101
|
Dimza M, Al-Ani M, Naik D, Kennedy S, Elsayed A, Parker A, Ahmed M, Aranda J, Vilaro J. Predictors of Survival to Hospital Discharge with IABP Use in Acute Myocardial Infarction with Cardiogenic Shock. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
102
|
Levy L, Ahmed M, Huszti E, Zhang C, Hunter S, Boonstra K, Sage A, Ghany R, Budev M, Shah P, Reynolds J, Snyder L, Belperio J, Singer L, Palmer S, Keshavjee S, Todd J, Weigt S, Martinu T. Bronchoalveolar Bile Acids are Associated with Acute Rejection, Inflammation, and Allograft Survival: A Multi-Center Study. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
103
|
Fathema K, Hassan MN, Mazumder MW, Benzamin M, Ahmed M, Islam MR, Haque N, Sutradhar PK, Rahman AR, Rukunuzzaman M. COVID 19 in Children: Gastrointestinal, Hepatobiliary and Pancreatic Manifestation. Mymensingh Med J 2021; 30:570-579. [PMID: 33830145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The most devastating pandemic of this era coronavirus disease-2019 (COVID-19) is caused by a novel virus named severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Although it is primarily a respiratory pathogen, it can also result in several extra-pulmonary manifestations includes gastrointestinal symptoms, hepatocellular injury. Angiotensin-converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2), the entry receptor for the causative coronavirus SARS-CoV-2 is co-express in the gastrointestinal tract, hepatocyte, and cholangiocytes similar to the respiratory mucosa. The presence of these receptors facilitates the entry into the tissue and causes direct viral tissue damage, which is a proposed mechanism of injury. Diarrhoea, nausea, vomiting, abdominal discomfort are common gastrointestinal manifestations, whereas derangement of liver function tests is the most hepatic manifestation in COVID-19. In this article, we reviewed on SARS-CoV-2 disease COVID-19 regarding gastrointestinal, hepatic, and pancreatic manifestation, the mechanisms by which the virus may inflict damage, and their management perspective.
Collapse
|
104
|
Jeng E, Esseghir F, Ahmed M, Parker A, Al-Ani M, Vilaro J, Aranda J, Peek G, Bleiweis M. Single Center Experience with Venoarterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant under the Contemporary UNOS Heart Allocation System. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
105
|
Padmanabhan A, Keshava SN, Ahmed M, Moorthy RK. Transient Blindness after Endovascular Parent Artery Occlusion to Treat Giant Aneurysm of Internal Carotid Artery: a Case Report. HONG KONG JOURNAL OF RADIOLOGY 2021. [DOI: 10.12809/hkjr2117191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
106
|
Gimpaya N, Khan R, Gallinger ZR, Scaffidi MA, Al Abdulqader AK, Ahmed M, Gholami R, Ramkissoon A, James PD, Mosko J, Griller N, Bansal R, Grover SC. A77 A REUSABLE POLYCARBONATE BOX TO DECREASE DROPLET CONTAMINATION DURING UPPER ENDOSCOPY: A SIMULATION-BASED STUDY FOR THE COVID-19 PANDEMIC. J Can Assoc Gastroenterol 2021. [PMCID: PMC7989228 DOI: 10.1093/jcag/gwab002.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Upper gastrointestinal (GI) endoscopic procedures are aerosol-generating, increasing the risk of healthcare workers (HCW) contracting Coronavirus disease 2019 (COVID-19). Aims To present a polycarbonate box (EndoBox) designed for use in upper GI endoscopy and evaluate its impact on the contamination of endoscopy staff during simulated procedures. Methods Simulated gastroscopies were performed using an upper body simulator placed in left lateral decubitus (LLD) and supine positions. The endoscopist and assistant wore personal protective equipment. Droplet exposure was measured using fluorescent abiotic surrogate particles. Two blinded observers independently viewed images from each scenario to qualitatively evaluate contamination levels. The primary outcome was the level of HCW contamination by droplets generated from a simulated cough with and without the EndoBox on the upper body simulator. The endoscopist’s ergonomic behaviour was also assessed using the Rapid Upper Limb Assessment (RULA) tool. Results Without the EndoBox, there was a higher level of contamination on the endoscopist when the upper body simulator is in the LLD position. A higher level of contamination was observed on the assistant when the simulator is in supine position. With the EndoBox, the contamination levels on the endoscopy staff were lower in both LLD and supine scenarios. The endoscopist’s ergonomics were rated 2 to 3 on the RULA tool when using the EndoBox. Conclusions The EndoBox reduces macroscopic droplet contamination during simulated gastroscopy. The endoscopist’s risk of musculoskeletal injury remained in the low risk categories as assessed by the RULA tool. Another advantage of the EndoBox design is the arch extending from the bottom that allows for removal of the box without withdrawing the endoscope. This enables rapid access to the patient’s airway if they experience respiratory distress. This study was limited by an inability to assess microscopic contamination and contamination at the level of the port or buttons when suction is applied. Within these limitations, the EndoBox may be a useful adjunct to traditional personal protective equipment. Funding Agencies SMHA AFP COVID-Related Innovation Funds
