities, and be prepared to manage such situations, otherwise workup can be sub-standard and dangerous medical mistakes can be made. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Treatment approach, delivery, and follow-up evaluation for cardiac rhythm disease management patients receiving radiation therapy: Retrospective physician surveys including chart reviews at numerous centers

    Energy Technology Data Exchange (ETDEWEB)

    Gossman, Michael S., E-mail: MGossman@TSRCC.com [Regulation Directive Medical Physics, Russell, KY (United States); Wilkinson, Jeffrey D. [Medtronic, Inc., Mounds View, MN (United States); Mallick, Avishek [Department of Mathematics, Marshall University, Huntington, WV (United States)

    2014-01-01

    In a 2-part study, we first examined the results of 71 surveyed physicians who provided responses on how they address the management of patients who maintained either a pacemaker or a defibrillator during radiation treatment. Second, a case review study is presented involving 112 medical records reviewed at 18 institutions to determine whether there was a change in the radiation prescription for the treatment of the target cancer, the method of radiation delivery, or the method of radiation image acquisition. Statistics are provided to illustrate the level of administrative policy; the level of communication between radiation oncologists and heart specialists; American Joint Committee on Cancer (AJCC) staging and classification; National Comprehensive Cancer Network (NCCN) guidelines; tumor site; patient's sex; patient's age; device type; manufacturer; live monitoring; and the reported decisions for planning, delivery, and imaging. This survey revealed that 37% of patient treatments were considered for some sort of change in this regard, whereas 59% of patients were treated without regard to these alternatives when available. Only 3% of all patients were identified with an observable change in the functionality of the device or patient status in comparison with 96% of patients with normal behavior and operating devices. Documented changes in the patient's medical record included 1 device exhibiting failure at 0.3-Gy dose, 1 device exhibiting increased sensor rate during dose delivery, 1 patient having an irregular heartbeat leading to device reprogramming, and 1 patient complained of twinging in the chest wall that resulted in a respiratory arrest. Although policies and procedures should directly involve the qualified medical physicist for technical supervision, their sufficient involvement was typically not requested by most respondents. No treatment options were denied to any patient based on AJCC staging, classification, or NCCN practice standards.

  9. No psychological distress in sportsmen aged 45 years and older after cardiovascular screening, including cardiac CT : The Measuring Athlete's Risk of Cardiovascular events (MARC) study

    NARCIS (Netherlands)

    Schurink, M. M.; Braber, T. L.; Prakken, N. H. J.; Doevendans, P. A. F. M.; Backx, F. J. G.; Grobbee, D. E.; Rienks, R.; Nathoe, H. M.; Bots, M. L.; Velthuis, B. K.; Mosterd, A.

    Background Psychological distress caused by cardiovascular pre-participation screening (PPS) may be a reason not to implement a PPS program. We assessed the psychological impact of PPS, including cardiac computed tomography (CT), in 318 asymptomatic sportsmen aged >= 45 years. Methods Coronary

  10. No psychological distress in sportsmen aged 45 years and older after cardiovascular screening, including cardiac CT : The Measuring Athlete’s Risk of Cardiovascular events (MARC) study

    NARCIS (Netherlands)

    Schurink, M. M.; Braber, T. L.; Prakken, N. H J; Doevendans, P. A F M; Backx, F. J G; Grobbee, D. E.; Rienks, R.; Nathoe, H. M.; Bots, M. L.; Velthuis, B. K.; Mosterd, A.

    2017-01-01

    Background Psychological distress caused by cardiovascular pre-participation screening (PPS) may be a reason not to implement a PPS program. We assessed the psychological impact of PPS, including cardiac computed tomography (CT), in 318 asymptomatic sportsmen aged ≥45 years. Methods Coronary artery

  11. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study.

    Science.gov (United States)

    Ferguson, T A; Patel, R; Bhandari, M; Matta, J M

    2010-02-01

    Using a prospective database of 1309 displaced acetabular fractures gathered between 1980 and 2007, we calculated the annual mean age and annual incidence of elderly patients > 60 years of age presenting with these injuries. We compared the clinical details and patterns of fracture between patients > 60 years of age (study group) with those 60 years of age and the remaining 1074 were fractures increased by 2.4-fold between the first half of the study period and the second half (10% (62) vs 24% (174), p Fractures characterised by displacement of the anterior column were significantly more common in the elderly compared with the younger patients (64% (150) vs 43% (462), respectively, p fractures in the study group included a separate quadrilateral-plate component (50.8% (58)) and roof impaction (40% (46)) in the anterior fractures, and comminution (44% (30)) and marginal impaction (38% (26)) in posterior-wall fractures. The proportion of elderly patients presenting with acetabular fractures increased during the 27-year period. The older patients had a different distribution of fracture pattern than the younger patients, and often had radiological features which have been shown in other studies to be predictive of a poor outcome.

  12. Survey indicated that core outcome set development is increasingly including patients, being conducted internationally and using Delphi surveys.

    Science.gov (United States)

    Biggane, Alice M; Brading, Lucy; Ravaud, Philippe; Young, Bridget; Williamson, Paula R

    2018-02-17

    There are numerous challenges in including patients in a core outcome set (COS) study, these can vary depending on the patient group. This study describes current efforts to include patients in the development of COS, with the aim of identifying areas for further improvement and study. Using the COMET database, corresponding authors of COS projects registered or published from 1 January 2013 to 2 February 2017 were invited via a personalised email to participate in a short online survey. The survey and emails were constructed to maximise the response rate by following the academic literature on enhancing survey responses. Personalised reminder emails were sent to non-responders. This survey explored the frequency of patient input in COS studies, who was involved, what methods were used and whether or not the COS development was international. One hundred and ninety-two COS developers were sent the survey. Responses were collected from 21 February 2017 until 7 May 2017. One hundred and forty-six unique developers responded, yielding a 76% response rate and data in relation to 195 unique COSs (as some developers had worked on multiple COSs). Of focus here are their responses regarding 162 COSs at the published, completed or ongoing stages of development. Inclusion of patient participants was indicated in 87% (141/162) of COSs in the published completed or ongoing stages and over 94% (65/69) of ongoing COS projects. Nearly half (65/135) of COSs included patient participants from two or more countries and 22% (30/135) included patient participants from five or more countries. The Delphi survey was reported as being used singularly or in combination with other methods in 85% (119/140) of projects. Almost a quarter (16/65) of ongoing studies reported using a combination of qualitative interviews, Delphi survey and consensus meeting. These findings indicated that the Delphi survey is the most popular method of facilitating patient participation, while the combination of

  13. Infliximab therapy in pediatric patients 7 years of age and younger.

    Science.gov (United States)

    Kelsen, Judith R; Grossman, Andrew B; Pauly-Hubbard, Helen; Gupta, Kernika; Baldassano, Robert N; Mamula, Petar

    2014-12-01

    Infliximab (IFX) is efficacious for induction and maintenance of remission in pediatric patients with moderate-to-severe inflammatory bowel disease (IBD). It has, however, not been studied in patients 7 years old and younger. Our aim was to characterize efficacy and safety of IFX therapy in this cohort. This was a retrospective study of patients with IBD ages 7 years and younger, treated with IFX between 1999 and 2011. Medical records were reviewed for age of diagnosis, disease phenotype, therapy, surgery, IFX infusion dates, dose, and intervals. Outcome measures included physician global assessment, corticosteroid requirement, and adverse events. Thirty-three children (ages 2.4-7 years) were included. Twenty patients had Crohn disease, 4 had ulcerative colitis, and 9 had indeterminate colitis. Maintenance of IFX therapy at 1, 2, and 3 years was 36%, 18%, and 12%, respectively. Patients of age 5 years and younger had the lowest rates of maintenance of therapy at 25% at year 1, and 10% at years 2 and 3 combined. Nine percent of all of the patients demonstrated response measured by the physician global assessment and were steroid free at 1 year. There were 8 infusion reactions. There were no malignancies, serious infections, or deaths. IFX demonstrated a modest response rate and a low steroid-sparing effect in patients with IBD 7 years old and younger. Although this is a limited study, there appears to be a trend for decreased sustained efficacy with IFX in this age group, particularly in children 5 years old and younger, when compared with the previously published literature in older children.

  14. Incidence of primary hypothyroidism in patients exposed to therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland

    Directory of Open Access Journals (Sweden)

    B A Laway

    2012-01-01

    Full Text Available Introduction: Hypothyroidism is a known consequence of external-beam radiotherapy to the neck encompassing a part or whole of the thyroid gland. In this non-randomized prospective study, we have tried to evaluate the response of the thyroid gland to radiation by assessing thyroid function before irradiation and at regular intervals after irradiation. Aims and Objectives: The aim of this study were to assess in the cancer patients, who were exposed to the therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland: the incidence of primary hypothyroidism, the time required to become hypothyroid, any relation between the total dose for the development of hypothyroidism, and whether there are any patient or treatment-related factors that are predictive for the development of hypothyroidism, including the use of concurrent chemotherapy. Materials and Methods: This non-randomized, prospective study was conducted for a period of 2 years in which thyroid function was assessed in 59 patients (cases of head and neck cancer, breast cancer, lymphoma patients and other malignancies, who had received radiotherapy to the neck region. 59 euthyroid healthy patients (controls were also taken, who had not received the neck irradiation. These patients/controls were assessed periodically for 2 years. Results: The incidence of hypothyroidism after external beam radiation therapy (EBRT to neck where radiation portals include part or whole of the thyroid gland was 16.94%, seven cases had subclinical hypothyroidism (11.86% and three cases had clinical hypothyroidism (5.08%. Mean time for development of hypothyroidism was 4.5 months. There was no effect of age, gender, primary tumor site, radiation dose and chemotherapy, whether neoadjuvant or concurrent with the development of hypothyroidism. Conclusion: In summary, we found that thyroid dysfunction is a prevalent, yet easily treatable source of morbidity in patients

  15. Prevalence of Burkholderia species, including members of Burkholderia cepacia complex, among UK cystic and non-cystic fibrosis patients.

    Science.gov (United States)

    Kenna, Dervla T D; Lilley, Daniel; Coward, Amy; Martin, Kate; Perry, Claire; Pike, Rachel; Hill, Robert; Turton, Jane F

    2017-04-01

    We aimed to establish the prevalence of different Burkholderia species among UK cystic fibrosis (CF) and non-CF patients over a 2 year period. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry was used to identify isolates to genus level, followed by recA/gyrB sequence clustering or species-specific PCR. In all, 1047 Burkholderia isolates were submitted for identification from 361 CF patients and 112 non-CF patients, 25 from the hospital environment and three from a commercial company. Potential cross-infection was assessed by pulsed-field gel electrophoresis (PFGE) and multi- locus-sequence typing (MLST). MICs were determined for 161 Burkholderia cepacia complex (Bcc) isolates. CF Trust registry data were sought to examine clinical parameters relating to Bcc infection. Burkholderia multivorans was the most prevalent species among CF patients affecting 56 % (192) patients, followed by Burkholderia cenocepacia IIIA (15 %; 52 patients). Five novel recA clusters were found. Among non-CF patients, Burkholderia cepacia was the most prevalent species (37/112; 34 %), with 18 of 40 isolates part of a UK-wide B. cepacia 'cluster'. This and three other clusters were investigated by PFGE and MLST. Cable-pili positive isolates included two novel sequence types and representatives of ET12. Antibiotic susceptibility varied between and within species and CF/non- CF isolates. CF Trust registry data suggested no significant difference in lung function between patients harbouring B. cenocepacia, B. multivorans and other Bcc species (P=0.81). The dominance of B. multivorans in CF, the presence of a B. cepacia cluster among non-CF patients and the existence of putative novel species all highlighted the continuing role of Burkholderia species as opportunistic pathogens.

  16. Biomarkers of oxidative stress in patients with wet age related macular degeneration.

    Science.gov (United States)

    Zafrilla, P; Losada, M; Perez, A; Caravaca, G; Mulero, J

    2013-03-01

    The aim of this study was to analyze biomarkers of oxidative stress in patients with wet age related macular degeneration (AMD). Case-control study that includes 163 patients with wet AMD (age group of 55-82 years with the mean age of 71 years and 170 age-matched healthy controls in the age group of 55-78 years with the mean age of 71 years. The following parameters were determined: reduced and oxidized Glutathione (GSH/GSSH), protein carbonyl groups, total antioxidant activity in plasma and the activity of endogenous antioxidant enzymes, such as, gluthatione peroxidase, gluthatione reductase and superoxide dismutase. We observed total antioxidant activity higher in control group (CG) compared with patients with wet AMD (7.1 ± 1.2 μM Trolox vs 5.8 ± 1.1 μM Trolox). Values of superoxide dismutase activity (SOD), gluthatione reductase (GR) and gluthatione peroxidase (GPx) are higher in control group than in patients with wet AMD. According to the GSH/GSSH results, average values were higher in the CG than in patients with wet AMD and data were not significantly different.. Values of protein carbonyl groups were higher in patients with wet AMD than in CG and significant differences were found. The finding of the present study suggests that the patients with wet AMD are an altered metabolic state of oxidation-reduction and that it is convenient to give therapeutic interventions with antioxidants. We have demonstrated that systematic oxidative stress, measured by different biomarkers is closely associated with the wet AMD.

  17. Socioeconomic deprivation and age are barriers to the online collection of patient reported outcome measures in orthopaedic patients.

    Science.gov (United States)

    Jenkins, P J; Sng, S; Brooksbank, K; Brooksbank, A J

    2016-01-01

    Introduction Questionnaires are used commonly to assess functional outcome and satisfaction in surgical patients. Although these have in the past been administered through written forms, there is increasing interest in the use of new technology to improve the efficiency of collection. The aim of this study was to assess the availability of internet access for a group of orthopaedic patients and the acceptability of online survey completion. Methods A total of 497 patients attending orthopaedic outpatient clinics were surveyed to assess access to the internet and their preferred means for completing follow-up questionnaires. Results Overall, 358 patients (72%) reported having internet access. Lack of access was associated with socioeconomic deprivation and older age. Multivariable regression confirmed increased age and greater deprivation to be independently associated with lack of internet access. Out of the total group, 198 (40%) indicated a preference for assessment of outcomes via email and the internet. Conclusions Internet access was not universal among the patients in our orthopaedic clinic. Reliance on internet collection of PROMs may introduce bias by not including results from patients in older age groups and those from the more deprived socioeconomic groups.

  18. Patient experienced continuity of care in the psychiatric healthcare system-a study including immigrants, refugees and ethnic danes.

    Science.gov (United States)

    Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne; Krasnik, Allan; Norredam, Marie

    2014-09-17

    The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.

  19. Patient Experienced Continuity of Care in the Psychiatric Healthcare System—A Study Including Immigrants, Refugees and Ethnic Danes

    Directory of Open Access Journals (Sweden)

    Natasja Koitzsch Jensen

    2014-09-01

    Full Text Available Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes. Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. Conclusions: The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.

  20. Risk of falls in the rheumatic patient at geriatric age.

    Science.gov (United States)

    Prusinowska, Agnieszka; Komorowski, Arkadiusz; Sadura-Sieklucka, Teresa; Księżopolska-Orłowska, Krystyna

    2017-01-01

    Evaluating the risk of falling of a geriatric rheumatic patient plays an essential role not only in planning and carrying out the physiotherapeutic process. The consequences of falls may be different and, although they do not always result in serious repercussions such as fractures or injuries, it is sufficient that they generate the fear of falling and cause a significant reduction in physical activity. Assessing functional capacity to define the risk of falling is of utmost importance in the case of patients after joint arthroplasty surgeries. The specificity of rheumatic patient's falls is determined by numerous factors. It is not always possible to avoid them. However, it becomes vital to include fall prevention in the rehabilitation process as well as to prepare the house for the needs of an elderly person so that they are safe and as self-dependent as possible.

  1. Prevalence of dental fluorosis in children taking part in an oral health programme including fluoride tablet supplements from the age of 2 years.

    Science.gov (United States)

    Eckersten, Charlotte; Pylvänen, Lena; Schröder, Ulla; Twetman, Svante; Wennhall, Inger; Matsson, Lars

    2010-09-01

    To investigate the prevalence of dental fluorosis in children who had participated in an oral health programme between the ages 2-5 years, including fluoride tablets from the age of 2 years. The study group consisted of 135 10- to 11-year-old children who had participated in the programme, including parent education, tooth-brushing instruction and prescribed fluoride tablets (0.25 mg NaF) (2-3 years: 1 tablet/day; 3-5 years: 2 tablets/day). The prevalence of dental fluorosis in the study group was compared with that in a nonintervention reference group consisting of 129 children of the same ages. The analysis was based on photos of the permanent maxillary front teeth using the Thylstrup & Fejerskov (TF) Index. No statistically significant difference in prevalence of dental fluorosis was seen between the two groups. Forty-three percent of the children in the study group and 38% in the reference group had fluorosis, the majority of a mild nature (TF-score 1). None had a TF score above 2. The pattern was the same after correction for parent reported intake of tablets at 3 and 5 years of age. Introduction of fluoride tablets at the age of 2 years did not result in increased prevalence of dental fluorosis.

  2. Microdeletions Including FMR1 in Three Female Patients with Intellectual Disability – Further Delineation of the Phenotype and Expression Studies

    Science.gov (United States)

    Zink, A.M.; Wohlleber, E.; Engels, H.; Rødningen, O.K.; Ravn, K.; Heilmann, S.; Rehnitz, J.; Katzorke, N.; Kraus, C.; Blichfeldt, S.; Hoffmann, P.; Reutter, H.; Brockschmidt, F.F.; Kreiß-Nachtsheim, M.; Vogt, P.H.; Prescott, T.E.; Tümer, Z.; Lee, J.A.

    2014-01-01

    Fragile X syndrome (FXS) is one of the most common causes of intellectual disability/developmental delay (ID/DD), especially in males. It is caused most often by CGG trinucleotide repeat expansions, and less frequently by point mutations and partial or full deletions of the FMR1 gene. The wide clinical spectrum of affected females partly depends on their X-inactivation status. Only few female ID/DD patients with microdeletions including FMR1 have been reported. We describe 3 female patients with 3.5-, 4.2- and 9.2-Mb de novo microdeletions in Xq27.3-q28 containing FMR1. X-inactivation was random in all patients, yet they presented with ID/DD as well as speech delay, macrocephaly and other features attributable to FXS. No signs of autism were present. Here, we further delineate the clinical spectrum of female patients with microdeletions. FMR1 expression studies gave no evidence for an absolute threshold below which signs of FXS present. Since FMR1 expression is known to be highly variable between unrelated females, and since FMR1 mRNA levels have been suggested to be more similar among family members, we further explored the possibility of an intrafamilial effect. Interestingly, FMR1 mRNA levels in all 3 patients were significantly lower than in their respective mothers, which was shown to be specific for patients with microdeletions containing FMR1. PMID:24715853

  3. MRI manifestations of thymus in myasthenia gravis (MG) patients in various age groups

    International Nuclear Information System (INIS)

    Wang Ying; Peng Xi; Li Zhizhao; Jiang Kuiming; Song Ting; Dong Tianfa; Xiao Youcheng

    2003-01-01

    Objective: To study MRI findings of the thymus in patients with myasthenia gravis (MG) in different age groups and to analyze the relationship between the morphological changes of thymus and the MG. Methods: In total 90 patients with MG (male: female=43:47) received MR scan and were divided into four groups (group A, B, C and D) by age. Fourteen patients out of 90 received additional enhanced scan. Group A included 33 patients aged under 10 years (m:f=18:15); 27 patients aged 11-25 years were in group B (m:f=12:15); group C had 17 patients aged 26-50 years (m:f=6:11); and in group D there were 13 patients whose ages were over 51 years (m:f=7:6). And 30 Non-MG patients aged 8-75 years were selected as control group, in which the thickness, the fat collection, and glandulous atrophy of thymus was studied on CT. Results: 1) The thymus was unremarkable in 44 cases out of 90 (48.88%). 2) Enlarged thymus was shown in 42 cases out of 90 (46.66%), in which non-nodular enlargement was revealed in 34 cases and nodular enlargement in 8 cases. There were 27 cases with abnormality of thymus out of 33 (81.81%) in group A, 12 cases out of 27 (44.44%) in group B and 3 cases in group C, but no abnormality was found in group D. 3) Only 4/90 patients (4.44%) had thymic mass that respectively seen in one case of group B, two of group C and one of group D. No evidence of the involvement of the adjacent structure was found on MRI in the cases of thymic mass. No thymus enlargement was revealed in control group. Fat collection in thymus was seen in both study groups and control group. Conclusion: Intimate relationship between the abnormality of the thymus gland and MG exists in children and teenagers. While in the middle-aged patients or the seniors, further studies should be made to find out whether there is a correlation

  4. CLINICAL PROFILE OF AMBLYOPIA PATIENTS BETWEEN 5-15 YEARS OF AGE

    Directory of Open Access Journals (Sweden)

    Mona Raghavendra Deshmuk

    2016-11-01

    Full Text Available BACKGROUND The aim of the study is to- 1. Diagnose strabismic, anisometropic and mixed amblyopia in age group 5-15 years. 2. Analyse these patients for age, sex, type of refractive error, type of squint, type of fixation pattern and classify them aetiologically. 3. Study effectiveness of different amblyopia treatments in this age group. MATERIALS AND METHODS Patients in 5-15 years of age in a period of two years were selected and assessed for amblyopia, which included a detailed history, visual acuity, retinoscopy, ocular movements and alignment, slit lamp examination, fundus examination. Patients were given amblyopia treatment and assessed for improvement. Settings and Design- Hospital-based descriptive study in a period of two years. RESULTS In 32 amblyopic patients, maximum patients were of age group between 5-7 years. 53.12% of patients were females. Amblyopia was predominant among anisometropic patients (75% with maximum of refractive error difference between 2.00 D to 4.00 D. Amongst them, maximum amblyopes were having hypermetropia with astigmatism (37.50%. In the strabismic type, esotropia was more common. Patients showing more than 2 Snellen’s line improvements after patching for 2 hrs. were 77.27% and for 6 hrs. were 22.72%. After part-time patching, maximum improvement in BCVA (best corrected visual acuity was seen in anisometropes (P<0.0001 followed by strabismic (P=0.025 and least with mixed (P=0.026 amblyopes. CONCLUSION Amblyopia is treatable if detected earlier. Lack of community or preschool vision screening was the main cause for late pickup of amblyopic children for timely management and hence significant visual impairment associated with the condition.

  5. ESTIMATION OF RIGHT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE IN DIFFERENT AGE GROUPS

    Directory of Open Access Journals (Sweden)

    R. A. Gajfulin

    2016-01-01

    Full Text Available Aim. To study the parameters of diastolic function of the right ventricle (RV in patients with ischemic heart disease (IHD in different age groups. Material and methods. Patients (n=678 with IHD aged 38 to 85 years were included into the study. They underwent echocardiography with assessment of RV diastolic function. The following parameters were assessed: rate of early and late diastolic RV filling (Et and At, rate of early and late diastolic motion of the ring of the tricuspid valve (e't and a't, the propagation velocity of RV early filling flow (Vpt. All patients were divided into 2 groups: 1st one - patients up to 60 years old (n=282 and the 2nd group - patients 60 years and older (n=396. Results. In IHD patients RV diastolic dysfunction was detected more often in older age group (34.3% than in group of patients younger than 60 years (22.3%, p=0.008. The next findings were found in the 2nd group: increase in At; reduction in Et/At ratio and e't/a't, as well as higher levels of systolic and mean pulmonary arterial pressure and the greater the thickness of the RV wall. The following parameters of diastolic RV function correlated with age: At (p=0.004; Et/At (p=0.001; Vpt (p=0.002 and e't/a't ratio (p=0.004. Conclusion. The results should be used in assessment of diastolic RV function in patients of different age groups.

  6. Comparison Between Sequential Therapy and Modified Bismuth-Included Quadruple Therapy for Helicobacter pylori Eradication in Chinese Patients.

    Science.gov (United States)

    Yang, Xiuhong; Tan, Pengsheng; Song, Lianying; Lu, Zhanying

    To compare the efficacy and safety of sequential therapy and modified bismuth-included quadruple therapy as a first-line Helicobacter pylori eradication in China. The patients were randomized to receive sequential therapy [n = 90; rabeprazole (20 mg twice daily) and amoxicillin (1 g twice daily) for 5 days, followed by rabeprazole (20 mg twice daily), tinidazole (500 mg twice daily) plus clarithromycin (500 mg twice daily) for another 5 days] or modified bismuth-included quadruple therapy [n = 109; rabeprazole (20 mg twice daily), levofloxacin hydrochloride (400 mg twice daily), clarithromycin (500 mg twice daily), and colloidal bismuth pectin (200 mg 3 times a day) for 7 days]. A follow-up urea breath test was applied 4 weeks later. A total of 199 patients were diagnosed with H. pylori infection. The intention-to-treat and per-protocol (PP) eradication rates were 91.7% and 92.6%, respectively, in the modified bismuth-included quadruple therapy group, and 74.4% and 76.1%, respectively, in the sequential therapy group. The eradication rates were significantly higher in the modified bismuth-included quadruple therapy group, compared with the sequential therapy group (P = 0.001 for intention to treat and P = 0.001 for PP). Adverse effects were reported by patients from both groups, but the difference did not reach significant level (P = 0.280). The modified bismuth-included quadruple therapy seemed to be superior to the sequential therapy as the first-line regimen for H. pylori eradication in Chinese patients.

  7. Functional Magnetic Resonance Imaging in Patients with the Wet Form of Age-Related Macular Degeneration

    Science.gov (United States)

    Lešták, Jan; Tintěra, Jaroslav; Karel, Ivan; Svatá, Zuzana; Rozsíval, Pavel

    2013-01-01

    Abstract The study is designed to determine the relationship between the progress of the wet form of age-related macular degeneration and the activity of the visual cortex examined using functional magnetic resonance imaging. Ten patients with the wet form of age-related macular degeneration (9 female and 1 male) with a mean age of 74.7 years (58–85 years) at various stages of bilateral involvement of the disease were included. Patients did not suffer from any other ocular nor neurological disease. All the patients underwent functional magnetic resonance imaging examinations with stimulation of both eyes using a black-and-white checkerboard of size 25.8 × 16.2 degrees. The group was compared with a group of healthy subjects with an average age of 54.1 years (45–65 years). For statistical evaluation, the Mann-Whitney U test was used. Comparing the extent of visual cortex activations we found a statistically significant difference between both the groups (p = 0.0247). However, the dependence of functional magnetic resonance imaging activity on visual acuity was not statistically significant (p = 0.223). We conclude that in patients with the wet form of age-related macular degeneration, lower functional magnetic resonance imaging activity of the visual cortex was found compared with the control group of healthy subjects. Dependence of functional magnetic resonance imaging activity on visual acuity was not statistically significant. PMID:28167987

  8. Coronary vascular age: An alternate means for predicting stress-induced myocardial ischemia in patients with suspected coronary artery disease.

    Science.gov (United States)

    Nappi, Carmela; Gaudieri, Valeria; Acampa, Wanda; Arumugam, Parthiban; Assante, Roberta; Zampella, Emilia; Mannarino, Teresa; Mainolfi, Ciro Gabriele; Imbriaco, Massimo; Petretta, Mario; Cuocolo, Alberto

    2018-01-22

    Coronary artery calcium (CAC) can be used to estimate vascular age in adults, providing a convenient transformation of CAC from Agatston units into a year's scale. We investigated the role of coronary vascular age in predicting stress-induced myocardial ischemia in subjects with suspected coronary artery disease (CAD). A total of 717 subjects referred to CAC scoring and 82 Rb PET/CT stress-rest myocardial perfusion imaging for suspected CAD were studied. CAC score was measured according to the Agatston method and coronary vascular age by equating estimated CAD risk for chronological age and CAC using the formula 39.1 + 7.25 × ln(CAC + 1). Stress-induced ischemia was present in 105 (15%) patients. Mean chronological age, CAC score, and coronary vascular age were higher (all P age was added to clinical variables. Including vascular age in the model, the global Chi square further increased from 68.77 to 106.38 (P age to clinical data, continuous net reclassification improvement (cNRI) was 0.57, while adding vascular age to clinical data and chronological age cNRI was 0.62. At decision curve analysis, the model including vascular age was associated with the highest net benefit compared to the model including only clinical data, to the model including chronological age and clinical data, and to a strategy considering that all patients had ischemia. The model including vascular age also showed the largest reduction in false-positive rate without missing any ischemic patients. In subjects with suspected CAD, coronary vascular age is strongly associated with stress-induced ischemia. The communication of a given vascular age would have a superior emotive impact improving observance of therapies and healthier lifestyles.

  9. Posterior lumbar interbody fusion for aged patients with degenerative spondylolisthesis: is intentional surgical reduction essential?

    Science.gov (United States)

    Lian, Xiao-Feng; Hou, Tie-Sheng; Xu, Jian-Guang; Zeng, Bing-Fang; Zhao, Jie; Liu, Xiao-Kang; Zhao, Cheng; Li, Hao

    2013-10-01

    Surgical reduction and posterior lumbar interbody fusion (PLIF) is commonly used to recover segmental imbalance in degenerative spondylolisthesis. However, whether intentional reduction of the slipped vertebra during PLIF is essential in aged patients with degenerative spondylolisthesis remains controversial. We compared the outcomes of surgical reduction and fusion in situ among aged patients who underwent PLIF for degenerative spondylolisthesis. A prospective randomized clinical trial on the surgical treatment of degenerative spondylolisthesis patients aged older than 70 years. Between January 2006 and December 2009, 73 patients aged 70 years or older with single-level degenerative spondylolisthesis requiring surgical treatment were included in this study. Clinical outcomes were assessed using the visual analog scale, Oswestry Disability Index, and Japanese Orthopedic Association scores. Radiographic outcomes included percentage of vertebral slippage, focal lordosis, and disc height. The 73 patients were randomly assigned to two groups treated using surgical reduction (Group A, n=36) and fusion in situ (Group B, n=37). Both groups were followed up for an average of 33.2 months (range, 24-54 months). The clinical and radiographic outcomes were compared between the two groups. Surgical complications were similar in the two groups. The average operative time and blood loss during surgery did not insignificantly differ (p>.05) between the two groups. Spondylolisthesis, disc height, and focal lordosis were significantly improved postoperatively in both groups. There was no obvious difference in clinical outcomes, as assessed using the visual analog scale, Oswestry Disability Index, and Japanese Orthopedic Association scores, although the radiographic outcomes were considerably better in Group A than in Group B. Posterior lumbar interbody fusion with pedicle screws fixation, with or without intraoperative reduction, provides good outcomes in the surgical treatment of

  10. Axonal Charcot-Marie-Tooth disease patient-derived motor neurons demonstrate disease-specific phenotypes including abnormal electrophysiological properties.

    Science.gov (United States)

    Saporta, Mario A; Dang, Vu; Volfson, Dmitri; Zou, Bende; Xie, Xinmin Simon; Adebola, Adijat; Liem, Ronald K; Shy, Michael; Dimos, John T

    2015-01-01

    Charcot-Marie-Tooth (CMT) disease is a group of inherited peripheral neuropathies associated with mutations or copy number variations in over 70 genes encoding proteins with fundamental roles in the development and function of Schwann cells and peripheral axons. Here, we used iPSC-derived cells to identify common pathophysiological mechanisms in axonal CMT. iPSC lines from patients with two distinct forms of axonal CMT (CMT2A and CMT2E) were differentiated into spinal cord motor neurons and used to study axonal structure and function and electrophysiological properties in vitro. iPSC-derived motor neurons exhibited gene and protein expression, ultrastructural and electrophysiological features of mature primary spinal cord motor neurons. Cytoskeletal abnormalities were found in neurons from a CMT2E (NEFL) patient and corroborated by a mouse model of the same NEFL point mutation. Abnormalities in mitochondrial trafficking were found in neurons derived from this patient, but were only mildly present in neurons from a CMT2A (MFN2) patient. Novel electrophysiological abnormalities, including reduced action potential threshold and abnormal channel current properties were observed in motor neurons derived from both of these patients. Human iPSC-derived motor neurons from axonal CMT patients replicated key pathophysiological features observed in other models of MFN2 and NEFL mutations, including abnormal cytoskeletal and mitochondrial dynamics. Electrophysiological abnormalities found in axonal CMT iPSC-derived human motor neurons suggest that these cells are hyperexcitable and have altered sodium and calcium channel kinetics. These findings may provide a new therapeutic target for this group of heterogeneous inherited neuropathies. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. The relationship between patients' perceptions of care quality and three factors: nursing staff job satisfaction, organizational characteristics and patient age.

    Science.gov (United States)

    Kvist, Tarja; Voutilainen, Ari; Mäntynen, Raija; Vehviläinen-Julkunen, Katri

    2014-10-18

    The relationship between nurses' job satisfaction and their perceptions of quality of care has been examined in previous studies. There is little evidence, however, about relationships between the job satisfaction of nursing staff and quality of care perceived by the patients. The aim of this study was to analyze, how the job satisfaction of nursing staff, organizational characteristics (hospital and unit type), and patients' age relate to patients' perceptions of the quality of care. The study was cross-sectional and descriptive, based on a secondary analysis of survey data acquired during the At Safe study in Finland. The study included 98 units at four acute care hospitals between autumn 2008 and spring 2009. The participants were 1909 patients and 929 nursing staff. Patients' perceptions of quality of care were measured using the 42-item RHCS questionnaire. Job satisfaction of nursing staff was measured with the 37-item KUHJSS scale. Statistical analyses included descriptive statistics, principal component analysis, t-tests, analysis of variance, linear regression, and multivariate analysis of variance. Patients' perceptions of overall quality of care were positively related to general job satisfaction of nursing staff. Adequate numbers of staff appeared to be the clearest aspect affecting quality of care. Older patients were more satisfied with staff number than younger patients. Patients cared for in outpatient departments felt more respected than patients in wards, whereas patients in wards reported better care of basic needs (e.g., hygiene, food) than outpatients. The evaluation of resources by nursing staff is related to patients' perceptions of the adequacy of nursing staff levels in the unit. The results emphasize the importance of considering patients' perceptions of the quality of care and assessments by nurses of their job satisfaction at the hospital unit level when evaluating quality of care.

  12. Serum Antioxidative Enzymes Levels and Oxidative Stress Products in Age-Related Cataract Patients

    Directory of Open Access Journals (Sweden)

    Dong Chang

    2013-01-01

    Full Text Available Purpose. To investigate the activity of antioxidative enzymes and the products of oxidative stress in patients with age-related cataracts and compare the findings with those in healthy control subjects. Method. Sixty patients with age-related cataract and sixty healthy controls of matched age and gender were included in this study. Serum samples were obtained to detect the antioxidative enzymes of superoxide dismutase (SOD, catalase (CAT, and glutathione peroxidase (GSH-Px, and oxidation degradation products of malondialdehyde (MDA, 4-hydroxynonenal (4-HNE, conjugated diene (CD, advanced oxidation protein products (AOPP, protein carbonyl (PC, and 8-hydroxydeoxyguanosine (8-OHdG. Results. Serum SOD, GSH-Px, and CAT activities in cataract group were significantly decreased as compared to the control subjects (P<0.05. The levels of MDA, 4-HNE, and CD in cataract patients were significantly higher than those in the control subjects (P<0.05, P<0.01. Cataract patients had higher levels of 8-OHdG, AOPP, and PC with respect to the comparative group of normal subjects (P<0.01. And there was no statistical significance in concentration of antioxidative enzymes and oxidative stress products in patients with different subtype cataract. Conclusions. Oxidative stress is an important risk factor in the development of age-related cataract, and augmentation of the antioxidant defence systems may be of benefit to prevent or delay cataractogenesis.

  13. Social demand for oral surgery in third age patients and its association with systemic pathologies.

    Science.gov (United States)

    Martínez-González, José-María; Martín-López, Félix; Barona-Dorado, Cristina; Martínez-Rodríguez, Natalia; Calvo-Guirado, Jose-Luis

    2010-11-01

    To determine the frequency of systemic pathologies in patients aged 65 years or more, who require oral care and possibly oral surgery. We carried out a cross-sectional descriptive study reviewing 3,388 medical histories for patients from the Department of Medicine and Oral Surgery of the School of Dentistry at the Complutense University of Madrid, who had requested surgical treatment. Those selected were at least 65 years of age or more, and were grouped according to their medical histories into categories of pathologies, which include: systemic, cardiovascular, digestive, respiratory, endocrine-metabolic, genitourinary, osteoarticular, nervous system and the sensory organs. Patients over the age of 65 most commonly present cardiovascular and digestive pathologies, which represent values of 30.8% and 13.75%, respectively. The rest of the systemic pathologies analyzed were categorized according to frequency, as follows: endocrino-metabolic pathologies 6.66%, respiratory pathologies 6.25%, genitourinary pathologies 3.75%, osteoarticular pathologies 2.91%, and pathologies of the nervous system and sensory organs 2.08%. The demand for surgical treatments by third age patients was relatively low, representing 2.18%. However, the presence of systemic pathologies was constant, and therefore, the anamnesis and patient medical history are fundamental for any surgical treatment.

  14. Distinctive Risk Factors and Phenotype of Younger Patients With Resistant Hypertension: Age Is Relevant.

    Science.gov (United States)

    Ghazi, Lama; Oparil, Suzanne; Calhoun, David A; Lin, Chee Paul; Dudenbostel, Tanja

    2017-05-01

    Resistant hypertension, defined as blood pressure >140/90 mm Hg despite using ≥3 antihypertensive medications, is a well-recognized clinical entity. Patients with resistant hypertension are at an increased risk of cardiovascular disease compared with those with more easily controlled hypertension. Coronary heart disease mortality rates of younger adults are stagnating or on the rise. The purpose of our study was to characterize the phenotype and risk factors of younger patients with resistant hypertension, given the dearth of data on cardiovascular risk profile in this cohort. We conducted a cross-sectional analysis with predefined age groups of a large, ethnically diverse cohort of 2170 patients referred to the Hypertension Clinic at the University of Alabama at Birmingham. Patients (n=2068) met the inclusion criteria and were classified by age groups, that is, ≤40 years (12.7% of total cohort), 41 to 55 years (32.1%), 56 to 70 years (36.1%), and ≥71 years (19.1%). Patients aged ≤40 years compared with those aged ≥71 years had significantly earlier onset of hypertension (24.7±7.4 versus 55.0±14.1 years; P hypertension, younger individuals have a distinct phenotype characterized by overlapping risk factors and comorbidities, including obesity, high aldosterone, and high dietary sodium intake compared with elderly. © 2017 American Heart Association, Inc.

  15. Age-dependent risk factors for malnutrition in traumatology and orthopedic patients.

    Science.gov (United States)

    Lambert, Christine; Nüssler, Andreas; Biesalski, Hans Konrad; Freude, Thomas; Bahrs, Christian; Ochs, Gunnar; Flesch, Ingo; Stöckle, Ulrich; Ihle, Christoph

    2017-05-01

    The aim of this study was to investigate the prevalence of risk of malnutrition (RoM) in an orthopedic and traumatology patient cohort with a broad range of ages. In addition to the classical indicators for risk assessment (low body mass index, weight loss, and comorbidity), this study aimed to analyze the effects of lifestyle factors (eating pattern, smoking, physical activity) on RoM. The prospective cohort study included 1053 patients in a level 1 trauma center in Germany. RoM was assessed by Nutritional Risk Screening (NRS) 2002 and for the elderly additionally by Mini Nutritional Assessment (MNA). Age-dependent risk factors identified in univariate statistical analysis were used for multivariate logistic regression models. The prevalence of patients at RoM (NRS ≥3) was 22%. In the three age categories (Malnutrition in trauma and orthopedic patients is not only a problem related to age. Lifestyle-related factors also contribute significantly to malnutrition in geriatric patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis.

    Science.gov (United States)

    Shalimar; Midha, Shallu; Hasan, Ajmal; Dhingra, Rajan; Garg, Pramod Kumar

    2017-01-01

    Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach. All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure. A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P pain free at those follow-up periods. Significant pain relief is achieved in the majority of patients with optimized medical and interventional treatment. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  17. Effect of patient age awareness on diagnostic agreement of chronic or aggressive periodontitis between clinicians; a pilot study.

    Science.gov (United States)

    Oshman, Sarah; El Chaar, Edgard; Lee, Yoonjung Nicole; Engebretson, Steven

    2016-07-25

    The aim of this pilot study was to test whether diagnostic agreement of aggressive and chronic periodontitis amongst Board Certified Periodontists, is influenced by knowledge of a patient's age. In 1999 at the International World Workshop age was removed as a diagnostic criteria for aggressive periodontitis. The impact of this change on the diagnostic reliability amongst clinicians has not yet been assessed. Nine periodontal case reports were twice presented to sixteen board certified periodontists, once with age withheld and again with patient age provided. Participants were instructed to choose a diagnosis of Chronic Periodontitis or Aggressive Periodontitis. Diagnostic agreement was calculated using the Fleiss Kappa test. Including the patients' age in case report information increased diagnostic agreement (the kappa statistic) from 0.49 (moderate agreement) to 0.61 (substantial agreement). These results suggest that knowledge of a patients' age influenced clinical diagnosis, when distinguishing between aggressive periodontitis and chronic periodontitis, which may in turn impact treatment decision-making.

  18. Oral cavity squamous cell carcinoma in 260 patients aged 80 years or more

    International Nuclear Information System (INIS)

    Ortholan, Cecile; Lusinchi, Antoine; Italiano, Antoine; Bensadoun, Rene-Jean; Auperin, Anne; Poissonnet, Gilles; Bozec, Alexandre; Arriagada, Rodrigo; Temam, Stephane; Benezery, Karen; Thariat, Juliette; Tao Yungan; Janot, Francois; Mamelle, Gerard; Vallicioni, Jacques; Follana, Philippe; Peyrade, Frederic; Sudaka, Anne; Bourhis, Jean; Dassonville, Olivier

    2009-01-01

    Purpose: We report the experience of two French cancer centers in the treatment of oral cavity squamous cell carcinoma (SCC) in patients aged ≥80 years. Materials and methods: Two hundred and sixty patients aged ≥80 years with a primary oral cavity SCC were included in this retrospective analysis. Results: Sex ratio was near to 1. Tobacco or alcohol intoxication was the main risk factor for 66% of men and 16% of women and leukoplakia, lichen planus, or oral traumatism for 55% of women and 11% of men (p < 0.0001). Two hundred patients received a loco-regional (LR) treatment with a curative intent (surgery and/or radiotherapy), 29 with a palliative intent and 31 did not receive a LR treatment. Curative treatments were initially planned to be adapted to age in 118 patients (59%). The median disease-specific survival (DSS) was 29 months. In multivariate analysis, the independent prognostic factors for DSS were stage (HR = 0.42 [0.24-0.72]), age (HR = 0.43 [0.24-0.75]) and performance status (HR = 0.50 [0.27-0.95]). The median overall survival (OS) was 14 months. In multivariate analysis, the independent prognostic factors for OS were age (HR = 0.52 [0.35-0.79]), stage (HR = 0.56 [0.38-0.84]), tumor differentiation (HR = 0.60 [0.33-0.93]) and performance status (HR = 0.6 [0.37-0.97]). In patients treated with a curative intent, treatment adapted to age was not associated with a decreased overall survival or disease-specific survival as compared with the standard treatment. However, prophylactic lymph node treatment in stages I-II tumors decreased the rate of nodal recurrence from 38% to 6% (p = 0.01). Conclusion: This study emphasizes the need for prospective evaluation of standard and adapted schedules in elderly patients with oral cavity cancer.

  19. OUTER RETINAL TUBULATION: Characteristics in Patients With Neovascular Age-Related Macular Degeneration.

    Science.gov (United States)

    Iaculli, Cristiana; Barone, Antonio; Scudieri, Marilisa; Giovanna Palumbo, Maria; Delle Noci, Nicola

    2015-10-01

    To assess the incidence, characteristics, best-corrected visual acuity (BCVA), central macular thickness (CMT), and retinal sensitivity correlations in patients with and without outer retinal tubulation (ORT) affected by subfoveal choroidal neovascularization due to neovascular age-related macular degeneration. Prospective case series including 78 eyes of 78 consecutive patients with subfoveal choroidal neovascularization due to neovascular age-related macular degeneration. Baseline and follow-up visits included BCVA, intraocular pressure, ophthalmoscopic examination, CMT as measured by spectral domain optical coherence tomography, and retinal sensitivity tested with fundus-related perimetry (MP-1). Fluorescent angiography was performed at baseline. At the end of the follow-up period, the mean BCVA and CMT of patients with ORT were statistically different from those without ORT (BCVA: 0.61 ± 0.13 vs. 0.37 ± 1.59, P macular degeneration suggest that these parameters are statistically different in patients with ORT; this may be due to the pathogenesis of ORT formation, secondary to retinal pigment epithelial tears or photoreceptor damage. MP-1 microperimeter is a noninvasive instrument that provides useful information to better characterize the functional aspect of ORT in patients with age-related macular degeneration.

  20. High proportion of genetic cases in patients with advanced cardiomyopathy including a novel homozygous Plakophilin 2-gene mutation.

    Directory of Open Access Journals (Sweden)

    Baerbel Klauke

    Full Text Available Cardiomyopathies might lead to end-stage heart disease with the requirement of drastic treatments like bridging up to transplant or heart transplantation. A not precisely known proportion of these diseases are genetically determined. We genotyped 43 index-patients (30 DCM, 10 ARVC, 3 RCM with advanced or end stage cardiomyopathy using a gene panel which covered 46 known cardiomyopathy disease genes. Fifty-three variants with possible impact on disease in 33 patients were identified. Of these 27 (51% were classified as likely pathogenic or pathogenic in the MYH7, MYL2, MYL3, NEXN, TNNC1, TNNI3, DES, LMNA, PKP2, PLN, RBM20, TTN, and CRYAB genes. Fifty-six percent (n = 24 of index-patients carried a likely pathogenic or pathogenic mutation. Of these 75% (n = 18 were familial and 25% (n = 6 sporadic cases. However, severe cardiomyopathy seemed to be not characterized by a specific mutation profile. Remarkably, we identified a novel homozygous PKP2-missense variant in a large consanguineous family with sudden death in early childhood and several members with heart transplantation in adolescent age.

  1. Association of HTRA1 rs11200638 with age-related macular degeneration (AMD) in Brazilian patients.

    Science.gov (United States)

    Lana, Tamires Prates; da Silva Costa, Sueli Matilde; Ananina, Galina; Hirata, Fábio Endo; Rim, Priscila Hae Hyun; Medina, Flávio MacCord; de Vasconcellos, José Paulo Cabral; de Melo, Mônica Barbosa

    2018-01-01

    Age-related macular degeneration is a multifactorial disease that can lead to vision impairment in older individuals. Although the etiology of age-related macular degeneration remains unknown, risk factors include age, ethnicity, smoking, hypertension, obesity, and genetic factors. Two main loci have been identified through genome-wide association studies, on chromosomes 1 and 10. Among the variants located at the 10q26 region, rs11200638, located at the HTRA1 gene promoter, has been associated with age-related macular degeneration in several populations and is considered the main polymorphism. We conducted a replication case-control study to analyze the frequency and participation of rs11200638 in the etiology of age-related macular degeneration in a sample of patients and controls from the State of São Paulo, Brazil, through polymerase chain reaction and enzymatic digestion. The frequency of the A allele was 57.60% in patients with age-related macular degeneration and 36.45% in controls (p value macular degeneration group compared to the control group (p = 1.21 e-07 and 0.0357, respectively). No statistically significant results were observed after stratification in dry versus wet types or advanced versus non-advanced forms. To our knowledge, this is the first time the association between rs11200638 and overall age-related macular degeneration has been reported in South America.

  2. Cognitive Impairment in Patients with Chronic Neuropathic or Radicular Pain: An Interaction of Pain and Age

    Directory of Open Access Journals (Sweden)

    Orla Moriarty

    2017-06-01

    Full Text Available A growing body of empirical research has confirmed an association between chronic pain and cognitive dysfunction. The aim of the present study was to determine whether cognitive function is affected in patients with a diagnosis of chronic neuropathic or radicular pain relative to healthy control participants matched by age, gender, and years of education. We also examined the interaction of pain with age in terms of cognitive performance. Some limitations of previous clinical research investigating the effects of chronic pain on cognitive function include differences in the pain and cognitive scale materials used, and the heterogeneity of patient participants, both in terms of their demographics and pathological conditions. To address these potential confounds, we have used a relatively homogenous patient group and included both experimental and statistical controls. We have also specifically investigated the interaction effect of pain and age on cognitive performance. Patients (n = 38 and controls (n = 38 were administered a battery of cognitive tests measuring IQ, spatial and verbal memory, attention, and executive function. Educational level, depressive symptoms, and state anxiety were assessed as were medication usage, caffeine, and nicotine consumption to control for possible confounding effects. Both the level of depressive symptoms and the state anxiety score were higher in chronic pain patients than in matched control participants. Chronic pain patients had a lower estimated IQ than controls, and showed impairments on measures of spatial and verbal memory. Attentional responding was altered in the patient group, possibly indicative of impaired inhibitory control. There were significant interactions between chronic pain condition and age on a number of cognitive outcome variables, such that older patients with chronic pain were more impaired than both age-matched controls and younger patients with chronic pain. Chronic pain did not appear

  3. Risk of new tumors in von Hippel-Lindau patients depends on age and genotype

    DEFF Research Database (Denmark)

    Binderup, Marie Louise Mølgaard; Budtz-Jørgensen, Esben; Bisgaard, Søs Marie Luise

    2016-01-01

    is not constant throughout the life span of vHL patients; instead, it varies significantly with age and genotype and depends on anatomical location. Retinal surveillance is crucial during the teenage years, whereas cerebellar surveillance is especially important in adulthood.Genet Med advance online publication......PURPOSE: The von Hippel-Lindau (vHL) phenotype is variable, which complicates genetic counseling and surveillance. We describe how the rate of new tumor development varies through the lifetimes of vHL patients and how it is influenced by age and genotype. METHODS: In a national cohort study, we...... included 52 VHL mutation carriers who were retrospectively followed for a total of 799 person-years. From birth to current age, 581 manifestations were diagnosed during 2,583 examinations in the study subjects. Manifestation rates were analyzed using Poisson regression and compared in groups of different...

  4. Trabeculectomy in Patients With Glaucoma Over 80 Years of Age: Relatively Short-term Outcomes.

    Science.gov (United States)

    Duman, Fulya; Waisbourd, Michael; Faria, Bruno; Addis, Victoria; Hsieh, Michael; Ekici, Feyzahan; Hark, Lisa A; Spaeth, George L

    2016-03-01

    To compare the surgical outcomes of trabeculectomy performed in elderly patients (above 80 y) with those of younger controls. We retrospectively reviewed the charts of patients who underwent trabeculectomy from January 1, 2009 through April 30, 2011 at the Wills Eye Hospital. Patients over 80 years of age were compared with younger controls. Outcome measures included intraocular pressure (IOP), visual acuity, number of glaucoma medications, surgical complications, and surgical failure. Surgical failure was defined as when IOP>21 mm Hg or <20% reduction below baseline or IOP<5 mm Hg or reoperation for glaucoma, or loss of light perception. Eighty-six eyes of patients over 80 years of age (range, 81 to 94 y) were compared with 86 eyes of younger controls (range, 22 to 79 y). Mean follow-up time was 23.9±8.0 and 25.1±8.0 months for each group, respectively. After 1 year, the failure rate was 31.3% in the elderly group, compared with 29.5% in the control group (P=0.98). At last follow-up visit, the rate of failure between the groups was similar (P=0.35). Postoperative complications were similar between the groups (P=0.25). The surgical outcomes of trabeculectomy in patients older than 80 years were found to be similar to those of younger controls. Taking into consideration elderly glaucoma patients' general health condition and life expectancy, age alone may not be a barrier to performing glaucoma filtration surgery.

  5. Efficacy and safety of infliximab in psoriatic patients over the age of 65.

    Science.gov (United States)

    Chiricozzi, Andrea; Pavlidis, Athanasios; Dattola, Annunziata; Bianchi, Luca; Chimenti, Maria Sole; Fida, Monika; Saraceno, Rosita

    2016-11-01

    Clinical data on the long-term safety and efficacy of infliximab on psoriatic patients who are older than 65 years are limited. The aim is to report the long-term efficacy, safety and tolerance of infliximab in geriatric patients. This was a retrospective study conducted at the Department of Dermatology of the University of Rome Tor Vergata. Clinical data were reported at week 12, 52, 104, 208. 151 charts were evaluated. A total of 27 patients were included. Range of the age was between 65 and 85 years; mean age was 73 years ±5.4; female to male ratio was 1:2; mean age of onset of psoriasis was 43 years±17. The average of treatment duration was 39 months ±27 (range 1-100). Fourteen patients suffered from plaque type psoriasis and 13 from psoriatic arthritis. At the baseline the mean PASI score was 15.6 ± 10.2. At week 12, 52, 104, and 208 the mean PASI was 2, 2.3, 1.9 and 1.8 respectively. A reduction in the mean PASI was maintained in the long-term treatment in 12 patients (p infliximab is effective and safe in patients over 65 years old and that IV therapy is also associated with a high compliance.

  6. Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients' treatment decisions

    Directory of Open Access Journals (Sweden)

    Jorgensen ML

    2013-08-01

    Full Text Available Mikaela L Jorgensen,1,2 Jane M Young,1,2 Michael J Solomon1,31Surgical Outcomes Research Centre (SOuRCe, Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia; 2Cancer Epidemiology and Services Research (CESR, Sydney School of Public Health, University of Sydney, NSW, Australia; 3Discipline of Surgery, University of Sydney, NSW, AustraliaPurpose: Older colorectal cancer patients are significantly less likely than younger patients to receive guideline-recommended adjuvant chemotherapy. Previous research has indicated that patient refusal of treatment is a contributing factor. This study aimed to identify potential barriers to adjuvant chemotherapy use in older patients by examining the associations between patient age, factors influencing chemotherapy treatment decisions, and preferences for information and decision-making involvement.Patients and methods: Sixty-eight patients who underwent surgery for colorectal cancer in Sydney, Australia, within the previous 24 months completed a self-administered survey.Results: Fear of dying, health status, age, quality of life, and understanding treatment procedures and effects were significantly more important to older patients (aged ≥65 years than younger patients in deciding whether to accept chemotherapy (all P < 0.05. Reducing the risk of cancer returning and physician trust were important factors for all patients. Practical barriers such as traveling for treatment and cost were rated lowest. Older patients preferred less information and involvement in treatment decision making than younger patients. However, 60% of the older group wanted detailed information about chemotherapy, and 83% wanted some involvement in decision making. Those preferring less information and involvement still rated many factors as important in their decision making, including understanding treatment procedures and effects.Conclusion: A range of factors appears to influence

  7. Emergence of Lamivudine-Resistant HBV during Antiretroviral Therapy Including Lamivudine for Patients Coinfected with HIV and HBV in China

    Science.gov (United States)

    Li, Yijia; Zhu, Ting; Song, Xiaojing; Huang, Ying; Yang, Feifei; Guan, Shuo; Xie, Jing; Gohda, Jin; Hosoya, Noriaki; Kawana-Tachikawa, Ai; Liu, Wenjun; Gao, George Fu; Iwamoto, Aikichi; Li, Taisheng; Ishida, Takaomi

    2015-01-01

    In China, HIV-1-infected patients typically receive antiretroviral therapy (ART) that includes lamivudine (3TC) as a reverse-transcriptase inhibitor (RTI) (ART-3TC). Previous studies from certain developed countries have shown that, in ART-3TC, 3TC-resistant HBV progressively emerges at an annual rate of 15–20% in patients coinfected with HIV-1 and HBV. This scenario in China warrants investigation because >10% of all HIV-infected patients in China are HBV carriers. We measured the occurrence of 3TC-resistant HBV during ART-3TC for HIV-HBV coinfection and also tested the effect of tenofovir disoproxil fumarate (TDF) used as an additional RTI (ART-3TC/TDF) in a cohort study in China. We obtained 200 plasma samples collected from 50 Chinese patients coinfected with HIV-1 and HBV (positive for hepatitis B surface antigen) and examined them for the prevalence of 3TC-resistant HBV by directly sequencing PCR products that covered the HBV reverse-transcriptase gene. We divided the patients into ART-3TC and ART-3TC/TDF groups and compared the efficacy of treatment and incidence of drug-resistance mutation between the groups. HIV RNA and HBV DNA loads drastically decreased in both ART-3TC and ART-3TC/TDF groups. In the ART-3TC group, HBV breakthrough or insufficient suppression of HBV DNA loads was observed in 20% (10/50) of the patients after 96-week treatment, and 8 of these patients harbored 3TC-resistant mutants. By contrast, neither HBV breakthrough nor treatment failure was recorded in the ART-3TC/TDF group. All of the 3TC-resistant HBV mutants emerged from the cases in which HBV DNA loads were high at baseline. Our results clearly demonstrated that ART-3TC is associated with the emergence of 3TC-resistant HBV in patients coinfected with HIV-1 and HBV and that ART-3TC/TDF reduces HBV DNA loads to an undetectable level. These findings support the use of TDF-based treatment regimens for patients coinfected with HIV-1 and HBV. PMID:26288093

  8. Emergence of Lamivudine-Resistant HBV during Antiretroviral Therapy Including Lamivudine for Patients Coinfected with HIV and HBV in China.

    Directory of Open Access Journals (Sweden)

    Lijun Gu

    Full Text Available In China, HIV-1-infected patients typically receive antiretroviral therapy (ART that includes lamivudine (3TC as a reverse-transcriptase inhibitor (RTI (ART-3TC. Previous studies from certain developed countries have shown that, in ART-3TC, 3TC-resistant HBV progressively emerges at an annual rate of 15-20% in patients coinfected with HIV-1 and HBV. This scenario in China warrants investigation because >10% of all HIV-infected patients in China are HBV carriers. We measured the occurrence of 3TC-resistant HBV during ART-3TC for HIV-HBV coinfection and also tested the effect of tenofovir disoproxil fumarate (TDF used as an additional RTI (ART-3TC/TDF in a cohort study in China. We obtained 200 plasma samples collected from 50 Chinese patients coinfected with HIV-1 and HBV (positive for hepatitis B surface antigen and examined them for the prevalence of 3TC-resistant HBV by directly sequencing PCR products that covered the HBV reverse-transcriptase gene. We divided the patients into ART-3TC and ART-3TC/TDF groups and compared the efficacy of treatment and incidence of drug-resistance mutation between the groups. HIV RNA and HBV DNA loads drastically decreased in both ART-3TC and ART-3TC/TDF groups. In the ART-3TC group, HBV breakthrough or insufficient suppression of HBV DNA loads was observed in 20% (10/50 of the patients after 96-week treatment, and 8 of these patients harbored 3TC-resistant mutants. By contrast, neither HBV breakthrough nor treatment failure was recorded in the ART-3TC/TDF group. All of the 3TC-resistant HBV mutants emerged from the cases in which HBV DNA loads were high at baseline. Our results clearly demonstrated that ART-3TC is associated with the emergence of 3TC-resistant HBV in patients coinfected with HIV-1 and HBV and that ART-3TC/TDF reduces HBV DNA loads to an undetectable level. These findings support the use of TDF-based treatment regimens for patients coinfected with HIV-1 and HBV.

  9. Patient-reported utilities in bilateral visual impairment from amblyopia and age-related macular degeneration.

    Science.gov (United States)

    van de Graaf, Elizabeth S; Despriet, Dominiek D G; Klaver, Caroline C W; Simonsz, Huibert J

    2016-05-17

    Utility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3-3.5 %). We previously measured decrease of utility in 35-year-old persons with unilateral persistent amblyopia. The current observational case-control study aimed to measure loss of utility in patients with amblyopia with recent decrease of vision in their better eye. As these patients are rare, the sample was supplemented by patients with bilateral age-related macular degeneration with similar decrease of vision. From our out-patient department, two groups of patients with recent deterioration to bilateral visual acuity less than Snellen 0.5 (bilateral visual impairment, BVI) were recruited, with either persistent amblyopia and age-related macular degeneration (AMB + AMD), or with bilateral age-related macular degeneration (BAMD). To measure utility, the time trade-off method and the standard gamble method were applied through interviews. Correlations were sought between utility values and visual acuity, age and Visual Function Questionnaire-25 scores. Seventeen AMB + AMD patients (mean age 72.9 years), and 63 BAMD patients (mean age 79.6 years) were included in the study. Among AMB + AMD, 80 % were willing to trade lifetime in exchange for cure. The overall mean time trade-off utility was 0.925. Among BAMD, 75 % were willing to trade, utility was 0.917. Among AMB + AMD, 38 % accepted risk of death in exchange for cure, overall mean standard gamble utility was 0.999. Among BAMD, 49 % accepted risk of death, utility was 0.998. Utility was not related to visual acuity but it was to age (p = 0.02). Elderly patients with BVI, caused by persistent amblyopia and age-related macular degeneration (AMD) or by bilateral AMD, had an approximately 8 % loss of TTO utility. Notably, the 8 % loss in elderly with BVI differs little from the 3.7 % loss we found previously in 35-year-old persons with unilateral

  10. Can balneotherapy improve the bowel motility in chronically constipated middle-aged and elderly patients?

    Science.gov (United States)

    Dandinoglu, Taner; Dandin, Ozgur; Ergin, Tuncer; Tihan, Deniz; Akpak, Yasam Kemal; Aydın, Oguz Ugur; Teomete, Uygar

    2017-06-01

    Balneotherapy or spa therapy is usually known for different application forms of medicinal waters and its effects on the human body. Our purpose is to demonstrate the effect of balneotherapy on gastrointestinal motility. A total of 35 patients who were treated for osteoarthritis with balneotherapy from November 2013 through March 2015 at our hospital had a consultation at the general surgery for constipation and defecation disorders. Patients followed by constipation scores, short-form health survey (SF-12), and a colonic transit time (CTT) study before and after balneotherapy were included in this study, and the data of the patients were analyzed retrospectively. The constipation score, SF-12 score, and CTT were found statistically significant after balneotherapy (p constipation in middle-aged and elderly patients, and it is our belief that treatment with thermal mineral water could considerably improve the quality of life of these patients.

  11. Hirschsprung’s Disease in Patients of Advanced Age

    Directory of Open Access Journals (Sweden)

    Ina Vrints

    2012-03-01

    Full Text Available Hirschsprung’s disease is a congenital motility disorder that is easily overlooked as a cause of chronic refractory constipation in adults. We present a case of Hirschsprung’s disease in a patient 70 years of age with a history of long-standing constipation, chronic use of laxatives, and recurrent episodes of colonic obstruction. Presumptive preoperative diagnosis was chronic ischemic sigmoid stenosis or intermittent sigmoid volvulus before Hirschsprung’s disease was suspected based on intraoperative colonoscopy and surgical findings. The diagnosis was confirmed by the absence of intrinsic ganglion cells on histopathologic examination of the surgical specimen and the absence of the rectoanal inhibitory reflex on postoperative manometry. A conservative surgical approach that limited the resection to the grossly diseased rectum successfully restored normal defecation despite the anastomosis being performed on the distal aganglionic rectum. This approach, which avoids extensive rectal dissection, may be suitable for older or frail patients. Heightened awareness of Hirschsprung’s disease is necessary to ensure its prompt recognition in the elderly.

  12. Protein carbonyl content: a novel biomarker for aging in HIV/AIDS patients.

    Science.gov (United States)

    Kolgiri, Vaishali; Patil, Vinayak Wamanrao

    The major complications of "treated" Human Immunodeficiency Virus (HIV) infection are cardiovascular disease, malignancy, renal disease, liver disease, bone disease, and perhaps neurological complications, which are phenomena of the normal aging process occurring at an earlier age in the HIV-infected population. The present study is aimed to explore protein carbonyl content as a biomarker for detecting oxidative DNA damage induced ART toxicity and/or accelerated aging in HIV/AIDS patients. To investigate the potential of carbonyl content as a biomarker for detecting oxidative Deoxyribonucleic acid (DNA) damage induced Antiretroviral Theraphy (ART) toxicity and/or accelerated aging in HIV/AIDS patients. In this case-control study a total 600 subjects were included. All subjects were randomly selected and grouped as HIV-negative (control group) (n=300), HIV-infected ART naive (n=100), HIV-infected on first line ART (n=100), and HIV-infected on second line ART (n=100). Seronegative control subjects were age- and sex-matched with the ART naive patients and the two other groups. Carbonyl protein was determined by the method described in Levine et al. DNA damage marker 8-OH-dG was determined using 8-hydroxy-2-deoxy Guanosine StressXpress ELA Kit by StressMarq Biosciences. Protein carbonyl content levels and oxidative DNA damage were significantly higher (paging in HIV/AIDS patients. Larger studies are warranted to elucidate the role of carbonyl content as a biomarker for premature aging in HIV/AIDS patients. Copyright © 2016 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

  13. Preoperative renin-angiotensin system inhibitors protect renal function in aging patients undergoing cardiac surgery.

    Science.gov (United States)

    Barodka, Viachaslau; Silvestry, Scott; Zhao, Ning; Jiao, Xiangyin; Whellan, David J; Diehl, James; Sun, Jian-Zhong

    2011-05-15

    Renal failure (RF) represents a major postoperative complication for elderly patients undergoing cardiac surgery. This observational cohort study examines effects of preoperative use of renin-angiotensin system (RAS) inhibitors on postoperative renal failure in aging patients undergoing cardiac surgery. We retrospectively analyzed a cohort of 1287 patients who underwent cardiac surgery at this institution (2003-2007). The patients included were ≥65 years old, scheduled for elective cardiac surgery, and without preexisting RF (defined by the criteria of the Society of Thoracic Surgeons as described in Method). Of all patients evaluated, 346 patients met the inclusion criteria and were divided into two groups: using (n = 122) or not using (n = 224) preoperative RAS inhibitors. A comparison of the two groups showed no significant differences in baseline parameters, including creatinine clearance, body mass index, history of diabetes and smoking, preoperative medicines (except that more patients with RAS inhibitors had a history of hypertension or congestive heart failure, fewer RAS inhibitor patients had chronic lung disease), in intraoperative perfusion and aortic cross-clamp time, and in postoperative complications and 30-d mortality. Multivariate logistic regression analysis demonstrated, however, that preoperative RAS inhibitors significantly and independently reduced the incidence of postoperative RF in the patients undergoing cardiac surgery compared with those not taking RAS inhibitors: 1.6% versus 7.6%, yielding an odds ratio of 0.19 (95 % CI 0.04-0.84, P = 0.029). Preoperative RAS inhibitors may have significant renoprotective effects for aging patients undergoing elective cardiac surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. [Clinical study of aged patients with secondary benign paroxysmal positional vertigo].

    Science.gov (United States)

    Zhu, Z J; Wei, L P; Xu, Z X; Xu, H J; Liu, Q; Luo, N

    2017-09-07

    Objective: To investigate the clinical features and evaluate the efficacy of manual reduction in treatment of age patients with secondary benign paroxysmal positional vertigo (s-BPPV). Methods: Thirty-two cases of aged patients ( the s-BPPV group: including 19 cases of female and 13 males, age from 60 to 86 years old)with secondary benign paroxysmal positional vertigo from Jul. 2013 to Sep. 2015 in our hospital were retrospectively analyzed. The results were compared with 121 patients( the primary group: including 82 cases of female and 39males, aged from 60 to 86 years old)with aged primary benign paroxysmal positional vertigo(p -BPPV). All the patients were followed up for 12 months. Statistical data analysis was carried out with SPSS 19.0. Results: 20.92%(32/153)of all the observed elderly patients with BPPV was the aged s-BPPV. The sex ratio and onset age had no significant difference between the two groups(χ(2)=0.79, P >0.05; t =0.37, P >0.05). The rate of two or more semicircular canal involvement in the secondary group(21.88%) was higher than that in primary group(6.61%)(χ(2)=6.67, P 0.05). The numbers of circulation of the first successful manual reduction management were (3.9±1.3)times in secondary group and (2.1±1.1)times in primary group, the difference was significant( t =3.15, P BPPV is not rare in clinical practice, sudden deafness and head trauma are frequent more than other reasons. The aged patients with secondary BPPV are prone to injury in multi-semicircular and bilateral canal compared with the primary BPPV. The effective rate after first manual reduction of secondary BPPV is lower than primary BPPV, it's needed more circulation of first success in manual reduction management. The total effective rates are not significant in two groups and recurrence rate is relatively high in secondary group.

  15. Comparison of normotensive and glaucoma simplex patients according to age and sex

    Directory of Open Access Journals (Sweden)

    Stojčić Milan

    2012-01-01

    Full Text Available Introduction. According to the level of intraocular pressure (IOP, open angle glaucoma is divided into high tension glaucoma (HTG and normal tension glaucoma (NTG. Objective. To determine if there are differences in the distribution of patients by age and sex between NTG and HTG. Methods. Our prospective study included 30 patients with NTG and 30 with HTG. A complete eye examination was performed. The examination included measuring of intraocular pressure by Goldmann applanation tonometry, examination of optic disc head by indirect ophthalmoscopy with Volk 90 D lens and visual field examination using the Octopus program. Results. The average damage of visual field in the group of patients with NTG was 8.14±4.43 dB, while in the group with HTG it was 7.40±2.84 dB (p>0.05. The average age of the group of patients with NTG was 66±11.58 years, while among those with HTG the average age was 59.7±11.63 years (p<0.01. Among the patients with NTG there were three times more women than men (χ2=9.124; p<0.01, while in the group of patients with HTG there were more men than women, but without statistically significant difference between the tested groups (χ2=1.851; p>0.05. Conclusion. Open angle glaucoma is a disease of elderly population. According to our results, risk factors for this disease can be age and sex. NTG is more frequently present than HTG among elderly population and females.

  16. Left Ventricular Diastolic Function in Essential Hypertensive Patients: Influence of Age and Left Ventricular Geometry

    Directory of Open Access Journals (Sweden)

    Rosa Eduardo Cantoni

    2002-01-01

    Full Text Available PURPOSE - To evaluate diastolic dysfunction (DD in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS - Four hundred sixty essential hypertensive patients (HT underwent Doppler echocardiography to obtain E/A wave ratio (E/A, atrial deceleration time (ADT, and isovolumetric relaxation time (IRT. All patients were grouped according to cardiac geometric patterns (NG - normal geometry; CR - concentric remodeling; CH- concentric hypertrophy; EH - eccentric hypertrophy and to age (60 years. One hundred six normotensives (NT persons were also evaluated. RESULTS - A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT - 1.38±0.03 vs HT - 1.27±0.02, p<0.01, was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR. Multiple regression analysis identified age as the most important predictor of DD (r²=0.30, p<0.01. CONCLUSION - DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients.

  17. Comparison of the acute effects of radiation therapy including or excluding the thymus, on the lymphocyte subpopulations of cancer patients

    International Nuclear Information System (INIS)

    Stratton, J.A.; Byfield, P.E.; Byfield, J.E.; Small, R.C.; Benfield, J.; Pilch, Y.

    1975-01-01

    Radiation therapy to either mediastinum or pelvis causes a rapid decrease in circulating lymphocytes of both B and T types and in addition an impairment in the function of the remaining lymphocytes, as measured by their ability to proliferate in response to mitogens. The acute depression is short-lived. Substantial recovery is apparent within 3 wk after cessation of therapy; however, most patients show a modest, chronic depression in both numbers and functional capacities of circulating lymphocytes. T cells are somewhat more sensitive than B cells, but both are affected. Irradiation of the thymus per se seems to have little influence on the acute changes which occur, as patients receiving pelvic and mediastinal (including thymic) radiotherapy show a similar degree of lymphopenia and depression of lymphocyte responsiveness

  18. How much information about the benefits of medicines is included in patient leaflets in the European Union? - A survey.

    Science.gov (United States)

    Dickinson, Rebecca; Raynor, David K; Knapp, Peter; MacDonald, Jan

    2017-04-01

    Patient information leaflets (PILs) are required with all licensed medicines throughout the European Union (EU) and they must include information about all side effects and their likelihood. This has led to criticism of a lack of balance, with little information included about potential benefits. Recent European Medicines Agency guidance proposed the inclusion of benefit information, and this study examined the current prevalence and type of such information in PILs in the EU. A survey and content analysis of the English translation of PILs in the EUwas carried out. Random quota sampling was used on the most frequently dispensed (n = 50) and newly licensed medicines (n = 50) in 2011/2. Leaflets were searched for benefit information meeting predefined criteria, and data synthesised and categorised into 10 categories. Eighty-five (85%) leaflets described how the medicine works, with 45 providing information about the rationale for treatment (more commonly for newly licensed (32/50) than most commonly dispensed medicines (13/50; P information. Current PILs do not appropriately communicate information about benefit. At the basic level, around a half did not include information about treatment rationale or whether the treatment was to treat symptoms, curative or preventative. However, for true informed decision making, patients need quantitative information about benefits and none of the leaflets provided this. © 2016 Royal Pharmaceutical Society.

  19. Gender Discrepancy in Diabetic Patients Hospitalized With Heart Failure: Does Age Matter?

    Science.gov (United States)

    Mohammed, Shaban; El-Menyar, Ayman; Rafie, Ihsan M; AlBinAli, Hajar A; Singh, Rajvir; Al Suwaidi, Jassim

    2016-09-01

    Gender discrepancy in the cardiovascular diseases has been evaluated in several studies. We studied the impact of gender disparity on the presentation and outcome of diabetic heart failure (DHF) patients. A retrospective analysis was conducted including all DHF patients admitted to the Heart Hospital between 1991 and 2013. Patients' demographics, presentation, management, and hospital outcomes were analyzed and compared based on gender and age. Out of 8266 HF patients, 4684 (56.7%) were diabetic, of whom 1817 (39%) were females. Mean age was comparable in both genders. DHF female patients were more likely to be hypertensive (79% vs. 65%, P = 0.001) and obese (13% vs. 4.6%, P = 0.001). DHF females were less likely to receive beta-blockers and angiotensin-converting-enzyme inhibitors/angiotensinogen-receptor blockers (25% vs. 30%, P = 0.001, 54% vs. 57%, P = 0.01, respectively), but were more likely to be on insulin therapy (21% vs. 16%, P = 0.001). In-hospital atrial fibrillation (P =0.90), ventricular tachycardia (P = 0.07), stroke (P = 0.45), and cardiac arrest (P = 0.26) were comparable. Overall in-hospital mortality was comparable in both genders (P = 0.83). In age ≤50 years, male gender was associated with a 3-fold increase in death (13% vs. 4%, P = 0.01), however, this mortality difference disappeared in DHF patients aged >50 years (P = 0.62). In DHF, female gender is characterized by having a high prevalence of metabolic syndrome components. Also, females are more likely to have better Left ventricular ejection fraction but less likely to receive cardiovascular evidence based medications. There is no significant difference in the overall hospital mortality between both genders, however, in the younger age; males have a significantly higher mortality.

  20. Impact of Age and Myopia on the Rate of Visual Field Progression in Glaucoma Patients.

    Science.gov (United States)

    Park, Hae-Young Lopilly; Hong, Kyung Euy; Park, Chan Kee

    2016-05-01

    Myopia is rapidly increasing in young populations and patients with glaucoma associated with myopia are reported to be young aged in East Asia. These young patients have a longer life expectancy, which increases their risk of end-of-life visual disabilities. There is a need to understand the clinical course of myopic glaucoma patients, which may be important for the care of these myopic populations. In this study, we evaluated the relationship between the age at presentation and the rate of glaucoma progression in the visual field (VF) according to the presence of myopia. The study was conducted as a prospective observational study including 179 patients with open-angle glaucoma who had undergone at least 5 VF examinations with a follow-up of at least 5 years. The progression rate of the mean deviation (MD) and the pattern standard deviation (PSD) are expressed as change in decibels (dB) per year. The slopes of the MD and PSD were calculated by linear regression analyses. Factors related to the slope of VF MD changes were analyzed with correlation and regression analyses. The slope of the linear fit line plotted against age at presentation and the rate of change in the VF MD was -0.026 (P presentation was significantly related to the rate of change in the VF in glaucomatous eyes with myopia compared to eyes without myopia. Older age was significantly related to the rate of change in the VF only in myopic glaucomatous eyes.

  1. Combining Antidepressants in Acute Treatment of Depression: A Meta-Analysis of 38 Studies Including 4511 Patients

    Science.gov (United States)

    Henssler, Jonathan; Bschor, Tom

    2016-01-01

    Objective: Combining antidepressants (ADs) for therapy of acute depression is frequently employed, but randomized studies have yielded conflicting results. We conducted a systematic review and meta-analysis aimed at determining efficacy and tolerability of combination therapy. Methods: MEDLINE, Embase, PsycINFO, and CENTRAL databases were systematically searched through March 2014 for controlled studies comparing combinations of ADs with AD monotherapy in adult patients suffering from acute depression. The prespecified primary outcome was standardized mean difference (SMD), secondary outcomes were response, remission, and dropouts. Results: Among 8688 articles screened, 38 studies were eligible, including 4511 patients. Combination treatment was statistically, significantly superior to monotherapy (SMD 0.29; 95% CI 0.16 to 0.42). During monotherapy, slightly fewer patients dropped out due to adverse events (OR 0.90; 95% CI 0.53 to 1.53). Studies were heterogeneous (I2 = 63%), and there was indication of moderate publication bias (fail-safe N for an effect of 0.1:44), but results remained robust across prespecified secondary outcomes and subgroups, including analyses restricted to randomized controlled trials and low risk of bias studies. Meta-regression revealed an association of SMD with difference in imipramine-equivalent dose. Combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors was superior to other combinations. Conclusion: Combining ADs seems to be superior to monotherapy with only slightly more patients dropping out. Combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors seems to be significantly more effective than other combinations. Overall, our search revealed a dearth of well-designed studies. PMID:27582451

  2. Combining Antidepressants in Acute Treatment of Depression: A Meta-Analysis of 38 Studies Including 4511 Patients.

    Science.gov (United States)

    Henssler, Jonathan; Bschor, Tom; Baethge, Christopher

    2016-01-01

    Combining antidepressants (ADs) for therapy of acute depression is frequently employed, but randomized studies have yielded conflicting results. We conducted a systematic review and meta-analysis aimed at determining efficacy and tolerability of combination therapy. MEDLINE, Embase, PsycINFO, and CENTRAL databases were systematically searched through March 2014 for controlled studies comparing combinations of ADs with AD monotherapy in adult patients suffering from acute depression. The prespecified primary outcome was standardized mean difference (SMD), secondary outcomes were response, remission, and dropouts. Among 8688 articles screened, 38 studies were eligible, including 4511 patients. Combination treatment was statistically, significantly superior to monotherapy (SMD 0.29; 95% CI 0.16 to 0.42). During monotherapy, slightly fewer patients dropped out due to adverse events (OR 0.90; 95% CI 0.53 to 1.53). Studies were heterogeneous (I(2) = 63%), and there was indication of moderate publication bias (fail-safe N for an effect of 0.1:44), but results remained robust across prespecified secondary outcomes and subgroups, including analyses restricted to randomized controlled trials and low risk of bias studies. Meta-regression revealed an association of SMD with difference in imipramine-equivalent dose. Combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors was superior to other combinations. Combining ADs seems to be superior to monotherapy with only slightly more patients dropping out. Combining a reuptake inhibitor with an antagonist of presynaptic α2-autoreceptors seems to be significantly more effective than other combinations. Overall, our search revealed a dearth of well-designed studies. © The Author(s) 2016.

  3. Effect of Age and Severity of Facial Palsy on Taste Thresholds in Bell's Palsy Patients.

    Science.gov (United States)

    Park, Jung Min; Kim, Myung Gu; Jung, Junyang; Kim, Sung Su; Jung, A Ra; Kim, Sang Hoon; Yeo, Seung Geun

    2017-04-01

    To investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell's palsy. This study included 29 patients diagnosed with Bell's palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined by House-Brackmann Scale, and their taste thresholds were assessed by EGM and chemical taste tests. EGM showed that taste thresholds at four locations on the tongue and one location on the central soft palate, 1 cm from the palatine uvula, were significantly higher in Bell's palsy patients than in controls ( p 0.05). The severity of facial palsy did not affect taste thresholds, as determined by both EGM and chemical taste tests ( p >0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell's palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly ( p Bell's palsy patients and healthy subjects ( p >0.05). Electrical taste thresholds were higher in Bell's palsy patients than in controls. These differences were observed in younger, but not in older, individuals.

  4. Ten-year outcome including patterns of failure and toxicity for adjuvant whole abdominopelvic irradiation in high-risk and poor histologic feature patients with endometrial carcinoma

    International Nuclear Information System (INIS)

    Stewart, Kimberly D.; Martinez, Alvaro A.; Weiner, Sheldon; Podratz, Karl; Stromberg, Jannifer S.; Schray, Mark; Mitchell, Christina; Sherman, Alfred; Chen, Peter; Brabbins, Donald A.

    2002-01-01

    Purpose: To evaluate the long-term results of treatment using adjuvant whole abdominal irradiation (WAPI) with a pelvic/vaginal boost in patients with Stage I-III endometrial carcinoma at high risk of intra-abdominopelvic recurrence, including clear cell (CC) and serous-papillary (SP) histologic features. Methods and Materials: In a prospective nonrandomized trial, 119 patients were treated with adjuvant WAPI between November 1981 and April 2000. All patients were analyzed, including those who did not complete therapy. The mean age at diagnosis was 66 years (range 39-88). Thirty-eight patients (32%) had 1989 FIGO Stage I-II disease and 81 (68%) had Stage III. The pathologic features included the following: 64 (54%) with deep myometrial invasion, 48 (40%) with positive peritoneal cytologic findings, 69 (58%) with high-grade lesions, 21 (18%) with positive pelvic/para-aortic lymph nodes, and 44 (37%) with SP or CC histologic findings. Results: The mean follow-up was 5.8 years (range 0.2-14.7). For the entire group, the 5- and 10-year cause-specific survival (CSS) rate was 75% and 69% and the disease-free survival (DFS) rate was 58% and 48%, respectively. When stratified by histologic features, the 5- and 10-year CSS rate for adenocarcinoma was 76% and 71%, and for serous papillary/CC subtypes, it was 74% and 63%, respectively (p=0.917). The 5- and 10-year DFS rate for adenocarcinoma was 60% and 50% and was 54% and 37% serous papillary/CC subtypes, respectively (p=0.498). For surgical Stage I-II, the 5-year CSS rate was 82% for adenocarcinoma and 87% for SP/CC features (p=0.480). For Stage III, it was 75% and 57%, respectively (p=0.129). Thirty-seven patients had a relapse, with the first site of failure the abdomen/pelvis in 14 (38%), lung in 8 (22%), extraabdominal lymph nodes in 7 (19%), vagina in 6 (16%), and other in 2 (5%). When stratified by histologic variant, 32% of patients with adenocarcinoma and 30% with the SP/CC subtype developed recurrent disease. Most

  5. Do Physician Recommendations for Colorectal Cancer Screening Differ by Patient Age?

    Directory of Open Access Journals (Sweden)

    Maida J Sewitch

    2007-01-01

    Full Text Available Colorectal cancer screening is underutilized, resulting in preventable morbidity and mortality. In the present study, age-related and other disparities associated with physicians’ delivery of colorectal cancer screening recommendations were examined. The present cross-sectional study included 43 physicians and 618 of their patients, aged 50 to 80 years, without past or present colorectal cancer. Of the 285 screen-eligible patients, 45% received a recommendation. Multivariate analyses revealed that, compared with younger nonde-pressed patients, older depressed patients were less likely to receive fecal occult blood test recommendations, compared with no recommendation (OR=0.31, 95% CI 0.09 to 1.02, as well as less likely to receive colonoscopy recommendations, compared with no recommendation (OR=0.14; 95% CI 0.03 to 0.66. Comorbidity and marital status were associated with delivery of fecal occult blood test and colonoscopy recommendations, respectively, compared with no recommendation. In summary, patient age and other characteristics appeared to influence physicians’ delivery of colorectal cancer screening and choice of modality.

  6. Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II.

    Science.gov (United States)

    Rupert, R L; Manello, D; Sandefur, R

    2000-01-01

    Health promotion and prevention services provided by the chiropractic profession historically have been referred to as maintenance care (MC). The primary objective of this investigation was to obtain information regarding multiple health issues of patients age 65 years and over who have had a long-term regimen of chiropractic health promotion and preventive care. The study also sought to explore the nature of the interventions and methods that were most commonly used by chiropractors when administering MC and to determine whether there were differences between patients who have had long-term exposure to these preventive services versus those who have not. This descriptive study was accomplished by selecting chiropractic patients (age 65 years and over) who had received health-promotion and prevention services for at least 5 years, with a minimum of 4 visits per year. To enhance the probability of securing a more representative patient sample, selection was made through the participation of chiropractors from 6 diverse geographic locations across the United States. Doctors were asked to enroll the first 10 consenting patients who met the inclusion criteria. A battery of diverse assessment instruments were completed by each patient to provide a patient health profile. Information related to each patient included answers to the SF-36D survey, patient health habits, expenditures of health services, frequency of use of health providers, and perceived value of chiropractic prevention and health promotion services. A total of 73 chiropractors participated in this investigation from the 6 study sites. In addition to an average 1.9 manual procedures used per patient, it was common to recommend stretching exercises (68.2%), aerobic exercises (55.6%), dietary advice (45.3%), and a host of other prevention strategies, including vitamins and relaxation. The patients investigated in this study reported making only half the annual number of visits to medical providers (4

  7. Results of surgical treatment of cervical cancer patients of childbearing age

    Directory of Open Access Journals (Sweden)

    V. S. Navruzova

    2015-01-01

    Full Text Available The world marked increase in the incidence of cervical cancer in young women, especially from 29 to 45 years old. Analysis showed that in patients with preserved ovarian function, not only the effectiveness of the treatment, but also the quality of life. It is associated with the acceleration, earlier puberty and the onset of sexual activity. In recent years more and more widely used radical surgery with preservation of the ovaries and the abduction of the radiation castration and preservation of reproductive function. In the National Cancer Research Centre of the Ministry of Health of the Republic of Uzbekistan analyzed the results of surgical treatment of 204 patients with cervical cancer younger. Age of patients from 23 to 45 years, that is, in the most hard-working, reproductive period. In our study patients met principally with exophytic – 82 (40.2 % and 68 (33.3 % еndophytic growth cervical tumors. Histological in 197 (96.6 % patients with squamous cervical cancer patients with 7 (3.4%. Adenocarcinoma of cervical cancer. Handard examination of the patient are further adapted to determine the level of sex hormones (estradiol, progesterone, determination of the tumor marter CA-125 levels of calcium and phosphate in the blood. 112 patients from the main group and the combined complex therapy surgical treatment with organ-component (conservation and ovarian transposition. The first group included 112 (55.1 % patients, who as part of combination therapy was performed and complex surgical treatment of ovarian transposition. The second group included 92 (44.9% patients who as part of combination therapy and complex surgery performed without ovarian transposition. Each group was divided into 3 subgroup included patients with stage process T1b–2aN0M0. Which performs the combined radiotherapy. The second subgroups included patients with stage process that runs systemic chemotherapy, surgery, combined radiotherapy. The third group included

  8. Structural knee joint pathology in patients aged 40 years or older with meniscal tears

    DEFF Research Database (Denmark)

    Pihl, Kenneth; Englund, Martin; Lohmander, L S

    2017-01-01

    using the International Cartilage Repair Society (ICRS) grading system. Univariable general linear models with Poisson distribution, log link and robust standard errors were used to assess the association between meniscal and other structural knee pathologies with presence of self-reported mechanical...... symptoms. Variables with p≤0.2 were included in final multivariable models (adjusted for age, sex and body mass index). Secondary analyses on diagnostic values of self-reported mechanical symptoms are reported in Pihl et al. OARSI 2017. Results: In total, 398 patients of the 491 KACS cohort patients were...

  9. Clinical Immunology Review Series: an approach to the patient with recurrent orogenital ulceration, including Behçet's syndrome.

    LENUS (Irish Health Repository)

    Keogan, M T

    2009-04-01

    Patients presenting with recurrent orogenital ulcers may have complex aphthosis, Behçet\\'s disease, secondary complex aphthosis (e.g. Reiter\\'s syndrome, Crohn\\'s disease, cyclical neutropenia) or non-aphthous disease (including bullous disorders, erythema multiforme, erosive lichen planus). Behçet\\'s syndrome is a multi-system vasculitis of unknown aetiology for which there is no diagnostic test. Diagnosis is based on agreed clinical criteria that require recurrent oral ulcers and two of the following: recurrent genital ulcers, ocular inflammation, defined skin lesions and pathergy. The condition can present with a variety of symptoms, hence a high index of suspicion is necessary. The most common presentation is with recurrent mouth ulcers, often with genital ulcers; however, it may take some years before diagnostic criteria are met. All patients with idiopathic orogenital ulcers should be kept under review, with periodic focused assessment to detect evolution into Behçet\\'s disease. There is often a delay of several years between patients fulfilling diagnostic criteria and a diagnosis being made, which may contribute to the morbidity of this condition. Despite considerable research effort, the aetiology and pathogenesis of this condition remains enigmatic.

  10. Screening of ARHSP-TCC patients expands the spectrum of SPG11 mutations and includes a large scale gene deletion.

    Science.gov (United States)

    Denora, Paola S; Schlesinger, David; Casali, Carlo; Kok, Fernando; Tessa, Alessandra; Boukhris, Amir; Azzedine, Hamid; Dotti, Maria Teresa; Bruno, Claudio; Truchetto, Jeremy; Biancheri, Roberta; Fedirko, Estelle; Di Rocco, Maja; Bueno, Clarissa; Malandrini, Alessandro; Battini, Roberta; Sickl, Elisabeth; de Leva, Maria Fulvia; Boespflug-Tanguy, Odile; Silvestri, Gabriella; Simonati, Alessandro; Said, Edith; Ferbert, Andreas; Criscuolo, Chiara; Heinimann, Karl; Modoni, Anna; Weber, Peter; Palmeri, Silvia; Plasilova, Martina; Pauri, Flavia; Cassandrini, Denise; Battisti, Carla; Pini, Antonella; Tosetti, Michela; Hauser, Erwin; Masciullo, Marcella; Di Fabio, Roberto; Piccolo, Francesca; Denis, Elodie; Cioni, Giovanni; Massa, Roberto; Della Giustina, Elvio; Calabrese, Olga; Melone, Marina A B; De Michele, Giuseppe; Federico, Antonio; Bertini, Enrico; Durr, Alexandra; Brockmann, Knut; van der Knaap, Marjo S; Zatz, Mayana; Filla, Alessandro; Brice, Alexis; Stevanin, Giovanni; Santorelli, Filippo M

    2009-03-01

    Autosomal recessive spastic paraplegia with thinning of corpus callosum (ARHSP-TCC) is a complex form of HSP initially described in Japan but subsequently reported to have a worldwide distribution with a particular high frequency in multiple families from the Mediterranean basin. We recently showed that ARHSP-TCC is commonly associated with mutations in SPG11/KIAA1840 on chromosome 15q. We have now screened a collection of new patients mainly originating from Italy and Brazil, in order to further ascertain the spectrum of mutations in SPG11, enlarge the ethnic origin of SPG11 patients, determine the relative frequency at the level of single Countries (i.e., Italy), and establish whether there is one or more common mutation. In 25 index cases we identified 32 mutations; 22 are novel, including 9 nonsense, 3 small deletions, 4 insertions, 1 in/del, 1 small duplication, 1 missense, 2 splice-site, and for the first time a large genomic rearrangement. This brings the total number of SPG11 mutated patients in the SPATAX collection to 111 cases in 44 families and in 17 isolated cases, from 16 Countries, all assessed using homogeneous clinical criteria. While expanding the spectrum of mutations in SPG11, this larger series also corroborated the notion that even within apparently homogeneous population a molecular diagnosis cannot be achieved without full gene sequencing. 2008 Wiley-Liss, Inc.

  11. Balancing the role of the dental school in teaching, research and patient care; including care for underserved areas.

    Science.gov (United States)

    Holbrook, W P; Brodin, P; Balciuniene, I; Brukiene, V; Bucur, M V; Corbet, E; Dillenberg, J; Djukanovic, D; Ekanayake, K; Eriksen, H; Fisher, J; Goffin, G; Hull, P; Kumchai, T; Lumley, P; Lund, J; Mathur, V; Novaes, A; Puriene, A; Roger-Leroi, V; Saito, I; Turner, S; Mabelya, L

    2008-02-01

    Inequalities within dentistry are common and are reflected in wide differences in the levels of oral health and the standard of care available both within and between countries and communities. Furthermore there are patients, particularly those with special treatment needs, who do not have the same access to dental services as the general public. The dental school should aim to recruit students from varied backgrounds into all areas covered by the oral healthcare team and to train students to treat the full spectrum of patients including those with special needs. It is essential, however, that the dental student achieves a high standard of clinical competence and this cannot be gained by treating only those patients with low expectations for care. Balancing these aspects of clinical education is difficult. Research is an important stimulus to better teaching and better clinical care. It is recognized that dental school staff should be active in research, teaching, clinical work and frequently administration. Maintaining a balance between the commitments to clinical care, teaching and research while also taking account of underserved areas in each of these categories is a difficult challenge but one that has to be met to a high degree in a successful, modern dental school.

  12. Arterial wall stiffness in patients with essential hypertension at young age

    Directory of Open Access Journals (Sweden)

    Kolesnik E.L.

    2014-11-01

    Full Text Available Research objective was investigating arterial wall stiffness in patients with hypertension at young age and assessing the relationship between subclinical target organs damage and ambulatory blood pressure monitoring (ABPM parameters. 30 male patients aged 18-35 years with essential hypertension stage I and II, hypertension 1 and 2nd grade were surveyed. The examination included general clinical methods, echocardiography, ABPM and suprasystolic sfigmography. It was found that the pulse wave velocity (PWVao (r = 0,557 p <0,01, central aortic blood pressure (SBPao (r = 0,492 p <0,01 and augmentation index (AIxao (r = 0,489 p <0.01 significantly increased with the pa¬tients’ age. Abdominal obesity (r = 0,566 p <0,01 and BMI (r = 0,599 p <0,01 impacted on the PWVao acceleration. Increasing of the left ventricular mass index (LVMI is highly associated with SBPao (r = 0,506 p <0,05 and PWVao (r = 0,434 p <0,05. According to ABPM the most significant correlation with arterial wall stiffness parameters demon¬strated diastolic blood pressure (DBP daytime level (AIxao (r = 0,418 p <0,01, with PWVao (r = 0,699 p <0.01 and SBPao (r = 0,695 p <0,01. Thus, age, excessive body weight and obesity should be considered as unfavorable factors that worsen arterial wall stiffness in patients with hypertension at the age before 35 years. Increase of DBP levels especially during the day causes maximum negative impact on the arterial wall stiffness parameters according to ABPM. Increased SBPao and PWVao in patients with hypertension at a young age are associated with increased left ventricular mass index.

  13. A randomised multicentre trial of acupuncture in patients with seasonal allergic rhinitis--trial intervention including physician and treatment characteristics.

    Science.gov (United States)

    Ortiz, Miriam; Witt, Claudia M; Binting, Sylvia; Helmreich, Cornelia; Hummelsberger, Josef; Pfab, Florian; Wullinger, Michael; Irnich, Dominik; Linde, Klaus; Niggemann, Bodo; Willich, Stefan N; Brinkhaus, Benno

    2014-04-06

    In a large randomised trial in patients with seasonal allergic rhinitis (SAR), acupuncture was superior compared to sham acupuncture and rescue medication. The aim of this paper is to describe the characteristics of the trial's participating physicians and to describe the trial intervention in accordance with the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) guidelines, to make details of the trial intervention more transparent to researchers and physicians. ACUSAR (ACUpuncture in Seasonal Allergic Rhinitis) was a three-armed, randomised, controlled multicentre trial. 422 SAR patients were randomised to semi-standardised acupuncture plus rescue medication (RM, cetirizine), sham acupuncture plus RM or RM alone. We sent a questionnaire to trial physicians in order to evaluate their characteristics regarding their education about and experience in providing acupuncture. During the trial, acupuncturists were asked to diagnose all of their patients according to Chinese Medicine (CM) as a basis for the semi-standardised, individualized intervention in the acupuncture group. Every acupuncture point used in this trial had to be documented after each session Acupuncture was administered in outpatient clinics by 46 (mean age 47 ± 10 years; 24 female/ 22 male) conventionally-trained medical doctors (67% with postgraduate specialization such as internal or family medicine) with additional extensive acupuncture training (median 500 hours (1st quartile 350, 3rd quartile 1000 hours with 73% presenting a B-diploma in acupuncture training (350 hours)) and experience (mean 14 years in practice). The most reported traditional CM diagnosis was 'wind-cold invading the lung' (37%) and 'wind-heat invading the lung' (37%), followed by 'lung and spleen qi deficiency' (9%). The total number of needles used was higher in the acupuncture group compared to the sham acupuncture group (15.7 ± 2.5 vs. 10.0 ± 1.6). The trial interventions were

  14. Characteristics and outcomes of patients with multiple myeloma aged 21-40years versus 41-60years

    DEFF Research Database (Denmark)

    Jurczyszyn, Artur; Nahi, Hareth; Avivi, Irit

    2016-01-01

    We compared the outcomes of multiple myeloma (MM) patients aged 21-40 and 41-60years in the novel agent era. This case-control study included 1089 patients between 2000 and 2015. Cases and controls were matched for sex, International Staging System (ISS) stage and institution. There were 173 pati...

  15. Tympanogram findings in patients with cleft palates aged six months to seven years

    Science.gov (United States)

    Yanti, A.; Widiarni, D.; Alviandi, W.; Tamin, S.; Mansyur, M.

    2017-08-01

    Cleft palate is one of the most common congenital craniofacial deformities. Otitis media with effusion (OME) is a middle ear disease having a prevalence of almost 90% in patients with cleft palates. Tympanometry is a fast, safe, non-invasive, and easy tool for diagnosing middle ear disease qualitatively and quantitatively. Studies have been conducted using tympanometry to detect middle ear conditions in patients with cleft palates, but no research has studied tympanogram findings in patients with cleft palates in Indonesia. The aim of this study is to determine the tympanogram findings in Indonesian children aged six months to seven years with cleft palates. This is a cross-sectional study of 30 patients (17 males and 13 females) with Veau classification of palatal clefts aged six months to seven years (median 26.5 months) who underwent tympanometry examinations using a 226 Hztympanometer. Tympanograms were classified using the Jerger/Liden classification. Examinations of 58 ears found that type B tympanograms occurred most frequently (70.7%). The quantitative values of tympanometry analyzed included SAA (0.1-0.2 cm3), TPP value (-197.2-(-146.8 daPa)), Vec value (0.5-0.6 cm3), and gradient value (0.03-0.07 cm3). Using the Fisher test, a significant relationship was found between age and type of tympanogram (p = 0.0039) with the risk of type B and C tympanograms in infants (6-60 months) as high as 4.8 times that of children without cleft palates. The type B tympanogram was most frequently seen in patients with cleft palates aged six months to seven years old with the quantitative values of tympanometry lower than the normal values. Therefore, there was a significant difference in the type of tympanogram seen with age.

  16. Does the Age of a Patient Affect the Outcome of Temporomandibular Joint Arthroscopic Surgery?

    Science.gov (United States)

    Cho, Jungsuk; Israel, Howard

    2017-06-01

    Although temporomandibular joint (TMJ) disorders encompass all age groups, it is generally considered to affect young to middle-age adults. The aim of this investigation was to study patients who met the criteria for TMJ arthroscopy and to determine whether there was a difference in outcomes between younger and older patients. This was a retrospective chart review of patients who underwent TMJ operative arthroscopy. The primary variable studied was patient age. Major outcome variables included changes in subjective pain measured by a visual analog scale (VAS) and changes in maximum interincisal opening (MIO) after arthroscopic surgery. Other variables of interest included the presence of systemic disease, synovitis, and osteoarthritis diagnosed arthroscopically. Data analysis included the Student t test, regression analysis (R Studio, Boston, MA), and χ 2 test with a P value less than .05 indicating statistical significance. The study population consisted of 103 patients diagnosed with internal derangement and severe inflammatory or degenerative TMJ disease (Wilkes stages II to V) who underwent operative arthroscopy. Patients were divided into 2 groups based on age (group Y, 40 yr old, n = 52, mean age, 56 yr). The presence of osteoarthritis diagnosed arthroscopically was significantly greater in group O than in group Y (P < .01). There was significant postoperative improvement in pain (VAS) and MIO in group Y (P < .01) and group O (P < .01). Although the 2 groups showed substantial improvement after arthroscopy, when comparing differences in outcomes between the groups, the absolute postoperative pain level for group O was significantly lower than for group Y (P < .05). Comparison of postoperative MIO did not show a significant difference between group Y and group O (P = .286). Groups Y and O showed substantial improvement in pain (VAS) and mandibular mobility (MIO) after surgical TMJ arthroscopy. Group O had a higher prevalence of arthroscopically diagnosed

  17. Outcome and Risk Factors Presented in Old Patients Above 80 Years of Age Versus Younger Patients After Ischemic Stroke

    DEFF Research Database (Denmark)

    Bentsen, Line; Christensen, Louisa; Christensen, Anders

    2014-01-01

    patients received stroke unit care in accordance with the guidelines. The population was dichotomized into patients aged less than 80 years and 80 years of age or older. Modified Rankin Scale (mRS) score and Barthel Index (BI) were used to assess 3-month and 1-year outcome. RESULTS: Patients 80 years...... of age or older presented with significantly more severe strokes than younger patients, median Scandinavian Stroke Scale score 39 vs 42 (P = .003). Median mRS score before stroke was significantly higher in patients aged 80 years or older (P

  18. Variations in GP–patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey

    OpenAIRE

    Burt, Jennifer Anne; Lloyd, Cathy; Campbell, John; Roland, Martin; Abel, Gary Alexander

    2016-01-01

    Background Doctor–patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor–patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. Aim To determine how reported GP–patient communication varies between patients from different ethnic groups, stratified by age and gender. ...

  19. Sex, aging, and preexisting cerebral ischemic disease in patients with aortic stenosis.

    Science.gov (United States)

    Wang, Ping; Acker, Michael A; Bilello, Michel; Melhem, Elias R; Stambrook, Elizabeth; Ratcliffe, Sarah J; Floyd, Thomas F

    2010-10-01

    Patients undergoing cardiac surgery have a high frequency of preexisting cerebral ischemic lesions, the presence of which appears to predict cognitive sequelae. Patients undergoing aortic valve replacement for aortic stenosis (AS) incur an exceptionally high risk for perioperative cerebral ischemia. The extreme risk in this subgroup may arise from the preexisting burden of cerebral ischemic disease. We tested the hypotheses that increasing age, female sex, coronary artery disease, and the severity of AS are predictive of the severity of preexisting cerebral ischemic lesions. A total of 95 subjects were included in this study. Subjects were imaged on 1.5 Tesla magnetic resonance imaging scanners to obtain multimodal image sets which were used for the automatic segmentation of cerebral lesion volume. The dependence of lesion volume upon age, sex, coronary artery disease, and the severity of AS were tested. The results demonstrate a strong correlation between aging, female sex, and white matter and ischemia-like lesion volume in patients with aortic stenosis. Women and those of advanced age presenting for aortic valve replacement for AS may incur a particularly high risk for postoperative neurologic sequelae due to an exceptional preexisting burden of cerebral ischemic disease. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy

    Directory of Open Access Journals (Sweden)

    Andreas Michalsen

    2013-01-01

    Full Text Available Fibromyalgia poses a challenge for therapy. Recent guidelines suggest that fibromyalgia should be treated within a multidisciplinary therapy approach. No data are available that evaluated multimodal treatment strategies of Integrative Medicine (IM. We conducted a controlled, nonrandomized pilot study that compared two inpatient treatment strategies, an IM approach that included fasting therapy and a conventional rheumatology (CM approach. IM used fasting cure and Mind-Body-Medicine as specific methods. Of 48 included consecutive patients, 28 were treated with IM, 20 with CM. Primary outcome was change in the Fibromyalgia Impact Questionnaire (FIQ score after the 2-week hospital stay. Secondary outcomes included scores of pain, depression, anxiety, and well being. Assessments were repeated after 12 weeks. At 2 weeks, there were significant improvements in the FIQ (P<0.014 and for most of secondary outcomes for the IM group compared to the CM group. The beneficial effects for the IM approach were reduced after 12 weeks and no longer statistically significant with the exception of anxiety. Findings indicate that a multimodal IM treatment with fasting therapy might be superior to CM in the short term and not inferior in the mid term. Longer-term studies are warranted to assess the clinical impact of integrative multimodal treatment in fibromyalgia.

  1. Mortality in patients treated with intravitreal bevacizumab for age-related macular degeneration.

    Science.gov (United States)

    Hanhart, Joel; Comaneshter, Doron S; Freier Dror, Yossi; Vinker, Shlomo

    2017-10-10

    The aim of this study is to analyze mortality in patients treated with bevacizumab for wet AMD. We conducted a retrospective case-control study between patients who received intravitreal injections of bevacizumab as the sole treatment for exudative AMD between September 2008 and October 2014 (n = 5385) and age and gender matched controls (n = 10,756). All individuals included in the study were reviewed for sociodemographic data and comorbidities. Survival analysis was performed using adjusted Cox regression, using relevant adjusted variables. During follow-up (maximum: 73 months), 1063 (19.7%) individuals after bevacizumab died compared with 1298 (12.1%) in the control group (P bevacizumab compared to a same age and gender group without wet AMD.

  2. [Aging-related physical and life style changes in the patients with reflux esophagitis].

    Science.gov (United States)

    Uetake, T; Fujino, M A

    2000-09-01

    Incidence of reflux esophagitis(RE) has increased over the past 10 years in Japan, where aging of the population is rapidly progressing. The majority(73.6%) of the patients with RE consisted of non-elderly males having life style problems and of elderly females suffering from posture alterations. This suggested the importance of the disease onset among elderly female population in addition to that of the non-elderly male population. The risk factors specific to the elderly patients include not only persistent acid secretion and presbyesophagus, but also complication with orthopedic regression diseases with posture changes and osteoporosis. The association with the latter orthopedic regression diseases has been significantly increasing and is suggested to promote development of RE. Further increase in the prevalence of RE is foreseen in this aging-accelerating country.

  3. Esophageal atresia with tracheoesophageal fistula in a patient with 7q35-36.3 deletion including SHH gene.

    Science.gov (United States)

    Busa, Tiffany; Panait, Nicoleta; Chaumoitre, Kathia; Philip, Nicole; Missirian, Chantal

    2016-10-01

    Terminal 7q deletion is rarely reported in the literature. Holoprosencephaly and sacral dysgenesis are found in association with this deletion, due to haploinsufficiency of SHH and HLBX9 genes respectively. We report on a 2-year-old boy with 7q35-36.3 deletion encompassing SHH identified by oligonucleotide array comparative genomic hybridization. In addition to other frequent features, the patient presented with esophageal atresia and tracheoeosophageal fistula diagnosed at birth. This case, together with two others previously described, one presenting with esophageal atresia, the other with congenital esophageal stenosis, confirms the possible association between congenital esophageal malformations and 7q terminal deletion including SHH. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Analysis of the chromosome X exome in patients with autism spectrum disorders identified novel candidate genes, including TMLHE

    Science.gov (United States)

    Nava, C; Lamari, F; Héron, D; Mignot, C; Rastetter, A; Keren, B; Cohen, D; Faudet, A; Bouteiller, D; Gilleron, M; Jacquette, A; Whalen, S; Afenjar, A; Périsse, D; Laurent, C; Dupuits, C; Gautier, C; Gérard, M; Huguet, G; Caillet, S; Leheup, B; Leboyer, M; Gillberg, C; Delorme, R; Bourgeron, T; Brice, A; Depienne, C

    2012-01-01

    The striking excess of affected males in autism spectrum disorders (ASD) suggests that genes located on chromosome X contribute to the etiology of these disorders. To identify new X-linked genes associated with ASD, we analyzed the entire chromosome X exome by next-generation sequencing in 12 unrelated families with two affected males. Thirty-six possibly deleterious variants in 33 candidate genes were found, including PHF8 and HUWE1, previously implicated in intellectual disability (ID). A nonsense mutation in TMLHE, which encodes the ɛ-N-trimethyllysine hydroxylase catalyzing the first step of carnitine biosynthesis, was identified in two brothers with autism and ID. By screening the TMLHE coding sequence in 501 male patients with ASD, we identified two additional missense substitutions not found in controls and not reported in databases. Functional analyses confirmed that the mutations were associated with a loss-of-function and led to an increase in trimethyllysine, the precursor of carnitine biosynthesis, in the plasma of patients. This study supports the hypothesis that rare variants on the X chromosome are involved in the etiology of ASD and contribute to the sex-ratio disequilibrium. PMID:23092983

  5. Comparison of Apraxia between Patients with Senile Dementia of Alzheimer Type and Normal Aged People

    Directory of Open Access Journals (Sweden)

    Fariba Yadegari

    2007-07-01

    Full Text Available Objective: In addition to memory deficits and aphasia, many patients with Alzheimer’s disease (AD are apraxic which may bring about disturbances in their daily living. The purpose of present study was investigating the presence of any apraxic disorder in patients with senile dementia of Alzheimer type (SDAT and comparison with normal aged people. Materials & Methods: In this case–control and analytical study 14 SDAT patients were compared with 20 normal ageing people that they were matched with patients according to age and education. Patients were selected from Iranian Alzheimer Association clients with psychiatrist diagnostic confirmation and MMSE scores between 15-27 and compared with controls with MMSE scores between 25-30. Apraxia Test was administered on both groups. The Test included 4 subtests: conceptual movements gestured conceptual movements, oral and respiratory movements & pantomime of movements of object manipulations. Data was analyzed by using Kolmogoroff – Smirnoff test, Man – Witney, T-test for independent groups and pearsonian correlation coefficient. Results: Findings showed that apraxia scores were significantly (P<0/001 different between groups so that (SDAT patients were diagnosed as apraxic and controls were not. Besides, comparison of subtests scores of (SDAT patients revealed that conceptual movements scores were significantly (P<0/001 less than the other subtests (more apraxic and oral and respiratory movements scores were significantly (P<0/001 higher than the other subtests (less apraxic. Conclusion: Apraxia could be considered as one of the neuropsychological signs early in the disease development. It can be applied complementarily for differential diagnosis. Also apraxia subgroup scoring could be used for apraxia categorization, understanding observed disorders and determining possible rehabilitation ways.

  6. Age-Related Differences in Clinical Characteristics and Esophageal Motility in Patients with Dysphagia.

    Science.gov (United States)

    Nakato, Rui; Manabe, Noriaki; Kamada, Tomoari; Matsumoto, Hideo; Shiotani, Akiko; Hata, Jiro; Haruma, Ken

    2017-06-01

    Dysphagia in elderly patients has a major effect on nutrition and quality of life (QOL). Although several studies have shown that aging itself is associated with changes in esophageal motility, the impact of these changes on dysphagia symptoms and QOL is unknown. This study assessed the manometric diagnoses of elderly patients with dysphagia compared with diagnoses in younger counterparts. Participants included 116 consecutive patients examined for dysphagia from 2007 to 2014. We divided patients into three groups by age: Group A, 66 years and older (24 men, 23 women); Group B, 45-65 years (18 men, 24 women); and Group C, 44 years and younger (15 men, 12 women). The three groups were compared in regard to symptoms, esophageal motility, and health-related QOL (HRQOL). All patients underwent esophageal manometry examination and completed a self-administered questionnaire concerning their symptoms; HRQOL assessment was based on results of the Short Form-8 General Health Survey. Symptoms rated ≥4 points on the Likert scale were defined as significant. Although all patients had dysphagia as a major symptom, more elderly patients reported globus sensation, whereas more young patients reported heartburn as the primary symptom. Manometric diagnoses were generally similar across the three groups. Ineffective esophageal motility was more prevalent in Groups A and C than in Group B, although the difference was not statistically significant. No significant differences in manometric parameters or HRQOL were detected among the three groups. Despite differences in symptom patterns, broad manometric diagnoses and impairment of HRQOL in elderly patients with dysphagia are similar to those in younger counterparts.

  7. Inappropriate Suppression of Thyrotropin Concentrations in Young Patients with Thyroid Nodules Including Thyroid Cancer: The Fukushima Health Management Survey.

    Science.gov (United States)

    Suzuki, Satoru; Nakamura, Izumi; Suzuki, Satoshi; Ohkouchi, Chiyo; Mizunuma, Hiroshi; Midorikawa, Sanae; Fukushima, Toshihiko; Ito, Yuko; Shimura, Hiroki; Ohira, Tetsuya; Matsuzuka, Takashi; Ohtsuru, Akira; Abe, Masafumi; Yamashita, Shunichi; Suzuki, Shinichi

    2016-05-01

    Serum thyroid hormone concentration is regulated through the hypothalamic-pituitary-thyroid axis. This study aimed to clarify the relationships between thyroid hormone regulation and ultrasonographic findings in subjects with thyroid nodules detected during thyroid ultrasound examination for the Fukushima Health Management Survey. As of October 31, 2014, a total of 296,253 subjects, who had been living in Fukushima Prefecture at the time of the Fukushima nuclear power plant accident and were aged ≤18 years on March 11, 2011, participated in two concurrent screening programs. In the primary screening, thyroid nodules were detected in 2241 subjects. A secondary confirmatory thyroid ultrasound examination and blood sampling for thyroid function tests were performed on 2004 subjects. The subjects were reassessed and classified into disease-free subjects (Group 1), subjects with cysts only (Group 2), subjects with nodules (Group 3), and subjects with malignancy or suspected malignancy (Group 4). Serum concentrations of free triiodothyronine (fT3), free thyroxine (fT4), thyrotropin (TSH), thyroglobulin, and the fT3/fT4 ratio were classified according to the diagnoses. Inverse relationships between age and log TSH values (Spearman's correlation r = -0.311, p = 0.015), serum fT3 concentration (r = -0.688, p < 0.001), and the fT3/fT4 ratio (r = -0.520, p < 0.001) were observed in Group 1. When analysis of covariance with Bonferroni post hoc comparisons was used in the four groups, the log TSH values were significantly lower in both Group 3 and Group 4 compared with Group 1 and Group 2 after correcting for age (p < 0.001; Group 1 vs. Group 3, p = 0.016; Group 1 vs. Group 4, p = 0.022; Group 2 vs. Group 3, p = 0.001; Group 2 vs. Group 4, p = 0.008). However, no significant differences were observed between the four groups regarding levels of fT3, fT4, fT3/fT4 ratio, and thyroglobulin (p = 0.304, 0.340, 0.208, and 0

  8. Quality of life metrics in arrhythmogenic right ventricular cardiomyopathy patients: The impact of age, shock and sex.

    Science.gov (United States)

    Rhodes, Ashley C; Murray, Brittney; Tichnell, Crystal; James, Cynthia A; Calkins, Hugh; Sears, Samuel F

    2017-12-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients face many medical and psychosocial challenges. However, the quality of life (QOL) outcomes of these patients remains largely unexplored. 159 ARVC patients completed a psychosocial survey including the Short Form Health Survey, Florida Shock Anxiety Scale, and Florida Patient Acceptance Survey. These cross-sectional data were used to examine the general and device-specific QOL of these patients compared to normative samples, and to determine the impact of age, shock and sex on these outcome measures. ARVC patients reported lower physical and mental QOL compared to a normative U.S sample. Compared to an implantable cardioverter defibrillator (ICD) sample, they reported higher mental and physical QOL. Compared to a hypertrophic cardiomyopathy sample, they reported lower physical but higher mental QOL. ARVC patients aged 18-35 reported significantly lower mental QOL than older patients. Male patients with no implantable defibrillator shock history reported significantly higher mental QOL scores than those with shock history. Shock anxiety scores were significantly higher among individuals who had experienced at least one shock. Female ARVC patients reported significantly higher shock anxiety and lower mental QOL compared to male patients. ARVC patients report lower mental and physical QOL than a U.S. normative sample, but report mostly superior QOL compared to relevant cardiac samples. Younger ARVC patients, female patients, and those who have experienced at least one device shock are at risk for psychosocial difficulties, including poorer QOL outcomes. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  9. [Dynamics of health and aging rate of patients of different age and sex in the treatment of moderate multiple pathologies].

    Science.gov (United States)

    Myakotnykh, V S; Gavrilov, I V; Egorin, K V; Meshchaninov, V N; Borovkova, T A

    2013-01-01

    The article presents results of investigation of the dynamics of health status of patients of different age and sex, with several non-serious diseases, in the course of their treatment in the hospital, as well as the determination of their biological age before and after the course of treatment. The clear differences in the number of diseases, their nature, duration of the treatment and its effectiveness depending on age and sex were revealed. However, at the age of older than 60 years these differences gradually disappearing. Multiple, although non-serious, pathology has a negative impact on the indicators of the biological age of men in the calendar age of 20-39 years and women in the calendar age of 20-39 and older than 60 years, but the rejuvenating effect of the treatment is extremely low. In a number of cases, in the process of treatment of multiple pathologies the indicators of initially reduced biological age get even higher and adapt to the indicators of the calendar age. The authors explain this from the position of the disturbed by the treatment adaptation of the organism to easy disease, as well as the opportunity of reviewing the biological age significantly reduced in relation to the calendar age as a pathological phenomenon similar to significantly increased biological age.

  10. Preliminary investigation of cognitive function in aged multiple sclerosis patients: Challenges in detecting comorbid Alzheimer's disease.

    Science.gov (United States)

    Roy, Shumita; Drake, Allison; Snyder, Stephanie; Cline, Breana; Khan, Anjum; Fuchs, Tom; Zivadinov, Robert; Weinstock-Guttman, Bianca; Szigeti, Kinga; Benedict, Ralph H B

    2018-03-13

    Cognitive impairment can be seen in patients of all ages with multiple sclerosis (MS). However, there is limited research on neurocognitive disorder in older adults with MS and how to detect Alzheimer's disease (AD) or its prodromal stage, amnestic mild cognitive impairment (aMCI). Thus, the MS clinician is challenged to discriminate between signs of MS-related cognitive decline versus a secondary neurodegenerative process. Compare cognition in older MS patients to patients with AD and aMCI. We evaluated cognitively impaired and unimpaired MS patients, AD patients, aMCI patients, and healthy controls (HCs), all elderly (n = 20 per group). AD and aMCI diagnoses were derived by consensus conference independent of the MS research project. Neuropsychological measures assessed domains commonly affected in AD, including verbal memory and expressive language. Cognitively impaired and unimpaired MS groups did not differ on any measures sensitive to AD. Unimpaired MS patients were comparable to HCs. Impaired MS patients showed decreased semantic fluency, similar to aMCI patients. Lastly, while both AD and aMCI groups had deficient memory retention, there was no evidence of a retention deficit in either MS group. Our findings suggest that the cognitive profiles of MS and AD are distinct. In contrast to AD, MS is not associated with impairment of memory consolidation. However, there may be overlap between cognitive deficits related to MS and aMCI. Thus, evidence of poor memory retention, in an older MS patient may merit comprehensive dementia evaluation. The study is preliminary and includes no AD biomarkers (e.g., amyloid imaging) to confirm or rule out AD pathology. Copyright © 2018 Elsevier B.V. All rights reserved.

  11. Population structure and characterization of viridans group streptococci (VGS) including Streptococcus pneumoniae isolated from adult patients with cystic fibrosis (CF).

    Science.gov (United States)

    Maeda, Yasunori; Elborn, J Stuart; Parkins, Michael D; Reihill, James; Goldsmith, Colin E; Coulter, Wilson A; Mason, Charlene; Millar, B Cherie; Dooley, James S G; Lowery, Colm J; Ennis, Madeleine; Rendall, Jacqueline C; Moore, John E

    2011-03-01

    A study was undertaken to examine the population structure of viridans group streptococci (VGS) in the sputum of adult patients with cystic fibrosis (CF). Freshly expectorated sputa (n=58) from 45 adult CF patients were examined by selective conventional culture on Mitis-Salivarius agar and yielded 190 isolates of VGS. Sequence analyses of the rpnB and 16-23S rRNA ITS genes identified these isolates to belong to 12 species of VGS and included S. anginosus, S. australis, S. cristatus, S. gordonii, S. infantis, S. mitis, S. mutans, S. oralis, S. parasanguinis, S. pneumoniae, S. salivarius and S. sanguinis. The most frequently VGS organism isolated was S. salivarius (47/190; 24.7%), followed by S. mitis (36/190; 19%), S. sanguinis (25/190; 13.2%), S. oralis (20/190; 11.0%), S. pneumoniae (19/190; 10.0%), S. parasanguinis (16/190; 8.4%), S. infantis (11/190; 5.8%), S. gordonii (7/190; 3.7%), S. anginosus (4/190; 2.1%), S. cristatus (2/190; 1.1%), S. australis (1/190; 0.5%), S. mutans (1/190; 0.5%) and S. agalactiae (1/190; 0.5%). All, but four, patients harboured at least one VGS species, which ranged from one to five streptococcal species, with a mean of 2.85 species per patient. There was no clonality at the subspecies level employing ERIC RAPD PCR. Antibiotic susceptibility was determined by Minimum Inhibitory Concentration (MIC) testing against penicillin, erythromycin and ciprofloxacin. Overall, resistance to penicillin with all VGS was 73/190 (38.4%) and 167/190 (87.9%) for erythromycin. With regard to ciprofloxacin, 27/190 (14.2%) were fully resistant, whilst a further 21/190 (11.1%) showed intermediate resistance, which equated to approximately three quarters (74.7%) of isolates being fully sensitive to this agent. In addition, as a comparator control population, we examined antibiotic susceptibility, as above, in a non-CF population comprising 12 individuals (50 VGS isolates), who were not receiving chronic antibiotics. In comparison, 8% and 38% of VGS

  12. Students’ Learning Experiences from Didactic Teaching Sessions Including Patient Case Examples as Either Text or Video: A Qualitative Study

    DEFF Research Database (Denmark)

    Pedersen, Kamilla; Holdgaard, Martin Møller; Paltved, Charlotte

    2017-01-01

    OBJECTIVES: The aim of this study was to explore medical students' learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students' ...... unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry....

  13. [METABOLIC STATUS OF PATIENTS OF DIFFERENT AGE GROUPS ON THE STAGES OF OSTEOARTHRITIS].

    Science.gov (United States)

    Stogov, M V; Ovchinnikov, E N; Sazonova, N V

    2015-01-01

    This study investigated the biochemical parameters of blood and urine in patients with osteoarthritis in the stages of the pathological process in different age groups. The patients of all age groups in the stages of osteoarthritis demonstrated metabolic acidosis, activation of the antioxidant system and increase in acute phase proteins. In addition to the total for all age groups metabolic shifts the characteristic age-related changes were observed: activated reaction of lipid peroxidation in middle-aged patients and negative calcium balance, with increasing energy metabolism disorders in elderly patients.

  14. Personalized therapy in multiple myeloma according to patient age and vulnerability

    DEFF Research Database (Denmark)

    Palumbo, Antonio; Bringhen, Sara; Ludwig, Heinz

    2011-01-01

    Most patients with newly diagnosed multiple myeloma (MM) are aged > 65 years with 30% aged > 75 years. Many elderly patients are also vulnerable because of comorbidities that complicate the management of MM. The prevalence of MM is expected to rise over time because of an aging population. Most e...

  15. Comorbidities in patients over 60 years of age treated at the rehabilitation clinic

    Directory of Open Access Journals (Sweden)

    Pietrzyńska Magdalena

    2015-12-01

    Full Text Available Patients aged above 60 represent a very diversified population group with respect to their health condition. This may result from multimorbidity. In the rehabilitation process of elderly patients it is especially crucial to identify not only the underlying diseases which constituted the grounds for referral to the rehabilitation clinic, but also the comorbidities that have to be taken into consideration while planning their rehabilitation. The aim of the present paper is the assessment of comorbidities in patients of the rehabilitation clinic. The study population included 1616 patients (447 man and 1169 women treated at the rehabilitation clinic. The factors put through analysis were the age and gender of the patient, the main diagnosed (underlying illness subject to rehabilitation treatment, as well as comorbidities. All diseases, both the underlying conditions and the comorbidities have been classified according to the International Statistical Classification of Diseases and Related Health Problems (10th revised edition. The main reasons for the treatment at the rehabilitation outpatient clinic were arthrosis of the spine, knee and hip joints, polyarthritis, osteoporosis, diseases of the central nervous system diseases and paralytic syndromes as consequences of strokes, hypertension or atherosclerosis, as well as post-traumatic conditions.

  16. Superficial vein thrombosis in patients with varicose veins: role of thrombophilia factors, age and body mass.

    Science.gov (United States)

    Karathanos, Ch; Sfyroeras, G; Drakou, A; Roussas, N; Exarchou, M; Kyriakou, D; Giannoukas, A D

    2012-03-01

    To investigate the association of various risk factors including thrombophilia defects, in patients with varicose veins (VVs) and history of episodes of superficial vein thrombosis (SVT). Two hundred and thirty patients with primary VVs were included in this prospective study. A total of 128 (43 men, age 56 ± 13) had an acute episode or a previous history of SVT, while 102 patients (27 men, age 48 ± 12) did not. Coagulation profile investigation included serum levels of protein C (PC), protein S (PS), anti-thrombin III (AT III), plasminogen (Plg), A(2) antiplasmin (A(2)Apl) and activated protein C resistance (APCR). This was performed at least 3 months after the SVT episode to ensure that the results were not altered. Age and body mass index (BMI) were also assessed. PC deficiency was detected in 3/128 (2.3%), PS deficiency in 19/128 (14.8%), AT III deficiency in 29/128 (22.7%), Plg deficiency in 9/128 (7%), A(2)Apl excess in 3/128 (2.3%) and APCR in 9/128 (7%) patients with SVT and 0/102 (0%), 3/102 (2.9%), 15/102 (14.7%), 6/102 (5.8%), 0/102 (0%) and 1/102 (0.9%) in the control group, respectively. BMI greater than 30 kg m(-2) was associated with SVT. In logistic regression analysis SVT was associated with PS deficiency (odds ratio (OR) 6.7, p = 0.004, 95% confidence interval (CI) 1.83-24.53), obesity (OR 3.5, p = 0.003, 95% CI 1.53-8.05) and age (OR 1.038, p = 0.001, 95% CI 1.01-1.06). Obesity, age and PS deficiency were found as factors associated with SVT episodes in patients with VVs. Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  17. Importance of Presurgical Breast MRI in Patients 60 Years of Age and Older

    Directory of Open Access Journals (Sweden)

    Stamatia V Destounis

    2014-01-01

    Full Text Available Objective: To demonstrate the importance of presurgical bilateral breast Magnetic Resonance Imaging (MRI in women 60 years of age and older. Materials and Methods: Institutional review board approval was obtained with waiver of informed consent for this retrospective review. From December 2003 to December 2011, all patients 60 years and older who had presurgical bilateral breast MRI were reviewed, revealing 1268 presurgical MRI examinations; 310 had a new lesion identified by MRI. Cases were excluded due to incomplete or missing data, resulting in 243 patients with 272 findings eligible for analysis. Data recorded included patient demographics, core biopsy method and pathology, type of surgery, and surgical pathology results. Results: Of 1268 exams performed in this population, 272 (21.5% patients with suspicious MRI findings underwent needle biopsy. Malignancy was found in 114 (42%, benign findings in 127 (47%, and atypia in 31 (11%. Of the malignancies, 83 were in the ipsilateral breast and 31 in the contralateral breast to the original diagnosis. Of the ipsilateral findings, 47 were in the same quadrant as the primary diagnosis, 28 in a different quadrant, and 8 were metastatic lymph nodes. Of the 31 atypical findings, 14 were contralateral to the primary diagnosis and 17 were ipsilateral. Two hundred and thirty-three patients underwent surgical excision; 111 changed their surgical management as a lesion was seen on MRI and was diagnosed as cancer on needle biopsy. Conclusions: Among the patients aged 60 years and above who had presurgical bilateral breast MRI, we found additional cancers in 9.0% (n = 114/1268 and atypia in 2.4% (n = 31/1268. A change in management as a result of the MRI-detected lesion occurred in 8.8% (n = 111/1268. These results demonstrate that performing presurgical bilateral breast MRI is of value in women 60 years of age and above.

  18. Treatment and blood glucose level control of diabetes patients aged 30 and above in Balcova

    Directory of Open Access Journals (Sweden)

    Kevser Tarı Selçuk

    2015-04-01

    Full Text Available AbstractObjective: This cross-sectional study aims to evaluate the treatment uptake and control rates of blood glucose, BMI, blood pressure, lipid levels in diabetes patients aged 30 and above in Balcova Heart Study. The association between treatment and blood glucose level control and socio-demographic characteristics will also be evaluated. Methods: The study included data from 1.643 diabetes patients aged 30 and above who participated in the baseline survey of Balcova’s Heart Project. Fasting blood glucose test was carried out for diagnosis of diabetes, and ADA 2011 diagnosis criteria were employed for the overall assessment. Descriptive statistics, chi-square, logistic regression analysis were used. The study was supported by Dokuz Eylul University Scientific Research Projects and Balcova Municipality. Results: Of all patients, 75.4% are receiving treatment, 32.6% of treated patients have blood glucose level, 21.8% have blood pressure, 9.4% have BMI, 34.7% have LDL, 45.2% have HDL, and 52.6% have triglyceride levels under control. According to logistic regression model, diabetes treatment is significantly high for 70 and above age group [OR=1.76, %95.0 CI:1.14-2.72]; for patients with social security[OR=2.21, %95.0 CI:1.39-3.52]; and for patients with coexisting chronic diseases[OR=2.24, %95.0 CI:1.74-2.89]. According to logistic regression model, blood glucose level control of treated patients is significantly high for patients with coexisting chronic diseases [OR=1.49, %95.0 GA:1.12-1.99]. Conclusions: One fourth of diabetes patients are not receiving treatment, and only one third of patients have blood glucose level under control. BMI, blood pressure, lipid control rates are below desired levels. Awareness of diabetes patient on importance of continuous follow-up should be raised, and quality follow-up should be improved.Key Words: Diabetes, diabetes treatment, blood glucose level

  19. Clinical profile of 266 Filipino patients with rheumatoid arthritis included in the rheumatoid arthritis database and registry (RADAR) of the Philippine General Hospital.

    Science.gov (United States)

    Penserga, Ester G; Natividad, Therese Aileen L; Salido, Evelyn S

    2015-05-01

    To describe Filipino patients with rheumatoid arthritis (RA) entered in the Rheumatoid arthritis database and registry (RADAR) of the Philippine General Hospital. Cases entered to RADAR from 2010-2012 were included. All fulfilled the 1987 American College of Rheumatology criteria for classification of RA. Included cases gave written infomed consent. Data extracted were demographics, clinical presentation, laboratory tests, treatment and disease course. Means and proportions were used for population characteristics. Two hundred and sixty-six cases were included. Mean age was 44 years, with 9 : 1 female preponderance and mean diagnosis time of 5 years. There was symmetrical polyarthritis with high tender and swollen joint count and mean Disease Activity Score of 28 joints, erythrocyte sedimentation rate of 5.27 (3.39, 8.13). Rheumatoid factor was positive in 2/3 of cases. Hypertension, tuberculosis and diabetes were important co-morbidities. Treatment included prednisone, non-steroidal anti-inflammatory drugs and methotrexate. At 12 months of treatment, evaluable cases (< 20%) showed improvement from high to moderate disease activity. Methotrexate average dose was 8.6 mg/week. Nine cases received biologic agents. Factors affecting treatment included access to rheumatology centers, low socioeconomic status, presence of co-morbid diseases and treatment adverse events. This study reports a cohort of Filipino RA patients seen in a government arthritis unit whose disease characteristics are similar to what is reported worldwide. This cohort differs from most studies in having a high female to male ratio, a long delay in diagnosis, and high attrition rate. Mean methotrexate dose was low and there was less access to biologic disease-modifying anti-rheumatic drugs. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  20. Patterns of Mortality in Patients Treated with Dental Implants: A Comparison of Patient Age Groups and Corresponding Reference Populations.

    Science.gov (United States)

    Jemt, Torsten; Kowar, Jan; Nilsson, Mats; Stenport, Victoria

    2015-01-01

    Little is known about the relationship between implant patient mortality compared to reference populations. The aim of this study was to report the mortality pattern in patients treated with dental implants up to a 15-year period, and to compare this to mortality in reference populations with regard to age at surgery, sex, and degree of tooth loss. Patient cumulative survival rate (CSR) was calculated for a total of 4,231 treated implant patients from a single clinic. Information was based on surgical registers in the clinic and the National Population Register in Sweden. Patients were arranged into age groups of 10 years, and CSR was compared to that of the reference population of comparable age and reported in relation to age at surgery, sex, and type of jaw/dentition. A similar, consistent, general relationship between CSR of different age groups of implant patients and reference populations could be observed for all parameters studied. Completely edentulous patients presented higher mortality than partially edentulous patients (P age groups showed mortality similar to or higher than reference populations, while older patient age groups showed increasingly lower mortality than comparable reference populations for edentulous and partially edentulous patients (P age groups of patients compared to reference populations was observed, indicating higher patient mortality in younger age groups and lower in older groups. The reported pattern is not assumed to be related to implant treatment per se, but is assumed to reflect the variation in general health of a selected subgroup of treated implant patients compared to the reference population in different age groups.

  1. Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands.

    Science.gov (United States)

    Leensen, Monique C J; Groeneveld, Iris F; Heide, Iris van der; Rejda, Tomas; van Veldhoven, Peter L J; Berkel, Sietske van; Snoek, Aernout; Harten, Wim van; Frings-Dresen, Monique H W; de Boer, Angela G E M

    2017-06-15

    To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes. Longitudinal prospective intervention study using a one-group design. Two hospitals in the Netherlands. Of the eligible patients, 56% participated; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included. Patients completed questionnaires on RTW, the importance of work, work ability (WAI), RTW self-efficacy, fatigue (MFI), and quality of life (EORTC QLQ C-30) at baseline and 6, 12 and 18 months follow-up. Before and after the exercise programme 1-repetition maximum (1RM) muscle strength and cardiorespiratory fitness (VO 2 peak) were assessed. Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme, 59% of the cancer patients returned to work, 86% at 12 months and 83% at 18 months. In addition, significant improvements (pfatigue levels were significantly reduced. After completing the exercise programme, 1RM muscle strength was significantly increased but there was no improvement in VO 2 peak level. RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme. A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW, reduced fatigue and increased importance of work, work ability, and quality of life. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Experiences of 23 patients ≥ 90 years of age treated with radiation therapy

    International Nuclear Information System (INIS)

    Oguchi, Masahiko; Ikeda, Hiroshi; Watanabe, Toshikazu; Shikama, Naoto; Ohata, Takeo; Okazaki, Youichi; Kiyono, Kunihiro; Sone, Shusuke

    1998-01-01

    Purpose: To present 23 patients ≥ 90 years old treated with radiotherapy, and to retrospectively evaluate the results of radiotherapy and tolerance in these patients. Methods and Materials: The clinical records of 27 patients over 90 years of age who were treated with radiotherapy at the Department of Radiology, Shinshu University Hospital, and eight affiliated general hospitals from 1990 until 1995 were reviewed. The strategy of radiotherapy was individually planned depending on the stage of the disease and performance status (PS) of the patient; however, it was not modified, based solely on chronologic age. The overall survival rate and disease-free survival rate were determined using the Kaplan-Meier method. The Radiation Therapy Oncology Group scoring criteria of acute and late reactions of radiation therapy were used. Results: This group of patients accounted for 0.37% of all patients treated with radiotherapy in these hospitals. Of these, 23 patients in whom cancer was pathologically confirmed and whose follow-up data were available for retrospective analysis were included in the final evaluation of data. The age of the 23 patients ranged from 90 to 96 years (median 93). Tumor was untreated and in the early stage in five patients, locoregionally advanced in 13, recurrent in four, and systemic in one. Definitive radiation therapy was administered in 12 patients (13 sites), preoperative intent in one, and palliative intent in 10. The period of observation ranged from 2.5 to 6 years (median 18 months). Seven patients were alive for 15-67 months. Fourteen patients died because of intercurrent diseases or senility associated with active cancer, and two because of senility without evidence of cancer. The overall and relapse-free survival rates were 65% and 30% at 1 year and 30% and 21% at 2 years, respectively. Definitive radiation therapy was completed in 13 of 13 patients (100%), and local control was attained in 9 of 13 patients at 6 months (62%). Palliative

  3. A Geriatric Patient: Age Is Not a Factor

    Directory of Open Access Journals (Sweden)

    Lisa Klodnitskaya

    2011-01-01

    Full Text Available Objective. A patient presented to the dental office expressing dissatisfaction with the appearance of his teeth, and as a result, of his smile. Our objective was to satisfy his initial chief complaint: “I don't like how my teeth look when I smile.” Methodology. Upon completing all initial exams and consultations, an esthetic dental treatment plan was formulated and agreed upon by both the practitioners and the patient. Results. The patient received periodontal treatment first to create esthetic gingival margins. Anterior ceramic crowns followed. Conclusion. The results surpassed all patient's expectations.

  4. Associations of plasma leptin to clinical manifestations in reproductive aged female patients with panic disorder.

    Science.gov (United States)

    Masdrakis, Vasilios G; Papageorgiou, Charalambos; Markianos, Manolis

    2017-09-01

    Preclinical studies suggest the implication of the adipocyte hormone leptin in anxiety and fear processes. We explored for potential differences regarding plasma leptin, cortisol and the ratio leptin/Body Mass Index (BMI) between 27 medication-free female patients with Panic Disorder (PD) and 42 age-matched female controls, and for potential associations between plasma leptin and psychometric evaluations including number of panic attacks during last week, Clinical Global Impression-Severity of Illness (CGI-S) and Symptoms Checklist-90-Revised (SCL-90-R). Cortisol levels showed no differences between patients and controls, or correlations to leptin or to any clinical features. Both groups demonstrated a strong positive correlation between leptin and BMI and similar leptin and leptin/BMI, despite patients' lower BMI. However, patients -but not controls- demonstrated significant negative correlations of leptin to the 'somatization', 'anxiety', and 'phobic anxiety' SCL-90-R subscales. Moreover, there was a significant negative correlation of leptin and of leptin/BMI ratio to the number of panic attacks during last week, while higher CGI-S was associated with lower leptin/BMI ratio. Our results, limited to PD female patients, suggest that lower leptin serum levels are significantly associated with greater severity of psychopathological manifestations, including number of panic attacks, symptoms of somatization, anxiety and phobic anxiety and overall clinical presentation. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  5. Impact of age on functional exercise correlates in patients with advanced lung cancer

    Directory of Open Access Journals (Sweden)

    Wang LY

    2013-09-01

    Full Text Available Li-Ying Wang,1,2 Huey-Dong Wu,3 Kuan-Yu Chen,4 Chen-Hsi Hsieh,5–7 Chung-Chun Lai21School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan; 2Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan; 3Department of Integrated Diagnostic & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan; 4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 5Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan; 6Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 7Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROCBackground: The functional exercise capacity and its correlates in advanced cancer patients in stratified age groups were examined.Materials and methods: A total of 105 patients with advanced lung cancer were recruited prospectively and stratified into young (≤50 years, middle (51–65 years, and old (>65 years age groups. Respiratory performances, which included maximal inspiratory and expiratory pressure, forced expiratory volume in 1 second, and forced vital capacity were measured. The distance ambulated in a 6-minute walk test was used as an indicator for functional capacity.Results: The young age group had lowest baseline pulmonary function and performed worse on the 6-minute walk test among the three age groups. The risk factors for poor functional capacity were female, lower percent predicted maximal expiratory pressure, worse dyspnea, and lower hemoglobin in the young age group; lower percent predicated forced expiratory volume in 1 second and forced vital capacity, and greater weight loss in the middle age group; and only worse dyspnea in the old age group. The above identified risk factors accounted for 73.6%, 58.5%, and 42.1% variance in 6-minute walk distance for the young, middle, and old age group

  6. Cerebrospinal fluid levels of Alzheimer's disease biomarkers in middle-aged patients with type 1 diabetes.

    Science.gov (United States)

    Ouwens, D Margriet; van Duinkerken, Eelco; Schoonenboom, S Niki M; Herzfeld de Wiza, Daniella; Klein, Martin; van Golen, Larissa; Pouwels, Petra J W; Barkhof, Frederik; Moll, Annette C; Snoek, Frank J; Teunissen, Charlotte E; Scheltens, Philip; Diamant, Michaela

    2014-10-01

    Type 1 diabetes is associated with moderate cognitive decline and cerebral alterations and may lead to an increased risk of dementia, including Alzheimer's disease. This study aimed to investigate the levels of risk markers for Alzheimer's disease in middle-aged patients with type 1 diabetes and controls, and their potential associations with cognitive and cerebral measures. Levels of β-amyloid (Aβ) 42, Tau, phosphorylated Tau (pTau), the soluble form of low-density lipoprotein receptor-related protein 1 (sLRP1) and macrophage colony-stimulating factor (MCSF) were quantified by ELISA in serum and cerebrospinal fluid (CSF) collected from 37 patients with type 1 diabetes and 15 controls. Associations between biomarkers and determinants of cognitive function and white matter integrity were assessed using hierarchical regression analysis controlling for age, HbA1c and estimated intelligence quotient (IQ). CSF levels of pTau, Aβ42 and LRP1 were higher in patients with type 1 diabetes than in controls (all p < 0.05). There was a trend towards increased Tau levels in patients with type 1 diabetes (p = 0.056), while CSF levels of MCSF were similar between patients with type 1 diabetes and controls. Regression analysis showed that elevated CSF sLRP1 levels were associated with better attention (β = 0.518; p = 0.002) and a better speed of information-processing (β = 0.368; p = 0.034), as well as increased integrity of the white matter of the right inferior fronto-occipital tract (β = 0.395; p = 0.022). Furthermore, elevated Tau levels were associated with decreased integrity of the white matter of right inferior fronto-occipital tract (β = -0.584; p = 0.002). CSF levels of biomarkers for Alzheimer's disease are altered in patients with type 1 diabetes compared with controls, but the observed profile does not match the profile characterising pre-Alzheimer's disease patients.

  7. Postoperative delirium after partial laryngectomy in a middle-aged patient: A case report.

    Science.gov (United States)

    Yu, Huiqian; Shen, Xia

    2018-02-01

    Postoperative delirium is a common occurrence in older patients. However, reports of postoperative delirium in middle-aged patients are limited, and the underlying mechanism of delirium in this patient population is not clear. A 45-year-old man who developed postoperative delirium on the second day after partial laryngectomy. Interviews of the surgical team, patient, and patient's spouse revealed that the patient was psychologically stressed, but had not been diagnosed or treated. The patient also suffered impairment in physiological functioning and sleep disturbance after surgery. Postoperative delirium. The postoperative delirium was treated with an antipsychotic drug. The patient recovered well. Preoperative psychological stress, which is often undiagnosed and untreated, can increase the risk of postoperative delirium in middle-aged patients undergoing laryngectomy. Therefore, screening for psychological stress and implementing strategies to prevent delirium should be considered for patients who undergo laryngectomy, even if they are not in high-risk older age groups.

  8. An Outcome Analysis of Mechanically Ventilated Middle Aged and Elderly Taiwanese Patients Undergoing Tracheostomy

    Directory of Open Access Journals (Sweden)

    Yueh-Chih Chung

    2013-06-01

    Conclusions: This study demonstrated that the utilization of medical resources and the decline in the number of tracheostomies performed were higher in patients aged ≥ 65 compared to patients under 65.

  9. [Hernia recurrence long term follow-up after open procedures of abdominal wall plasty-prospective study including 142 patients].

    Science.gov (United States)

    Mureşan, Mircea; Mureşan, Simona; Bara, Tivadar; Neagoe, Radu; Sala, Daniela; Suciu, Bogdan

    2016-01-01

    The incisional hernia continues to be a frequent complication of laparotomies. The purpose of study is the analysis of hernia disease relapse after one year after different open plasties methods of the abdominal wall. A prospective longitudinal study was performed that included 142 patients. An analysis was performed on the individual data, the level of obesity, intra-surgical variations in intra-abdominal pressure, the intensity of post-surgical pain, the post-surgical complications, and the types of plasties of abdominal wall, simple and with polypropylene mesh. The analysis of studied group showed a general rate of relapse of 16.9%, and within the 4 procedures, 40.74% in the case of simple plasties, of 16.07% after the only plasties, 6.97% after the retro-muscular plasties, and 6.25% after the full substitution of parietal defect. On analysing the collected, hernia relapse was statistically significantly related to the level of obesity, variations in intra-abdominal pressure, post-surgical pain, and the type of procedure performed. Hernia is a frequent complication of laparotomies. Hernia relapse was more frequent in the case of simple plasties. Among the mesh procedures, the onlay plasty showed a higher rate of relapse and post-surgical complications. Hernia relapse was more frequent in the case of variations of intra-abdominal pressure, and with increased post-surgical pain. The use of an echography examination may increase the accuracy of the presence of hernia disease. Copyright © 2015 Academia Mexicana de Cirugía A.C. All rights reserved.

  10. Atrial septal defect: repair in patients over thirty-five years of age.

    Science.gov (United States)

    Breyer, R H; Monson, D O; Ruggie, N T; Weinberg, M; Najafi, H

    1979-01-01

    Fifty-eight patients over age 35 underwent repair of atrial septal defect. The operative mortality was zero for the seven N.Y.H.A. class I and 26 N.Y.H.A. class II patients. One of 16 class III patients and two of nine class IV patients died; consequently, overall hospital mortality was five percent. The operative mortality was not related to age or level of pulmonary hypertension. Long-term clinical improvement was documented in 75 percent of patients who had been symptomatic preoperatively. The suggestion in early reports that pulmonary hypertension, or age per se, many contraindicate repair of an ASD cannot be supported by our results.

  11. Age-specific mortality among TB patients in Denmark 1998-2010

    DEFF Research Database (Denmark)

    Fløe, Andreas; Løkke, Anders; Ibsen, Rikke

    Objective: To evaluate the age-specific mortality in a national TB cohort, and to estimate relative age-specific mortality compared with matched controls, in a retrospective case-control study. Methods: Using Danish National Patient Registry, we retrospectively identified TB-patients between 1998...... followed for max. 12 (span: 0-12) years. Mortality was higher for cases than controls in all age groups, and significantly so for age groups above 20 years, peaking at a Hazard Ratio of 8.7 (95% CI: 5.53;16.69) in the 30-39 years age Conclusion: Cumulative mortality of TB-patients is significantly inferior...... to matched controls. While the difference in survival is substantial among elderly patients, a high relative risk of dying is particularly of concern among young and middle-aged adult TB patients....

  12. Microdeletions including FMR1 in three female patients with intellectual disability - further delineation of the phenotype and expression studies

    DEFF Research Database (Denmark)

    Zink, A M; Wohlleber, E; Engels, H

    2014-01-01

    in all patients, yet they presented with ID/DD as well as speech delay, macrocephaly and other features attributable to FXS. No signs of autism were present. Here, we further delineate the clinical spectrum of female patients with microdeletions. FMR1 expression studies gave no evidence for an absolute...

  13. Molecular pathology of haemophilia B: identification of five novel mutations including a LINE 1 insertion in Indian patients.

    NARCIS (Netherlands)

    Mukherjee, S.; Mukhopadhyay, A.; Banerjee, D.; Chandak, G.R.; Ray, K.

    2004-01-01

    Heterogeneous mutations in factor IX (FIX) gene cause haemophilia B and a large number of mutations have been characterized. However, reports on gene defects among Indian haemophilia B patients are rare despite a high estimate of such patients in the country. We report identification of 22

  14. A Proposal for Including Patient-Generated Web-based Creative Writing Material into Psychotherapy: Advantages and Challenges.

    Science.gov (United States)

    Lawver, Timothy

    2008-06-01

    Creative writing presents both a challenging and promising modality for psychotherapy. Though it has been used in various settings, the application within a session can be difficult. This case study presents a use of a web-based format to engage a resistant patient through her creative writing. Benefits and potential pitfalls of using a patient's writing in therapy are discussed.

  15. Alcohol septal ablation for obstructive hypertrophic cardiomyopathy: outcomes in young, middle-aged, and elderly patients.

    Science.gov (United States)

    Leonardi, Robert A; Townsend, Jacob C; Patel, Chetan A; Wolf, Bethany J; Todoran, Thomas M; Powers, Eric R; Steinberg, Daniel H; Fernandes, Valerian L; Nielsen, Christopher D

    2013-11-01

    We compared the efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) in young, middle-aged, and elderly patients. Intersociety guidelines suggest based on limited evidence that young patients with medically refractory symptoms of obstructive HCM should undergo surgical myectomy while elderly patients may be more appropriate for ASA. Data for 360 patients undergoing 389 ASAs were prospectively collected and retrospectively analyzed according to age. Young (elderly (≥65 years) patients comprised 28, 40, and 32% of the study population, respectively. Young patients had thicker left ventricular septal walls at baseline, and elderly patients had more comorbidity and dyspnea. Resting, mean left ventricular outflow tract gradients (LVOTGs) were similar across the age groups at baseline (62, 66, and 68 mm Hg, respectively; P = NS for all comparisons). LVOTGs and dyspnea were significantly and similarly improved in all age groups immediately after ASA and through 12 months of follow-up (P elderly patients (9.1 and 6.3% vs. 20.8%, respectively; P ≤ 0.016 for elderly vs. others). Mortality rates for young and middle-aged patients were lower than for elderly patients, but the differences were not statistically significant. Patients undergoing ASA had significant and similar improvements in LVOTGs and symptoms regardless of age. Procedural complications were increased in elderly patients, who had numerically but not statistically significantly higher mortality rates. Copyright © 2012 Wiley Periodicals, Inc.

  16. The Prognostic Significance of Pretreatment Serum CEA Levels in Gastric Cancer: A Meta-Analysis Including 14651 Patients

    Science.gov (United States)

    Deng, Kai; Yang, Li; Hu, Bing; Wu, Hao; Zhu, Hong; Tang, Chengwei

    2015-01-01

    Background Carcinoembryonic antigen (CEA) is commonly used as a serum tumor marker in clinical practice; however, its prognostic value for gastric cancer patients remains uncertain. This meta-analysis was performed to assess the prognostic value of CEA and investigate CEA as a tumor marker. Methods PubMed, EMBASE and other databases were searched for potentially eligible studies. Forty-one studies reporting the prognostic effect of pretreatment serum CEA expression in gastric cancer patients were selected. Data on 14651 eligible patients were retrieved for the meta-analysis. Based on the data extracted from the available literature, the hazard ratio (HR) and 95% confidence interval (CI) for an adverse prognosis were estimated for gastric cancer patients with elevated pretreatment serum levels of CEA (CEA+) relative to patients with normal pretreatment CEA levels (CEA-). Results The CEA+ patients had a significantly poorer prognosis than the CEA- patients in terms of overall survival (OS: HR 1.716, 95% CI 1.594 - 1.848, P 0.05). In the pooled analyses of multivariate-adjusted HRs, the results suggested that pretreatment serum CEA may be an independent prognostic factor in gastric cancer (OS: HR 1.681, 95% CI 1.425 - 1.982; DSS: HR 1.900, 95% CI 1.441 - 2.505; DFS: HR 2.579, 95% CI 1.935 - 3.436). Conclusion/Significance The meta-analysis based on the available literature supported the association of elevated pretreatment serum CEA levels with a poor prognosis for gastric cancer and a nearly doubled risk of mortality in gastric cancer patients. CEA may be an independent prognostic factor for gastric cancer patients and may aid in determining appropriate treatment which may preferentially benefit the CEA+ patients. PMID:25879931

  17. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul Dlpm; Frith, Peter A; Zwerink, Marlies; Monninkhof, Evelyn M; van der Palen, Job; Effing, Tanja W

    2017-08-04

    Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary

  18. Neurocognitive functioning in school-aged cystinosis patients

    NARCIS (Netherlands)

    Besouw, M. T. P.; Hulstijn-Dirkmaat, G. M.; van der Rijken, R. E. A.; van Dael, C. M.; Vande Walle, J.; Lilien, M. R.; Levtchenko, E. N.

    2010-01-01

    Introduction Cystinosis is an autosomal recessive disorder leading to intralysosomal cystine accumulation in various tissues. It causes renal Fanconi syndrome and end stage renal failure around the age of 10 years if not treated with cysteamine. Children with cystinosis seem to have a normal

  19. Neurocognitive functioning in school-aged cystinosis patients.

    NARCIS (Netherlands)

    Besouw, M.T.; Hulstijn-Dirkmaat, G.M.; Rijken, R.E.A. van der; Cornelissen, E.A.M.; Dael, C.M. van; Walle, J. van der; Lilien, M.R.; Levtchenko, E.N.

    2010-01-01

    INTRODUCTION: Cystinosis is an autosomal recessive disorder leading to intralysosomal cystine accumulation in various tissues. It causes renal Fanconi syndrome and end stage renal failure around the age of 10 years if not treated with cysteamine. Children with cystinosis seem to have a normal

  20. Anterior Cervical Discectomy with Instrumented Allograft Fusion: Lordosis Restoration and Comparison of Functional Outcomes among Patients of Different Age Groups.

    Science.gov (United States)

    Muzević, Dario; Splavski, Bruno; Boop, Frederick A; Arnautović, Kenan I

    2018-01-01

    To investigate clinical parameters of anterior cervical discectomy and fusion (ACDF) treatment and outcomes using osseous allografts in different age groups, study the postoperative results of restoration of lordosis, and evaluate the utility of bone allografts for ACDF, including graft subsidence. We reviewed data from 154 patients with clinical symptoms and radiologic signs of disc herniation and/or cervical spondylosis. Decompression was achieved through discectomy, osteophyte ablation, endplate drilling, and foraminotomy. Fusion was achieved with allografts, demineralized bone matrix, and cervical plates/screws. The relationships between preoperative and postoperative cervical spine configuration (ie, Benzel's criteria), pain intensity, and neurologic status were analyzed. The mean patient age was 51 years, and the median duration of symptoms was 6 months. The mean age differed significantly between the patients with diabetes and those without diabetes. The mean body mass index (BMI) was 30.36. Fifty-two patients had disc herniation, and 102 had spondylosis. Surgery was performed on a total of 313 levels. The median duration of follow-up was 24 months. Marked improvements in postoperative spine configuration or preservation of lordosis were recorded. Overall, 122 patients were neurologically intact, and 32 patients experienced residual postsurgery neurologic deficits (minor, n = 22; moderate, n = 9; severe, n = 1). Postoperative pain intensity and neurologic status were significantly improved. Outcomes were excellent in 66 patients, good in 61, fair in 24, and poor in 3 (no mortality). No significant differences in patient age, smoking habits, diabetes, or BMI were seen among outcomes, or between patients with soft disc herniation or spondylosis. Osseous allografting can excellently restore cervical lordosis regardless of age and is an excellent graft choice for ACDF. Patients of advanced age with comorbidities should not be denied surgery. Copyright © 2017

  1. Lower extremity venous thrombosis in patients younger than 50 years of age

    Directory of Open Access Journals (Sweden)

    Kreidy R

    2012-03-01

    Full Text Available Raghid Kreidy1, Pascale Salameh2, Mirna Waked31Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, 2Laboratory of Clinical and Epidemiological Research, Faculty of Pharmacy, Lebanese University, 3Department of Pulmonary Medicine, Saint George Hospital, University Medical Center, University of Balamand, Beirut, LebanonAim: Lower extremity deep venous thrombosis in the young adult is uncommon and has not been well studied in the literature. The aim of this study is to define risk factors for deep venous thrombosis among patients younger than 50 years of age, to compare them with a control group, and to suggest recommendations for the management and treatment of venous thrombosis in this particular group of patients.Methods: From January 2003 to January 2011, 66 consecutive Lebanese patients (29 males and 37 females younger than 50 years, diagnosed in an academic tertiary-care center with lower extremity deep venous thrombosis by color flow duplex scan, were retrospectively reviewed. Their age varied between 21 and 50 years (mean 38.7 years. The control group included 217 patients (86 males and 131 females older than 50 years (range: 50–96 years; mean 72.9 years.Results: The most commonly reported risk factors in the younger age group were inherited thrombophilia (46.9% compared with 13.8% in the control group; P < 0.001, pregnancy (18.2% compared with 0.5%; P < 0.001, treatment with estrogen drugs (13.6% compared with 2.3%; P = 0.001, and family history of venous thromboembolism (9.1% compared with 3.8%; P = 0.084.Conclusion: Inherited thrombophilia is the most commonly observed risk factor among patients younger than 50 years, with a prevalence of three times more than the control group. Young adults should be screened for thrombophilia even in the presence of transient acquired risk factors. Pregnancy and treatment with estrogen drugs essentially when associated with inherited thrombophilia

  2. Early vascular aging in young and middle-aged ischemic stroke patients: the Norwegian Stroke in the Young Study.

    Directory of Open Access Journals (Sweden)

    Sahrai Saeed

    Full Text Available Ischemic stroke survivors have high risk of cardiovascular morbidity and mortality even at young age, suggesting that early arterial aging is common among such patients.We measured aortic stiffness by carotid-femoral pulse wave velocity (PWV in 205 patients (69% men aged 15-60 years with acute ischemic stroke in the prospective Norwegian Stroke in the Young Study. High for age carotid-femoral PWV was identified in the reference normogram.Patients were on average 49 ± 10 years old, 34% had a history of hypertension and 37% had metabolic syndrome (MetS. In the total study population, higher PWV was associated with history of hypertension (β = 0.18, higher age (β = 0.34, systolic blood pressure (BP (β = 0.28 and serum creatinine (β = 0.18 and lower high-density lipoprotein (HDL cholesterol (β = -0.10, all p < 0.01 in multivariate linear regression analysis (multiple R2 = 0.42, p < 0.001. High for age PWV was found in 18% of patients. In univariate analyses, known hypertension was associated with a 6-fold, MetS with a 4-fold and presence of carotid plaque with a 3.7-fold higher risk for high for age PWV (all p < 0.01. In multiple logistic regression analysis higher systolic BP (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.02-1.06; p < 0.01, history of hypertension (OR 3.59; 95% CI 1.52-8.51; p < 0.01, low HDL cholesterol (OR 3.03; 95% CI 1.00-9.09; p = 0.05 and higher serum creatinine (OR 1.04; 95% CI 1.01-1.06; p < 0.01 were associated with high for age PWV.Higher PWV is common in younger and middle-aged ischemic stroke patients and associated with a clustering of classical cardiovascular risk factors. ClinicalTrials.gov NCT01597453.

  3. Density heterogeneity and fluid-blood levels in patients aged over 55 with lobar hematoma.

    Science.gov (United States)

    Renard, D; Waconge, A; Bouly, S; Castelli, C; Thouvenot, E

    2016-01-01

    Density heterogeneity and fluid-blood levels (FBLs) are frequently seen on acute CT scans of deep brain hemorrhage. Our aim was to analyze the density heterogeneity and FBLs seen on acute/subacute CT in patients aged>55 with lobar haemorrhage (LH), and to study the relationship of these brain abnormalities with other parameters, including cerebral amyloid angiopathy (CAA)-related abnormalities. This was an observational study and retrospective analysis of early CT scans (55 years with acute lobar hemorrhage who, between 2012 and 2015, were entered into our stroke database. A total of 37 LH episodes (without trauma, abnormal coagulation/platelet counts, vascular malformation, tumor or vasculitis) in 35 patients were analyzed. Other studied parameters were gender, age, history of hypertension, blood pressure on admission, prior antiplatelet treatment, aPTT, PTT, platelet count, hematocrit, timing of first CT, LH volume, involved lobe, cortical superficial siderosis, microbleeds, chronic LH and CAA (classic and modified Boston) criteria. CAA-related abnormalities seen on MRI were also scored. Overall, in 26 LH episodes (70%), CT was performed within 24h. Density heterogeneity and FBLs were seen in 19 (51%) and 9 (24%) LH episodes, respectively. Also, according to classic and modified Boston criteria, 18 (51%) and 24 (69%) patients, respectively, fulfilled criteria for probable/definite CAA. As for the presence of FBLs, a statistically significant association was found with both the presence of probable/definite CAA according to modified Boston criteria (P=0.033) and the presence of superficial siderosis (P=0.019). Density heterogeneity and, to a lesser degree, FBLs are frequently seen in patients aged>55 with LH. FBLs may also be associated with CAA-related hemorrhage. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Quality assessment of delineation and dose planning of early breast cancer patients included in the randomized Skagen Trial 1

    DEFF Research Database (Denmark)

    Francolini, Giulio; Thomsen, Mette S; Yates, Esben S

    2017-01-01

    BACKGROUND AND PURPOSE: To report on a Quality assessment (QA) of Skagen Trial 1, exploring hypofractionation for breast cancer patients with indication for regional nodal radiotherapy. MATERIAL AND METHODS: Deviations from protocol regarding target volume delineations and dose parameters (Dmin...

  5. Neurological soft signs in OCD patients with early age at onset, versus patients with schizophrenia and healthy subjects.

    Science.gov (United States)

    Jaafari, Nematollah; Baup, Nicolas; Bourdel, Marie-Chantal; Olié, Jean-Pierre; Rotge, Jean-Yves; Wassouf, Issa; Sharov, Igor; Millet, Bruno; Krebs, Marie-Odile

    2011-01-01

    Compelling evidence suggests that both schizophrenia and obsessive compulsive disorder (OCD) are related to deviant neurodevelopment. Neurological soft signs (NSS) have been proposed to be a marker of abnormal brain development in schizophrenia. The purpose of this study is to examine whether NSS are also a marker in patients with OCD, in particular, in early-onset OCD. The authors included 162 subjects and compared patients with OCD, patients with schizophrenia (SCZ), and healthy control subjects. They were all examined for NSS (Krebs' Scale), extrapyramidal symptoms (Simpson-Angus Scale), and were rated on the Abnormal Involuntary Movements Scale (AIMS). The authors found no differences between NSS total scores and subscores in OCD versus controls, whereas total NSS, motor coordination, and motor integration were significantly lower in OCD than in SCZ. OCD patients with early-onset (before age 13) did not differ from those with later-onset OCD. These results support the idea that NSS, as determined by current scales, is relatively specific to schizophrenia, although they do not preclude the existence of a neurological dysfunction in OCD. Further studies are required to determine the type of neurological signs that could be useful trait-markers in the phenotypic characterization of subtype OCD.

  6. Analysis of oxybutynin treatment for hyperhidrosis in patients aged over 40 years

    Science.gov (United States)

    Wolosker, Nelson; Krutman, Mariana; Teivelis, Marcelo Passos; de Paula, Rafael Pessanha; Kauffman, Paulo; de Campos, Jose Ribas Milanez; Puech-Leão, Pedro

    2014-01-01

    ABSTRACT Objective: Our aim was to analyze the effectiveness of oxybutynin for hyperhidrosis treatment in patients over 40 years. Methods: Eighty-seven patients aged over 40 years were divided into two groups. One group consisted of 48 (55.2%) patients aged between 40 and 49 years, and another was composed of 39 (44.8%) patients aged over 50 years (50 to 74 years). A comparative analysis of Quality of Life and level of hyperhidrosis between the groups was carried out 6 weeks after a protocol treatment with oxybutynin. A validated clinical questionnaire was used for evaluation. Results: In the younger age group, 75% of patients referred a “partial” or “great” improvement in level of hyperhidrosis after treatment. This number was particularly impressive in patients over 50 years, in which 87.2% of the cases demonstrated similar levels of improvement. Over 77% of patients in both groups demonstrated improvement in Quality of Life. Excellent outcomes were observed in older patients, in which 87.1% of patients presented “slightly better” (41%) or “much better” (46.1%) improvement. Conclusion: Patients aged over 40 years with hyperhidrosis presented excellent results after oxybutynin treatment. These outcomes were particularly impressive in the age group over 50 years, in which most patients had significant improvement in Quality of Life and in level of hyperhidrosis. PMID:24728245

  7. Outcomes of basilar artery occlusion in patients aged 75 years or older in the Basilar Artery International Cooperation Study.

    Science.gov (United States)

    Vergouwen, Mervyn D I; Compter, Annette; Tanne, David; Engelter, Stefan T; Audebert, Heinrich; Thijs, Vincent; de Freitas, Gabriel; Algra, Ale; Jaap Kappelle, L; Schonewille, Wouter J

    2012-11-01

    Patients with an acute basilar artery occlusion (BAO) have a high risk of long-lasting disability and death. Only limited data are available on functional outcome in elderly patients with BAO. Using data from the Basilar Artery International Cooperation Study, we aimed to determine outcomes in patients ≥75 years. Primary outcome measure was poor functional outcome (modified Rankin scale score 4-6). Secondary outcomes were death, insufficient vessel recanalization (defined as thrombolysis in myocardial infarction score 0-1) and symptomatic intracranial hemorrhage (SICH). Patients were divided into four age-groups, based on quartiles: 18-54, 55-64, 65-74, and ≥75 years. Outcomes were compared between patients ≥75 years and patients aged 18-54 years. Risk ratios with corresponding 95 % confidence intervals (CI) were calculated and Poisson regression analyses were performed to calculate adjusted risk ratios (aRR). We included 619 patients [18-54 years n = 153 (25 %), 55-64 years n = 133 (21 %), 65-74 years n = 171 (28 %), and ≥75 years n = 162 (26 %)]. Compared with patients aged 18-54 years, patients ≥75 years were at increased risk of poor functional outcome [aRR 1.33 (1.14-1.55)] and death [aRR 2.47 (1.75-3.51)]. Nevertheless, 35/162 (22 %, 95 % CI 15-28 %) of patients ≥75 years had good functional outcome. No significant differences between age groups were observed for recanalization rate and incidence of SICH. Although patients ≥75 years with BAO have an increased risk of poor outcome compared with younger patients, a substantial group of patients ≥75 years survives with a good functional outcome.

  8. Role of angiotensin II type 1 receptor antagonists in the treatment of hypertension in patients aged >or=65 years.

    Science.gov (United States)

    Gradman, Alan H

    2009-01-01

    Systolic blood pressure (SBP) increases with age, and hypertension affects approximately two-thirds of adults in the US aged >60 years. Blood pressure (BP) increases as a consequence of age-related structural changes in large arteries, which lead to loss of elasticity and reduced vascular compliance. Increased pulse wave velocity augments SBP, resulting in a high prevalence of isolated systolic hypertension. Because age itself elevates cardiovascular risk, effective treatment of hypertension in an older (aged >or=65 years) patient population prevents many more events per 1000 patients treated than treatment of younger hypertensive patients. Recommendations for treating hypertension are similar in older patients compared with the general population. The Seventh Report of the Joint National Committee on Detection, Prevention, Evaluation, and Treatment of High Blood Pressure recommends target BP goals of hypertension, and treatment goals to include patients with coronary artery disease, other types of vascular disease and heart failure. Randomized clinical trials have demonstrated the efficacy of calcium channel antagonists (calcium channel blockers [CCBs]), low-dose diuretics, ACE inhibitors and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) in reducing the risk of stroke and other adverse cardiovascular outcomes in older patients; beta-adrenoceptor antagonists are less effective in terms of endpoint reduction. The majority of older patients require two or more drugs to achieve BP goals. Despite active treatment, half of these patients do not achieve target BP, in part because of the reluctance of physicians to intensify treatment, a phenomenon referred to as 'clinical inertia'. ARBs are effective antihypertensive agents in older patients and have been shown to reduce cardiovascular endpoints in patients with hypertension, diabetic nephropathy, cerebrovascular disease and heart failure. ARBs produce additive BP reduction when

  9. Experience of aging in patients with rheumatic disease: A comparison with the general population

    NARCIS (Netherlands)

    Bode, Christina; Taal, Erik; Westerhof, Gerben Johan; van Gessel, L.; van de Laar, Mart A F J

    2012-01-01

    Objectives: Self-perceptions of aging have been shown to predict mental and physical health and even longevity. This study examined the aging perceptions of patients with rheumatic disease and compared them with the general Dutch population. Methods: Consecutive patients visiting a rheumatology

  10. Protein carbonyl content: a novel biomarker for aging in HIV/AIDS patients

    Directory of Open Access Journals (Sweden)

    Vaishali Kolgiri

    2017-01-01

    Conclusions: Carbonyl content may has a role as a biomarker for detecting oxidative DNA damage induced ART toxicity and/or accelerated aging in HIV/AIDS patients. Larger studies are warranted to elucidate the role of carbonyl content as a biomarker for premature aging in HIV/AIDS patients.

  11. Does age really matter? Recall of information presented to newly referred patients with cancer

    NARCIS (Netherlands)

    Jansen, J.; Butow, P.N.; van Weert, J.C.M.; van Dulmen, S.; Devine, R.J.; Heeren, T.J.; Bensing, J.M.; Tattersall, M.H.N.

    2008-01-01

    Purpose To examine age- and age-related differences in recall of information provided during oncology consultations. Patients and Methods Two hundred sixty patients with cancer diagnosed with heterogeneous cancers, seeing a medical or radiation oncologist for the first time, participated in the

  12. Does age really matter? Recall of information presented to newly referred patients with cancer.

    NARCIS (Netherlands)

    Jansen, J.; Butow, P.N.; Weert, J.C.M. van; Dulmen, S. van; Devine, R.J.; Heeren, T.J.; Bensing, J.M.; Tattersall, M.H.N.

    2008-01-01

    Purpose: To examine age- and age-related differences in recall of information provided during oncology consultations. Patients and Methods: Two hundred sixty patients with cancer diagnosed with heterogeneous cancers, seeing a medical or radiation oncologist for the first time, participated in the

  13. Outcome of different post-orchiectomy management for stage I seminoma: Japanese multi-institutional study including 425 patients.

    Science.gov (United States)

    Kamba, Tomomi; Kamoto, Toshiyuki; Okubo, Kazutoshi; Teramukai, Satoshi; Kakehi, Yoshiyuki; Matsuda, Tadashi; Ogawa, Osamu

    2010-12-01

    To clarify the contemporary clinical outcome of stage I seminoma and to provide information on treatment options to patients. A retrospective analysis of 425 patients who underwent orchiectomy for stage I seminoma between 1985 and 2006 at 25 hospitals in Japan. Relapse-free survival rates were calculated using the Kaplan-Meier method and clinicopathological factors associated with relapse were examined by univariate and multivariate analyses using the Cox proportional hazards model. A total of 30 out of 425 patients had relapsed. Relapse-free survival rates at 10 years were 79, 94 and 94% in the surveillance, chemotherapy and radiotherapy groups, respectively. Post-orchiectomy management and rete testis invasion were identified as independent predictive factors associated with relapse. Rete testis invasion remained to be an independent predictive factor, even if the cases with relapses in the contralateral testis were censored. Only one patient, who relapsed after adjuvant radiotherapy, died of the disease. Overall survival at 10 years was 100, 100 and 99% in the surveillance, chemotherapy and radiotherapy groups, respectively. More than half of the patients were lost to follow up within 5 years. The outcome of Japanese patients with stage I seminoma is similar to previously published Western reports. Surveillance policy is becoming a popular option in Japan, although the relapse rate in patients opting for surveillance policy is higher than those opting for adjuvant chemotherapy or radiotherapy. Rete testis invasion is an independent predictive factor associated with relapse regardless of the post-orchiectomy management. Long-term follow up is mandatory for detection of late relapse. © 2010 The Japanese Urological Association.

  14. ORIGINAL ARTICLES Haemophilia patients aged 0 - 18 years in the ...

    African Journals Online (AJOL)

    2003-06-06

    Jun 6, 2003 ... Stata Corporation,. 1999. 11. Medical and Dental Professional Board Register of Medical Practitioners. Pretoria: Health. Professions Council of South Africa, 2000. 12. ... Haemophilia can cause severe disability and .a reduced life expectancy. ... been transmitted to patients, especially in those treated with.

  15. The frequency of diagnostic errors in radiologic reports depends on the patient's age

    International Nuclear Information System (INIS)

    Diaz, Sandra; Ekberg, Olle

    2010-01-01

    Background: Patients who undergo treatment may suffer preventable medical errors. Some of these errors are due to diagnostic imaging procedures. Purpose: To compare the frequency of diagnostic errors in different age groups in an urban European population. Material and Methods: A total of 19 129 reported radiologic examinations were included. During a 6-month period, the analyzed age groups were: children (aged 0-9 years), adults (40-49 years), and elderly (86-95 years). Results: The frequency of radiologic examinations per year was 0.3 in children, 0.6 in adults, and 1.1 in elderly. Significant errors were significantly more frequent in the elderly (1.7%) and children (1.4%) compared with adults (0.8%). There were 60 false-positive reports and 232 false-negative reports. Most errors were made by staff radiologists after hours when they reported on examinations outside their area of expertise. Conclusion: Diagnostic errors are more frequent in children and the elderly compared with middle-aged adults

  16. Clinical and radiological outcome of the cemented Contemporary acetabular component in patients < 50 years of age.

    Science.gov (United States)

    Schmitz, M W J L; Timmer, C; Rijnen, W H C; Gardeniers, J W M; Schreurs, B W

    2013-12-01

    Despite the worldwide usage of the cemented Contemporary acetabular component (Stryker), no published data are available regarding its use in patients aged Contemporary acetabular component with the Exeter cemented stem between January 1999 and January 2006. There were 152 hips in 126 patients, 61 men and 65 women, mean age at surgery 37.6 years (16 to 49 yrs). One patient was lost to follow-up. Mean clinical follow-up of all implants was 7.6 years (0.9 to 12.0). All clinical questionnaire scores, including Harris hip score, Oxford hip score and several visual analogue scales, were found to have improved. The eight year survivorship of all acetabular components for the endpoints revision for any reason or revision for aseptic loosening was 94.4% (95% confidence interval (CI) 89.2 to 97.2) and 96.4% (95% CI 91.6 to 98.5), respectively. Radiological follow-up was complete for 146 implants. The eight year survival for the endpoint radiological loosening was 93.1% (95% CI 86.2 to 96.6). Three surviving implants were considered radiologically loose but were asymptomatic. The presence of acetabular osteolysis (n = 17, 11.8%) and radiolucent lines (n = 20, 13.9%) in the 144 surviving cups indicates a need for continued observation in the second decade of follow-up in order to observe their influence on long-term survival. The clinical and radiological data resulting in a ten-year survival rate > 90% in young patients support the use of the Contemporary acetabular component in this specific patient group.

  17. Factors associated with a clinician's offer of screening HIV-positive patients for sexually transmitted infections, including syphilis.

    Science.gov (United States)

    Heller, R; Fernando, I; MacDougall, M

    2011-06-01

    This retrospective study assessed whether Quality Improvement Scotland national standards for the sexual health care offered to HIV-positive individuals are being met by the Edinburgh genitourinary (GU) medicine clinic; specifically whether HIV-positive patients are offered: (a) sexually transmitted infection (STI) screening annually and (b) syphilis testing six-monthly. The study also reviewed what factors were associated with a clinician's offer of STI screening and syphilis testing. Of the 509 patients seen within the study period, case notes documented that 64% were offered STI screens, and 69% were offered syphilis testing, results consistent with audits of services elsewhere. Sexual orientation (P offer of STI screening, while gender (P offer of syphilis testing. Our results suggest that one explanation for clinicians failing to offer STI screens and syphilis serology testing is their (implicit) risk assessment that STI testing is not required in individual patients.

  18. A randomised double-blind placebo-controlled pilot trial of a combined extract of sage, rosemary and melissa, traditional herbal medicines, on the enhancement of memory in normal healthy subjects, including influence of age.

    Science.gov (United States)

    Perry, N S L; Menzies, R; Hodgson, F; Wedgewood, P; Howes, M-J R; Brooker, H J; Wesnes, K A; Perry, E K

    2018-01-15

    To evaluate for the first time the effects of a combination of sage, rosemary and melissa (Salvia officinalis L., Rosmarinus officinalis L. and Melissa officinalis L.; SRM), traditional European medicines, on verbal recall in normal healthy subjects. To devise a suitable study design for assessing the clinical efficacy of traditional herbal medicines for memory and brain function. Forty-four normal healthy subjects (mean age 61 ± 9.26y SD; m/f 6/38) participated in this study. A double-blind, randomised, placebo-controlled pilot study was performed with subjects randomised into an active and placebo group. The study consisted of a single 2-week term ethanol extract of SRM that was chemically-characterised using high resolution LC-UV-MS/MS analysis. Immediate and delayed word recall were used to assess memory after taking SRM or placebo (ethanol extract of Myrrhis odorata (L.) Scop.). In addition analysis was performed with subjects divided into younger and older subgroups (≤ 62 years mean age n = 26: SRM n = 10, Placebo n = 16; ≥ 63 years n = 19: SRM n = 13, Placebo n = 6). Overall there were no significant differences between treatment and placebo change from baseline for immediate or delayed word recall. However subgroup analysis showed significant improvements to delayed word recall in the under 63 year age group (p memory in healthy subjects under 63 years of age. Short- and long- term supplementation with SRM extract merits more robust investigation as an adjunctive treatment for patients with Alzheimer's disease and in the general ageing population. The study design proved a simple cost effective trial protocol to test the efficacy of herbal medicines on verbal episodic memory, with future studies including broader cognitive assessment. Copyright © 2017 Elsevier GmbH. All rights reserved.

  19. Impact of age at diagnosis on racial disparities in endometrial cancer patients.

    Science.gov (United States)

    Tarney, Christopher M; Tian, Chunqiao; Wang, Guisong; Dubil, Elizabeth A; Bateman, Nicholas W; Chan, John K; Elshaikh, Mohamed A; Cote, Michele L; Schildkraut, Joellen M; Shriver, Craig D; Conrads, Thomas P; Hamilton, Chad A; Maxwell, G Larry; Darcy, Kathleen M

    2017-08-08

    Although black patients with endometrial cancer (EC) have worse survival compared with white patients, the interaction between age/race has not been examined. The primary objective was to evaluate the impact of age at diagnosis on racial disparities in disease presentation and outcome in EC. We evaluated women diagnosed with EC between 1991 and 2010 from the Surveillance, Epidemiology, and End Results. Mutation status for TP53 or PTEN, or with the aggressive integrative, transcript-based, or somatic copy number alteration-based molecular subtype were acquired from the Cancer Genome Atlas. Logistic regression model was used to estimate the interaction between age and race on histology. Cox regression model was used to estimate the interaction between age and race on survival. 78,184 white and 8518 black patients with EC were analyzed. Median age at diagnosis was 3-years younger for black vs. white patients with serous cancer and carcinosarcoma (P<0.0001). The increased presentation of non-endometrioid histology with age was larger in black vs. white patients (P<0.0001). The racial disparity in survival and cancer-related mortality was more prevalent in black vs. white patients, and in younger vs. older patients (P<0.0001). Mutations in TP53, PTEN and the three aggressive molecular subtypes each varied by race, age and histology. Aggressive histology and molecular features were more common in black patients and older age, with greater impact of age on poor tumor characteristics in black vs. white patients. Racial disparities in outcome were larger in younger patients. Intervention at early ages may mitigate racial disparities in EC. Copyright © 2017. Published by Elsevier Inc.

  20. Patient Age Is Significantly Related to the Progression of Papillary Microcarcinoma of the Thyroid Under Observation

    Science.gov (United States)

    Ito, Yasuhiro; Kihara, Minoru; Higashiyama, Takuya; Kobayashi, Kaoru; Miya, Akihiro

    2014-01-01

    Background: We showed previously that subclinical low-risk papillary thyroid microcarcinoma (PTMC) could be observed without immediate surgery. Patient age is an important prognostic factor of clinical papillary thyroid carcinoma (PTC). In this study, we investigated how patient age influences the observation of low-risk PTMC. Methods: Between 1993 and 2011, 1235 patients with low-risk PTMC chose observation without immediate surgery. They were followed periodically with ultrasound examinations. These patients were enrolled in this study. We divided them into three subsets based on age at the beginning of observation: young (<40 years), middle-aged (40–59 years), and old patients (≥60 years). Observation periods ranged from 18 to 227 months (average 75 months). Results: We set three parameters for the evaluation of PTMC progression: (i) size enlargement, (ii) novel appearance of lymph-node metastasis, and (iii) progression to clinical disease (tumor size reaching 12 mm or larger, or novel appearance of nodal metastasis). The proportion of patients with PTMC progression was lowest in the old patients and highest in the young patients. On multivariate analysis, young age was an independent predictor of PTMC progression. However, none of the 1235 patients showed distant metastasis or died of PTC during observation. Although only 51 patients (4%) underwent thyrotropin (TSH) suppression based on physician preference, the PTMC of all patients enrolled in this TSH suppression study, except one, were clinically stable. To date, 191 patients underwent surgery for various reasons after observation. None showed recurrence except for one in the residual thyroid, and none died of PTC after surgery. Conclusions: Old patients with subclinical low-risk PTMC may be the best candidates for observation. Although PTMC in young patients may be more progressive than in older patients, it might not be too late to perform surgery after subclinical PTMC has progressed to clinical

  1. Low employment and low willingness of being reemployed in Chinese working-age maintained hemodialysis patients.

    Science.gov (United States)

    Huang, Bihong; Lai, Bihong; Xu, Ling; Wang, Ying; Cao, Yanpei; Yan, Ping; Chen, Jing

    2017-11-01

    Returning to society plays an important role in improving the quality of life in maintenance hemodialysis (MHD) patients, and retention of employment is one of the core enablers. The study is to assess the employment status and to determine the variables for unemployment in Chinese MHD patients. Prevalent MHD patients from four dialysis centers in Shanghai China were enrolled. We assessed patients' employment status, current social functioning, hemodialysis modality, annual income and general health condition. Among current unemployed working-age patients, the reasons of quitting jobs and willingness of being reemployed were evaluated. A total of 231 patients were studied, among which 114 patients were unemployed 1 year before hemodialysis. Among 117 employed patients, 16 patients quitted jobs before dialysis inception, while 49 patients quitted jobs at the initiation of HD, and 26 patients followed after a few months' HD. The main reasons for ceasing employment were physical insufficiency, conflict between dialysis and work schedules, lack of support from employers and resistance from family members. Among the 166 patients who were in their working age, 26 patients were employed. The unemployed patients had the characters of elder age, lower education level, higher annual family income, higher female ratio, lower blood flow, lower physical functioning, and social functioning and lower frequency of weekend hemodialysis and HDF/HF. Among the 140 unemployed patients, only 47 patients had the willingness of being reemployed. Their unemployment status was positively associated with elder age ((OR) 3.13, 95% CI, 1.08-9.1), lower education level ((OR) 1.97, 95% CI, 1.05-5.92), and higher family income ((OR) 7.75, 95% CI, 2.49-24.14). Ratio of employment and willingness of being reemployed was low in MHD working-age patients. Lack of social and family's support also hampered patient's returning to society except for the HD treatment quality.

  2. Complementary role of adjunctive breast magnetic resonance imaging and scintimammography in patients of all ages undergoing breast cancer surgery

    International Nuclear Information System (INIS)

    Howarth, D.; Slater, S.; Lau, P.; Booker, J.; Clark, D.; Sillar, R.

    2005-01-01

    The aims of this study were to assess breast MRI and scintimammography (SMM) for the detection of breast cancer, and to determine any complementary role of these tests to each other and conventional imaging. Seventy-two patients (age 35-81 years) with a suspicious breast mass were investigated by mammography, breast ultrasound, breast MRI and SMM before undergoing surgical excision of the breast mass. Sensitivity, specificity and area under receiver operator characteristic curves were calculated for each test. Of the 72 patients, there were 66 proven malignant tumours, including two patients with bilateral breast cancer. When comparing the diagnostic sensitivity of breast MRI and SMM for lesion size, both tests showed higher sensitivities for lesions >25 mm in size, particularly for SMM. When these tests were compared for patient age, patients less than 51 years showed higher sensitivities for both tests. This was statistically significant for breast MRI. The overall respective diagnostic sensitivities for mammography, mammography with breast ultrasound, breast MRI and SMM were 56, 67,86 and 85%. The differences were significant between mammography, mammography/ultrasound and both breast MRI and SMM. Breast MRI and SMM offer incremental diagnostic advantage in the diagnosis of breast cancer. Although improved diagnostic accuracy is seen in patients of all ages, those patients less than 51 years of age receive the greatest diagnostic benefit. Copyright (2005) Blackwell Science Pty Ltd

  3. The effects of infographics and several quantitative versus qualitative formats for cardiovascular disease risk, including heart age, on people's risk understanding.

    NARCIS (Netherlands)

    Damman, Olga C; Vonk, Suzanne I; Van den Haak, Maaike J; van Hooijdonk, Charlotte M J; Timmermans, Danielle R M

    2018-01-01

    To study how comprehension of cardiovascular disease (CVD) risk is influenced by: (1) infographics about qualitative risk information, with/without risk numbers; (2) which qualitative risk dimension is emphasized; (3) heart age vs. traditional risk format.

  4. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul D.L.P.M.; Frith, Peter A.; Zwerink, Marlies; Monninkhof, Evelyn M.; van der Palen, Job; Effing-Tijdhof, Tanja W

    2017-01-01

    Background: Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease.

  5. Comorbid subjective health complaints in patients with sciatica: a prospective study including comparison with the general population.

    Science.gov (United States)

    Grøvle, Lars; Haugen, Anne J; Ihlebaek, Camilla M; Keller, Anne; Natvig, Bård; Brox, Jens I; Grotle, Margreth

    2011-06-01

    Chronic nonspecific low back pain is accompanied by high rates of comorbid mental and physical conditions. The aims of this study were to investigate if patients with specific back pain, that is, sciatica caused by lumbar herniation, report higher rates of subjective health complaints (SHCs) than the general population and if there is an association between change in sciatica symptoms and change in SHCs over a 12-month period. A multicenter cohort study of 466 sciatica patients was conducted with follow-up at 3 months and 1 year. Comorbid SHCs were measured by 27 items of the SHC inventory. Odds ratios (ORs) for each SHC were calculated with comparison to a general population sample (n=928) by logistic regression. The SHC number was calculated by summing all complaints present. At baseline, the ORs for reporting SHCs for the sciatica patients were significantly elevated in 15 of the 27 items with a mean (S.D.) SHC number of 7.5 (4.4), compared to 5.2 (4.4) in the general population (Psciatica, the SHC number was reduced to normal levels. Among those with persisting or worsening sciatica, the number increased to a level almost double that of the general population. Compared to the general population, the prevalence of subjective health complaints in sciatica is increased. During follow-up, the number of health complaints increased in patients with persisting or worsening sciatica. Copyright © 2010 Elsevier Inc. All rights reserved.

  6. Results of Clipping Surgery for Aneurysmal Subarachnoid Hemorrhage in Elderly Patients Aged 90 or Older.

    Science.gov (United States)

    Suzuki, Yota; Watanabe, Atsushi; Wakui, Kenji; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro

    2016-01-01

    The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing. Although advanced age is one of the recognized risk factors for poor outcome, conservative treatment for aneurysmal subarachnoid hemorrhage cannot provide satisfactory outcome in elderly patients. The aim of this study is to assess the outcome in patients aged 90 or older, for whom ruptured aneurysms were treated by clipping. We retrospectively reviewed the medical records of non-traumatic SAH patients who were hospitalized at the Chiba Neurosurgical Clinic between 2004 and 2013. Of the 702 patients, 8 patients (1.1 %) were aged 90 or older. Of them, four underwent clipping surgery and the other four died or were managed conservatively. Their preoperative conditions were evaluated with the World Federation of Neurosurgical Societies Grading Scale of SAH, and the Fisher classification was used to assess the bleeding severity. The location of the ruptured aneurysm was determined by three-dimensional computed tomographic angiography or cerebral angiography. The Glasgow Outcome Scale evaluation was assigned at discharge. Four patients (four female, all WFNS grade 1), aged 90 or older, underwent clipping surgery. Fisher classification was three in two patients and four in the other two. Location of the ruptured aneurysm was internal carotid artery in two, anterior communicating artery in one, and posterior inferior cerebellar artery in one patient. Two of these four patients had a favorable outcome. We propose that advanced age alone does not exclude suitable surgical clipping in patients with aneurysmal rupture in the tenth decade of life.

  7. The range of peripapillary retinal nerve fibre layer and optic disc parameters in children aged up to but not including 18 years of age, as measured by optical coherence tomography: protocol for a systematic review.

    Science.gov (United States)

    Creavin, Alexandra L; Williams, Cathy; Tilling, Kate; Timpson, Nicholas; Higgins, Julian P T

    2016-04-30

    The parameters of the optic disc and peripapillary retinal nerve fibre layer (pRNFL) in children may vary with disease processes that contribute to visual impairment and blindness and so could be useful as an objective measure in at-risk children. There is no standardised reference for the normal parameters of the optic disc and pRNFL in children; however, there are a large number of small individual studies that have been undertaken to look at these measures. A systematic review of current literature on the range of pRNFL and optic disc parameters in children aged less than 18 years will be performed. Studies will be considered for review if they report numerical data on optic disc and pRNFL parameters, measured using optical coherence tomography. Outcome measures will include mean pRNFL thickness and cup-disc ratio. The bibliographic databases Medline, CINAHL, EMBASE, Scopus and Web of Science will be systematically searched from 1991. Screening of search results will be conducted by two authors working independently, as will extraction of primary and secondary outcome data. Ten per cent of all other data extraction will be checked by a second author. Results will be compiled and presented in evidence tables. Where possible and appropriate, study-specific estimates will be combined to obtain an overall summary estimate of pRNFL thickness and cup-disc ratio across studies and results will be presented by age of population. Subgroup analyses will be undertaken for children of different ethnicities. This review aims to provide an overview of the parameters of the optic disc and pRNFL in children of different ages in order to identify gaps in knowledge and to improve understanding of what might be considered within/outside the range of normality. The findings will be presented in peer-reviewed journals and will be presented at conferences. PROSPERO CRD42016033068.

  8. Tiotropium improves lung function, exacerbation rate, and asthma control, independent of baseline characteristics including age, degree of airway obstruction, and allergic status

    DEFF Research Database (Denmark)

    Kerstjens, Huib A M; Moroni-Zentgraf, Petra; Tashkin, Donald P

    2016-01-01

    BACKGROUND: Many patients with asthma remain symptomatic despite treatment with inhaled corticosteroids (ICS) with or without long-acting β2-agonists (LABAs). Tiotropium add-on to ICS plus a LABA has been shown to improve lung function and reduce exacerbation risk in patients with symptomatic ast...

  9. Age of language acquisition and cortical language organization in multilingual patients undergoing awake brain mapping.

    Science.gov (United States)

    Fernández-Coello, Alejandro; Havas, Viktória; Juncadella, Montserrat; Sierpowska, Joanna; Rodríguez-Fornells, Antoni; Gabarrós, Andreu

    2017-06-01

    OBJECTIVE Most knowledge regarding the anatomical organization of multilingualism is based on aphasiology and functional imaging studies. However, the results have still to be validated by the gold standard approach, namely electrical stimulation mapping (ESM) during awake neurosurgical procedures. In this ESM study the authors describe language representation in a highly specific group of 13 multilingual individuals, focusing on how age of acquisition may influence the cortical organization of language. METHODS Thirteen patients who had a high degree of proficiency in multiple languages and were harboring lesions within the dominant, left hemisphere underwent ESM while being operated on under awake conditions. Demographic and language data were recorded in relation to age of language acquisition (for native languages and early- and late-acquired languages), neuropsychological pre- and postoperative language testing, the number and location of language sites, and overlapping distribution in terms of language acquisition time. Lesion growth patterns and histopathological characteristics, location, and size were also recorded. The distribution of language sites was analyzed with respect to age of acquisition and overlap. RESULTS The functional language-related sites were distributed in the frontal (55%), temporal (29%), and parietal lobes (16%). The total number of native language sites was 47. Early-acquired languages (including native languages) were represented in 97 sites (55 overlapped) and late-acquired languages in 70 sites (45 overlapped). The overlapping distribution was 20% for early-early, 71% for early-late, and 9% for late-late. The average lesion size (maximum diameter) was 3.3 cm. There were 5 fast-growing and 7 slow-growing lesions. CONCLUSIONS Cortical language distribution in multilingual patients is not homogeneous, and it is influenced by age of acquisition. Early-acquired languages have a greater cortical representation than languages acquired

  10. Age and Comorbidities Affect Quality of Life in Patients With Osteoarthrtitis and Knee Replacement

    Directory of Open Access Journals (Sweden)

    Fernandez-Cuadros

    2016-08-01

    Full Text Available Background Osteoarthritis (OA is a multifactorial, disabling and degenerative disease that worsens with age and affects patient’s health-related quality of life (HRQOL. Objectives The current study aimed to assess if age and comorbidities have an influence on knee OA and knee replacement outcome before and after the surgery. Methods A quasi-experimental intervention study was conducted on a sample of 125 patients with knee osteoarthritis and designed to assess total knee arthroplasty (TKA outcomes before and after the surgery. One orthopedic surgeon performed all surgeries with the same type of joint prosthesis from 2008 to 2012. The HRQOL was assessed by the short form (36 health survey (SF-36 questionnaire. Results It was observed that knee osteoarthritis significantly affects all the dimensions of HRQOL before the surgery included in the SF-36 questionnaire and a clinical improvement observed after the intervention with total knee arthroplasty. Age influenced bodily pain (P = 0.012 and vitality (P = 0.002 in knee osteoarthritis (before the intervention, and on physical (P = 0.040 and mental health components (P = 0.002, after total knee arthroplasty. Previous arthroplasties and comorbidities had no effect on knee OA. However, previous total knee/hip arthroplasty were associated with the improvement in physical functioning (P = 0.021 after the TKA; comorbidities influenced the dimension of mental health (MH (P = 0.036 after the surgery. Conclusions Total knee arthroplasty is justified according to the perception of clinical improvement and the improvement in the dimensions of HRQOL reported by the patients. Age affects knee osteoarthritis and TKA outcomes. Comorbidities have no influence on knee OA, but affect mental health after the intervention.

  11. A randomised multicentre trial of acupuncture in patients with seasonal allergic rhinitis – trial intervention including physician and treatment characteristics

    OpenAIRE

    Ortiz, Miriam; Witt, Claudia M; Binting, Sylvia; Helmreich, Cornelia; Hummelsberger, Josef; Pfab, Florian; Wullinger, Michael; Irnich, Dominik; Linde, Klaus; Niggemann, Bodo; Willich, Stefan N; Brinkhaus, Benno

    2014-01-01

    Background In a large randomised trial in patients with seasonal allergic rhinitis (SAR), acupuncture was superior compared to sham acupuncture and rescue medication. The aim of this paper is to describe the characteristics of the trial’s participating physicians and to describe the trial intervention in accordance with the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) guidelines, to make details of the trial intervention more transparent to researchers a...

  12. Cost-effectiveness of hematopoietic stem cell mobilization strategies including plerixafor in multiple myeloma and lymphoma patients.

    Science.gov (United States)

    Tichopád, Aleš; Vítová, Veronika; Kořístek, Zdeněk; Lysák, Daniel

    2013-12-01

    Peripheral blood stem cells (PBSCs) are preferred source of hematopoietic stem cells for autologous transplantation. Mobilization of PBSCs using chemotherapy and/or granulocyte colony-stimulating factor (G-CSF) however fails in around 20%. Combining G-CSF with plerixafor increases the mobilizations success. We compared cost-effectiveness of following schemes: the use of plerixafor "on demand" (POD) during the first mobilization in all patients with inadequate response, the remobilization with plerixafor following failure of the first standard mobilization (SSP), and the standard (re)mobilization scheme without plerixafor (SSNP). Decision tree models populated with data from a first-of-a-kind patient registry in six Czech centers (n = 93) were built to compare clinical benefits and direct costs from the payer's perspective. The success rates and costs for POD, SSP and SSNP mobilizations were; 94.9%, $7,197; 94.7%, $8,049; 84.7%, $5,991, respectively. The direct cost per successfully treated patient was $7,586, $8,501, and $7,077, respectively. The cost of re-mobilization of a poor mobilizer was $5,808 with G-CSF only and $16,755 if plerixafor was added. The total cost of plerixafor "on-demand" in the sub-cohort of poor mobilizers was $17,120. Generally, plerixafor improves the mobilization success by 10% and allows an additional patient to be successfully mobilized for incremental $11,803. Plerixafor is better and cheaper if used "on demand" than within a subsequent remobilization. Copyright © 2013 Wiley Periodicals, Inc.

  13. Thyroid profiles in a patient with resistance to thyroid hormone and episodes of thyrotoxicosis, including repeated painless thyroiditis.

    Science.gov (United States)

    Taniyama, Matsuo; Otsuka, Fumiko; Tozaki, Teruaki; Ban, Yoshiyuki

    2013-07-01

    Thyrotoxic disease can be difficult to recognize in patients with resistance to thyroid hormone (RTH) because the clinical symptoms of thyrotoxicosis cannot be observed, and thyrotropin (TSH) may not be suppressed because of hormone resistance. Painless thyroiditis is a relatively common cause of thyrotoxicosis, but its occurrence in RTH has not been reported. We assessed the thyroid profile in a patient with RTH and episodes of thyrotoxicosis who experienced repeated painless thyroiditis. A 44-year-old Japanese woman with RTH, which was confirmed by the presence of a P453A mutation in the thyroid hormone receptor β (TRβ) gene, showed a slight elevation of the basal levels of thyroid hormones, which indicated that her pituitary RTH was mild. She experienced a slight exacerbation of hyperthyroxinemia concomitant with TSH suppression. A diagnosis of painless thyroiditis was made because of the absence of TSH receptor antibodies, low Tc-99m pertechnetate uptake by the thyroid gland, and transient suppression followed by a slight elevation of TSH following the elevation of thyroid hormones. The patient's complaints of general malaise and occasional palpitations did not change throughout the course of painless thyroiditis. Three years later, painless thyroiditis occurred again without any deterioration of the clinical manifestations. Mild pituitary RTH can be overcome by slight exacerbation of hyperthyroxinemia during mild thyrotoxicosis. When pituitary resistance is severe and TSH is not suppressed, thyrotoxicosis may be overlooked.

  14. Is Age a Determinant for Nausea and Vomiting in Disabled Patients ...

    African Journals Online (AJOL)

    2016-06-24

    Jun 24, 2016 ... care surgery in children.[5]. Also in adults 30% of surgical patients are affected by PONV every year.[6]. In this study, we aimed to investigate and compare the PONV incidence in patients with disabilities aged under 18 years with patients are equal or greater than. 18 years received different dental ...

  15. Younger age is an independent predictor of worse prognosis among Lebanese nonmetastatic breast cancer patients: analysis of a prospective cohort

    Directory of Open Access Journals (Sweden)

    El Chediak A

    2017-06-01

    Full Text Available Alissar El Chediak,1 Raafat S Alameddine,1 Ayman Hakim,1 Lara Hilal,2 Sarah Abdel Massih,1 Lana Hamieh,3 Deborah Mukherji,1 Sally Temraz,1 Maya Charafeddine,1 Ali Shamseddine1 1Division of Hematology/Oncology, Department of Internal Medicine, 2Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon; 3Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA Background: Several retrospective studies have reported that younger age at presentation is associated with a worse prognosis for nonmetastatic breast cancer patients. In this study, we prospectively assessed the association between different baseline characteristics (age, tumor characteristics, mode of treatment, etc and outcomes among newly diagnosed nonmetastatic Lebanese breast cancer patients.Methods: We recruited a sample of 123 women newly diagnosed with nonmetastatic breast cancer presenting to American University of Beirut Medical Center. Immunohistochemical, molecular (vitamin D receptor, methylene tetrahydrofolate reductase polymorphisms, and genetic assays were performed. Patient characteristics were compared by age group (<40 and ≥40 years. A Cox regression analysis was performed to evaluate the variables affecting the disease-free survival (DFS. Outcome data were obtained, and DFS was estimated.Results: Among the 123 patients, 47 were 40 years of age or younger, and 76 were older than 40 years. Median follow-up duration was 58 months. Nine out of 47 patients <40 years (19.1% experienced disease relapse in contrast to four out of 76 patients >40 years (5.2%. A wide immunohistochemical panel included Ki-67, cyclin B1, p53, platelet-derived growth factor receptor, and vascular endothelial growth factor receptor, and did not reveal any significant difference in these markers between the two age groups. Older patients had a larger percentage of Luminal A than younger patients. On multivariate analysis

  16. Younger Age Is Associated with Poorer Survival in Patients with Signet-Ring Cell Carcinoma of the Colon without Distant Metastasis

    Directory of Open Access Journals (Sweden)

    Ben Huang

    2016-01-01

    Full Text Available Background. In general, younger age is associated with better survival in patients with colon cancer. In this study, we aim to analyze the impact of age on cancer-specific survival (CSS in patients with signet-ring cell carcinoma (SRCC of the colon, a particularly aggressive type of colon cancer. Methods. Information on patients with SRCC of the colon with no distant metastasis was extracted from the US Surveillance, Epidemiology, and End Results (SEER database. An X-tile plot was used to determine the optimal cutoff age at diagnosis. Results. A total of 776 patients were included in data analysis. The X-tile program revealed an optimal cutoff at 35 years of age. A higher percentage of stage III disease and a higher percentage of N2 disease were observed in patients ≤ 35 years of age. The multivariate Cox proportional model demonstrated that patients ≤ 35 years of age were more likely to have a poorer survival outcome compared with patients aged >35 years (HR 1.411, 95% CI 1.032–1.929, and P=0.031. Conclusion. In contrast to the association of younger age with better survival in colon cancer patients, younger age (≤35 years is associated with poorer survival outcome in patients with SRCC of the colon without distant metastasis.

  17. [Relationship between dysphagia and malnutritition in patients over 65 years of age].

    Science.gov (United States)

    Galán Sánchez-Heredero, María José; Santander Vaquero, Cecilio; Cortázar Sáez, Milagros; de la Morena López, Felipe; Susi García, Rosario; Martínez Rincón, María Del Carmen

    2014-01-01

    The main objective of this study was to understand the relationship between oropharyngeal dysphagia, nutritional risk factors and functional impairment in the elderly (>65y) admitted to a medical-surgical hospital unit. Secondary objectives were to determine the prevalence of oropharyngeal dysphagia, the nutritional status and their functional capacity. A cross-sectional observational study was performed. It included patients over 65 years of age admitted to the Gastroenterology-Urology Department in La Princesa University Hospital (Madrid, Spain) during the months of February and March. The following variables were recorded: age, sex, body mass index, family support, diagnosis, comorbidity, oropharyngeal dysphagia (EAT-10 and volume-viscosity evaluation method), malnutrition (Mininutritional Assessment) and functional capacity (Barthel index). A total of 167 patients were recruited, with 30.8% and 15.4% prevalence of dysphagia and malnutrition, respectively. Prevalence of malnutrition increased to 75% in patients with oropharyngeal dysphagia. The logistic regression analysis showed how conditions as low score on the Barthel index (OR 0.97 [95% CI, 0.95-0.99]), comorbidity (OR 7.98 [CI 95%, 3.09-20.61]) and dysphagia (OR 4.07 [CI 95%, 1.57-10.52]) were associated with a greater likelihood of suffering malnutrition. Oropharyngeal dysphagia is one of the most underdiagnosed and underestimated conditions among elderly patients and one that has a greater effect on their nutritional status. Accordingly, we suggest using established diagnostic methods with a multidisciplinary team collaboration for its early detection. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  18. Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Catena, Vittorio, E-mail: v.catena@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Palussiere, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)

    2016-10-15

    AimTo review outcomes and local evolution of treated lesions following percutaneous image-guided screw fixation (PIGSF) of pathological/insufficiency fractures (PF/InF) and impeding fractures (ImF) in cancer patients at two tertiary centres.Materials and methodsThirty-two consecutive patients (mean age 67.5 years; range 33–86 years) with a range of tumours and prognoses underwent PIGSF for non/minimally displaced PF/InF and ImF. Screws were placed under CT/fluoroscopy or cone-beam CT guidance, with or without cementoplasty. Clinical outcomes were assessed using a simple 4-point scale (1 = worse; 2 = stable; 3 = improved; 4 = significantly improved). Local evolution was reviewed on most recent follow-up imaging. Technical success, complications, and overall survival were evaluated.ResultsThirty-six lesions were treated with 74 screws mainly in the pelvis and femoral neck (58.2 %); including 47.2 % PF, 13.9 % InF, and 38.9 % ImF. Cementoplasty was performed in 63.9 % of the cases. Technical success was 91.6 %. Hospital stay was ≤3 days; 87.1 % of lesions were improved at 1-month follow-up; three major complications (early screw-impingement radiculopathy; accelerated coxarthrosis; late coxofemoral septic arthritis) and one minor complication were observed. Unfavourable local evolution at imaging occurred in 3/24 lesions (12.5 %) at mean 8.7-month follow-up, including poor consolidation (one case) and screw loosening (two cases, at least 1 symptomatic). There were no cases of secondary fractures.ConclusionsPIGSF is feasible for a wide range of oncologic patients, offering good short-term efficacy, acceptable complication rates, and rapid recovery. Unfavourable local evolution at imaging may be relatively frequent, and requires close clinico-radiological surveillance.

  19. Impact of a multifaceted educational intervention including serious games to improve the management of invasive candidiasis in critically ill patients.

    Science.gov (United States)

    Ferrer, R; Zaragoza, R; Llinares, P; Maseda, E; Rodríguez, A; Quindós, G

    Infections caused by Candida species are common in critically ill patients and contribute to significant morbidity and mortality. The EPICO Project (Epico 1 and Epico 2.0 studies) recently used a Delphi approach to elaborate guidelines for the diagnosis and treatment of this condition in critically ill adult patients. We aimed to evaluate the impact of a multifaceted educational intervention based on the Epico 1 and Epico 2.0 recommendations. Specialists anonymously responded to two online surveys before and after a multifaceted educational intervention consisting of 60-min educational sessions, the distribution of slide kits and pocket guides with the recommendations, and an interactive virtual case presented at a teleconference and available for online consultation. A total of 74 Spanish hospitals. Specialists of the Intensive Care Units in the participating hospitals. Specialist knowledge and reported practices evaluated using a survey. The McNemar test was used to compare the responses in the pre- and post-intervention surveys. A total of 255 and 248 specialists completed both surveys, in both periods, respectively. The pre-intervention surveys showed many specialists to be unaware of the best approach for managing invasive candidiasis. After both educational interventions, specialist knowledge and reported practices were found to be more in line with nearly all the recommendations of the Epico 1 and Epico 2.0 guidelines, except as regards de-escalation from echinocandins to fluconazole in Candida glabrata infections (p=0.055), and the duration of antifungal treatment in both candidemia and peritoneal candidiasis. This multifaceted educational intervention based on the Epico Project recommendations improved specialist knowledge of the management of invasive candidiasis in critically ill patients. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  20. Metal load assessment in patient pulmonary lavages: towards a comprehensive mineralogical analysis including the nano-sized fraction.

    Science.gov (United States)

    Forest, Valérie; Vergnon, Jean-Michel; Guibert, Cyril; Bitounis, Dimitrios; Leclerc, Lara; Sarry, Gwendoline; Pourchez, Jérémie

    Mineralogical analyses of clinical samples have been proved useful to identify causal relationship between exposure to airborne particles and pulmonary diseases. The most striking example is asbestosis where the assessment of asbestos bodies in patient lung samples has allowed defining values specific of pathologies. However, this type of analyses only considers the micro-sized fraction of the particles, neglecting the specific impact of nano-sized particles which have been otherwise shown to be reactive and able to induce biological effects. Similarly, in nanotoxicology, the mineralogical analysis of pulmonary fluids could be used as an indicator of exposure to inhaled nanoparticles and could help investigations on the relationship between exposure to these nanoparticles and lung diseases. We designed this study first to demonstrate the technical feasibility of this approach, then to get a clear picture of the metals present, and in what form, in patient lungs and finally to determine if indeed it is worth investigating separately the micro, sub-micro and nano fractions. Broncho-alveolar lavages were recovered from 100 patients suffering from interstitial lung diseases. A protocol was specifically developed to isolate three fractions containing respectively microparticles, sub-microparticles and nanoparticles with ions. The metal content in each fraction was qualitatively and quantitatively characterized. Results showed significant differences between the three fractions in terms of metal load confirming that the separate analysis of the fractions is relevant. It also means that the assessment of the micro-sized fraction alone, as commonly done in clinical practice, only gives a partial view of the mineralogical analysis.

  1. Relationship between age at menarche and skeletal maturation stages in Taiwanese female orthodontic patients.

    Science.gov (United States)

    Lai, Eddie Hsiang-Hua; Chang, Jenny Zwei-Chieng; Jane Yao, Chung-Chen; Tsai, Shih-Jaw; Liu, Jen-Pei; Chen, Yi-Jane; Lin, Chun-Pin

    2008-07-01

    The age at menarche reflects a pubertal girl's physiologic maturity. The aims of this study were to evaluate the relationship between the age at menarche and skeletal maturation in female orthodontic patients. Hand-wrist radiographs and lateral cephalometric radiographs from 304 adolescent female subjects (age, 8-18.9 years) were selected from the files of the Department of Orthodontics, National Taiwan University Hospital (NTUH). Hand-wrist bone maturation stages were assessed using the NTUH Skeletal Maturation Index (NTUH-SMI). Cervical vertebral maturation stages (CVMS) were determined using the latest CVMS Index. Menarcheal ages were self-reported by the patients and verified by the patients' mothers. The relationships between the NTUH-SMI or CVM stages and menarcheal status were investigated. More than 90% of the 148 subjects who had already attained menstruation had skeletal maturation beyond the NTUH-SMI stage four or CVMS III. However, the subjects who had never experienced menarche mostly had skeletal maturation before NTUH-SMI stage five or CVMS IV. During the period of orthodontic treatment, 19 females experienced their menarche. The mean age at menarche for the 167 female patients in total was 11.97 years. In average, menarche occurred between NTUH-SMI stages four and five or between CVM stages III and IV. The percentage of girls with menses increased from 1.2% at age 9 to 6.6% at age 10, 39.5% at age 11, 81.4% at age 12, 97% at age 13, and 100% at age 14. Compared with the results obtained 20 years previously, we found a downward shift of 0.47 years per decade for the mean age at menarche in female orthodontic patients. The majority of female orthodontic patients have passed the pubertal growth spurt when they experience their menarche. Menarche usually follows the pubertal growth spurt by about 1 year and occurs after NTUH-SMI stage four or CVMS III.

  2. Comparison of the Quality of Life in Elderly With Young and Middle Age Chronic Renal Failure Patients

    Directory of Open Access Journals (Sweden)

    Masomeh Rambod

    2011-04-01

    Full Text Available Objectives: The aim of this study was to compare the quality of life in elderly with the young and middle age chronic renal failure Patients. Methods & Materials: This cross-sectional study of 202 chronic renal failure patients included young (age≤40 years, middle age (41-59 years, and elderly (age≥60 years patients. The subjects were selected by census method. The data were collected using the "Ferrans and Powers quality of life index- dialysis version" and were analyzed using SPSS-14 with one-way ANOVA and Scheffe’s test. Results: In general, 43.6%, 40.1% and 16.3% of the participants were elderly, middle age and young patients respectively. There were no significant differences in overall quality of life between the three groups (F=1.51, P>0.05. Socioeconomic familial subscale of quality of life was not statistically different in the groups (P0.05. Conclusion: This study indicated that socioeconomic familial subscale of quality of life in young patients was lower than elderly and middle age. Therefore, comprehensive insurance and referring to renal and transplant support society for young patients are suggested in order to improve the patients’ quality of life, especially in the socioeconomic domain.

  3. Health-Related Quality of Life in Locally Advanced Cervical Cancer Patients After Definitive Chemoradiation Therapy Including Image Guided Adaptive Brachytherapy: An Analysis From the EMBRACE Study

    International Nuclear Information System (INIS)

    Kirchheiner, Kathrin; Pötter, Richard; Tanderup, Kari; Lindegaard, Jacob C.; Haie-Meder, Christine; Petrič, Primož; Mahantshetty, Umesh; Jürgenliemk-Schulz, Ina M.; Rai, Bhavana; Cooper, Rachel; Dörr, Wolfgang; Nout, Remi A.; Lindegaard, Jacob; Tanderup, Kari; Fokdal, Lars; Van Der Steen Banasik, Elzbieta; Haie-Meder, Christine; Dumas, Isabelle

    2016-01-01

    Purpose: This study analyzed functioning and symptom scores for longitudinal quality of life (QoL) from patients with locally advanced cervical cancer who underwent definitive chemoradiation therapy with image guided adaptive brachytherapy in the EMBRACE study. Methods and Materials: In total, 744 patients at a median follow-up of 21 months were included. QoL was prospectively assessed using European Organization for Research and Treatment of Cancer Quality of Life core module 30 (EORTC QLQ-C30) and EORTC cervical cancer module 24 (CX24) questionnaires at baseline, then every 3 months during the first year, every 6 months in the second and third years, and finally yearly thereafter in patients with no evidence of disease. Outcomes were evaluated over time and compared to those from an age-matched female reference population. Results: General QoL and emotional and social functioning were impaired at baseline but improved during the first 6 months after treatment, to reach a level comparable to that of the reference population, whereas cognitive functioning remained impaired. Both social and role functioning showed the lowest scores at baseline but which increased after treatment to reach a plateau at 6 months and then declined slightly at 3 and 4 years. The overall symptom experience was elevated at baseline and decreased to a level within the range of that of the reference population. Similarly, tumor-related symptoms (eg, pain, appetite loss, and constipation), which were present before treatment, decreased substantially at the first follow-up after treatment. Several treatment-related symptoms developed either immediately after and persisted over time (diarrhea, menopausal symptoms, peripheral neuropathy, and sexual functioning problems) or developed gradually after treatment (lymphedema and dyspnea). Conclusions: This longitudinal prospective QoL analysis showed that patients' general QoL and functioning were impaired before treatment compared to

  4. Health-Related Quality of Life in Locally Advanced Cervical Cancer Patients After Definitive Chemoradiation Therapy Including Image Guided Adaptive Brachytherapy: An Analysis From the EMBRACE Study

    Energy Technology Data Exchange (ETDEWEB)

    Kirchheiner, Kathrin, E-mail: kathrin.kirchheiner@meduniwien.ac.at [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna and General Hospital of Vienna, Vienna (Austria); Pötter, Richard [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna and General Hospital of Vienna, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna (Austria); Tanderup, Kari; Lindegaard, Jacob C. [Department of Oncology, Aarhus University Hospital, Aarhus (Denmark); Haie-Meder, Christine [Department of Radiotherapy, Gustave-Roussy, Villejuif (France); Petrič, Primož [Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana (Slovenia); Department of Radiation Oncology, National Center for Cancer Care and Research, Doha (Qatar); Mahantshetty, Umesh [Department of Radiation Oncology, Tata Memorial Hospital, Mumbai (India); Jürgenliemk-Schulz, Ina M. [Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht (Netherlands); Rai, Bhavana [Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh (India); Cooper, Rachel [Leeds Cancer Centre, St James' s University Hospital, Leeds (United Kingdom); Dörr, Wolfgang [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna and General Hospital of Vienna, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna (Austria); Nout, Remi A. [Department of Radiation Oncology, Leiden University Medical Center, Leiden (Netherlands); Lindegaard, Jacob; Tanderup, Kari; Fokdal, Lars; Van Der Steen Banasik, Elzbieta; Haie-Meder, Christine; Dumas, Isabelle; and others

    2016-04-01

    Purpose: This study analyzed functioning and symptom scores for longitudinal quality of life (QoL) from patients with locally advanced cervical cancer who underwent definitive chemoradiation therapy with image guided adaptive brachytherapy in the EMBRACE study. Methods and Materials: In total, 744 patients at a median follow-up of 21 months were included. QoL was prospectively assessed using European Organization for Research and Treatment of Cancer Quality of Life core module 30 (EORTC QLQ-C30) and EORTC cervical cancer module 24 (CX24) questionnaires at baseline, then every 3 months during the first year, every 6 months in the second and third years, and finally yearly thereafter in patients with no evidence of disease. Outcomes were evaluated over time and compared to those from an age-matched female reference population. Results: General QoL and emotional and social functioning were impaired at baseline but improved during the first 6 months after treatment, to reach a level comparable to that of the reference population, whereas cognitive functioning remained impaired. Both social and role functioning showed the lowest scores at baseline but which increased after treatment to reach a plateau at 6 months and then declined slightly at 3 and 4 years. The overall symptom experience was elevated at baseline and decreased to a level within the range of that of the reference population. Similarly, tumor-related symptoms (eg, pain, appetite loss, and constipation), which were present before treatment, decreased substantially at the first follow-up after treatment. Several treatment-related symptoms developed either immediately after and persisted over time (diarrhea, menopausal symptoms, peripheral neuropathy, and sexual functioning problems) or developed gradually after treatment (lymphedema and dyspnea). Conclusions: This longitudinal prospective QoL analysis showed that patients' general QoL and functioning were impaired before treatment compared to

  5. Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol

    NARCIS (Netherlands)

    Archambault, P.M.; Turgeon, A.F.; Witteman, H.O.; Lauzier, F.; Moore, L.; Lamontagne, F.; Horsley, T.; Gagnon, M.P.; Droit, A.; Weiss, M.; Tremblay, S.; Lachaine, J.; Sage, N. Le; Emond, M.; Berthelot, S.; Plaisance, A.; Lapointe, J.; Razek, T.; Belt, T.H. van de; Brand, K; Berube, M.; Clement, J.; Iii, F.J. Grajales; Eysenbach, G.; Kuziemsky, C.; Friedman, D.; Lang, E.; Muscedere, J.; Rizoli, S.; Roberts, D.J.; Scales, D.C.; Sinuff, T.; Stelfox, H.T.; Gagnon, I.; Chabot, C.; Grenier, R.; Legare, F.

    2015-01-01

    BACKGROUND: Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the

  6. Effects of Magnification on Emotion Perception in Patients With Age-Related Macular Degeneration.

    Science.gov (United States)

    Johnson, Aaron P; Woods-Fry, Heather; Wittich, Walter

    2017-05-01

    Individuals with low vision often experience difficulties in performing tasks of daily living, such as face perception. This leads them to having difficulties with social interactions, as they can no longer correctly perceive the emotion of others. The present study investigated the effects of magnification on face perception in participants with age-related macular degeneration (AMD), and their ability to detect and categorize emotions. It was hypothesized that patients with AMD would be less accurate in comparison to healthy controls, but that magnification would improve their performance to that of controls. Faces containing happy, angry, or neutral emotion were both doubled (equivalent of arm's length distance) and decreased by half in size (equivalent of across the street). The ability to detect and to discriminate emotional content was compared between 20 AMD patients and 7 age-matched controls. Eye movements were recorded while conducting both tasks. Regardless of stimulus size, when compared to controls, we observed that individuals with AMD consistently performed with lower accuracy in both emotion detection and categorization tasks. Moreover, having images undergo a 2-fold increase in size did improve performance, but did not equate AMD participants' performance to that of the controls in either the emotion detection or categorization task. Eye movements in AMD participants were highly variable in position compared to controls. The data suggest that magnification alone does not appear to be the answer for improving emotion perception within individuals with low vision. Next steps should include an evaluation of the effects of viewing strategy.

  7. Aging

    International Nuclear Information System (INIS)

    Sasaki, Hideo; Kodama, Kazunori; Yamada, Michiko

    1991-01-01

    The hypothesis that exposure to ionizing radiation accelerates the aging process has been actively investigated at ABCC-RERF since 1958, when longitudinal cohort studies of the Adult Health Study (AHS) and the Life Span Study (LSS) were initiated. In their 1975 overall review of aging studies related to the atomic bomb (A-bomb) survivors, Finch and Beebe concluded that while most studies had shown no correlation between aging and radiation exposure, they had not involved the large numbers of subjects required to provide strong evidence for or against the hypothesis. Extending LSS mortality data up to 1978 did not alter the earlier conclusion that any observed life-shortening was associated primarily with cancer induction rather than with any nonspecific cause. The results of aging studies conducted during the intervening 15 years using data from the same populations are reviewed in the present paper. Using clinical, epidemiological, and laboratory techniques, a broad spectrum of aging parameters have been studied, such as postmortem morphological changes, tests of functional capacity, physical tests and measurements, laboratory tests, tissue changes, and morbidity. With respect to the aging process, the overall results have not been consistent and are generally thought to show no relation to radiation exposure. Although some preliminary results suggest a possible radiation-induced increase in atherosclerotic diseases and acceleration of aging in the T-cell-related immune system, further study is necessary to confirm these findings. In the future, applying the latest gerontological study techniques to data collected from subjects exposed 45 years ago to A-bomb radiation at relatively young ages will present a new body of data relevant to the study of late radiation effects. (author) 103 refs

  8. The effects of infographics and several quantitative versus qualitative formats for cardiovascular disease risk, including heart age, on people's risk understanding.

    Science.gov (United States)

    Damman, Olga C; Vonk, Suzanne I; van den Haak, Maaike J; van Hooijdonk, Charlotte M J; Timmermans, Danielle R M

    2018-03-11

    To study how comprehension of cardiovascular disease (CVD) risk is influenced by: (1) infographics about qualitative risk information, with/without risk numbers; (2) which qualitative risk dimension is emphasized; (3) heart age vs. traditional risk format. For aim 1, a 2 (infographics versus text) x 2 (risk number versus no risk number) between-subjects design was used. For aim 2, three pieces of information were tested within-subjects. Aim 3 used a simple comparison group. Participants (45-65 yrs old) were recruited through an online access panel; low educated people were oversampled. They received hypothetical risk information (20%/61yrs). Primary outcomes: recall, risk appraisals, subjective/objective risk comprehension. behavioral intentions, information evaluations. Infographics of qualitative risk dimensions negatively affected recall, subjective risk comprehension and information evaluations. No effect of type of risk dimension was found on risk perception. Heart age influenced recall, comprehension, evaluations and affective risk appraisals. Infographics of hypothetical CVD risk information had detrimental effects on measures related to risk perception/comprehension, but effects were mainly seen in undereducated participants. Heart age influenced perceptions/comprehension of hypothetical risk in a way that seemed to support understanding. Heart age seems a fruitful risk communication approach in disease risk calculators. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups.

    Science.gov (United States)

    Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring; Lamberts, Morten; Hansen, Morten Lock; Karasoy, Deniz; Christiansen, Christine Benn; Torp-Pedersen, Christian; Sorensen, Rikke

    2017-09-01

    Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization. Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population. A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users 79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged 79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

  10. The combination of vestibular impairment and congenital sensorineural hearing loss predisposes patients to ocular anomalies, including Usher syndrome.

    Science.gov (United States)

    Kletke, S; Batmanabane, V; Dai, T; Vincent, A; Li, S; Gordon, K A; Papsin, B C; Cushing, S L; Héon, E

    2017-07-01

    The co-occurrence of hearing impairment and visual dysfunction is devastating. Most deaf-blind etiologies are genetically determined, the commonest being Usher syndrome (USH). While studies of the congenitally deaf population reveal a variable degree of visual problems, there are no effective ophthalmic screening guidelines. We hypothesized that children with congenital sensorineural hearing loss (SNHL) and vestibular impairment were at an increased risk of having USH. A retrospective chart review of 33 cochlear implants recipients for severe to profound SNHL and measured vestibular dysfunction was performed to determine the ocular phenotype. All the cases had undergone ocular examination and electroretinogram (ERG). Patients with an abnormal ERG underwent genetic testing for USH. We found an underlying ocular abnormality in 81.81% (27/33) of cases; of which 75% had refractive errors, and 50% of those patients showed visual improvement with refractive correction. A total of 14 cases (42.42%; 14/33) had generalized rod-cone dysfunction on ERG suggestive of Usher syndrome type 1, confirmed by mutational analysis. This work shows that adding vestibular impairment as a criterion for requesting an eye exam and adding the ERG to detect USH increases the chances of detecting ocular anomalies, when compared with previous literature focusing only on congenital SNHL. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Andalusian Registry for Familial Adenomatous Polyposis: Analysis of patients included Registro Andaluz de la Poliposis Adenomatosa Familiar: Análisis de los pacientes incluidos

    Directory of Open Access Journals (Sweden)

    M. Garzón Benavides

    2010-11-01

    Full Text Available Objective: To evaluate the phenotype and genotype characteristic of patients included in the Andalusian Registry for familial adenomatous polyposis, the genotype/phenotype correlation and the impact of Registry in the frequency of colorectal cancer of registered. Material and methods: A descriptive study of 77 patients with FAP belonging to 33 families, included in a centralized database visited by the physicians of the hospitals taking part in the present study, on prior signing of confidentiality letters. All genetic studies were carried out in the Immunology Service of our institution. Results: We have included in our study 77 patients of 33 families; 31 probands with a mean age of 32 years (13-51 and 46 relatives at risk with a mean age of 21.8 years (6-55. Genetic study informed in 68/77 with positive result in 92.6%. Ten probands showed colorectal cancer (CRC at the time of diagnosis (32.2%. Only two affected relatives showed CRC at diagnosis (4.3%, a statistically significant difference (p Objetivos: Valorar las características fenotípicas y genotípicas de los pacientes incluidos en el Registro Andaluz de la poliposis adenomatosa familiar, la relación genotipo/fenotipo y el impacto del Registro en la frecuencia de cáncer colorrectal de los familiares registrados. Material y métodos: Estudio descriptivo de 77 pacientes con PAF, pertenecientes a 33 familias, incluidos en una base de datos centralizada a la que tienen acceso los responsables de los hospitales participantes, previa firma de cartas de confidencialidad. Todos los estudios genéticos se realizan en el Servicio de Inmunología de nuestro Hospital. Resultados: 77 pacientes registrados (50,6% varones: 31 probandos, edad media: 32 años (13-51 y 46 familiares afectos, edad media 21,8 años (6-55. Estudio genético informado en 68/77 con resultado positivo en 92,6%. Cáncer colorrectal al diagnóstico en diez probandos (32,2% y 2 familiares afectos (4,3%, diferencia estad

  12. Dental Age Estimation (DAE): Data management for tooth development stages including the third molar. Appropriate censoring of Stage H, the final stage of tooth development.

    Science.gov (United States)

    Roberts, Graham J; McDonald, Fraser; Andiappan, Manoharan; Lucas, Victoria S

    2015-11-01

    The final stage of dental development of third molars is usually helpful to indicate whether or not a subject is aged over 18 years. A complexity is that the final stage of development is unlimited in its upper border. Investigators usually select an inappropriate upper age limit or censor point for this tooth development stage. The literature was searched for appropriate data sets for dental age estimation and those that provided the count (n), the mean (x¯), and the standard deviation (sd) for each of the tooth development stages. The Demirjian G and Demirjian H were used for this study. Upper and lower limits of the Stage G and Stage H data were calculated limiting the data to plus or minus three standard deviations from the mean. The upper border of Stage H was limited by appropriate censoring at the maximum value for Stage G. The maximum age at attainment from published data, for Stage H, ranged from 22.60 years to 34.50 years. These data were explored to demonstrate how censoring provides an estimate for the correct maximum age for the final stage of Stage H as 21.64 years for UK Caucasians. This study shows that confining the data array of individual tooth developments stages to ± 3sd provides a reliable and logical way of censoring the data for tooth development stages with a Normal distribution of data. For Stage H this is inappropriate as it is unbounded in its upper limit. The use of a censored data array for Stage H using Percentile values is appropriate. This increases the reliability of using third molar Stage H alone to determine whether or not an individual is over 18 years old. For Stage H, individual ancestral groups should be censored using the same technique. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  13. Late-Onset Hypogonadism in Male Patients Over 60 Years of Age with Metabolic Syndrome

    Directory of Open Access Journals (Sweden)

    Ekrem Kara

    2013-06-01

    Full Text Available Purpose: The aim of the study was to determine serum androgen levels and the frequency of late-onset hypogonadism (LOH in patients over 60 years of age with metabolic syndrome (MS and its correlation with parameters of MS. Material and Method: Men over 60 years of age who were diagnosed with MS according to the Adult Treatment Panel III (ATP III criteria in the internal medicine outpatient clinics at Cerrahpasa Medical School (n=30 and healthy controls (n=30 were included in the study. Total testosterone and sex hormone binding globulin (SHBG levels were analysed. Bioavailable and free testosterone levels were calculated. The participants filled up the Beck Depression Inventory (BDI and Aging Male Symptoms (AMS questionnaire forms themselves without any help of the physician. Results: LOH rates were 30% and 13.3% in the MS group and healthy control group, respectively (p=0.11. Serum total testosterone and SHBG levels were significantly lower in the MS group compared to controls (p=0.004 and p=0.003, respectively. A negative correlation was found between total testosterone and MS components. BDI and AMS questionnaire scores in the two groups were not significantly different.Discussion: Serum total testosterone and SHBG levels were lower in the MS group, and inversely proportional to this, insulin resistance and intensity of MS components were increased. Turk Jem 2013; 17: 22-7

  14. Communication Preferences in Young, Middle-Aged, and Elderly Cancer Patients.

    Science.gov (United States)

    Richter, Diana; Ernst, Jochen; Lehmann, Claudia; Koch, Uwe; Mehnert, Anja; Friedrich, Michael

    2015-01-01

    While psychosocial distress and supportive care needs of young adult cancer patients have been increasingly studied, little knowledge exists about preferences for communicating bad news. We aimed to analyze patients' communication preferences against their actual experiences with regard to doctor-patient interactions. We surveyed a total of 270 cancer patients with different tumor entities. 3 age groups (young, middle-aged, and elderly) were compared concerning their communication preferences (MPP; Measure of Patients' Preferences questionnaire) and the impact on distress (National Comprehensive Cancer Network Distress Thermometer). We found no age differences of communication preferences and the content of bad news. A significant difference was found in the dimension 'professional expertise/patient orientation (p younger patients. Binary logistic regression showed an impact of 'children' (odds ratio (OR) 0.296; 95% confidence interval (CI) 0.155, 0.563), tumor staging (OR 1.737, 95% CI 1.028, 2.936), and insufficient 'privacy' (OR 0.987; 95% CI 0.978, 0.997) and 'clarity' (OR 1.013; 95% CI 1.002, 1.025) on distress. Communication preferences related to breaking bad news depend less on age differences than on other variables. Future studies should investigate the long-term impact of ineffective patient-physician communication, taking into account unmet patient preferences in different age groups. © 2015 S. Karger GmbH, Freiburg.

  15. Whole-body-MR imaging including DWIBS in the work-up of patients with head and neck squamous cell carcinoma: A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Noij, Daniel P., E-mail: d.noij@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Boerhout, Els J., E-mail: e.boerhout@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Pieters-van den Bos, Indra C., E-mail: i.pieters@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Comans, Emile F., E-mail: efi.comans@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Oprea-Lager, Daniela, E-mail: d.oprea-lager@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Reinhard, Rinze, E-mail: r.reinhard@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Hoekstra, Otto S., E-mail: os.hoekstra@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Bree, Remco de, E-mail: r.debree@vumc.nl [Department Otolaryngology/Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Graaf, Pim de, E-mail: p.degraaf@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Castelijns, Jonas A., E-mail: j.castelijns@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands)

    2014-07-15

    Objectives: To assess the feasibility of whole-body magnetic resonance imaging (WB-MRI) including diffusion-weighted whole-body imaging with background-body-signal-suppression (DWIBS) for the evaluation of distant malignancies in head and neck squamous cell carcinoma (HNSCC); and to compare WB-MRI findings with {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography ({sup 18}F-FDG-PET/CT) and chest-CT. Methods: Thirty-three patients with high risk for metastatic spread (26 males; range 48–79 years, mean age 63 ± 7.9 years (mean ± standard deviation) years) were prospectively included with a follow-up of six months. WB-MRI protocol included short-TI inversion recovery and T1-weighted sequences in the coronal plane and half-fourier acquisition single-shot turbo spin-echo T2 and contrast-enhanced-T1-weighted sequences in the axial plane. Axial DWIBS was reformatted in the coronal plane. Interobserver variability was assessed using weighted kappa and the proportion specific agreement (PA). Results: Two second primary tumors and one metastasis were detected on WB-MRI. WB-MRI yielded seven clinically indeterminate lesions which did not progress at follow-up. The metastasis and one second primary tumor were found when combining {sup 18}F-FDG-PET/CT and chest-CT findings. Interobserver variability for WB-MRI was κ = 0.91 with PA ranging from 0.82 to 1.00. For {sup 18}F-FDG-PET/CT κ could not be calculated due to a constant variable in the table and PA ranged from 0.40 to 0.99. Conclusions: Our WB-MRI protocol with DWIBS is feasible in the work-up of HNSCC patients for detection and characterization of distant pathology. WB-MRI can be complementary to {sup 18}F-FDG-PET/CT, especially in the detection of non {sup 18}F-FDG avid second primary tumors.

  16. Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands

    NARCIS (Netherlands)

    Leensen, Monique C. J.; Groeneveld, Iris F.; van der Heide, Iris; Rejda, Tomas; van Veldhoven, Peter L. J.; van Berkel, Sietske; Snoek, Aernout; van Harten, Wim; Frings-Dresen, Monique H. W.; de Boer, Angela G. E. M.

    2017-01-01

    Objectives To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to

  17. Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients : A prospective study in the Netherlands

    NARCIS (Netherlands)

    Leensen, Monique C.J.; Groeneveld, Iris F.; Heide, Iris Van Der; Rejda, Tomas; Van Veldhoven, Peter L.J.; Berkel, Sietske Van; Snoek, Aernout; van Harten, Willem H.; Frings-Dresen, Monique H.W.; Boer, Angela G.E.M.

    2017-01-01

    Objectives To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to

  18. Oral administration and younger age decrease plasma concentrations of voriconazole in pediatric patients.

    Science.gov (United States)

    Kato, Karin; Nagao, Miki; Yamamoto, Masaki; Matsumura, Yasufumi; Takakura, Shunji; Fukuda, Kazuhiko; Ichiyama, Satoshi

    2016-01-01

    Voriconazole is used for treating or preventing invasive aspergillosis and other invasive fungal infections. To minimize adverse reactions and to maximize treatment effects, therapeutic drug monitoring should be performed. However, it is challenging to optimize daily voriconazole dosing because limited data have been published so far on pediatric patients. We retrospectively analyzed voriconazole concentrations in patients aged 0-18 years. In addition, a literature review was conducted. In our study cohort, younger age and oral administration were significantly associated with lower plasma voriconazole concentrations (P voriconazole (P = 0.01). Reports of voriconazole administration in pediatric patients show that higher doses are required in younger children and in patients receiving oral administration. Hence, the current data suggest that we should escalate both initial and maintenance doses of voriconazole in pediatric patients, particularly in patients of younger age receiving an oral administration of voriconazole. Copyright © 2015. Published by Elsevier Ltd.

  19. Outcomes of robotic-assisted radical prostatectomy for patients in two extreme age-groups (years vs > 65 years).

    Science.gov (United States)

    Coman, Radu-Tudor; Crisan, Nicolae; Andras, Iulia; Bud, Gabriela; Matei, Deliu-Victor; DE Cobelli, Ottavio; Coman, Ioan; Bocsan, Ioan-Stelian

    2018-01-01

    To assess the outcomes of robotic radical prostatectomy in two different age subgroups of pre-operatively potent patients: younger than 50 years and older than 65 years. We included in the present study a number of 202 patients with prostate cancer divided into two groups: 99 patients older than 65 years (group 1) and 103 patients younger than 50 years (group 2). More than half of the younger patients were low-risk vs 57% of the older patients who were high-risk. Overall positive surgical margins rate was 21.2% in group 1 vs 12.1% in group 2. The early biochemical recurrence at 6 months after radical prostatectomy was 4% in group 1 vs 11.6% in group 2. The continence rate at 6 months was similar between the two groups and was not correlated with the patients' age (p=0.72), nerve-sparing (p=0.3 for group 1, p=0.92 for group 2) or pathological staging (overall p=0.81, p=0.89 in group 1 and p=0.63 in group 2). We observed a significantly higher rate of potency for patients in group 2 (91.5% vs 47.2%, p<0.0001). The most important factor associated with the regain of potency at 6 months after the procedure was the age of the patient (p<0.0001), independently of the type of nerve-sparing performed. Age seems to be the most important predictor of the regain of potency after robotic radical prostatectomy. Patients should be counseled accordingly in order to have realistic expectations about the functional results after robotic-assisted surgery.

  20. Multiple schwannomas, including a plexiform variant, in a patient in the absence of neurofibromatosis I or II

    Directory of Open Access Journals (Sweden)

    Snehlata R Hingway

    2015-01-01

    Full Text Available Multiple schwannomatosis, is defined as two or more, pathologically proven schwannomas, without radiographic evidence of vestibular nerve tumor, below 18 years, or absence of VIII nerve dysfunction beyond 30 years with absence of stigmata of neurofibromatosis 2 (NF2. The plexiform schwannoma (PS is a rare tumor. The gross appearance is an important diagnostic criterion for diagnosis of PSs. It is associated with NF2, which was ruled out in this case. Here we present a 50 year female patient with two nonintradermal schwannomas, in the supraclavicular and infraauricular deep soft tissues. One was plexiform, diagnosed on cytology and confirmed by histopathology. She also had multiple pulmonary and pleural lesions. Fine needle aspiration cytology smears from both supraclavicular and infraauricular lesions as well as the lung lesion sampled, showed spindle cells in a myxoid background, having wavy nuclei with pointed ends. Verocay body - like palisading of nuclei was noted.

  1. Association between functional performance and executive cognitive functions in an elderly population including patients with low ankle–brachial index

    Science.gov (United States)

    Ferreira, Naomi Vidal; Cunha, Paulo Jannuzzi; da Costa, Danielle Irigoyen; dos Santos, Fernando; Costa, Fernando Oliveira; Consolim-Colombo, Fernanda; Irigoyen, Maria Cláudia

    2015-01-01

    Introduction Peripheral arterial disease, as measured by the ankle–brachial index (ABI), is prevalent among the elderly, and is associated with functional performance, assessed by the 6-minute walk test (6MWT). Executive cognitive function (ECF) impairments are also prevalent in this population, but no existing study has investigated the association between ECF and functional performance in an elderly population including individuals with low ABI. Aim To investigate the association between functional performance, as measured by the 6MWT, and loss in ECF, in an elderly sample including individuals with low ABI. Method The ABI group was formed by 26 elderly individuals with low ABI (mean ABI: 0.63±0.19), and the control group was formed by 40 elderly individuals with normal ABI (mean ABI: 1.08±0.07). We analyzed functional performance using the 6MWT, global cognition using the Mini-Mental State Examination (MMSE), and ECF using the Digit Span for assessing attention span and working memory, the Stroop Color Word Test (SCWT) for assessing information processing speed and inhibitory control/impulsivity, and the Controlled Oral Word Association Test (COWAT) for assessing semantic verbal fluency and phonemic verbal fluency. We also used a factor analysis on all of the ECF tests (global ECF). Results Before adjustment, the ABI group performed worse on global cognition, attention span, working memory, inhibitory control/impulsivity, semantic verbal fluency, and phonemic verbal fluency. After adjustment, the ABI group performance remained worse for working memory and semantic verbal fluency. In a simple correlation analysis including all of the subjects, the 6MWT was associated with global cognition, attention span, working memory, information processing speed, inhibitory control/impulsivity, semantic verbal fluency, and global ECF. After adjustment, all the associations remained statistically significant. Conclusion This study found an independent association between

  2. Radiation therapy for stage I-II non-small cell lung cancer in patients aged 75 years and older

    International Nuclear Information System (INIS)

    Furuta, Masaya; Hayakawa, Kazushige; Katano, Susumu

    1996-01-01

    Between 1976 and 1992, 32 patients aged 75 and older with stage I-II non-small cell lung cancer (NSCLC) were given definitive radiation therapy. These patients did not undergo surgery because of old age, poor cardiac/pulmonary condition, or refusal to give consent. The mean age was 79 years, and 11 patients were over 80 years old. The histologic type was squamous cell carcinoma in 25 patients and adenocarcinoma in 7. The clinical T and N stage was T1N0 in 4 patients, T2N0 in 9, and T2N0 in 19. The total dose of radiation therapy given to each patient exceeded 60 Gy using 10-MV X-rays. The treatment was completed in all 32 patients without treatment-related complications. The 2- and 5-year overall actuarial survival rates were 40% and 16%, respectively. Eleven intercurrent deaths occurred, including 7 patients who died of heart disease. The 2- and 5-year cause-specific survival rates were 57% and 36%, respectively. None of the patients developed severe pneumonitis requiring hospitalization. All but three patients received radiation therapy on an inpatient basis. The mean duration of the hospital stay for initial treatment was 56 days, and mean ratio to total survival period (mean 739 days) was 8%. Although many elderly patients have concurrent medical complications such as heart disease and chronic pulmonary disease, the present study showed that elderly patients with clinical stage I-II NSCLC can expert a realistic probability of long-term survival with definitive radiation therapy. (author)

  3. Increased active von Willebrand factor during disease development in the aging diabetic patient population.

    Science.gov (United States)

    Chen, Shuang Feng; Xia, Zuo Li; Han, Ji Ju; Wang, Yi Ting; Wang, Ji Yue; Pan, Shao Dong; Wu, Ya Ping; Zhang, Bin; Li, Guang Yao; Du, Jing Wei; Gao, Hen Qiang; de Groot, Philip G; de Laat, Bas; Hollestelle, Martine J

    2013-02-01

    Type 2 diabetes is known to cause endothelial activation resulting in the secretion of von Willebrand factor (VWF). We have shown that levels of VWF in a glycoprotein Ib-binding conformation are increased in specific clinical settings. The aim of the current study is to investigate whether active VWF levels increase during aging and the development of diabetes within the population of patients suffering from type 2 diabetes. Patients and controls were divided into two groups based on age: older and younger than 60 years of age. VWF antigen, VWF propeptide, VWF activation factor and total active VWF were measured. Patients older than 60 years of age had increased levels of total active VWF, VWF activation factor and VWF propeptide compared to younger patients and controls. All measured VWF parameters were associated with age in diabetic patients. Total active VWF and VWF propeptide correlated with the period of being diagnosed with diabetes. Regression analyses showed that especially the VWF activation factor was strongly associated with diabetes in patients older than 60 years of age. In conclusion, we found that the conformation of VWF could be involved in the disease process of diabetes and that the VWF in a glycoprotein Ib-binding conformation could play a role as risk marker during the development of diabetes in combination with an increase in age. Our study shows that the active quality of VWF was more important than the quantity.

  4. Safety and efficacy of vismodegib in patients aged ≥65 years with advanced basal cell carcinoma.

    Science.gov (United States)

    Chang, Anne Lynn S; Lewis, Karl D; Arron, Sarah T; Migden, Michael R; Solomon, James A; Yoo, Simon; Day, Bann-Mo; McKenna, Edward F; Sekulic, Aleksandar

    2016-11-15

    Because many patients with unresectable basal cell carcinoma (BCC) are aged ≥65 years, this study explores the efficacy and safety of vismodegib in these patients with locally advanced (la) or metastatic (m) basal cell carcinoma (BCC) in the ERIVANCE BCC trial and the expanded access study (EAS).We compared patients aged ≥65 years to patients aged <65 years taking vismodegib 150 mg/day, using descriptive statistics for response and safety. Patients aged ≥65 years (laBCC/mBCC) were enrolled in ERIVANCE BCC (33/14) and EAS (27/26). Investigator-assessed best overall response rate in patients ≥65 and <65 years was 46.7%/35.7% and 72.7%/52.6% (laBCC/mBCC), respectively, in ERIVANCE BCC and 45.8%/33.3% and 46.9%/28.6%, respectively, in EAS. These differences were not clinically meaningful. Safety was similar in both groups, although those aged ≥65 years had a higher percentage of grade 3-5 adverse events than those aged <65 years. Vismodegib demonstrated similar clinical activity and adverse events regardless of age.

  5. Age-related changes in plasma levels of BDNF in Down syndrome patients

    Directory of Open Access Journals (Sweden)

    Licastro Federico

    2010-01-01

    Full Text Available Abstract Background The prevalence of coronary artery diseases is low among Down Syndrome (DS patients and they rarely die of atherosclerotic complications. Histopathological investigations showed no increase in atherosclerosis, or even a total lack of atherosclerotic changes, in DS Aim The aim of our study is to investigate the relationship between age and brain-derived neurotrophic factor (BDNF levels in Down Syndrome (DS. Subjects and methods Three groups of DS patients were studied: the first consisted of 23 children (age 2-14 years; the second of 14 adults (age 20-50 years, the third group of 13 elderly persons (>60 years and a controls group of 20 healthy patients (age 15-60 years. The analytes of interest were quantified using a biochip array analyzer (Evidence®, Randox Ltd., Crumlin, UK. Results Plasma BDNF was higher in DS patients than in controls and there was a significant age-related increase. Serum levels of IL-6 and MCP-1 were also higher in DS children and adults, but not in older patients, than in healthy control. High levels of circulating BDNF may protect DS patients from the clinical complications of atherosclerosis. However, the striking drop in peripheral BDNF levels with age might predispose these patients to clinical manifestations of dementia in later life.

  6. Dysbiosis and compositional alterations with aging in the gut microbiota of patients with heart failure.

    Science.gov (United States)

    Kamo, Takehiro; Akazawa, Hiroshi; Suda, Wataru; Saga-Kamo, Akiko; Shimizu, Yu; Yagi, Hiroki; Liu, Qing; Nomura, Seitaro; Naito, Atsuhiko T; Takeda, Norifumi; Harada, Mutsuo; Toko, Haruhiro; Kumagai, Hidetoshi; Ikeda, Yuichi; Takimoto, Eiki; Suzuki, Jun-Ichi; Honda, Kenya; Morita, Hidetoshi; Hattori, Masahira; Komuro, Issei

    2017-01-01

    Emerging evidence has suggested a potential impact of gut microbiota on the pathophysiology of heart failure (HF). However, it is still unknown whether HF is associated with dysbiosis in gut microbiota. We investigated the composition of gut microbiota in patients with HF to elucidate whether gut microbial dysbiosis is associated with HF. We performed 16S ribosomal RNA gene sequencing of fecal samples obtained from 12 HF patients and 12 age-matched healthy control (HC) subjects, and analyzed the differences in gut microbiota. We further compared the composition of gut microbiota of 12 HF patients younger than 60 years of age with that of 10 HF patients 60 years of age or older. The composition of gut microbial communities of HF patients was distinct from that of HC subjects in both unweighted and weighted UniFrac analyses. Eubacterium rectale and Dorea longicatena were less abundant in the gut microbiota of HF patients than in that of HC subjects. Compared to younger HF patients, older HF patients had diminished proportions of Bacteroidetes and larger quantities of Proteobacteria. The genus Faecalibacterium was depleted, while Lactobacillus was enriched in the gut microbiota of older HF patients. These results suggest that patients with HF harbor significantly altered gut microbiota, which varies further according to age. New concept of heart-gut axis has a great potential for breakthroughs in the development of novel diagnostic and therapeutic approach for HF.

  7. THE RELATIONSHIP BETWEEN ANISOMETROPIA, PATIENT AGE, AND THE DEVELOPMENT OF AMBLYOPIA

    Science.gov (United States)

    Donahue, Sean P

    2005-01-01

    Purpose Anisometropia is a common cause of amblyopia. The relationship between anisometropia, patient age, and the development of amblyopia is unknown. Photoscreening identifies children with anisometropia in a manner that is not biased by visual acuity and allows a unique opportunity to evaluate how patient age influences the prevalence and depth of anisometropic amblyopia. Methods A statewide preschool photoscreening program screened 120,000 children and identified 792 with anisometropia greater than 1.0 diopter. Age was correlated with visual acuity and amblyopia depth. Data were compared with those from 562 strabismic children similarly identified. Results Only 14% (6/44) of anisometropic children aged 1 year or less had amblyopia. Prevalence was 40% (32/80) for 2-year-olds, 65% (119/182) for 3-year-olds, and peaked at 76% (age 5). Amblyopia depth also increased with age. Moderate amblyopia prevalence was 2% (ages 0 to 1), 17% (age 2), and rose steadily to 45% (ages 6 to 7). Severe amblyopia was rare prior to age 4, 9% at age 4, 14% at age 5, and 9% at ages 6 to 7. In contrast, children with strabismus had a stable prevalence of amblyopia (30% at ages 0 to 2, 42% at ages 3 to 4, 44% at ages 5 to 7). Conclusions Younger children with anisometropic refractive error have a lower prevalence and depth of amblyopia than do older children. By age 4, when most children undergo traditional screening, amblyopia has usually already developed. New vision screening technologies that allow early detection of anisometropia provide ophthalmologists an opportunity to intervene early, perhaps retarding, or even preventing, the development of amblyopia. PMID:17057809

  8. Metabolic risk factors, coping with stress, and psychological well-being in patients with age-related macular degeneration.

    Science.gov (United States)

    Cavar, Ivan; Lovrić, Sanjin; Vukojević, Mladenka; Sesar, Irena; Petric-Vicković, Ivanka; Sesar, Antonio

    2014-03-01

    The aim of this study was to determine the relationship between the risk factors (age, obesity, hypertension, hyperlipidemia, smoking, consumption of alchohol and drugs, positive family history, and exposure to sunlight), coping with stress, psychological well-being and age-related macular degeneration (ARMD). Forty patients with ARMD (case group) and 63 presbyopes (control group) participated in the study. Patient data were collected through general information questionnaire including patient habits, the COPE questionnaire that showed the way the patients handling stress, and the GHQ that analyzed the psychological aspects of their quality of life. These questionnaires were administered to the patients during ophthalmologic examination. The study involved 46 (44.66%) men and 57 (55.33%) women. Statistical analysis showed that the major risks for the development of ARMD were elevated cholesterol, triglycerides and LDL cholesterol in plasma. A significantly higher number ofARMD patients had a positive family history when compared with presbyopes. This study showed presbyopes to cope with emotional problems significantly better and to have a lower level of social dysfunction when compared with ARMD patients. However, it is necessary to conduct further studies in a large number of patients to determine more accurately the pathophysiological mechanisms of metabolic factors as well as the impact of the disease on the quality of life in patients with ARMD.

  9. Adipocyte tissue volume in bone marrow is increased with aging and in patients with osteoporosis

    DEFF Research Database (Denmark)

    Justesen, J; Dokkedahl, Karin Stenderup; Ebbesen, E N

    2001-01-01

    Aging of the human skeleton is characterized by decreased bone formation and bone mass and these changes are more pronounced in patients with osteoporosis. As osteoblasts and adipocytes share a common precursor cell in the bone marrow, we hypothesized that decreased bone formation observed during...... aging and in patients with osteoporosis is the result of enhanced adipognesis versus osteoblastogenesis from precursor cells in the bone marrow. Thus, we examined iliac crest bone biopsies obtained from 53 healthy normal individuals (age 30-100) and 26 patients with osteoporosis (age 52-92). Adipose...... tissue volume fraction (AV), hematopoietic tissue volume fraction (HV) and trabecular bone volume fraction (BV) were quantitated as a percentage of total tissue volume fraction (TV) (calculated as BV + AV + HV) using the point-counting method. We found an age-related increase in AV/TV (r = 0.53, P

  10. Age-related cognitive effects of ECT and ECT-induced mood improvement in depressive patients

    NARCIS (Netherlands)

    bosboom, P.R.; Deijen, J.B.

    2006-01-01

    This explorative study investigated the interaction between electroconvulsive therapy (ECT) treatment-effect, reduced depression, and neuropsychological outcome in relation to age. Follow-up neuropsychological assessment was conducted with depressive patients treated with ECT. From a potential

  11. Serum APOE, leptin, CFH and HTRA1 levels in Pakistani age related macular degeneration patients.

    Science.gov (United States)

    Qureshi, Irfan Zia; Ambreen, Fareeha

    2017-06-01

    To determine the association between serum levels of apolipoprotein E, leptin, complimentary factor H and high temperature requirement A-1 in patients with age-related macular degeneration. This case-control study was conducted at the Quaid-i-Azam University, Islamabad, Pakistan, from May to October 2013, and comprised patients with age-related macular degeneration and matching controls. The confirmation of age-related macular degeneration was carried out through slit lamp examination, fundoscopy and ocular coherence tomography. The selected subjects were not suffering with any other systemic or ophthalmic complication(s). Serum apolipoprotein E, leptin, complimentary factor H and high temperature requirement A-1 were estimated in serum samples of all subjects. SPSS 18 was used for data analysis. Of the 190 participants, 90(47.4%) were patients with age-related macular degeneration and 100(52.6%) were controls. Significantly elevated serum apolipoprotein E (page-related macular degeneration patients.

  12. Including limitations in news coverage of cancer research: effects of news hedging on fatalism, medical skepticism, patient trust, and backlash.

    Science.gov (United States)

    Jensen, Jakob D; Carcioppolo, Nick; King, Andy J; Bernat, Jennifer K; Davis, LaShara; Yale, Robert; Smith, Jessica

    2011-05-01

    Past research has demonstrated that news coverage of cancer research, and scientific research generally, rarely contains discourse-based hedging, including caveats, limitations, and uncertainties. In a multiple message experiment (k = 4 news stories, N = 1082), the authors examined whether hedging shaped the perceptions of news consumers. The results revealed that participants were significantly less fatalistic about cancer (p = .039) and marginally less prone to nutritional backlash (p = .056) after exposure to hedged articles. Participants exposed to articles mentioning a second researcher (unaffiliated with the present study) exhibited greater trust in medical professions (p = .001). The findings provide additional support for the inclusion of discourse-based hedging in cancer news coverage and suggest that news consumers will use scientific uncertainty in illness representations.

  13. Patients' experiences of nursing actions during intravitreal treatment for wet age-related macular degeneration

    OpenAIRE

    Rönn Emsfors, Åsa; Elgán, Carina

    2015-01-01

    Purpose: The aim was to identify and describe nursing actions performed by nursing staff in which patients with wet age-related macular degeneration (AMD) experience good nursing care. Method: An explorative and descriptive qualitative design based on the Critical incident technique (CIT) was used. A strategic sample of 16 patients, aged 61-87 years (eleven women and five men) with wet AMD who received intravitreal treatment were interviewed. Results: Two main areas of good nursing care was i...

  14. Social demand for oral surgery in third age patients and its association with systemic pathologies

    OpenAIRE

    Martínez González, José María; Martín López, Félix; Barona Dorado, Cristina; Martínez Rodríguez, Natalia; Calvo Guirado, José Luis

    2010-01-01

    Objectives: To determine the frequency of systemic pathologies in patients aged 65 years or more, who require oral care and possibly oral surgery. Study Design: We carried out a cross-sectional descriptive study reviewing 3,388 medical histories for patients from the Department of Medicine and Oral Surgery of the School of Dentistry at the Complutense University of Madrid, who had requested surgical treatment. Those selected were at least 65 years of age or more, and were grouped accordi...

  15. The evaluation of endothelial function and structure in hirsute patients in reproductive age.

    Science.gov (United States)

    Atasayan, Kemal; Yoldemir, Tevfik; Ramoglu, Sedef; Yavuz, Dilek Gogas

    2016-11-01

    To evaluate the endothelial function and structure in patients with hirsutism in reproductive age. The study was conducted on 69 consecutive women admitted with complaints of hirsutism and 63 voluntary healthy women, as controls. A total of 132 subjects who applied to the Gynecology and Infertility Outpatient Clinics were included. Participants with modified Ferriman Gallway (mFG) score over 8 were considered to be hirsute. The demographic, metabolic, hormonal characteristics, risk factors of cardiovascular disease, CIMT (carotis intima media thickness) and FMD (flow-mediated dilatation) were compared between hirsute women and those in the control group. A prospective case-control study was performed. There was no statistically significant difference in CIMT (0,50±0,08 vs 0,52±0,08, p=0.38) and FMD (10,80±6,83 vs 9,57±6,52, p=0.34) values between the study and control groups, respectively. There was no statistically significant correleation between CIMT and FMD values with age, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio, CRP (C-reactive protein), total cholesterol, LDL (low density lipoprotein), HDL (high density lipoprotein), total testosteron, FAI (free androjen index), androstenedion, SHBG (sex hormone binding globuline), DHEA-S, hirsutism score, sistolic blood pressure, diastolic blood pressure, HOMA-IR (homeostatic model of assesment insuline resistance) value. The effect of the presence of hirsutism on either CIMT and FMD values, among young patients was not significant. Since endothelial dysfunction might became evident after a long period of physio-pathological process, our findings obtained from younger patients may not really show the impact of hirsutism on endothelial function in short term. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. The effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery.

    Science.gov (United States)

    Song, Inkyung; Kim, Dong Yeon; Kim, Youn Jin

    2012-11-01

    Inflation and deflation of a pneumatic tourniquet used in total knee replacement surgery induces various changes in patient's hemodynamic and metabolic status, which may result in serious complications, especially in aged patients. Near-infrared spectroscopy (NIRS) is a monitoring device designed to estimate the regional cerebral oxygen saturation. We evaluated the effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery, using NIRS. Twenty-eight American Society of Anesthesiologists physical status I or II patients, over the age of sixty-five years undergoing total knee replacement surgery, were included. Under general anesthesia, the mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), stroke volume (SV), and regional cerebral oxygen saturation (rSO(2)) were recorded before induction of anesthesia and every 2 min after tourniquet deflation for 20 min. Arterial blood gas analysis was performed 5 min before, in addition to 0, and 10 min after tourniquet deflation. The decrease of rSO(2) was not significant during 20-min deflation period. MAP, CO and SV showed significant decrease during 2 to 12, 4 to 6 and 2 to 6-min period after tourniquet deflation, respectively (P deflation caused significant changes in hemodynamic and metabolic status, but not in regional cerebral oxygen saturation. It is recommended to monitor neurologic status, as well as hemodynamic and metabolic status to avoid serious complications, especially in aged patients.

  17. Older age and steroid use are associated with increasing polypharmacy and potential medication interactions among patients with inflammatory bowel disease.

    Science.gov (United States)

    Parian, Alyssa; Ha, Christina Y

    2015-06-01

    Comorbidity and polypharmacy, more prevalent among older persons, may impact the treatment of patients with inflammatory bowel disease (IBD). The aims of this study were to assess the frequency of polypharmacy and medication interactions within a cohort of older patients with IBD and describe IBD treatment patterns. Cohort study of 190 patients with IBD 65 years or older followed at a tertiary IBD referral center from 2006 to 2012. Data collected included demographics, IBD-specific characteristics including disease activity, and comorbidity. Medication histories were extracted from medical records, and data were used to classify polypharmacy, frequency, and severity of potential medication interactions and inappropriate medication use. Older patients with IBD were prescribed an average of 9 routine medications. Severe polypharmacy (≥10 routine medications) was present in 43.2% of studied patients and associated with increasing age, greater comorbidity, and steroid use. Overall, 73.7% of patients had at least 1 potential medication interaction, including 40% of patients with potential IBD medication-associated interactions. Chronic steroids were prescribed to 40% of the older patients including 24% who were in remission or with mild disease activity. Only 39.5% of patients were on immunomodulators and 21.1% on biologics. Approximately, 35% of patients were given at least 1 Beers inappropriate medication and almost 10% were receiving chronic narcotics. Older patients with IBD are at increased risk for severe polypharmacy and potential major medication interactions especially with increasing comorbidity and chronic steroid use. Steroid-maintenance therapies are prevalent among the older patients with IBD with lower utilization of steroid-sparing regimens.

  18. Changes of serum sex hormones levels in aged patient with peptic ulcer

    International Nuclear Information System (INIS)

    Huang Xiuhai; Xiao Chuangqing; He Yunnan; Li Xuewen; Bi Chao; Zhang Yifan

    2005-01-01

    Objective: To investigate the changes of serum contents of testosterone (T), estradiol (E 2 ) and cortisol (Cor) in aged patients with peptic ulcer. Methods: Serum T, E 2 and Cor levels were determined with CLIA in 86 aged patients with peptic ulcer both before treatment (active stage) and after treatment for 6 weeks (healing stage) as well as in 76 controls. Results: Serum contents of T and E 2 in the patients during active stage were significantly lower than those in patients during healing stage and in controls (both P 0.05). Conclusion: A lower serum T and E 2 contents was present in aged patients with peptic ulcer during active stage. (authors)

  19. Radiation therapy for the old aged patient suffered from carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Arai, Tatsuo; Morita, Shinroku; Fukuhisa, Kenjiro; Wada, Susumu.

    1984-01-01

    Since a majority of old aged patients have the troublesome complications and their physical or mental emaciation is clearly appeared, it is necessary for them to adopt a new treatment method which was considered about thier such conditions. The crude survival rate of old aged, over 71, patients suffered from carcinoma of the uterine cervix were 63.6% (7/11) for stage 1, 60% (36/60) for stage 2, 50% (53/106) for stage 3 and 28.6% (8/28) for stage 4. About 20% of patients in each stages were suffered from the complications. We considered the treatment method for the old aged patients such as follows: the radiation dose must be reduced 10% for 71 to 75 year old and 20% for 76 to 80 year old. In the case of over 81 year old, an intracavitary irradiation is only applied for the palliative aim at the out patient clinic. (author)

  20. Serum AGEs in black South African patients with type 2 diabetes

    African Journals Online (AJOL)

    known to be derived from lipid and lipoprotein oxidation.2,3. Furthermore, the observed significant differences in the correlation coefficients between serum AGEs measured in diabetic patients and those measured in non-diabetic subjects could be attributed to the effect of hyperglycaemia on the formation of AGEs.2,3.

  1. Influence of patients' age at implantation on mortality and defibrillator shocks.

    Science.gov (United States)

    Saba, Samir; Adelstein, Evan; Wold, Nicholas; Stein, Kenneth; Jones, Paul

    2017-05-01

    Patients have increasing comorbidities and competing causes of death with advancing age, raising questions about the effectiveness of the implantable cardioverter defibrillators (ICD) in older age. We therefore investigated the effect of patients' age at initial device implantation on all-cause mortality and on the risk of ICD shocks in single-chamber (V-ICD), dual-chamber (D-ICD), and cardiac resynchronization therapy defibrillator (CRT-D) recipients. We reviewed de-identified records of 67 128 ICD recipients enrolled in the Boston Scientific ALTITUDE database of remote monitored patients [V-ICD (n = 11 422), D-ICD (n = 23 974), and CRT-D (n = 31 732)]. Over a mean follow-up of 2.3 ± 1.4 years, patients in all ICD groups had increased all-cause mortality but decreased risk of defibrillator shocks and/or anti-tachycardia pacing per 10 year increase in age. Compared with the youngest age group (defibrillators have higher mortality but fewer ICD shocks and/or therapies compared with younger patients. These data highly suggest less benefit of ICD therapy with increasing age, presumably because of competing risks of non-arrhythmic mortality. The role of defibrillator therapy in older patients may need to be evaluated with randomized controlled trials. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  2. Relationship Between Age at Menarche and Skeletal Maturation Stages in Taiwanese Female Orthodontic Patients

    OpenAIRE

    Lai, Eddie Hsiang-Hua; Chang, Jenny Zwei-Chieng; Yao, Chung-Chen Jane; Tsai, Shih-Jaw; Liu, Jen-Pei; Chen, Yi-Jane; Lin, Chun-Pin

    2008-01-01

    Background/Purpose: The age at menarche reflects a pubertal girl's physiologic maturity. The aims of this study were to evaluate the relationship between the age at menarche and skeletal maturation in female orthodontic patients. Methods: Hand-wrist radiographs and lateral cephalometric radiographs from 304 adolescent female subjects (age, 8–18.9 years) were selected from the files of the Department of Orthodontics, National Taiwan University Hospital (NTUH). Hand-wrist bone maturation sta...

  3. Successful aging theory and the patient with chronic renal disease: application in the clinical setting.

    Science.gov (United States)

    Blevins, Candy; Toutman, Meredith Flood

    2011-01-01

    As life expectancies increase, nurses will care for more individuals with chronic conditions, one of which is chronic renal disease. Increasing diversity and complexity of older adult healthcare needs signals a need to reconceptualize perceptions of successful aging. By emphasizing health promotion and adaptation, successful aging is possible for those with chronic renal disease. This article provides an overview of theory-based strategies for fostering successful aging in the patient with chronic renal disease.

  4. The Importance of Aging in Gray Matter Changes Within Tinnitus Patients Shown in Cortical Thickness, Surface Area and Volume.

    Science.gov (United States)

    Yoo, Hye Bin; De Ridder, Dirk; Vanneste, Sven

    2016-11-01

    Aging and sensorineural hearing loss are known to be involved in the development of chronic tinnitus. This study explores the structural changes of gray matter using surface base methods and focuses more specifically on changes in cortical thickness in 127 tinnitus patients. The linear relationships between cortical thickness and behavioral measures including aging, tinnitus loudness, tinnitus duration, tinnitus distress, and hearing loss were analyzed. Three dimensional T1-weighted MR images were acquired and cortical gray matter volumes were segmented using FreeSurfer on Talairach space. The results showed that cortical thickness and volume are negatively correlated to age in widespread regions of frontal cortices, and positively to bilateral entorhinal cortex and left rostral anterior cingulate cortex. The cortical thickness changes related to hearing loss overlap with those related to normal aging. The gray matter volumes of bilateral amygdalae, hippocampi, nuclei accumbens, and thalami are all significantly negatively correlated to age. Tinnitus-related distress level and subjective loudness were negatively correlated only to the thalamic volume. The results suggest that the primary factor of long-term structural changes in chronic tinnitus patients is age and age related hearing loss, rather than hearing loss per se. Tinnitus related factors such as subjective tinnitus loudness, tinnitus duration, and the level of chronic tinnitus related distress were not correlated to important morphometric changes in this study.

  5. Understanding why cancer patients accept or turn down psycho-oncological support: a prospective observational study including patients' and clinicians' perspectives on communication about distress.

    Science.gov (United States)

    Zwahlen, Diana; Tondorf, Theresa; Rothschild, Sacha; Koller, Michael T; Rochlitz, Christoph; Kiss, Alexander

    2017-05-30

    International standards prioritize introducing routine emotional distress screening in cancer care to accurately identify patients who most need psycho-oncological treatment, and ensure that patients can access appropriate supportive care. However, only a moderate proportion of distressed patients accepts referrals to or uses psycho-oncological support services. Predictors and barriers to psycho-oncological support service utilization are under-studied. We know little about how patients and oncologists perceive the discussions when oncologists assess psychosocial distress with a screening instrument. We aim to 1) assess the barriers and predictors of uptake of in-house psycho-oncological support along the distress screening pathway in cancer patients treated at a University Oncology Outpatient Clinic and, 2) determine how patients and clinicians perceive communication about psychosocial distress after screening with the Distress Thermometer. This is a quantitative prospective observational study with qualitative aspects. We will examine medical and demographic variables, cancer patient self-reports of various psychological measures, and aspects of the patient-clinician communication as variables that potentially predict uptake of psycho-oncological support service. We will also assess the patients' reasons for accepting or refusing psycho-oncological support services. We assess at three points in time, based on paper-and-pencil questionnaires and two patient interviews during the study period. We will monitor outcomes (psycho-oncology service uptake) four months after study entry. The study will improve our understanding of characteristics of patients who accept or refuse psycho-oncological support, and help us understand how patients' and oncologists perceive communication about psychosocial distress, and referral to a psycho-oncologist. We believe this is the first study to focus on factors that affect uptake or rejection of psycho-oncological support services

  6. Results of Surgical Treatment of Lung Cancer in Patients of Different Age Groups

    Directory of Open Access Journals (Sweden)

    Alexei L. Charyshkin

    2017-06-01

    Full Text Available Background: Lung cancer is one of the most common cancers in the world. The main objective of our study was to analyze the results of the surgical treatment of non-small cell lung cancer (NSCLC in patients of different age groups. Methods and Results: We examined 280 patients (262/93.6% men and 18/6.4% women aged from 39 to 75 years with NSCLC who underwent surgical treatment in the Ulyanovsk Regional Oncology Center in the period from 2010 to 2016. The mean age of patients was 64.9±10.1 years. Concomitant diseases were identified in 256(91.4% patients: cardiovascular diseases in 170(60.7%, COPD in 147 (52.5%, lower extremity peripheral artery disease (stages II and III chronic ischemia in 49(17.5%, a combination of concomitant pathology in 110(39.3% patients. A total of 85(30.4% pneumonectomies were performed, 56 of them in patients of young and middle age. Among early postoperative complications, the most frequent complications were purulent-inflammatory complications of the soft tissues of wounds (38.5% and bronchopleural fistula (31.1%. The most severe complications, such as myocardial infarction, acute stroke, and acute limb ischemia, developed in patients with concomitant cardiovascular diseases, which caused the postoperative mortality of 4.6%. Conclusion: There were no statistically significant differences in the structure of complications depending on sex and age.

  7. Short Term Results of Cardiac Surgery in Patients over 80 Years of Age

    Directory of Open Access Journals (Sweden)

    Kemal Uzun

    2011-08-01

    Full Text Available Background: Despite relatively higher risk of cardiac operation over 80 years of age, the rate of cardiac operations in this age group is rising gradually. We aimed in our study to draw attention to the increased frequency of this age group patients and retrospectively to investigate postoperative short term results in our patients.Patients and Method: In this study 58 patients (31 males, 27 females; mean age 83.74±2.769; range 80 to 89 years who underwent cardiac surgery in our clinic between June 2008 and July 2010 were reviewed. Fifty two patients (89.7% underwent coronary artery by-pass grafting (CABG (5 of them off-pump, one patient (1.7% underwent CABG + aortic valve replacement (AVR, one patient (1.7% underwent CABG + mitral valve replacement (MVR, one patient (1.7% underwent CABG + left ventricle aneurysmectomy, one patient (1.7% underwent AVR + MVR, and two patients (3.4% underwent CABG + AVR + MVR. We used biological valves in all patients requiring valve replacement. Left internal mammary artery was used in 49 (90.74% of 54 patients in whom left anterior descending artery was diseased. The number of distal anastomosis was 3.14±1.00 in average.Results: Hospital mortality was 1.7% with one case. This patient who had preoperative renal function disorder lost his life due to multiorgan failure which was induced by renal failure. 0ne patient was reopened because of postoperative bleeding (1.7%. Twelve patients developed temporary atrial fibrillation (20.7%. Permanent pace-maker implantation was not required for any patient. Three patients (5.2% suffered for wound infections at saphenous vein region. No sternal infection or mediastinitis was encountered. No patient experienced minor or major neurologic event. While two patients (3.4% remained intubated for more than 24 hours, 6 patients (10.3% stayed in intensive care unit for more than 2 days.Conclusion: When rational decisions are made in the selection of patients and surgical

  8. Homocysteine & its metabolite homocysteine-thiolactone & deficiency of copper in patients with age related macular degeneration - A pilot study.

    Science.gov (United States)

    Bharathselvi, Muthuvel; Biswas, Sayantan; Raman, Rajiv; Selvi, Radhakrishnan; Coral, Karunakaran; Narayanansamy, Angayarkanni; Ramakrishnan, Sivaramakrishnan; Sulochana, Konerirajapuram N

    2016-06-01

    Age related macular degeneration (ARMD) is a leading cause of blindness, particularly in persons above 60 yr of age. Homocysteine is implicated in many ocular diseases including ARMD. This study was undertaken to assess the status and relationship between plasma homocysteine, homocysteine - thiolactone, homocysteinylated protein and copper levels in patients with ARMD. A total of 16 patients with ARMD and 16 age-matched controls were recruited for the study. Plasma glutathione, homocysteine, homocysteine - thiolactone and extent of homocysteine conjugation with proteins, copper and thiobarbituric acid reactive substances were measured. Homocysteine levels were elevated with increase in homocysteine-thiolactone, thiobarbituric acid reactive substances and a decrease of glutathione. The levels of homocysteinylated protein were elevated in ARMD. The elevated homocysteine, homocysteine-thiolactone correlated with the decrease in copper level. Elevated homocysteine and its metabolite homocysteine-thiolactone and decreased levels of copper may play an important role in the pathogenesis of ARMD.

  9. The Comparison of Sagittal Spinopelvic Parameters between Young Adult Patients with L5 Spondylolysis and Age-Matched Control Group

    Science.gov (United States)

    Oh, Young Min; Choi, Ha Young

    2013-01-01

    Objective To compare spinopelvic parameters in young adult patients with spondylolysis to those in age-matched patients without spondylolysis and investigate the clinical impact of sagittal spinopelvic parameters in patients with L5 spondylolysis. Methods From 2009 to 2012, a total of 198 young adult male patients with spondylolysis were identified. Eighty age-matched patients without spondylolysis were also selected. Standing lateral films that included both hip joints were obtained for each subject. Pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis angle, sacral inclination, lumbosacral angle, and sacral table angle were measured in both groups. A comparative study of the spinopelvic parameters of these two groups was performed using SPSS 15.0 (SPSS Inc., Chicago, IL, USA). Results Among the aforementioned spinopelvic parameters, PI, SS and STA were significantly different between patients with spondylolysis and those without spondylolysis. PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Conclusion PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Patients with spondylolysis have low STA at birth, which remains constant during growth; a low STA translates into high SS. As a result, PI is also increased in accordance with SS. Therefore, we suggest that STA is an important etiologic factor in young adult patients with L5 spondylolysis. PMID:24278649

  10. Gender differences in presentation, management and inhospital outcome in patients with ST-segment elevation myocardial infarction: data from 5000 patients included in the ORBI prospective French regional registry.

    Science.gov (United States)

    Leurent, Guillaume; Garlantézec, Ronan; Auffret, Vincent; Hacot, Jean Philippe; Coudert, Isabelle; Filippi, Emmanuelle; Rialan, Antoine; Moquet, Benoît; Rouault, Gilles; Gilard, Martine; Castellant, Philippe; Druelles, Philippe; Boulanger, Bertrand; Treuil, Josiane; Avez, Bertrand; Bedossa, Marc; Boulmier, Dominique; Le Guellec, Marielle; Le Breton, Hervé

    2014-05-01

    Gender differences in presentation, management and outcome in patients with ST-segment elevation myocardial infarction (STEMI) have been reported. To determine whether female gender is associated with higher inhospital mortality. Data from ORBI, a regional STEMI registry of 5 years' standing, were analysed. The main data on presentation, management, inhospital outcome and prescription at discharge were compared between genders. Various adjusted hazard ratios were then calculated for inhospital mortality (women versus men). The analysis included 5000 patients (mean age 62.6±13 years), with 1174 women (23.5%). Women were on average 8 years older than men, with more frequent co-morbidities. Median ischaemia time was 215 minutes (26 minutes longer in women; Ppresentation, revascularization time and reperfusion strategy (hazard ratio for women 1.33, 95% confidence interval 1.01-1.76; P=0.04). One in four patients admitted for STEMI was female, with significant differences in presentation. Female gender was associated with less-optimal treatment, both in the acute-phase and at discharge. Efforts should be made to reduce these differences, especially as female gender was independently associated with an elevated risk of inhospital mortality. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Assessment of peritrochanteric high T2 signal depending on the age and gender of the patients

    Energy Technology Data Exchange (ETDEWEB)

    Haliloglu, Nuray, E-mail: nurayunsal2@hotmail.co [Ankara University School of Medicine, Department of Radiology (Turkey); Inceoglu, Deniz; Sahin, Gulden [Ankara University School of Medicine, Department of Radiology (Turkey)

    2010-07-15

    Introduction: The aim of this study is to evaluate the incidence of peritrochanteric high T2 signal (peritrochanteric edema, peritendinitis) on routine MR imaging studies and to determine whether reporting peritrochanteric edema is always clinically relevant depending on the age and gender of the patients. Materials and methods: We evaluated 79 consecutive bilateral hip MR images performed in our department between January 2006 and December 2006 (57 female, 22 male patients, mean age 49 years). Each study was evaluated for areas of T2 hyperintensity representing edema around the greater trochanter. Patients with a known fracture, tumor, history of radiation therapy, history of hip surgery and prothesis were excluded from the study. Patients with signal intensity alterations within the thickened gluteus medius/minimus tendons (tendinitis) or peritrochanteric bursal fluid accumulation (bursitis) were also excluded. All patients were scanned with our routine MR imaging protocol for hip imaging. Results: In 55 of the 79 patients (70%) peritrochanteric edema was detected on MR images and 52 of these 55 patients (95%) had these changes on both hips. The median age was 56 years for the patients with peritrochanteric edema and 35.5 years for the patients without peritrochanteric edema. There was statistical significance between the median ages of the patients and a significant increased risk of peritrochanteric edema was found over 40 years of age. There was no significant difference between male and female patients. Conclusion: Bilateral peritrochanteric high T2 signal may be a part of the degeneration process and we suggest that it may not be necessarily reported if the clinical findings do not support greater trochanteric pain syndrome.

  12. Assessment of peritrochanteric high T2 signal depending on the age and gender of the patients

    International Nuclear Information System (INIS)

    Haliloglu, Nuray; Inceoglu, Deniz; Sahin, Gulden

    2010-01-01

    Introduction: The aim of this study is to evaluate the incidence of peritrochanteric high T2 signal (peritrochanteric edema, peritendinitis) on routine MR imaging studies and to determine whether reporting peritrochanteric edema is always clinically relevant depending on the age and gender of the patients. Materials and methods: We evaluated 79 consecutive bilateral hip MR images performed in our department between January 2006 and December 2006 (57 female, 22 male patients, mean age 49 years). Each study was evaluated for areas of T2 hyperintensity representing edema around the greater trochanter. Patients with a known fracture, tumor, history of radiation therapy, history of hip surgery and prothesis were excluded from the study. Patients with signal intensity alterations within the thickened gluteus medius/minimus tendons (tendinitis) or peritrochanteric bursal fluid accumulation (bursitis) were also excluded. All patients were scanned with our routine MR imaging protocol for hip imaging. Results: In 55 of the 79 patients (70%) peritrochanteric edema was detected on MR images and 52 of these 55 patients (95%) had these changes on both hips. The median age was 56 years for the patients with peritrochanteric edema and 35.5 years for the patients without peritrochanteric edema. There was statistical significance between the median ages of the patients and a significant increased risk of peritrochanteric edema was found over 40 years of age. There was no significant difference between male and female patients. Conclusion: Bilateral peritrochanteric high T2 signal may be a part of the degeneration process and we suggest that it may not be necessarily reported if the clinical findings do not support greater trochanteric pain syndrome.

  13. Age, Neurological Status MRC Scale, and Postoperative Morbidity are Prognostic Factors in Patients with Glioblastoma Treated by Chemoradiotherapy.

    Science.gov (United States)

    Verlut, Clotilde; Mouillet, Guillaume; Magnin, Eloi; Buffet-Miny, Joëlle; Viennet, Gabriel; Cattin, Françoise; Billon-Grand, Nora Clelia; Bonnet, Emilie; Servagi-Vernat, Stéphanie; Godard, Joël; Billon-Grand, Romain; Petit, Antoine; Moulin, Thierry; Cals, Laurent; Pivot, Xavier; Curtit, Elsa

    2016-01-01

    Temozolomide and concomitant radiotherapy followed by temozolomide has been used as a standard therapy for the treatment of newly diagnosed glioblastoma multiform since 2005. A search for prognostic factors was conducted in patients with glioblastoma routinely treated by this strategy in our institution. This retrospective study included all patients with histologically proven glioblastoma diagnosed between June 1, 2005, and January 1, 2012, in the Franche-Comté region and treated by radiotherapy (daily fractions of 2 Gy for a total of 60 Gy) combined with temozolomide at a dose of 75 mg/m(2) per day, followed by six cycles of maintenance temozolomide (150-200 mg/m(2), five consecutive days per month). The primary aim was to identify prognostic factors associated with overall survival (OS) in this cohort of patients. One hundred three patients were included in this study. The median age was 64 years. The median OS was 13.7 months (95% confidence interval, 12.5-15.9 months). In multivariate analysis, age over 65 years (hazard ratio [HR] = 1.88; P = 0.01), Medical Research Council (MRC) scale 3-4 (HR = 1.62; P = 0.038), and occurrence of postoperative complications (HR = 2.15; P = 0.028) were associated with unfavorable OS. This study identified three prognostic factors in patients with glioblastoma eligible to the standard chemotherapy and radiotherapy treatment. Age over 65 years, MRC scale 3-4, and occurrence of postoperative complications were associated with unfavorable OS. A simple clinical evaluation including these three factors enables to estimate the patient prognosis. MRC neurological scale could be a useful, quick, and simple measure to assess neurological status in glioblastoma patients.

  14. THE INFLUENCE OF COMBINATION NON-MEDICAL TREATMENT INCLUDING FUNCTIONAL PROGRAMMED ELECTRICAL STIMULATION ON THE CLINICAL AND INSTRUMENTAL PARAMETERS IN PATIENTS WITH CEREBRAL PALSY WITH SPASTIC DIPLEGIA

    Directory of Open Access Journals (Sweden)

    V. V. Eliseev

    2015-01-01

    Full Text Available Background: Cerebral palsy is the leading cause of physical disability in pediatric  age. The search for new methods and improvement of old rehabil- itation techniques is ongoing, due to low efficacy of the latter. Aim: To assess the efficacy of a func- tional programmed electrical muscle stimulation as a part  of combination treatment of patients with cerebral palsy in the form of spastic diplegia. Materials and methods: We analyzed the results of treatment of 71 children with cerebral palsy and spastic diplegia, who had  been  randomized  into two groups  depending on the type of treatment. In  the  first group,  the  patients  (n = 38 received a course of functional programmed electric stim- ulation  in combination with  other  non-medical treatment  methods.  The  second   group   (n = 33 underwent a usual  course  of electrical  stimula- tion in combination with non-medical  treatment, similar to that  in the first group. The third group (control   included   41   children   without    cere- bral palsy. Clinical and  instrumental parameters were  assessed  in all study  participants. Results: After the course of combination treatment in the group  1, the  tonus  of m. gastrocnemius was de- creased significantly by 41%, that of the posterior group  of femur muscles by 43%, adductor group of femur muscles by 36%. In the group  2, the re- spective parameters decreased by 24, 21 and 21%. Muscle power  endurance was  increased  signifi- cantly in patients of both groups: that of long back extensors by 12.5 and 6.2 sec, of m. rectus abdomi- nis by 10.6 sec and 5.2 sec, of gluteal muscles by 9.3 and 4.6 sec, of m. quadriceps  by 19.8 and 7.2 sec, of m. anterior  tibialis by 12.1 and 4.6 sec, respec- tively. After the  treatment, the  active movement volume in the large joints of lower extremities  in the group 1 patients  improved as follows: by 15.6° in hip joints, by 11.1° in knee joints and by

  15. Assessment of biochemical liver function tests in relation to age among steady state sickle cell anemia patients.

    Science.gov (United States)

    Akuyam, S A; Abubakar, A; Lawal, N; Yusuf, R; Aminu, S M; Hassan, A; Musa, A; Bello, A K; Yahaya, I A; Okafor, P A

    2017-11-01

    Multiorgan failure including liver dysfunction is a common finding in sickle cell anemia (SCA) patients, the cause of which is multifactorial with advancing age said to be a major determinant. There is a paucity of data on liver function among SCA patients in relation to age in northern Nigerian hospitals, including Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. This study was to assess the biochemical liver function tests (LFTs) as they relate to age among SCA patients in steady state, with a view to improving the overall monitoring of these patients. This study was carried out in ABUTH, Zaria, Northern Nigeria. LFTs were carried out in 100 SCA and 100 apparently healthy participants (controls). The SCA group was made up of fifty adults and fifty children diagnosed of SCA, whereas the control group was made up of fifty adults and fifty children who were apparently healthy and had hemoglobin AA. Paired two-tailed Student's t-test for matched samples and Pearson's linear correlation statistical methods were employed for the data analysis using Microsoft Office Excel 2007. A P ≤ 0.05 was considered as statistically significant. The serum concentrations of total bilirubin (TB), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and AST/ALT ratio were significantly higher in SCA patients compared to the controls (P = 0.001, P = 0.001, P = 0.05, P = 0.05 and P = 0.001, respectively). Serum total protein (TP) and ALB were significantly lower (P = 0.01 and P < 0.05, respectively) in SCA patients compared with the controls. The levels of TB, ALT, AST, ALP, and AST/ALT were significantly lower in SCA adults compared to SCA children, whereas TP and ALB were higher in SCA adults compared to the SCA children. There were significant negative correlations between age and each of TB, ALT, AST, ALP, and AST/ALT, and significant positive correlations between age and each of TP and ALB in SCA patients. There are mild LFTs derangements

  16. Feasibility of including patients with migration background in a structured heart failure management programme: A prospective case-control study exemplarily on Turkish migrants.

    Directory of Open Access Journals (Sweden)

    Roman Pfister

    Full Text Available Structured management programmes deliver optimized care in heart failure patients and improve outcome. We examined the feasibility of including patients with migration background speaking little or no German in a heart failure management programme.After adaption of script material and staff to Turkish language we aimed to recruit 300 Turkish and 300 German (control group patients within 18 months using the operational basis of a local heart failure management programme for screening, contact and inclusion. Of 488 and 1,055 eligible Turkish and German patients identified through screening, 165 Turkish (34% and 335 German (32% patients consented on participation (p = 0.46. General practitioners contributed significantly more of the Turkish (84% than of the German patients (16%, p<0.001. Contact attempts by programme staff were significantly less successful in Turkish (52% than in German patients (60%, p = 0.005 due to significantly higher rate of missing phone numbers (36% vs 25%, invalid address data (28% vs 7% and being unreachable by phone more frequently (39% vs 26%, all p<0.001. Consent rate was significantly higher in successfully contacted Turkish (63% compared to German patients (50%, p<0.001.The inclusion of Turkish minority patients into a heart failure management programme is feasible with higher consent rate than in Germans. However, effort is high due to inherent logistic adaptions and barriers in identification and contacting of patients.DRKS00007780.

  17. Correlation of matrix metalloproteinases-1 and -3 with patient age and grade of lumbar disc herniation.

    Science.gov (United States)

    Zigouris, Andreas; Batistatou, Anna; Alexiou, George A; Pachatouridis, Dimitrios; Mihos, Evaggelos; Drosos, Dimitrios; Fotakopoulos, George; Doukas, Michail; Voulgaris, Spyridon; Kyritsis, Athanasios P

    2011-02-01

    The authors studied the histological alterations and the expression of matrix metalloproteinase (MMP)-1 and MMP-3 in disc specimens of patients who had undergone operations for lumbar disc herniation. Forty-three lumbar disc specimens were evaluated histopathologically for degenerative changes and immunohistochemical expression of MMP-1 and MMP-3. The observed degenerative changes provided a degenerative score that was applied in each patient. Sections of disc immunostained for MMP-1 and MMP-3 were evaluated semiquantitatively. Patients were categorized in 3 age groups: 60 years of age. The expression of MMP-1 and MMP-3 were correlated to patient's age, degenerative score, and grade of lumbar disc herniation. There was no statistically significant difference in the degenerative score between the age groups. Degenerative changes were more pronounced in greater grades of herniation (p correlation between MMP-1 and MMP-3 expression and both degenerative score and herniation grade. For the group of patients 30-60 years of age, there was no significant difference between MMP-1 expression and degenerative score, but the correlation between MMP-1 expression and grade of herniation was significant. There was a significant correlation between MMP-3 expression and both degenerative score and herniation grade. Regarding the patients > 60 years of age, there was a significant correlation between MMP-1 and MMP-3 expression and both degenerative score and herniation grade. There was a significantly lower expression of both MMP-1 and MMP-3 in the group correlation was found in MMP-1 and MMP-3 expression between the groups of patients who were 30-60 and > 60 years of age. Interestingly, in age groups > 30 years, there were no statistically significant differences between the expression of MMP-1 and MMP-3, whereas in patients correlated to the age of the patients and the grade of herniation. An important finding in this study is the differential expression of MMP-1 and MMP-3

  18. Most patients with colorectal tumors at young age do not visit a cancer genetics clinic.

    NARCIS (Netherlands)

    Overbeek, L.I.H.; Hoogerbrugge, N.; Krieken, J.H.J.M. van; Nagengast, F.M.; Ruers, T.J.M.; Ligtenberg, M.J.L.; Hermens, R.P.M.G.

    2008-01-01

    PURPOSE: This study examined the referral process for genetic counseling at a cancer genetics clinic in patients with colorectal cancer and to search for determinants of variation in this referral process. METHODS: Patients who were recently diagnosed with colorectal cancer at a young age or

  19. Usefulness of ultrasonography for detection of breast cancer in patients under 30 years of age

    International Nuclear Information System (INIS)

    Kim, Ji Hyung; Oh, Ki Keun; Yoon, Sang Wook

    1995-01-01

    The purpose of this study was to compare mammography and breast sonography in detection of breast cancer and to suggest reasonable guideline of breast imaging in breast cancer patients under 30 years of age in whom breast cancer shows different clinicopathologic characteristics compared with breast cancer in older women. Authors reviewed medical records of 27 patients under 30 years of age with pathologically-proven breast cancer. Age, family history, physical examination findings, indications for breast sonography were reviewed. Cases in whom breast cancer lesion is detectable and cases in whom not detectable using mammography or breast sonography were reviewed. And then, authors evaluated the usefulness of each method and reasons for nonvisualization of lesion on mammography. Among 27 patients, 25 patients had palpable breast mass as indication of mammography and breast sonography. Cancer lesions were detectable in 16 of 25 patients (64%) on mammography and 24 of 25 patients (96%) on breast ultrasonography. Reasons for nonvisualization of cancer lesions on mammography were dense breast with nodular parenchyma pattern and minimal breast change of ductal carcinoma in situ. In breast cancer patients under 30 years of age who have palpable breast mass as a initial, and main clinical problem, breast ultrasonography is superior to mammography in detecting and diagnosing breast cancer. We suggest that guidelines can avoid unnecessary mammography in these patients

  20. Subjective health expectations of patients with age-related macular degeneration treated with antiVEGF drugs.

    Science.gov (United States)

    Péntek, Márta; Brodszky, Valentin; Biró, Zsolt; Kölkedi, Zsófia; Dunai, Árpád; Németh, János; Baji, Petra; Rencz, Fanni; Gulácsi, László; Resch, Miklós D

    2017-10-10

    Subjective expectations regarding future health may influence patients' judgement of current health and treatment effects, as well as adherence to therapies in chronic diseases. We aimed to explore subjective expectations on longevity and future health-related quality of life (HRQOL) of patients with age-related macular degeneration (AMD) treated with antiVEGF injections and analyse the influencing factors. Consecutive AMD patients in two ophthalmology centres were included. Demographics, clinical characteristics and informal care utilisation were recorded. Current health was evaluated by the EQ-5D generic health status questionnaire and time trade-off (TTO) methods. Happiness was measured on a visual analogue scale (VAS). Subjective life-expectancy and expected EQ-5D status at ages 70, 80 and 90 were surveyed. T-test was applied to compare subgroups and Pearson correlations were performed to analyse relationships between variables. One hundred twenty two patients were involved (females 62%) with a mean (SD) age of 75.2 (7.9) years and disease duration of 2.9 (2.5) years. The majority were in AREDS-4 state, the better eye's ETDRS was 64.7 (15.4). EQ-5D and TTO revealed moderate deterioration of health (0.66 vs. 0.72, p = 0.131), happiness VAS was 6.3 (2.2). Correlation between EQ-5D and ETDRS was moderate (R = 0.242, p Subjective life-expectancy did not differ significantly from statistical life-expectancy and had no significant impact on TTO. The self-estimated mean EQ-5D score was 0.60, 0.40 and 0.24 for ages 70, 80 and 90 which is lower than the population norm of age-groups 65-74, 75-84 and 85+ (0.77, 0.63 and 0.63, respectively). Age, gender, current EQ-5D, need for informal care and happiness were deterministic factors of subjective health expectations. AMD patients with antiVEGF treatment have comparable HRQOL as the age-matched general public but expect a more severe deterioration of health with age. Older patients with worse HRQOL have worse

  1. Improvement of reading speed after providing of low vision aids in patients with age-related macular degeneration.

    Science.gov (United States)

    Nguyen, Nhung Xuan; Weismann, Malte; Trauzettel-Klosinski, Susanne

    2009-11-01

    Age-related macular degeneration (AMD) is the most common cause of severe visual impairment, including loss of reading ability, among elderly persons in developed countries. The aim of the present study was to evaluate reading ability before and after providing of appropriate low vision aids. Five hundred and thirty patients with different stages of AMD (age 82 +/- 8 years) were included in this retrospective study. All patients underwent a standardized ophthalmological examination including evaluation of magnification requirement and careful providing of low vision aids. Before and after the provision of low vision aids, reading speed [words per minute (wpm)] was evaluated using standardized reading texts. For the whole group, the average best-corrected distance visual acuity of the better eye was 0.18 +/- 0.15, with 69% of patients having visual acuity of 0.1 (20/200) or better. The mean magnification requirement was 7.4 +/- 6.3-fold (range 2-25). Visual rehabilitation was achieved with optical visual aids in 58% of patients, whereas 42% of patients needed electronically closed-circuit TV systems. Mean reading speed was 20 +/- 33 wpm before and increased significantly to 72 +/- 35 (p reading speed before (0.4 +/- 3.8 versus 20 +/- 28 wpm, p reading speed compared to patients with visual acuity of 0.1 or better following rehabilitation (p read; in contrast, reading ability was achieved in 94% of patients after the provision of low vision aids for the whole group. Our results indicate the great value of low vision rehabilitation through adequate providing of vision aids for the improvement of reading ability, with a highly significant increase of reading speed without training of eccentric viewing in patients with retained central fixation. The prompt implementation of low vision aids in patients with macular degeneration will help them to maintain and regain their reading ability, which can lead to an increase in independence, communication, mental agility and

  2. Survival and Toxicity in Patients With Disseminated Germ CellCancer Aged 40 Years and Older

    DEFF Research Database (Denmark)

    Thomsen, Frederik B; Bandak, Mikkel; Thomsen, Maria F

    2014-01-01

    , etoposide and cisplatin (BEP). A control-group of 135 patients aged 18-35 years was randomly selected matched on year of BEP treatment. Cumulated doses of BEP as well as bone marrow toxicity, renal- and lung functions were recorded before, during and after termination of treatment. All patients were...... followed until death or October 1, 2011. RESULTS: The cumulated doses of BEP were comparable between the two groups, however, more patients aged ≥40 years were reduced in bleomycin doses based on a decrease in carbon monoxide diffusion capacity corrected for haemoglobin (P = 0.03). No differences between...

  3. Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials.

    Science.gov (United States)

    Howard, George; Roubin, Gary S; Jansen, Olav; Hendrikse, Jeroen; Halliday, Alison; Fraedrich, Gustav; Eckstein, Hans-Henning; Calvet, David; Bulbulia, Richard; Bonati, Leo H; Becquemin, Jean-Pierre; Algra, Ale; Brown, Martin M; Ringleb, Peter A; Brott, Thomas G; Mas, Jean-Louis

    2016-03-26

    Age was reported to be an effect-modifier in four randomised controlled trials comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA), with better CEA outcomes than CAS outcomes noted in the more elderly patients. We aimed to describe the association of age with treatment differences in symptomatic patients and provide age-specific estimates of the risk of stroke and death within narrow (5 year) age groups. In this meta-analysis, we analysed individual patient-level data from four randomised controlled trials within the Carotid Stenosis Trialists' Collaboration (CSTC) involving patients with symptomatic carotid stenosis. We included only trials that randomly assigned patients to CAS or CEA and only patients with symptomatic stenosis. We assessed rates of stroke or death in 5-year age groups in the periprocedural period (between randomisation and 120 days) and ipsilateral stroke during long-term follow-up for patients assigned to CAS or CEA. We also assessed differences between CAS and CEA. All analyses were done on an intention-to-treat basis. Collectively, 4754 patients were randomly assigned to either CEA or CAS treatment in the four studies. 433 events occurred over a median follow-up of 2·7 years. For patients assigned to CAS, the periprocedural hazard ratio (HR) for stroke and death in patients aged 65-69 years compared with patients younger than 60 years was 2·16 (95% CI 1·13-4·13), with HRs of roughly 4·0 for patients aged 70 years or older. We noted no evidence of an increased periprocedural risk by age group in the CEA group (p=0·34). These changes underpinned a CAS-versus CEA periprocedural HR of 1·61 (95% CI 0·90-2·88) for patients aged 65-69 years and an HR of 2·09 (1·32-3·32) for patients aged 70-74 years. Age was not associated with the postprocedural stroke risk either within treatment group (p≥0·09 for CAS and 0·83 for CEA), or between treatment groups (p=0·84). In these RCTs, CEA was clearly superior to CAS in

  4. Autonomous nodule of the thyroid: correlation of patient age, nodule size, and functional status

    International Nuclear Information System (INIS)

    Blum, M.; Shenkman, L.; Hollander, C.S.

    1975-01-01

    In light of new techniques for measuring circulating thyroid hormones and for studying the thyroid gland, we present our experience with 35 patients with solitary autonomous nodules of the thyroid to define more precisely the clinical course of patients with this disorder. The patients ranged in age from 19 to 80 years and 31 of the 35 were female. Younger patients were generally euthyroid and sought attention because of a thyroid mass; virtually all older patients were hyperthyroid. Eighteen had obvious clinical features of hyperthyroidism and 5 over age 70 had apathetic hyperthyroidism; all 5 of the elderly and 13 of the 18 under age 70 had elevated thyroxine (T 4 ) and triiodothyronine (T 3 ) levels. Isolated elevation of T 3 and elevated basal metabolic rate were observed in 5 previously untreated clinically hyperthyroid young patients. In each of these, thyroid uptake of 131 I was not suppressible with exogenous T 3 and BMR was elevated in those tested. Two elderly patients, who had previously been treated for conventional hyperthyroidism with radioactive iodine, had T 3 toxicosis when hyperthyroidism recurred. There was a strong positive correlation between the age of the patient, the size of the nodule and the thyroid functional state. The mean area of the nodules projected on 131 I rectilinear scan for euthyroid patients was 5.1 cm 2 . The mean area of the nodules in hyperthyroid subjects was significantly higher, 13.4 cm 2 in patients with T 3 toxicosis and 19.3 cm 2 in subjects with conventional hyperthyroidism. Progression from a euthyroid state to hyperthyroidism was observed in four patients. One of these became thyrotoxic within days after an injection of iodinated contrast medium. Spontaneous resolution of nodules occurred in two patients

  5. Middle ear impedance studies in elderly patients implications on age-related hearing loss

    Directory of Open Access Journals (Sweden)

    Olusola Ayodele Sogebi

    2015-04-01

    Full Text Available INTRODUCTION: Controversies arise with respect to functioning of the middle ear over time.OBJECTIVE: To assess changes in middle ear impedance that may be related to aging, and/or if there was an association of these changes with those of the inner ear in the elderly patients.METHODS: Cross-sectional, comparative study of elderly patients managed in ear, nose and throat clinics. A structured questionnaire was administered to obtain clinical information. Pure tone audiometry, tympanometry, and acoustic reflexes were performed. Comparative analyses were performed to detect intergroup differences between clinico-audiometric findings and middle ear measures, viz. tympanograms and acoustic reflexes.RESULTS: One hundred and three elderly patients participated in the study; 52.4% were male, averagely 70.0 ± 6.3 years old, age-related hearing loss in 59.2%, abnormal tympanograms in 39.3%, absent acoustic reflex in 37.9%. There was no association between age and gender in patients with abnormal tympanograms and absent acoustic reflex. Significantly more patients with different forms and grades of age-related hearing loss had abnormal tympanometry and absent acoustic reflex.CONCLUSION: Some abnormalities were observed in the impedance audiometric measures of elderly patients, which were significantly associated with parameters connected to age-related hearing loss.

  6. Middle ear impedance studies in elderly patients implications on age-related hearing loss.

    Science.gov (United States)

    Sogebi, Olusola Ayodele

    2015-01-01

    Controversies arise with respect to functioning of the middle ear over time. To assess changes in middle ear impedance that may be related to aging, and/or if there was an association of these changes with those of the inner ear in the elderly patients. Cross-sectional, comparative study of elderly patients managed in ear, nose and throat clinics. A structured questionnaire was administered to obtain clinical information. Pure tone audiometry, tympanometry, and acoustic reflexes were performed. Comparative analyses were performed to detect intergroup differences between clinico-audiometric findings and middle ear measures, viz. tympanograms and acoustic reflexes. One hundred and three elderly patients participated in the study; 52.4% were male, averagely 70.0±6.3 years old, age-related hearing loss in 59.2%, abnormal tympanograms in 39.3%, absent acoustic reflex in 37.9%. There was no association between age and gender in patients with abnormal tympanograms and absent acoustic reflex. Significantly more patients with different forms and grades of age-related hearing loss had abnormal tympanometry and absent acoustic reflex. Some abnormalities were observed in the impedance audiometric measures of elderly patients, which were significantly associated with parameters connected to age-related hearing loss. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  7. Uremia causes premature ageing of the T cell compartment in end-stage renal disease patients

    Directory of Open Access Journals (Sweden)

    Meijers Ruud WJ

    2012-09-01

    Full Text Available Abstract Background End-stage renal disease (ESRD patients treated with renal replacement therapy (RRT have premature immunologically aged T cells which may underlie uremia-associated immune dysfunction. The aim of this study was to investigate whether uremia was able to induce premature ageing of the T cell compartment. For this purpose, we examined the degree of premature immunological T cell ageing by examining the T cell differentiation status, thymic output via T cell receptor excision circle (TREC content and proliferative history via relative telomere length in ESRD patients not on RRT. Results Compared to healthy controls, these patients already had a lower TREC content and an increased T cell differentiation accompanied by shorter telomeres. RRT was able to enhance CD8+ T cell differentiation and to reduce CD8+ T cell telomere length in young dialysis patients. An increased differentiation status of memory CD4+ T cells was also noted in young dialysis patients. Conclusion Based on these results we can conclude that uremia already causes premature immunological ageing of the T cell system and RRT further increases immunological ageing of the CD8+ T cell compartment in particular in young ESRD patients.

  8. High Satisfaction and Return to Sports After Total Shoulder Arthroplasty in Patients Aged 55 Years and Younger.

    Science.gov (United States)

    Garcia, Grant H; Liu, Joseph N; Sinatro, Alec; Wu, Hao-Hua; Dines, Joshua S; Warren, Russell F; Dines, David M; Gulotta, Lawrence V

    2017-06-01

    Young, active candidates for total shoulder arthroplasty (TSA) are a unique group of patients. Not only do they demand longevity and improved function, but they also desire a return to physical activities. To determine the rate of return to sports in patients aged ≤55 years undergoing TSA. Case series; Level of evidence, 4. This was a retrospective review of consecutive patients who underwent anatomic TSA at a single institution. Exclusion criteria included age at the time of surgery >55 years and sports questionnaire, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) score. From 70 eligible patients, 59 patients (61 shoulders) were included with an average follow-up of 61.0 months (range, 25-103 months) and average age at the time of surgery of 48.9 years (range, 25-55 years). The average VAS score improved from 5.6 to 0.9 ( P sports. Moreover, patients in 96.4% of shoulders (55/57) restarted at least 1 sport at an average of 6.7 months. Direct rates of return were as follows: fitness sports (97.2%), golf (93.3%), singles tennis (87.5%), swimming (77.7%), basketball (75.0%), and flag football (66.7%). Patients in 47 shoulders (82.4%) returned to a similar or higher level of sports; 90.3% returned to high-demand sports, and 83.8% returned to high upper extremity sports. There was no significant difference in rates of return to sports by body mass index, sex, age, preoperative diagnosis, revision status, and dominant extremity. In patients aged ≤55 years undergoing TSA, there was a 96.4% rate of return to ≥1 previous sports at an average of 6.7 months. Furthermore, at an average follow-up of 61.0 months, no patients needed revision of their glenoid component, despite an 83.8% rate of return to high upper extremity sports. While caution should still be advised in young, active patients undergoing TSA, these results demonstrate a high satisfaction rate and improved ability to return to most sports after surgery.

  9. Patient-Reported Outcome (PRO) questionnaires for young to middle-aged adults with hip and groin disability

    DEFF Research Database (Denmark)

    Thorborg, K; Tijssen, M; Habets, B

    2015-01-01

    BACKGROUND/AIM: To recommend Patient-Reported Outcome (PRO) questionnaires to measure hip and groin disability in young-aged to middle-aged adults. METHODS: A systematic review was performed in June 2014. The methodological quality of the studies included was determined using the COnsensus...... ratings of poor study methodology (23% and 31%, respectively), whereas IHOT-33 and HOS had a somewhat larger distribution (46%). These PROs all contain adequate measurement qualities for content validity (except HOS), test-retest reliability, construct validity, responsiveness and interpretability....... No information or poor quality rating on methodological aspects made it impossible to fully evaluate the remaining PROs at present. CONCLUSIONS: HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for assessment of young-aged to middle-aged adults with pain related to the hip joint, undergoing non...

  10. Mineralogical Composition of Urinary Stones and Their Frequency in Patients: Relationship to Gender and Age

    Directory of Open Access Journals (Sweden)

    Behnam Keshavarzi

    2016-12-01

    Full Text Available This investigation reports the mineralogy and possible pathological significance of urinary stones removed from patients in Fars province, Iran. X-ray diffraction (XRD, scanning electron microscopy (SEM and polarizing microscope (PM techniques were used to investigate the mineralogical compositions of urinary stones. The identified mineral components include whewellite, weddellite, hydroxyapatite, uricite and cystine. These techniques revealed that the whewellite and uricite were the most common mineral phases. Platy-like/monoclinic whewellite, prismatic/monoclinic uric acid and hexagonal cystine crystals were revealed by SEM. Biominerals (calcium carbonate and quartz were also identified in PM images. Of the variables determining the type of precipitated minerals, the effects of pH on depositional conditions proved to be the most apparent parameter, as shown by occurrences and relationships among the studied minerals. Our results revealed the importance of detailed knowledge of mineralogical composition in assessing the effects of age and sex. The highest incidence of urinary stones was observed in the 40–60 age group. Calcium oxalate and uric acid stones are more frequent in men than women. Finally, the study concluded that knowledge of the mineralogical composition of urinary stones is important as it helps the scientific community to explain the chemistry and the etiology of the calculi in the urinary system.

  11. Patient age as a factor of antibiotic resistance in methicillin-resistant Staphylococcus aureus.

    Science.gov (United States)

    Garcia, Alexander; Delorme, Thierry; Nasr, Payman

    2017-12-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of nosocomial infections. A thorough understanding of the epidemiology and distribution of MRSA allows the development of better preventive measures and helps to control or reduce the rate of infection among the general population. A retrospective survey was performed on 511 cases of MRSA infections from inpatient, outpatient and nursing home populations over a 12-month period. To study the relationships between two continuous quantitative variables (patient age vs resistance percentage), a simple linear regression was calculated for each antibiotic to predict the antibiotic resistance percentage with respect to patient age.Results/Key findings. The pattern of antibiotic resistance with respect to the age of patients depended on the antibiotic mode of action. Antibiotics that target DNA synthesis (i.e. fluoroquinolones) display a direct correlation with the age of patients, with higher rates of resistance among the older population, while antibiotics that target ribosomal functions (i.e. aminoglycosides) or cell wall synthesis (i.e. cephalosporin) do not display an age-dependent pattern and have a consistent degree of resistance across all age classes. Antibiotics that target DNA synthesis result in a progressively higher number of resistant isolates among the older population. The results emphasize the importance of patient age on antibiotic selection as a preventive measure to reduce the rate of resistant infections in each susceptible population. This pattern suggests that physicians should take into consideration patient age as another factor in determining the best antibiotic regiment with the aim of curtailing the emergence of newer resistant phenotypes in the future.

  12. Change of the State of the Natural Antioxidant Barrier of a Body and Psychological Parameters in Patients Aged above 60

    Directory of Open Access Journals (Sweden)

    Katarzyna Porzych

    2017-01-01

    Full Text Available Background. The goal of this study is to assess the natural antioxidant barrier of the organism and selected psychological aspects of the aging process in patients above 60 years old. Methods. The study included a total of 52 patients aged above 60 (mean age 67 ± 3.4 and 32 healthy subjects (mean age 22 ± 3.4 as a control group. All patients underwent psychological assessment using Test of Attentional Performance version 2.3 (TAP 2.3, four subtests: alertness, cross-modal integration, neglect with central task, and working memory and biochemical analysis of venous blood concerning values of the selected parameters of oxidative stress (HT, GSH, GPXOS, GPXRBC, GRRBC1, SODRBC1, MDARBC1, NO2−/NO3−, and CP. Results. Disorders of attention were observed mainly in elderly people, but an assumption that elderly people have developed more efficient ways of working memory use than younger people may be true. Results showed the reduced effectiveness of the body’s natural antioxidant barrier in elderly people. Moderate positive and negative correlations among parameters of oxidative stress and psychological parameters were observed in the control group. Discussion. Intensification of the attention deficits and oxidative stress may be observed as one of the pathogenic factors of age-dependent diseases.

  13. Efficacy and safety analysis by age cohort of inotuzumab ozogamicin in patients with relapsed or refractory acute lymphoblastic leukemia enrolled in INO-VATE.

    Science.gov (United States)

    Jabbour, Elias J; DeAngelo, Daniel J; Stelljes, Matthias; Stock, Wendy; Liedtke, Michaela; Gökbuget, Nicola; O'Brien, Susan; Wang, Tao; Paccagnella, M Luisa; Sleight, Barbara; Vandendries, Erik; Advani, Anjali S; Kantarjian, Hagop M

    2018-01-30

    Inotuzumab ozogamicin (InO) has demonstrated efficacy and tolerability in patients aged 18 to 78 years with relapsed/refractory acute lymphoblastic leukemia (ALL) in the INO-VATE trial. This subset analysis compared the efficacy and safety of InO in younger and older patients. Intent-to-treat analyses of morphologic responses and overall survival (OS) included 326 randomized patients, and safety assessments included 307 patients receiving 1 or more doses of the study treatment. Of the 326 patients, 164 received InO at a starting dose of 1.8 mg/m 2 /cycle (0.8 mg/m 2 on day 1 and 0.5 mg/m 2 on days 8 and 15 of a 21- to 28-day cycle [≤6 cycles]); 60 patients were aged ≥55 years, and 104 were aged <55 years. For older and younger patients, the median duration of InO therapy and the types and frequencies of adverse events of any grade were generally similar. Although the remission rates, median duration of remission (DOR), and progression-free survival were similar with InO for those aged <55 years and those aged ≥55 years, OS was longer for younger patients (median, 8.6 vs 5.6 months; hazard ratio, 0.610). Among patients proceeding to hematopoietic stem cell transplantation after InO treatment (28% of older patients and 58% of younger patients), the incidence of veno-occlusive disease was greater in older patients (41% vs 17%). The study database was not locked at the time of this analysis. InO was tolerable in older patients with relapsed/refractory ALL. Although OS was longer for younger patients versus older patients, InO demonstrated high response rates with similar DOR in the 2 age groups. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

  14. Relationship between serum insulin level and age and sex in 980 patients with essential hypertension

    International Nuclear Information System (INIS)

    Cai Jianlin; Ji Naijun; Mei Yubin; Wang Chengyao; Fan Bifu; Chen Donghai; Guan Li; Tong Lijun; Li Fuyuan; Gao Meiying

    2004-01-01

    Objective: To investigate the change of serum insulin level in essential hypertension patients and its relationship with age and sex. Methods: The levels of serum insulin were determined with radioimmunoassay in 980 essential hypertension patients and 120 controls. Results: The levels of serum insulin in the essential hypertension patients were significantly higher than those in the controls (t=4.280, P<0.01). However, there were no significant differences among the levels in different sex and age groups. The same held true for women before and after menopause as well as different stages of hypertension. Conclusion: The average serum insulin level in EH patients was significantly higher than the level in controls, and had positive correlation to mean arterial pressure. But no significant differences were found among different sex and age groups, so serum insulin could be a new independent risk factor of essential hypertension

  15. Predictors of Long-Term Care Utilization by Dutch Hospital Patients aged 65+

    Directory of Open Access Journals (Sweden)

    Elderkamp-de Groot Rianne

    2010-05-01

    Full Text Available Abstract Background Long-term care is often associated with high health care expenditures. In the Netherlands, an ageing population will likely increase the demand for long-term care within the near future. The development of risk profiles will not only be useful for projecting future demand, but also for providing clues that may prevent or delay long-term care utilization. Here, we report our identification of predictors of long-term care utilization in a cohort of hospital patients aged 65+ following their discharge from hospital discharge and who, prior to hospital admission, were living at home. Methods The data were obtained from three national databases in the Netherlands: the national hospital discharge register, the long-term care expenses register and the population register. Multinomial logistic regression was applied to determine which variables were the best predictors of long-term care utilization. The model included demographic characteristics and several medical diagnoses. The outcome variables were discharge to home with no formal care (reference category, discharge to home with home care, admission to a nursing home and admission to a home for the elderly. Results The study cohort consisted of 262,439 hospitalized patients. A higher age, longer stay in the hospital and absence of a spouse were found to be associated with a higher risk of all three types of long-term care. Individuals with a child had a lower risk of requiring residential care. Cerebrovascular diseases [relative risk ratio (RRR = 11.5] were the strongest disease predictor of nursing home admission, and fractures of the ankle or lower leg (RRR = 6.1 were strong determinants of admission to a home for the elderly. Lung cancer (RRR = 4.9 was the strongest determinant of discharge to the home with home care. Conclusions These results emphasize the impact of age, absence/presence of a spouse and disease on long-term care utilization. In an era of demographic and

  16. The Outcome of Bariatric Surgery in Patients Aged 75 years and Older.

    Science.gov (United States)

    Nor Hanipah, Zubaidah; Punchai, Suriya; Karas, Linden A; Szomstein, Samuel; Rosenthal, Rahul J; Brethauer, Stacy A; Aminian, Ali; Schauer, Philip R

    2017-12-30

    Bariatric surgery has been shown to be safe and effective in patients aged 60-75 years; however, outcomes in patients aged 75 or older are undocumented. Patients aged 75 years and older who underwent bariatric procedures in two academic centers between 2006 and 2015 were studied. A total of 19 patients aged 75 years and above were identified. Eleven (58%) were male, the median age was 76 years old (range 75-81), and the median preoperative body mass index (BMI) was 41.4 kg/m 2 (range 35.8-57.5). All of the bariatric procedures were primary procedures and performed laparoscopically: sleeve gastrectomy (SG) (n = 11, 58%), adjustable gastric band (AGB) (n = 4, 21%), Roux-en-Y gastric bypass (RYGB) (n = 2, 11%), banded gastric plication (n = 1, 5%), and gastric plication (n = 1, 5%). The median operative time was 120 min (range 75-240), and the median length of stay was 2 days (range 1-7). Three patients (16%) developed postoperative atrial fibrillation which completely resolved at discharge. At 1 year, the median percentage of total weight loss (%TWL) was 18.4% (range 7.4-22.0). The 1-year %TWL varied among the bariatric procedures performed: SG (21%), RYGB (22%), AGB (7%), and gastric plication (8%). There were no 30-day readmissions, reoperations, or mortalities. Our experience suggests that bariatric surgery in selected patients aged 75 years and older would be safe and effective despite being higher risk. Age alone should not be the limiting factor for selecting patients for bariatric surgery.

  17. Beta-Cell Age Calculator, a Translational Yardstick to Communicate Diabetes Risk with Patients: Tehran Lipid and Glucose Study

    OpenAIRE

    Bozorgmanesh, Mohammadreza; Hadaegh, Farzad; Azizi, Fereidoun

    2012-01-01

    Aims. To provide a yardstick for physicians/patients to efficiently communicate/measure incident diabetes risk. Methods. We included data on 5,960 (3,438 women) diabetes-free adults, aged ≥20 years at baseline who either developed diabetes during two consecutive examinations or completed the followup. Age, systolic blood pressure, family history of diabetes, waist-to-height ratio (WHtR), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDLD-C), and fasting plasma glucose (FPG) w...

  18. Mitral valve replacement in patients under 65 years of age: mechanical or biological valves?

    Science.gov (United States)

    Reineke, David C; Heinisch, Paul Philipp; Winkler, Bernhard; Englberger, Lars; Carrel, Thierry P

    2015-03-01

    There is controversy regarding the optimal choice of prosthetic valves in patients less than 65 years of age requiring mitral valve replacement (MVR). Recently, trends for valve replacement are moving towards biological prosthesis also in younger patients, which is justified by the fact that a later valve-in-valve procedure is feasible in the case of degeneration of the tissue valve. This strategy is increasingly recommended in aortic valve surgery but is questionable for MVR. The purpose of this review is to evaluate current guidelines and analyse evidence for biological MVR in patients under 65 years. There are differences between guidelines of the American Heart Association and those of the European Society of Cardiology concerning the choice of prostheses in patients undergoing MVR. Although the European Society of Cardiology recommends a mechanical mitral valve in patients under 65 years of age, the American Heart Association does not provide detailed advice for these patients. Mitral valve replacement with biological valves in patients under 65 years is associated with higher rates of reoperation due to structural valve deterioration. In addition, several studies showed a decreased survival after biological MVR. Evidence for biological MVR in patients less than 65 years without comorbidities or contraindication for oral anticoagulation does not exist. Recommendations for patients less than 65 years of age should not be blurred by current 'en-vogue' methods for promising but not yet proven valve-in-valve strategies.

  19. ASID (HICSIG) position statement: infection control guidelines for patients with influenza-like illnesses, including pandemic (H1N1) influenza 2009, in Australian health care facilities.

    Science.gov (United States)

    Stuart, Rhonda L; Cheng, Allen C; Marshall, Caroline L; Ferguson, John K

    2009-10-19

    Standard and Droplet Precautions are considered adequate to control the transmission of influenza in most health care situations. Vaccination of health care staff, carers and vulnerable patients against seasonal and, eventually, pandemic influenza strains is an essential protective strategy. Management principles include: performance of hand hygiene before and after every patient contact or contact with the patient environment, in accord with the national 5 Moments for Hand Hygiene Standard; disinfection of the patient environment; early identification and isolation of patients with suspected or proven influenza; adoption of a greater minimum distance of patient separation (2 metres) than previously recommended; use of a surgical mask and eye protection for personal protection on entry to infectious areas or within 2 metres of an infectious patient; contact tracing for patient and health care staff and restriction of prophylactic antivirals mainly to those at high risk of severe disease; in high aerosol-risk settings, use of particulate mask, eye protection, impervious long-sleeved gown, and gloves donned in that sequence and removed in reverse sequence, avoiding self-contamination; exclusion of symptomatic staff from the workplace until criteria for non-infectious status are met; reserving negative-pressure ventilation rooms (if available) for intensive care patients, especially those receiving non-invasive ventilation; ensuring that infectious postpartum women wear surgical masks when caring for their newborn infants and practise strict hand hygiene; and implementation of special arrangements for potentially infected newborns who require nursery or intensive care.

  20. Should nutritional status evaluation be included in the initial needs assessment of leprosy patients with disability prior to socio-economic.

    Science.gov (United States)

    Vaz, M; Diffey, B; Jacob, A J; Vaz, M

    2001-06-01

    Because of the large numbers of leprosy patients with disability and the limited resources available, it is important that socio-economic rehabilitation (SER) is targeted towards those who are most in need. Towards this purpose, current assessments of leprosy patients prior to initiating SER include the evaluation of income, assets and household possessions. Conspicuously absent is the nutritional assessment of the patient. In the absence of weight loss associated with illness, population studies indicate that undernutrition reflects poor socio-economic conditions. In this study of 151 cured leprosy patients with disability, 57% of the patients were found to be undernourished using body mass index (kg/m2) derived from body weight and height, and 10% of the patients were severely undernourished (grade III). Undernutrition in the patients was poorly though significantly correlated with personal income (r = 0.18, P nutritional status evaluation by anthropometry as part of the initial screening of leprosy patients prior to instituting SER. We believe that this simple and objective evaluation can add to the assessment of 'threat' of economic deprivation or actual economic 'dislocation', and thus help in the prioritization of leprosy patients for SER.

  1. Array-CGH in patients with Kabuki-like phenotype: Identification of two patients with complex rearrangements including 2q37 deletions and no other recurrent aberration

    Directory of Open Access Journals (Sweden)

    González Eva

    2008-04-01

    Full Text Available Abstract Background Kabuki syndrome (KS is a multiple congenital anomaly syndrome characterized by specific facial features, mild to moderate mental retardation, postnatal growth delay, skeletal abnormalities, and unusual dermatoglyphic patterns with prominent fingertip pads. A 3.5 Mb duplication at 8p23.1-p22 was once reported as a specific alteration in KS but has not been confirmed in other patients. The molecular basis of KS remains unknown. Methods We have studied 16 Spanish patients with a clinical diagnosis of KS or KS-like to search for genomic imbalances using genome-wide array technologies. All putative rearrangements were confirmed by FISH, microsatellite markers and/or MLPA assays, which also determined whether the imbalance was de novo or inherited. Results No duplication at 8p23.1-p22 was observed in our patients. We detected complex rearrangements involving 2q in two patients with Kabuki-like features: 1 a de novo inverted duplication of 11 Mb with a 4.5 Mb terminal deletion, and 2 a de novo 7.2 Mb-terminal deletion in a patient with an additional de novo 0.5 Mb interstitial deletion in 16p. Additional copy number variations (CNV, either inherited or reported in normal controls, were identified and interpreted as polymorphic variants. No specific CNV was significantly increased in the KS group. Conclusion Our results further confirmed that genomic duplications of 8p23 region are not a common cause of KS and failed to detect other recurrent rearrangement causing this disorder. The detection of two patients with 2q37 deletions suggests that there is a phenotypic overlap between the two conditions, and screening this region in the Kabuki-like patients should be considered.

  2. An Exploratory Analysis of Child Feeding Beliefs and Behaviors Included in Food Blogs Written by Mothers of Preschool-Aged Children.

    Science.gov (United States)

    Doub, Allison E; Small, Meg; Birch, Leann

    2016-02-01

    This study analyzed child feeding beliefs and behaviors, types of recipes, and their associations in blogs focused on child feeding. The authors selected 13 blogs using purposive snowball sampling, from which 158 blog posts were sampled and coded using directed qualitative content analysis. Child feeding beliefs and behaviors and types of recipes were coded using schemes developed from existing literature. Code frequencies were calculated. Chi-square tests for independence examined associations between child feeding and recipe codes. Bonferroni corrections were applied: P feeding beliefs and behaviors were coded in 78% and 49% of posts, respectively. Beliefs about children's food preferences (48% of posts) and involving children in food preparation (27% of posts) were the most frequent codes. Recipes were included in 66% of posts. Most recipes were for mixed dishes (32% of recipes), followed by sweets and desserts (19% of recipes). Vegetable recipes were more likely in posts that included behavior encouraging balance and variety (χ2 [1, n = 104] = 18.54; P feeding practices. Future research should explore how mothers use blogs to learn about child feeding. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  3. Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values

    International Nuclear Information System (INIS)

    Ubeda, Carlos; Miranda, Patricia; Vano, Eliseo

    2015-01-01

    Purpose: To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency. Methods: Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs. Results: Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for <1 yr; 213 for 1 to <5 yr; 82 for 5 to <10 yr; and 102 for 10 to <16 yr. The third quartile values obtained for DAP by diagnostic and therapeutic procedures and age range were 1.17 and 1.11 Gy cm 2 for <1 yr; 1.74 and 1.90 Gy cm 2 for 1 to <5 yr; 2.83 and 3.22 Gy cm 2 for 5 to <10 yr; and 7.34 and 8.68 Gy cm 2 for 10 to <16 yr, respectively. The third quartile value obtained for the DAP/body weight ratio for the full sample of procedures was 0.17 (Gy cm 2 /kg) for diagnostic and therapeutic procedures. Conclusions: The data presented in this paper are an initial attempt at establishing local DRLs in pediatric interventional cardiology, from a large sample of procedures for the standard age bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there may be large differences

  4. Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values

    Energy Technology Data Exchange (ETDEWEB)

    Ubeda, Carlos, E-mail: cubeda@uta.cl [Medical Technology Department, Radiological Sciences Center, Health Sciences Faculty, Tarapaca University, Arica 1000000 (Chile); Miranda, Patricia [Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago 7500539 (Chile); Vano, Eliseo [Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, Madrid 28040 (Spain)

    2015-02-15

    Purpose: To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency. Methods: Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs. Results: Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for <1 yr; 213 for 1 to <5 yr; 82 for 5 to <10 yr; and 102 for 10 to <16 yr. The third quartile values obtained for DAP by diagnostic and therapeutic procedures and age range were 1.17 and 1.11 Gy cm{sup 2} for <1 yr; 1.74 and 1.90 Gy cm{sup 2} for 1 to <5 yr; 2.83 and 3.22 Gy cm{sup 2} for 5 to <10 yr; and 7.34 and 8.68 Gy cm{sup 2} for 10 to <16 yr, respectively. The third quartile value obtained for the DAP/body weight ratio for the full sample of procedures was 0.17 (Gy cm{sup 2}/kg) for diagnostic and therapeutic procedures. Conclusions: The data presented in this paper are an initial attempt at establishing local DRLs in pediatric interventional cardiology, from a large sample of procedures for the standard age bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there

  5. Patent foramen ovale in a large population of ischemic stroke patients: diagnosis, age distribution, gender, and race.

    Science.gov (United States)

    Gupta, Vishal; Yesilbursa, Dilek; Huang, Wen Ying; Aggarwal, Kul; Gupta, Vijaya; Gomez, Camilo; Patel, Vinod; Miller, Andrew P; Nanda, Navin C

    2008-02-01

    Patent foramen ovale (PFO) is a well-recognized risk factor for ischemic strokes. The true prevalence of PFO among stroke patients is still under debate. Transesophageal echocardiography (TEE) is the "gold standard" in diagnosing PFO but the physiology requires right-to-left atrial shunting. In this report, we evaluate the prevalence of PFO in a diverse group of ischemic stroke patients studied by TEE. TEE of 1,663 ischemic stroke patients were reviewed for cardiac source of embolism, including PFO and atrial septal aneurysm (ASA). Agitated saline bubble injection was performed to look for right to left atrial shunting. Success of maneuvers to elevate right atrial pressure (RAP) was noted by looking at the atrial septal bulge. Among 1,435 ischemic stroke patients analyzed, the presence or absence of PFO could not be determined in 32.1% because bulging of the septum could not be demonstrated in patients with negative contrast study despite aggressive maneuvers to elevate RAP. Of the remaining 974 patients, 294 patients (30.2%) had a PFO. The mean age was 61.5 years in both groups, with a bimodal distribution of PFO and the highest prevalence occurring in gender or racial difference in the prevalence of PFO, but there was a bimodal distribution in prevalence with age.

  6. Circulating Endothelial Progenitor Cells in Type 1 Diabetic Patients: Relation with Patients’ Age and Disease Duration

    Directory of Open Access Journals (Sweden)

    Adolfo Arcangeli

    2017-10-01

    Full Text Available ObjectivesCirculating endothelial progenitor cells (cEPCs have been reported to be dysfunctional in diabetes mellitus (DM patients, accounting for the vascular damage and the ensuing high risk for cardiovascular disease (CVD characteristic of this disease. The aim of the present study was to evaluate the number of circulating cEPCs in type 1 DM (T1DM patients, without clinical vascular damage, of different ages and with different disease duration.MethodsAn observational, clinical-based prospective study was performed on T1DM patients enrolled in two clinical centers. cEPCs were determined by flow cytometry, determining the number of CD34/CD133/VEGFR2-positive cells within peripheral blood mononuclear cells (PBMCs.ResultsThe number of cEPCs was lower in adult T1DM patients, whilst higher in childhood/young patients, compared to controls of the same age range. When patients were grouped into two age groups (≥ or <20 years (and categorized on the basis of the duration of the disease, the number of cEPCs in young (<20 years patients was higher compared with older subjects, regardless of disease duration. A subset of patients with very high cEPCs was identified in the <20 years group.ConclusionThere is an association between the number of cEPCs and patients’ age: childhood/young T1DM patients have significantly higher levels of cEPCs, respect to adult T1DM patients. Such difference is maintained also when the disease lasts for more than 10 years. The very high levels of cEPCs, identified in a subset of childhood/young patients, might protect vessels against endothelial dysfunction and damage. Such protection would be less operative in older subjects, endowed with lower cEPC numbers, in which complications are known to develop more easily.

  7. Age as a factor in assessing risk to patients from the use of X-rays

    International Nuclear Information System (INIS)

    Heron, J. Le

    1996-01-01

    Any use of ionizing radiation carries with it a risk and it is often necessary to estimate this risk for groups of irradiated persons, or for individuals. Such persons include patients in diagnostic radiology. In diagnostic radiology effective dose has become widely used as the preferred index of patient dose. This is primarily for two reasons - effective dose is linked to a useful definition of radiation detriment and, because it converts an actual irradiation into an equivalent uniform whole body dose (in terms of detriment), it is able to cope with the partial body irradiations characteriztic of diagnostic radiology. But while effective dose has these attractions, it is based on assumptions that could impose limitations on its use for risk assessment. Effective dose is an index that has been averaged over populations and risk projection models, and its application to individuals or specialized groups of the population may not be appropriate. In this paper the collective risk from the use of diagnostic radiology in a large New Zealand teaching hospital is assessed using an age-specific approach, and this is compared with the collective risk assessed using the coefficients given in ICRP Publication 60 for the general public. (author)

  8. Evaluating the physiological reserves of older patients with cancer: the value of potential biomarkers of aging?

    Science.gov (United States)

    Pallis, Athanasios G; Hatse, Sigrid; Brouwers, Barbara; Pawelec, Graham; Falandry, Claire; Wedding, Ulrich; Lago, Lissandra Dal; Repetto, Lazzaro; Ring, Alistair; Wildiers, Hans

    2014-04-01

    Aging of an individual entails a progressive decline of functional reserves and loss of homeostasis that eventually lead to mortality. This process is highly individualized and is influenced by multiple genetic, epigenetic and environmental factors. This individualization and the diversity of factors influencing aging result in a significant heterogeneity among people with the same chronological age, representing a major challenge in daily oncology practice. Thus, many factors other than mere chronological age will contribute to treatment tolerance and outcome in the older patients with cancer. Clinical/comprehensive geriatric assessment can provide information on the general health status of individuals, but is far from perfect as a prognostic/predictive tool for individual patients. On the other hand, aging can also be assessed in terms of biological changes in certain tissues like the blood compartment which result from adaptive alterations due to past history of exposures, as well as intrinsic aging processes. There are major signs of 'aging' in lymphocytes (e.g. lymphocyte subset distribution, telomere length, p16INK4A expression), and also in (inflammatory) cytokine expression and gene expression patterns. These result from a combination of the above two processes, overlaying genetic predispositions which contribute significantly to the aging phenotype. These potential "aging biomarkers" might provide additional prognostic/predictive information supplementing clinical evaluation. The purpose of the current paper is to describe the most relevant potential "aging biomarkers" (markers that indicate the biological functional age of patients) which focus on the biological background, the (limited) available clinical data, and technical challenges. Despite their great potential interest, there is a need for much more (validated) clinical data before these biomarkers could be used in a routine clinical setting. This manuscript tries to provide a guideline on how

  9. Rate of shunt revision as a function of age in patients with shunted hydrocephalus due to myelomeningocele.

    Science.gov (United States)

    Dupepe, Esther B; Hopson, Betsy; Johnston, James M; Rozzelle, Curtis J; Jerry Oakes, W; Blount, Jeffrey P; Rocque, Brandon G

    2016-11-01

    OBJECTIVE It is generally accepted that cerebrospinal fluid shunts fail most frequently in the first years of life. The purpose of this study was to describe the risk of shunt failure for a given patient age in a well-defined cohort with shunted hydrocephalus due to myelomeningocele (MMC). METHODS The authors analyzed data from their institutional spina bifida research database including all patients with MMC and shunted hydrocephalus. For the entire population, the number of shunt revisions in each year of life was determined. Then the number of patients at risk for shunt revision during each year of life was calculated, thus enabling them to calculate the rate of shunt revision per patient in each year of life. In this way, the timing of all shunt revision operations for the entire clinic population and the likelihood of having a shunt revision during each year of life were calculated. RESULTS A total of 655 patients were enrolled in the spina bifida research database, 519 of whom had a diagnosis of MMC and whose mean age was 17.48 ± 11.7 years (median 16 years, range 0-63 years). Four hundred seventeen patients had had a CSF shunt for the treatment of hydrocephalus and thus are included in this analysis. There were 94 shunt revisions in the 1st year of life, which represents a rate of 0.23 revisions per patient in that year. The rate of shunt revision per patient-year initially decreased as age increased, except for an increase in revision frequency in the early teen years. Shunt revisions continued to occur as late as 43 years of age. CONCLUSIONS These data substantiate the idea that shunt revision surgeries in patients with MMC are most common in the 1st year of life and decrease thereafter, except for an increase in the early teen years. A persistent risk of shunt failure was observed well into adult life. These findings underscore the importance of routine follow-up of all MMC patients with shunted hydrocephalus and will aid in counseling patients and

  10. Age-related treatment patterns in sickle cell disease patients and the associated sickle cell complications and healthcare costs.

    Science.gov (United States)

    Blinder, Morey A; Vekeman, Francis; Sasane, Medha; Trahey, Alex; Paley, Carole; Duh, Mei Sheng

    2013-05-01

    This study explored the blood transfusion patterns, SCD complications, utilization of iron chelation therapies (ICT), healthcare resource use, and costs in pediatric, transitioning (18 years old) and adult patients with SCD. Data from Florida (1998-2009), New Jersey (1996-2009), Missouri (1997-2010), Kansas (2001-2009), and Iowa (1998-2010) state Medicaid were used. Patients with ≥2 SCD diagnoses and ≥1 transfusion event were included. Rates of transfusion events, SCD complications, and proportion of eligible patients receiving ICT were calculated. ICT eligibility was defined as receiving ≥10 transfusions over lifetime. SCD complications included pain, pulmonary event, infection event, renal, cardiovascular, stroke, leg ulcers, and avascular necrosis. Regressions were used to assess risk factors for transfusion and identify the main drivers of costs. The sample included 3,208 patients. The transfusion rate increased from 1-year-old to a peak at 16 years old, then dropped until age 26 and remained stable thereafter. In contrast the frequency of diagnoses for SCD complications increased markedly after age 16. Post-transition patients (≥18 years old) were significantly associated with fewer transfusions (odds ratio: 0.80, P = 0.002). Among eligible patients for ICT, there was no statistically significant difference in total cost between the ICT and no ICT groups (adjusted cost difference, $136, P = 0.114). Patients transitioning to adult care received less transfusions and hydroxyurea, less ICT when eligible for chelation therapy, had higher healthcare costs and suffered from more frequent SCD related complications than pediatric patients. These findings highlight the changes in treatment patterns corresponding to transition to adult care. Copyright © 2013 Wiley Periodicals, Inc.

  11. Impact of Age on Survival of Patients with Operable Breast Cancer

    Directory of Open Access Journals (Sweden)

    Mohamadreza Neishaboury

    2015-11-01

    Full Text Available Background: Breast cancer arising in young patients (≤ 40 years is being considered as a distinct clinical entity with more aggressive tumor features and poorer survival. Our aim was to assess the impact of age on survival among a large group of Iranian women diagnosed with breast cancer.Methods: In a cross-sectional study, demographic and clinicopathological characteristics of patients with breast cancer who were treated in two referral centers in Tehran, Iran during the past 13 years were reviewed and extracted from an electronic database. Patients were divided into two groups based on the age at the time of diagnosis (≤40 and >40 years. The association of age with different clinicopathological features and its impact on disease-free survival were assessed. Results: Study population comprised of 353(26.1% patients who were 40 years old or younger and 1000(73.9% who were older. Compared to older patients, younger participants had more commonly tumor size larger than 5 cm (P = 0.034, higher chance of lymph node metastasis (P = 0.036, and overexpression of HER-2 (P = 0.004. No significant differences were observed between the two groups regarding ER, PR, and LNR (lymph node ratio. Age was the only factor affecting patients' disease-free survival and younger patients had higher chance of local or distant metastases compared to older subjects (HR: 1.49, 95%CI: 1.02-2.17, P = 0.038.Conclusions: Based on the results of current study, it can be suggested that younger patients who are diagnosed with breast cancer tend to have larger tumor size, higher chance of lymph node metastasis and overexpression of HER-2 compared to patients older than 40 years. Age was the only significant factor that was associated with shorter disease-free survival.

  12. Correlations between choroidal abnormalities, Lisch nodules, and age in patients with neurofibromatosis type 1

    Directory of Open Access Journals (Sweden)

    Makino S

    2014-01-01

    Full Text Available Shinji Makino, Hironobu Tampo, Yusuke Arai, Hiroto ObataDepartment of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, JapanAbstract: To evaluate correlations between choroidal abnormalities, Lisch nodules, and age in patients with neurofibromatosis type 1 (NF1, we examined ten cases with NF1 using near-infrared reflectance imaging. Patients ranged in age from 4 to 39 years. The angle used for near-infrared reflectance imaging was 55°. We counted the total number of choroidal abnormalities in an area within a 55° angle centered on the fovea and the total number of Lisch nodules on the iris by slit-lamp examination. No positive correlation was found between the number of Lisch nodules and patient age (Spearman's rank correlation coefficient ρ=0.117, P=0.7414. Choroidal abnormalities tended to increase with age (ρ=0.6150, but this difference was not statistically significant (P=0.0650. A positive correlation was found between the number of choroidal abnormalities and Lisch nodules (ρ=0.783, P=0.0267. In conclusion, choroidal abnormalities tend to increase with patient age and are correlated with the number of Lisch nodules.Keywords: neurofibromatosis type 1, near-infrared reflectance, choroidal abnormality, Lisch nodule, age

  13. Treatment of Myasthenia Gravis in Patients with Elderly Onset at Advanced Age

    Directory of Open Access Journals (Sweden)

    Noriko Nishikawa

    2015-01-01

    Full Text Available The number of patients with late-onset myasthenia gravis (MG among patients ≥50 years has been increasing recently. We encountered three patients who developed elderly-onset MG at a particularly advanced age (≥80 years. All were female and positive for anti-acetylcholine receptor antibodies. About 4 years have passed since MG onset in all three patients and symptoms have been controlled without recurrence using a combination of oral low-dose prednisolone and tacrolimus. As many cases of elderly-onset MG do not require strong immunosuppression, we recommend minimum immunosuppressive treatment to avoid adverse events, particularly in patients at an advanced age of ≥80 years.

  14. The effects of red cell transfusion donor age on nosocomial infection among trauma patients.

    Science.gov (United States)

    Loftus, Tyler J; Thomas, Ryan M; Murphy, Travis W; Nguyen, Linda L; Moore, Frederick A; Brakenridge, Scott C; Efron, Philip A; Mohr, Alicia M

    2017-10-01

    We hypothesized that packed red blood cell (PRBC) transfusions from older donors would be associated with fewer nosocomial infections among trauma patients. We performed a four-year retrospective analysis of 264 consecutive adult trauma patients who received ≥1 PRBC transfusion during admission. The capacity of donor age to predict nosocomial infection was assessed by logistic regression. Thirty-three percent of all patients developed a nosocomial infection. Donor age was significantly higher among patients with nosocomial infection (40.3 vs. 37.6 years, p = 0.035), and the incidence of infection was directly proportional to donor age. The association between donor age and infection was strongest among recipients age ≥60 years, and was significant on multivariate regression for this cohort (OR 1.07 (95% CI 1.01-1.13), p = 0.024). Among trauma patients receiving PRBC transfusions, blood from older donors may be associated with increased risk for nosocomial infection. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Advanced non-small cell lung cancer in patients aged 45 years or younger: outcomes and prognostic factors

    Directory of Open Access Journals (Sweden)

    Hsu Chia-Lin

    2012-06-01

    Full Text Available Abstract Background Lung cancer in young patients (less or equal to 45 years is uncommon and has clinical characteristics different from that in older patients. We investigated the outcomes and prognostic factors of young patients with advanced non-small cell lung cancer (NSCLC. Methods From January 2000 to December 2009, we enrolled patients aged ≤45 years and diagnosed with stage IIIB or IV NSCLC. Their clinical data, including age, gender, performance status, histologic types, disease stages, laboratory data at diagnosis, treatment modalities, and survival were reviewed and analyzed. A Cox proportional hazard model was used to calculate the hazard ratio (HR and its 95% confidence interval (CI. Results A total of 144 patients with advanced NSCLC were included. Female patients were more prevalent (n = 74, 51.4%. Adenocarcinoma was the most common histologic type (n = 119, 82.6% in both genders (male, n = 54, 77.1%; female, n = 65, 87.8%. Epidermal growth factor receptor (EGFR sequences were determined using tumor specimens from 58 patients, and 29 showed an EGFR mutation. No significant difference in median survival was found between patient groups with and without the EGFR mutation (798 vs. 708 days, p = 0.65. In multivariate analysis, male gender (HR, 1.70; 95% CI: 1.08-2.68, body mass index (BMI less than 25 kg/m2 (HR, 2.72; 95% CI: 1.39-5.30, stage IV disease (HR, 2.62; 95% CI: 1.50-4.57, and anemia (HR, 2.08; 95% CI: 1.15-3.77 were associated with a short survival time. Conclusions Low BMI, stage IV disease, anemia at diagnosis, and male gender were the negative prognostic factors for young patients with advanced NSCLC.

  16. The prognostic value of age for 1030 patients with early stage breast cancer after postoperative radiotherapy

    International Nuclear Information System (INIS)

    Xu Liming; Li Ruiying; Wang Ping; Xu Liang; Hao Jianlei; Liu Xiaobin; Pang Qingsong; Zhu Li; Cui Yong

    2010-01-01

    Objective: To analyze the prognostic value of age in patients with early stage breast cancer. Methods: The clinical characteristics of 1030 patients with early stage breast cancer (the number of positive axillary lymph nodes was less than 3) were retrospectively reviewed. Of all the patients, 468(stage I, n = 227; and stage II , n = 241) received breast conserving surgery (BCS) and 562 (stage I, n =184; and stage II, n= 378) received modified mastectomy. Patients were divided into young-age group (≤35, 136 patients), middle-age group (> 35-≤60,738 patients) and old-age group (> 60, 156 patients). The number of patients without postoperative radiation therapy after BCS is 16, 60 and 39 in the three groups, respectively. Two-dimensional conventional fractionated radiotherapy was administered. The prognostic value of the tumor size, status of axillary lymph nodes or hormonal receptors, postoperative radiation therapy were analyzed. Results: The follow-up rate was 97.86%. Of 795 patients followed up more than 5 years, 110, 569 and 116 patients were devided into the three groups, respectively. There were 40, 202 and 87 patients without radiation therapy in the three groups. The 5-year recurrence rates of the three groups were 6.2%, 8.7% and 10.4% (χ 2 = 1.14, P= 0.567). The 5-year distant metastasis rates were 4.3% , 9.5 % and 2. 5% (χ 2 = 5.31 , P = 0.070) . The 5 - year survival rates were 91.2% , 92.6% and 82.1% (χ 2 = 6. 83, P = 0.033). The young-age group had more tumors smaller than 2. 0 cm (65.4%), less positive axillary lymph nodes (13.2%), poorer differential tumor and less positive hormone acceptors (48.0%). Of patients with tumor larger than 2. 0 cm who had no radiotherapy after BCS, the 5-year survival rates were 94%, 87% and 71% (χ 2 = 20.69, P= 0.000) in the three groups. The corresponding recurrence rates were 23%, 18% ,7%, (χ 2 = 9.97, P = 0.007), and distant metastasis rates were 23%, 25% and 10% (χ 2 =8.51, P=0.014). Conclusions: The age is

  17. Opioid escalation in patients with cancer pain: the effect of age.

    Science.gov (United States)

    Mercadante, Sebastiano; Ferrera, Patrizia; Villari, Patrizia; Casuccio, Alessandra

    2006-11-01

    Elderly people are commonly considered more susceptible to opioid effects. However, no data regarding the need for opioid escalation in patients already receiving opioids for the management of chronic pain are available. The purpose of this study was to evaluate the differences between younger and older patients during the crucial phase of opioid titration. One hundred consecutive patients with cancer pain requiring further opioid dose refinement were recruited for this cohort study. Pain intensity, dose of opioids, number of opioids used (need to switch), routes of administration used, and opioid-related symptoms were measured from admission until dose stabilization. Opioid escalation indexes (OEIs) were calculated. For the purpose of analysis, patients were divided into three age groups (OEI, or other parameters between younger and older patients. Similarly, adverse effects did not significantly differ between the three groups, although an overall distress score worsened in older patients during acute titration and then improved at stabilization time. These data contradict the assumption that older patients who already receive opioids are more susceptible than younger adults to opioid effects during opioid titration. Although the elderly require lower doses, opioid effects do not appear to vary with age in this population. However, the group of patients over 75 was relatively small and data should be interpreted with caution. Careful titration based on the individual response seems appropriate irrespective of age.

  18. Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

    Directory of Open Access Journals (Sweden)

    Patrick Mulligan

    2013-01-01

    Full Text Available Background: Subdural hematoma (SDH is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005, yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44% were discharged home, 16 (36% discharged to nursing home or rehab, 6 (13% to hospice and 3 (7% died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

  19. Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation.

    Science.gov (United States)

    Biagi, Federico; Schiepatti, Annalisa; Maiorano, Gregorio; Fraternale, Giacomo; Agazzi, Simona; Zingone, Fabiana; Ciacci, Carolina; Volta, Umberto; Caio, Giacomo; Tortora, Raffaella; Klersy, Catherine; Corazza, Gino R

    2017-12-08

    Coeliac disease is characterised by an increased mortality mostly due to its complications. To study the risk of developing complications according to clinical presentation and age at diagnosis, a combined retrospective-prospective longitudinal study was performed in three Italian centres. Incidence of complications and mortality rates were calculated using type and age at diagnosis of coeliac disease, sex, and centre of diagnosis as predictors. Patients referred after being found to suffer from coeliac disease elsewhere were excluded. Between 01/1999 and 06/2015, 2225 adult coeliac patients were directly diagnosed in our centres. 17 of them developed a complication and 29 died. In patients older than 60 years at diagnosis of coeliac disease, the risk of complication is 18 times higher than in patients diagnosed at 18-40 years and 9 times higher than in patients diagnosed at 40-60 years. Classical presentation increases the risk of complications by 7 times compared to non-classical presentation; in asymptomatic patients the risk of complication is virtually absent. The risk of developing complications in coeliac patients is linked to age at diagnosis of coeliac disease and type of clinical presentation. Follow-up methods of coeliac patients should be tailored according to these parameters. Copyright © 2017. Published by Elsevier Ltd.

  20. Patient's anxiety and fear of anesthesia: effect of gender, age, education, and previous experience of anesthesia. A survey of 400 patients.

    Science.gov (United States)

    Mavridou, Paraskevi; Dimitriou, Varvara; Manataki, Adamantia; Arnaoutoglou, Elena; Papadopoulos, Georgios

    2013-02-01

    Patients express high anxiety preoperatively, because of fears related to anesthesia and its implications. The purpose of this survey was to gain insight into these fears and to study whether they are affected by patients' sex, age, education, or previous experience of anesthesia. Questionnaires with fixed questions were distributed to consenting, consecutive surgical patients before the pre-anesthetic visit. The questionnaires included patients' demographics and questions related to their fears about anesthesia. Four-hundred questionnaires were collected and analyzed. Eighty-one percent of patients experience preoperative anxiety. The main sources of their anxiety were fear of postoperative pain (84 %), of not waking up after surgery (64.8 %), of being nauseous or vomiting (60.2 %), and of drains and needles (59.5 %). Patients are less concerned about being paralyzed because of anesthesia (33.5 %) or of revealing personal issues (18.8 %). Gender seems to affect patients fears, with women being more afraid (85.3 vs. 75.6 % of men, p = 0.014). The effects of patients' age, level of education, and previous experience of anesthesia are minor, except for individual questions. Sixty-three percent of our patients (mostly women 67.4 vs. 57.4 % of men, p = 0.039) talk about these fears with their relatives, although a vast majority of 95.5 % would prefer to talk with the anesthesiologist and be reassured by him. All patients, mostly women, express fears about anesthesia; this fear leads to preoperative anxiety. Slight differences are observed for some individual questions among patients of different sex, education level, and previous experience of anesthesia.

  1. Abnormal functional connectivity of the amygdala in first-episode and untreated adult major depressive disorder patients with different ages of onset.

    Science.gov (United States)

    Ye, Jing; Shen, Zonglin; Xu, Xiufeng; Yang, Shuran; Chen, Wei; Liu, Xiaoyan; Lu, Yi; Liu, Fang; Lu, Jin; Li, Na; Sun, Xuejin; Cheng, Yuqi

    2017-03-01

    Major depressive disorder (MDD) is a common mental disorder with high morbidity. As a part of the limbic system, the amygdala is important in the processing of emotional information. Structural and functional connectivity (FC) abnormalities in the amygdala have been observed in MDD patients. The present study was carried out to identify the features of amygdala FC in adult MDD patients with different ages of onset. Sixty-nine first-episode and untreated MDD patients and 81 healthy controls (CTLs) were included in this study and underwent 3D structural imaging and resting-state functional MRI scanning. The patients and CTLs were divided into two groups according to age of onset: young adult (amygdala seeds to the whole brain of MDD patients and matched CTLs in these two different onset age groups were analysed. We found that the volume of the bilateral amygdala increased to a greater extent in young adult patients compared with old adult patients. We also observed a trend toward different amygdala FC by onset age in MDD patients. In young adult patients, the left amygdala showed more abnormal resting-state FC with other regions compared with matched controls. However, in old adult patients, compared with matched controls, the right amygdala showed more abnormal changes in the resting-state FC with other regions. MDD patients with different ages of onset showed different changes in the structure and FC of the amygdala. These results might help us to understand the high heterogeneity of MDD.

  2. Altered functional connectivity links in neuroleptic-naïve and neuroleptic-treated patients with schizophrenia, and their relation to symptoms including volition

    Directory of Open Access Journals (Sweden)

    Weidan Pu

    2014-01-01

    Full Text Available In order to analyze functional connectivity in untreated and treated patients with schizophrenia, resting-state fMRI data were obtained for whole-brain functional connectivity analysis from 22 first-episode neuroleptic-naïve schizophrenia (NNS, 61 first-episode neuroleptic-treated schizophrenia (NTS patients, and 60 healthy controls (HC. Reductions were found in untreated and treated patients in the functional connectivity between the posterior cingulate gyrus and precuneus, and this was correlated with the reduction in volition from the Positive and Negative Symptoms Scale (PANSS, that is in the willful initiation, sustenance, and control of thoughts, behavior, movements, and speech, and with the general and negative symptoms. In addition in both patient groups interhemispheric functional connectivity was weaker between the orbitofrontal cortex, amygdala and temporal pole. These functional connectivity changes and the related symptoms were not treated by the neuroleptics. Differences between the patient groups were that there were more strong functional connectivity links in the NNS patients (including in hippocampal, frontal, and striatal circuits than in the NTS patients. These findings with a whole brain analysis in untreated and treated patients with schizophrenia provide evidence on some of the brain regions implicated in the volitional, other general, and negative symptoms, of schizophrenia that are not treated by neuroleptics so have implications for the development of other treatments; and provide evidence on some brain systems in which neuroleptics do alter the functional connectivity.

  3. Cannabis Use Patterns and Motives: A Comparison of Younger, Middle-Aged, and Older Medical Cannabis Dispensary Patients

    Science.gov (United States)

    Haug, Nancy A.; Padula, Claudia B.; Sottile, James E.; Vandrey, Ryan; Heinz, Adrienne J.; Bonn-Miller, Marcel O.

    2017-01-01

    Introduction Medical cannabis is increasingly being used for a variety of health conditions as more states implement legislation permitting medical use of cannabis. Little is known about medical cannabis use patterns and motives among adults across the lifespan. Methods The present study examined data collected at a medical cannabis dispensary in San Francisco, California. Participants included 217 medical cannabis patients who were grouped into age-defined cohorts (younger: 18–30, middle-aged: 31–50, and older: 51–72). The age groups were compared on several measures of cannabis use, motives and medical conditions using one-way ANOVAs, chi-square tests and linear regression analyses. Results All three age groups had similar frequency of cannabis use over the past month; however, the quantity of cannabis used and rates of problematic cannabis use were higher among younger users relative to middle-aged and older adults. The association between age and problematic cannabis use was moderated by age of regular use initiation such that earlier age of regular cannabis use onset was associated with more problematic use in the younger users, but not among older users. Middle-aged adults were more likely to report using medical cannabis for insomnia, while older adults were more likely to use medical cannabis for chronic medical problems such as cancer, glaucoma and HIV/AIDS. Younger participants reported cannabis use when bored at a greater rate than middle-aged and older adults. Conclusions Findings suggest that there is an age-related risk for problematic cannabis use among medical cannabis users, such that younger users should be monitored for cannabis use patterns that may lead to deleterious consequences. PMID:28340421

  4. Effect of age on left ventricular function during exercise in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Hakki, A.H.; DePace, N.L.; Iskandrian, A.S.

    1983-01-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p . not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p . 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p . not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease

  5. Outcomes and Tolerability of Chemoradiation Therapy for Pancreatic Cancer Patients Aged 75 Years or Older

    International Nuclear Information System (INIS)

    Miyamoto, David T.; Mamon, Harvey J.; Ryan, David P.

    2010-01-01

    Purpose: To review the outcomes and tolerability of full-dose chemoradiation in elderly patients aged 75 years or older with localized pancreatic cancer. Methods and Materials: We retrospectively reviewed patients aged 75 years or older with nonmetastatic pancreatic cancer treated with chemoradiation therapy at two institutions from 2002 to 2007. Patients were analyzed for treatment toxicity, local recurrences, distant metastases, and survival. Results: A total of 42 patients with a median age of 78 years (range, 75-90 years) who received chemoradiation therapy for pancreatic cancer were identified. Of the patients, 24 had locally advanced disease treated with definitive chemoradiation, and 18 had disease treated with surgery and chemoradiation. Before chemoradiotherapy, the mean Eastern Cooperative Oncology Group performance status was 1.0 ± 0.8, and the mean 6-month weight loss was 5.3 ± 3.8 kg. The mean radiation dose delivered was 48.1 ± 9.2 Gy. All patients received fluoropyrimidine-based chemotherapy concurrently with radiotherapy. In all, 8 patients (19%) were hospitalized, 7 (17%) had an emergency room visit, 15 (36%) required a radiation treatment break, 3 (7%) required a chemotherapy break, 9 (21%) did not complete therapy, and 22 (49%) had at least one of these adverse events. The most common toxicities were nausea, pain, and failure to thrive. Median overall survival was 8.6 months (95% confidence interval, 7.2-13.1) in patients who received definitive chemoradiation therapy and 20.6 months (95% confidence interval, 9.5-∞) in patients who underwent resection and chemoradiation therapy. Conclusions: In this dataset of very elderly patients with pancreatic cancer and good Eastern Cooperative Oncology Group performance status, outcomes after chemoradiotherapy were similar to those among historic controls for patients with locally advanced and resected pancreatic cancer, although many patients experienced substantial treatment-related toxicity.

  6. Risk factors for endophthalmitis in age-related cataract patients undergoing phacoemulsification

    Directory of Open Access Journals (Sweden)

    Lei Ge

    2018-02-01

    Full Text Available AIM: To explore the risk factors for endophthalmitis in age-related cataract patients undergoing phacoemulsification, in order to provide reasonable intervention countermeasures to reduce the incidence of eddophthalmitis after phacoemulsification, increase the surgery efficacy. METHODS: The 4 500 cases(6 180 eyesof age-related cataract patients with phacoemulsification in our hospital were analyzed, and cases of endopathalmitis needed to have vitreous puncture to collect the sample for analysis, the infectious bacteria, funfal distribution and the operation time, patients age, complications, surgical incision were analyzed for the risk factors of endophthalmitis in senile cataract patients. Data were statistically analyzed by SPSS 18.0.RESULTS: In our study, among the 4500 cases(6180 eyeswith phacoemulsification, the endophthalmitis infection rate was 0.19%(12/6180, the incidence of endophthalmitis was significantly higher in patients with age ≥75 years, with diabetes, hypertension, coronary heart disease history, and the temporal transparent corneal tunnel incision surgery(PPCONCLUSION: For the cataract patients over 75 years old or with diabetes, interventions should be done well before surgery. Surgical incision should be selected in the surgical procedure and avoid complications such as vitreous overflow and posterior capsular rupture in order to reduce the incidence of intraocular infection and improve the postoperative recovery.

  7. Awareness and Uptake of Family Screening in Patients Diagnosed with Colorectal Cancer at a Young Age

    Directory of Open Access Journals (Sweden)

    Niamh M. Hogan

    2015-01-01

    Full Text Available Background. One-fifth of people who develop colorectal cancer (CRC have a first-degree relative (FDR also affected. There is a large disparity in guidelines for screening of relatives of patients with CRC. Herein we address awareness and uptake of family screening amongst patients diagnosed with CRC under age 60 and compare guidelines for screening. Study Design. Patients under age 60 who received surgical management for CRC between June 2009 and May 2012 were identified using pathology records and theatre logbooks. A telephone questionnaire was carried out to investigate family history and screening uptake among FDRs. Results. Of 317 patients surgically managed for CRC over the study period, 65 were under age 60 at diagnosis (8 deceased. The mean age was 51 (30–59. 66% had node positive disease. 25% had a family history of colorectal cancer in a FDR. While American and Canadian guidelines identified 100% of these patients as requiring screening, British guidelines advocated screening for only 40%. Of 324 FDRs, only 40.9% had been screened as a result of patient’s diagnosis. Conclusions. Uptake of screening in FDRs of young patients with CRC is low. Increased education and uniformity of guidelines may improve screening uptake in this high-risk population.

  8. Age-related cutoffs for cervical movement behaviour to distinguish chronic idiopathic neck pain patients from unimpaired subjects.

    Science.gov (United States)

    Niederer, Daniel; Vogt, Lutz; Wilke, Jan; Rickert, Marcus; Banzer, Winfried

    2015-03-01

    The present study aims to develop age-dependent cutoff values in a quasi-experimental, cross-sectional diagnostic test study. One hundred and twenty (120) asymptomatic subjects (n = 100, 36♀, 18 75 years, for normative values; n = 20, 23-75 years, 15♀, for selectivity analyses) and 20 patients suffering from idiopathic neck pain (selectivity analyses, 22-71 years, 15♀) were included. Subjects performed five repetitive maximal cervical flexion/extension movements in an upright sitting position. Cervical kinematic characteristics (maximal range of motion (ROM), coefficient of variation (CV) and mean conjunct movements in rotation and flexion (CM)) were calculated from raw 3D ultrasonic data. Regression analyses were conducted to reveal associations between kinematic characteristics and age and gender and thus to determine normative values for healthy subjects. Age explains 53 % of the variance in ROM (decrease 10.2° per decade), 13 % in CV (increase 0.003 per decade) and 9 % in CM (increase 0.57° per decade). Receivers operating characteristic (ROC) analyses were conducted for differences between individual values of the kinematic characteristics and normative values to optimise cutoff values for distinguishing patients from unimpaired subjects (20 patients and 20 healthy). Cutoff values distinguished asymptomatic subjects' and chronic nonspecific neck patient's movement characteristics with sufficient quality (sensitivity 70-80 %, specificity 65-70 %). By including such classifications, the present findings expand actual research stating an age-related decrease in kinematic behaviour only using categorising span widths across decades. Future study is warranted to reveal our results' potential applicability for intervention onset decision making for idiopathic neck pain patients.

  9. Effect of age and disease on bone mass in Japanese patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Sugawara Norio

    2012-02-01

    Full Text Available Abstract Background There have been a limited number of studies comparing bone mass between patients with schizophrenia and the general population. The aim of this study was to compare the bone mass of schizophrenia patients with that of healthy subjects in Japan. Methods We recruited patients (n = 362, aged 48.8 ± 15.4 (mean ± SD years who were diagnosed with schizophrenia or schizoaffective disorder based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV. Bone mass was measured using quantitative ultrasound densitometry of the calcaneus. The osteosono-assessment index (OSI was calculated as a function of the speed of sound and the transmission index. For comparative analysis, OSI data from 832 adults who participated in the Iwaki Health Promotion Project 2009 was used as representative of the general community. Results Mean OSI values among male schizophrenic patients were lower than those in the general population in the case of individuals aged 40 and older. In females, mean OSI values among schizophrenic patients were lower than those in the general community in those aged 60 and older. In an analysis using the general linear model, a significant interaction was observed between subject groups and age in males. Conclusions Older schizophrenic patients exhibit lower bone mass than that observed in the general population. Our data also demonstrate gender and group differences among schizophrenic patients and controls with regard to changes in bone mass associated with aging. These results indicate that intervention programs designed to delay or prevent decreased bone mass in schizophrenic patients might be tailored according to gender.

  10. Effect of age and disease on bone mass in Japanese patients with schizophrenia.

    Science.gov (United States)

    Sugawara, Norio; Yasui-Furukori, Norio; Umeda, Takashi; Tsuchimine, Shoko; Fujii, Akira; Sato, Yasushi; Saito, Manabu; Furukori, Hanako; Danjo, Kazuma; Matsuzaka, Masashi; Takahashi, Ippei; Kaneko, Sunao

    2012-02-20

    There have been a limited number of studies comparing bone mass between patients with schizophrenia and the general population. The aim of this study was to compare the bone mass of schizophrenia patients with that of healthy subjects in Japan. We recruited patients (n = 362), aged 48.8 ± 15.4 (mean ± SD) years who were diagnosed with schizophrenia or schizoaffective disorder based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Bone mass was measured using quantitative ultrasound densitometry of the calcaneus. The osteosono-assessment index (OSI) was calculated as a function of the speed of sound and the transmission index. For comparative analysis, OSI data from 832 adults who participated in the Iwaki Health Promotion Project 2009 was used as representative of the general community. Mean OSI values among male schizophrenic patients were lower than those in the general population in the case of individuals aged 40 and older. In females, mean OSI values among schizophrenic patients were lower than those in the general community in those aged 60 and older. In an analysis using the general linear model, a significant interaction was observed between subject groups and age in males. Older schizophrenic patients exhibit lower bone mass than that observed in the general population. Our data also demonstrate gender and group differences among schizophrenic patients and controls with regard to changes in bone mass associated with aging. These results indicate that intervention programs designed to delay or prevent decreased bone mass in schizophrenic patients might be tailored according to gender.

  11. The reliability and validity of Chinese version of SF36 v2 in aging patients with chronic heart failure.

    Science.gov (United States)

    Dong, Aishu; Chen, Sisi; Zhu, Lianlian; Shi, Lingmin; Cai, Yueli; Zeng, Jingni; Guo, Wenjian

    2017-08-01

    Chronic heart failure (CHF), a major public health problem worldwide, seriously limits health-related quality of life (HRQOL). How to evaluate HRQOL in older patients with CHF remains a problem. To evaluate the reliability and validity of the Chinese version of the Medical Outcomes Study Short Form version 2 (SF-36v2) in CHF patients. From September 2012 to June 2014, we assessed QOL using the SF-36v2 in 171 aging participants with CHF in four cardiology departments. Convergent and discriminant validity, factorial validity, sensitivity among different NYHA classes and between different age groups, and reliability were determined using standard measurement methods. A total of 150 participants completed a structured questionnaire including general information and the Chinese SF-36v2; 132 questionnaires were considered valid, while 21 patients refused to take part. 25 of the 50 participants invited to complete the 2-week test-retest questionnaires returned completed questionnaires. The internal consistency reliability (Cronbach's α) of the total SF-36v2 was 0.92 (range 0.74-0.93). All hypothesized item-subscale correlations showed satisfactory convergent and discriminant validity. Sensitivity was measured in different NYHA classes and age groups. Comparison of different NYHA classes showed statistical significance, but there was no significant difference between age groups. We confirmed the SF-36v2 as a valid instrument for evaluating HRQOL Chinese CHF patients. Both reliability and validity were strongly satisfactory, but there was divergence in understanding subscales such as "social functioning" because of differing cultural background. The reliability, validity, and sensitivity of SF-36v2 in aging patients with CHF were acceptable.

  12. Rehabilitation of patients aged 65 and over after total hip replacement

    DEFF Research Database (Denmark)

    Hørdam, Britta

    by a randomised clinical trial by using telephone interviews and counseling postoperatively, and testing improvement in patients´health status after THR. The last study involved testing the effect of nursing intervention by providing a measurement of patients´healthrelated quality of life.......The overall aim of this thesis was to investigate improvement in health status of patients aged 65 and over after total hip replacement (THR) as a result of nursing rehabilitation. The projects conssits of three studies, first a description of patients´health status after THR, followed...

  13. Increased epigenetic age and granulocyte counts in the blood of Parkinson's disease patients

    Science.gov (United States)

    Horvath, Steve; Ritz, Beate R.

    2015-01-01

    It has been a long standing hypothesis that blood tissue of PD Parkinson's disease (PD) patients may exhibit signs of accelerated aging. Here we use DNA methylation based biomarkers of aging (“epigenetic clock”) to assess the aging rate of blood in two ethnically distinct case-control data sets. Using n=508 Caucasian and n=84 Hispanic blood samples, we assess a) the intrinsic epigenetic age acceleration of blood (IEAA), which is independent of blood cell counts, and b) the extrinsic epigenetic age acceleration rate of blood (EEAA) which is associated with age dependent changes in blood cell counts. Blood of PD subjects exhibits increased age acceleration according to both IEAA (p=0.019) and EEAA (p=6.1×10−3). We find striking differences in imputed blood cell counts between PD cases and controls. Compared to control subjects, PD subjects contains more granulocytes (p=1.0×10−9 in Caucasians, p=0.00066 in Hispanics) but fewer T helper cells (p=1.4×10−6 in Caucasians, p=0.0024 in Hispanics) and fewer B cells (p=1.6×10−5 in Caucasians, p=4.5×10−5 in Hispanics). Overall, this study shows that the epigenetic age of the immune system is significantly increased in PD patients and that granulocytes play a significant role. PMID:26655927

  14. Unique transcriptomic response to sepsis is observed among patients of different age groups.

    Science.gov (United States)

    Raymond, Steven L; López, María Cecilia; Baker, Henry V; Larson, Shawn D; Efron, Philip A; Sweeney, Timothy E; Khatri, Purvesh; Moldawer, Lyle L; Wynn, James L

    2017-01-01

    Sepsis is a major cause of morbidity and mortality, especially at the extremes of age. To understand the human age-specific transcriptomic response to sepsis, a multi-cohort, pooled analysis was conducted on adults, children, infants, and neonates with and without sepsis. Nine public whole-blood gene expression datasets (636 patients) were employed. Age impacted the transcriptomic host response to sepsis. Gene expression from septic neonates and adults was more dissimilar whereas infants and children were more similar. Neonates showed reductions in inflammatory recognition and signaling pathways compared to all other age groups. Likewise, adults demonstrated decreased pathogen sensing, inflammation, and myeloid cell function, as compared to children. This may help to explain the increased incidence of sepsis-related organ failure and death in adults. The number of dysregulated genes in septic patients was proportional to age and significantly differed among septic adults, children, infants, and neonates. Overall, children manifested a greater transcriptomic intensity to sepsis as compared to the other age groups. The transcriptomic magnitude for adults and neonates was dramatically reduced as compared to children and infants. These findings suggest that the transcriptomic response to sepsis is age-dependent, and diagnostic and therapeutic efforts to identify and treat sepsis will have to consider age as an important variable.

  15. ABCB1 genotypes and haplotypes in patients with dementia and age-matched non-demented control patients

    Directory of Open Access Journals (Sweden)

    Frankfort Suzanne V

    2006-09-01

    Full Text Available Abstract Amyloid β is an in vitro substrate for P-glycoprotein (P-gp, an efflux pump at the blood brain barrier (BBB. The Multi Drug Resistance (ABCB1 gene, encoding for P-gp, is highly polymorphic and this may result in a changed function of P-gp and may possibly interfere with the pathogenesis of Alzheimer's disease. This study investigates to what extent ABCB1 Single Nucleotide Polymorphisms (SNPs; C1236T in exon 12, G2677T/A in exon 21 and C3435T in exon 26 and inferred haplotypes exist in an elderly population and if these SNPs and haplotypes differ between patients with dementia and age-matched non-demented control patients. ABCB1 genotype, allele and haplotype frequencies were neither significantly different between patients with dementia and age-matched controls, nor between subgroups of different types of dementia nor age-matched controls. This study shows ABCB1 genotype frequencies to be comparable with described younger populations. To our knowledge this is the first study on ABCB1 genotypes in dementia. ABCB1 genotypes are presently not useful as a biomarker for dementia, as they were not significantly different between demented patients and age-matched control subjects.

  16. Radiation therapy and patient age in the survival from early-stage breast cancer

    International Nuclear Information System (INIS)

    Joslyn, Sue A.

    1999-01-01

    Purpose: To analyze the use of radiation therapy following local excision of invasive localized breast cancer and subsequent survival by 5-year age category. Methods: Data for 27,399 women diagnosed with localized stage of breast cancer and treated with local excision surgery from 1983 through 1992 were collected and provided by the national Surveillance, Epidemiology, and End Results (SEER) program. Use of radiation therapy was analyzed by race, ethnic background, geographic location, and age at diagnosis. Survival for women treated with local excision plus radiation therapy was compared to that of women treated with local excision alone for each 5-year age category. Results: Subjects in older age groups were significantly less likely (p < 0.001) to receive radiation following local excision compared to younger age groups. Statistically significant survival advantages were conferred on women receiving radiation therapy in each 5-year age category from age 35 to 84 years (ranging from p = 0.02 to p < 0.0001). Conclusion: While the use of radiation therapy following local excision of early-stage breast tumors drops significantly in older age groups, women aged 35-84 years receiving radiation therapy had significant reductions in mortality. These results did not appear to be influenced by the presence of mortal comorbid conditions. These results strongly suggest the need to consider carefully patient characteristics other than age in deciding the course of treatment for early-stage breast cancer

  17. Subsequent malignancies associated with carcinoma of the uterine cervix: including an analysis of the effect of patient and treatment parameters on incidence and sites of metachronous malignancies

    International Nuclear Information System (INIS)

    Kapp, D.S.; Fischer, D.; Grady, K.J.; Schwartz, P.E.

    1982-01-01

    The incidence and sites of metachronous malignancies were retrospectively determined from the records of 763 patients seen at Yale University Medical Center and affiliated hospitals with previously untreated, invasive carcinoma of the uterine cervix from 1953-1972. These patients were treated predominantly with radiation therapy; follow-up status was known for periods of 5-25 years or until time of death in over 96% of the patients. Forty-four patients had second malignancies noted at least 6 months after the initial cervical cancer was diagnosed. The expected incidence of second malignancies was determined from the Connecticut State Tumor Registry data controlling for year of diagnosis of the cervical cancer, patient age, sex, and time at risk (person-years exposure). To correct for any error in estimation of second malignancies introduced by the existence of a latency period for the development of a second cancer, the expected incidence of malignancies was also computed for 5-year time intervals following the cervical cancer. No significant increase in second malignancies was found (observed/expected-44/36) for the entire follow-up period nor for any individual 5-year interval. However, a statistically significant increase in lung cancer and vulva-vaginal cancer was noted and a significant decrease in breast cancer was observed. Cox regression analyses were performed to study the effect of total radium exposure and total external beam treatment, adjusting for other factors. No statistically significant increased risks were found

  18. Implications of Public Reporting of Risk-Adjusted Mortality Following Percutaneous Coronary Intervention: Misperceptions and Potential Consequences for High-Risk Patients Including Nonsurgical Patients.

    Science.gov (United States)

    Gupta, Anuj; Yeh, Robert W; Tamis-Holland, Jacqueline E; Patel, Shalin H; Guyton, Robert A; Klein, Lloyd W; Rab, Tanveer; Kirtane, Ajay J

    2016-10-24

    Assessment of clinical outcomes such as 30-day mortality following coronary revascularization procedures has historically been used to spur quality improvement programs. Public reporting of risk-adjusted outcomes is already mandated in several states, and proposals to further expand public reporting have been put forward as a means of increasing transparency and potentially incentivizing high quality care. However, for public reporting of outcomes to be considered a useful surrogate of procedural quality of care, several prerequisites must be met. First, the reporting measure must be truly representative of the quality of the procedure itself, rather than be dominated by other underlying factors, such as the overall level of illness of a patient. Second, to foster comparisons among physicians and institutions, the metric requires accurate ascertainment of and adjustment for differences in patient risk profiles. This is particularly relevant for high-risk clinical patient scenarios. Finally, the potential deleterious consequences of public reporting of a quality metric should be considered prior to expanding the use of public reporting more broadly. In this viewpoint, the authors review in particular the characterization of high-risk patients currently treated by percutaneous coronary interventional procedures, assessing the adequacy of clinical risk models used in this population. They then expand upon the limitations of 30-day mortality as a quality metric for percutaneous coronary intervention, addressing the strengths and limitations of this metric, as well as offering suggestions to enhance its future use in public reporting. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. The brave new world of older patients: preparing general practice training for an ageing population.

    Science.gov (United States)

    Bonney, Andrew; Phillipson, Lyn; Jones, Sandra C; Hall, Julie; Sharma, Rashmi

    2015-11-01

    Develop and pilot test evidence-based resources for general practice training practices to enhance older patients' (65+ years) interactions with General Practice Registrars (GPRs). In Australia, general practice trainees, referred to as GPRs, see fewer older patients and patients with chronic conditions than doctors who have completed their specialist GP training. This reduces learning opportunities for GPRs in the management of these important patient groups. Therefore, developing effective strategies to improve GPR-older patient interaction is critical to primary care training, to meet the current and future needs of an ageing population. Adopting a social marketing approach, GPR practice resources were developed to address knowledge and attitudinal barriers at the practice and patient level to improve older patient comfort, and willingness to engage, with GPR care. Two focus groups with older patients (n=18) and interviews with staff of training practices (n=12) were utilised to pre-test resources. Amended resources were pilot tested and evaluated in a naturalistic GPR training practice setting using a structured patient questionnaire (n=44). Pilot evaluation suggests improved comfort and willingness of older patients to interact with GPRs. In all, 54% of survey participants indicated they would be more likely to make an appointment with a Registrar in the future as a result of exposure to the resources. In all, 40% of patients would feel comfortable having a GPR manage a complex or chronic condition, which compares favourably with 28% of similarly aged patients in previous research. The use of tailored, engaging and informative GPR resources for older patients and practice staff may be an important contributor to addressing the growing problem of ensuring GPRs are adequately engaged in treating older patients. The adoption of a social marketing framework was instrumental in enhancing the acceptance and effectiveness of this intervention.

  20. The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica

    Directory of Open Access Journals (Sweden)

    Homayoun Tabesh

    2015-01-01

    Full Text Available Background: Ninety percent of all people sometimes during their lives experience low back pain, and 30-40% develops radicular leg pain with the sciatica characteristics. Although for clinical diagnosis of lumbar disc herniation (LDH straight leg raising (SLR test in 85-90% of cases indicates LDH, but in our practice with LDH patients this test is frequently negative despite radicular leg pain due to LDH. Hence, we decided to evaluate this test in LDH in different age groups. Materials and Methods: All patients with leg pain referring to neurosurgery clinic were enrolled. Those with a history of pain other than sciatica excluded and SLR test and magnetic resonance imaging (MRI of the lumbosacral spine performed. The patients with negative MRI findings excluded and finally 269 patients with true sciatica and positive MRI were included. SLR tests were performed for different age groups. Results: Of 269 patients, 167 were male. The age range was 16-80 years. The most involved levels were L5-S1 (47% and L4-L5 (42%, respectively. The rate of positive SLR result, which was 100%, 87% and 82% for 10-19, 20-29 and 30-39 years age group respectively. With an increment of age, the rate of positive test regularly declined . The chance of positive SLR in men is 1.3 times the women (odds ratio [OR] 2.4; 95% confidence interval [CI] = 1.265-4.557; P = 0.007. Increasing the age has suppression effect in positivity of SLR so that for each 1-year the chance of SLR become 0.27 times less to become positive and this is also statically meaningful (OR = 0.271;95% CI = 0.188-0.391; P,0.001. The chance of positive SLR for patients under 60 is 5.4 folds more than patients above 60 years old (OR = 5.4; 95% CI = 4-8.3; P, 0.001. Conclusion: Age, sex (male, and disk level had statistically the effect on SLR positive test.

  1. Gender and age effects on the continuous reaction times method in volunteers and patients with cirrhosis

    DEFF Research Database (Denmark)

    Lauridsen, Mette Enok Munk; Grønbæk, Henning; Næser, Esben

    2012-01-01

    Abstract Minimal hepatic encephalopathy (MHE) is a metabolic brain disorder occurring in patients with liver cirrhosis. MHE lessens a patient's quality of life, but is treatable when identified. The continuous reaction times (CRT) method is used in screening for MHE. Gender and age effects...... on the CRT method are unknown and may confound the results. The aim of this study was to standardise the CRT method outcomes for age and gender effects. We studied 121 volunteers without known disease and 181 patients with cirrhosis by a CRT test. Reaction time to an auditory signal was measured 100 times......, the 10th, 50th, and 90th reaction time percentiles were recorded, and the CRT index was calculated as the 50th percentile/(90th percentile-10th percentile), as a measure of intra-individual stability in reaction times. In volunteers, men reacted faster than women and their reaction times slowed with age...

  2. Risk and benefit of dual antiplatelet treatment among nonrevascularized myocardial infarction patients in different age groups

    DEFF Research Database (Denmark)

    Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring

    2017-01-01

    revascularization. METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all.......63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. CONCLUSION: Dual anti-platelet treatment use was less likely...... among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted....

  3. 131I therapy of teen-age hyperthyroidism: the primary results in 46 patients

    International Nuclear Information System (INIS)

    Wang Kaiming

    2001-01-01

    Objective: To explore various conditions of teen-age hyperthyroidism with 131 I therapy. Methods: 46 patients were administrated with 131 I, the changes of T 3 and T 4 level of serum were tested by radioimmunoassay. The improvement of clinical symptoms has been observed in 46 cases with teen-age hyperthyroidism by 131 I before and after treatment. Results: 39 of 46 (84%) has been proved complete responses (CR), partial responses (PR) 7 cases. 3 months later; we found that 39 patients have hypothyroidism symptoms, T 3 and T 4 level of serum decreased. There are significance increases of TSH 23 percent patients. Conclusion: It has been proved that treatment of teen-age hyperthyroidism by 131 I is effective and safe

  4. The influence of general anesthesia on the brain in aged patients with previous ischemic cerebrovascular disease

    International Nuclear Information System (INIS)

    Kokubo, Yasuaki; Kayama, Takamasa; Kondo, Rei; Oki, Masato; Takaoka, Seiji

    2008-01-01

    Whenever we discuss the overall results of surgical treatment for unruptured cerebral aneurysms, especially in aged patients, we tend to consider advanced age or general anesthesia as causes for unfavorable results. There are no reports concerning ischemic stroke events following general anesthesia in aged patients with a prior history of cerebrovascular disease. The purpose of this study is to clarify the influence of general anesthesia on the brats in aged patients with a previous history of ischemic cerebrovascular disease. The subjects were 30 consecutive patients over 70 years of age with previous ischemic cerebrovascular disease who underwent various surgeries except brain and cardiac surgery under general anesthesia. The patients were 70 to 85 years old, with a mean age of 76. Twenty-three were men and 7 were women. Surgical procedures were 12 gastrointestinal, 6 orthopedic and 4 urogenital and others. The type of cerebrovascular disease evaluated by neuroradiologist and anesthesiologist based on MR imaging was devided as follows: 16 patients had minor stroke, 7 had transient ischemic attack/reversible ischemic neurological deficit (TIA/RIND) and 7 had asymptomatic cerebral infarction. MR angiography was also assessed to evaluate the main artery in the brain. Blood pressure and arterial blood gas (PaCO 2 ) during general anesthesia were analyzed, and the rate of systemic and neurological complications following general anesthesia were evaluated. MR angiography revealed no occlusion or severe stenosis of the main artery in the brain of any of the patients. The minimum systolic blood pressure showed less than 100 mmHg transiently for 5-20 minutes in 28 of 30 patients during general anesthesia. The minimum value was 65 mmHg maintained for 5 minutes. The minimum PaCO 2 during general anesthesia was as follows: 1 case 36 mmHg. There were no neurological complications following general anesthesia in this study. One of 30 patients (3.3%) had suffered from pneumonia

  5. Using patient reported outcome measures in health services: A qualitative study on in