Collapse
|
107
|
Gopalakrishna A, Bole R, Parikh N, Ahmed M, Pagel E, Book J, Yang D, Jimbo M, Ziegelmann M, Lomas D, Kohler T. 116 Comparison of Nitrous Oxide Sedation versus Oral Sedation in Patients Undergoing Rezūm Prostate Ablation: A Feasibility Study. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
108
|
Ahmed M, Ahmed M, Dey S, Osman K, Mohamed A, Abdelrahman N. Pain Control With Intra-Articular Steroid Injection Can Reduce Dementia-related Mood and Behavioral Changes in Nursing Home Settings. J Am Med Dir Assoc 2021; 22:B7. [PMID: 34287187 DOI: 10.1016/j.jamda.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
109
|
Dahab L, Dahab L, Abdelgadir K, Obeid T, Dey S, Ahmed M, Al-Safi W, Mohamed A, Lungba R, Abu Bakr A, Abdelrahman N. Effect of COVID-19 Pandemic on Depression and Medications Use on Nursing Home Residents. J Am Med Dir Assoc 2021; 22:B20-B21. [PMID: 34287166 PMCID: PMC7902226 DOI: 10.1016/j.jamda.2021.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
110
|
Kostko O, Xu B, Ahmed M. Local electronic structure of histidine in aqueous solution. Phys Chem Chem Phys 2021; 23:8847-8853. [DOI: 10.1039/d1cp00361e] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
X-Ray spectroscopy coupled with DFT calculations reveals the pH dependent electronic structure of an amino acid in an aqueous environment.
Collapse
|
111
|
Hasni MS, Chaudhary M, Mushtaq MH, Durrani AZ, Rashid HB, Ali M, Ahmed M, Sattar H, Aqib AI, Zhang H. Active Surveillance and Risk Assessment of Avian Influenza Virus Subtype H9 from Non-Vaccinated Commercial Broilers of Pakistan. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2021. [DOI: 10.1590/1806-9061-2020-1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
112
|
Cui W, Yousaf N, Bhosle J, Minchom A, Nicholson AG, Ahmed M, McDonald F, Locke I, Lee R, O'Brien M, Popat S. Real-world outcomes in thoracic cancer patients with severe Acute respiratory syndrome Coronavirus 2 (COVID-19): Single UK institution experience. Cancer Treat Res Commun 2020; 25:100261. [PMID: 33310368 PMCID: PMC7709731 DOI: 10.1016/j.ctarc.2020.100261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022]
Abstract
The immediate morbidity from COVID-19 is high in UK thoracic cancer patients. Mortality, hospitalisation and treatment interruption rates were high. All patients who died were current or ex-smokers.
Background UK COVID-19 mortality rates are amongst the highest globally. Controversy exists on the vulnerability of thoracic cancer patients. We describe the characteristics and sequelae of patients with thoracic cancer treated at a UK cancer centre infected with COVID-19. Methods Patients undergoing care for thoracic cancer diagnosed with COVID-19 (RT-PCR/radiology/clinically) between March-June 2020 were included. Data were extracted from patient records. Results Thirty-two patients were included: 14 (43%) diagnosed by RT-PCR, 18 (57%) by radiology and/or convincing symptoms. 88% had advanced thoracic malignancies. Eleven of 14 (79%) patients diagnosed by RT-PCR and 12 of 18 (56%) patients diagnosed by radiology/clinically were hospitalised, of which four (29%) and 2 (11%) patients required high-dependency/intensive care respectively. Three (21%) patients diagnosed by RT-PCR and 2 (11%) patients diagnosed by radiology/clinically required non-invasive ventilation; none were intubated. Complications included pneumonia and sepsis (43% and 14% respectively in patients diagnosed by RT-PCR; 17% and 11% respectively in patients diagnosed by radiology/clinically). In patients receiving active cancer treatment, therapy was delayed/ceased in 10/12 (83%) and 7/11 (64%) patients diagnosed by RT-PCR and radiology/clinically respectively. Nine (28%) patients died; all were smokers. Median time from symptom onset to death was 7 days (range 3–37). Conclusions The immediate morbidity from COVID-19 is high in thoracic cancer patients. Hospitalisation and treatment interruption rates were high. Improved risk-stratification models for UK cancer patients are urgently needed to guide safe cancer-care delivery without compromising efficacy.
Collapse
|
113
|
Byrne R, Curley S, Ahmed K, Ahmed M, Gibney J, Mcgillicuddy F. HDL efflux capacity, and particle remodelling in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
114
|
Etienne A, Ahmed M, Andriamialivelo S, Ahmed Bedja S, Ben Aboubacar F, Bibi J, Gujadhur V, Jaffar Bandjee MC, Rafalimanantsoa Solofoniaina A, Randriamampionona L, Said Anli A, Solet JL, Menudier L, Rasamoelina H. Measles virus circulation between the State members of the Indian Ocean Commission? Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
115
|
Walker PM, Hirayama Y, Lane GJ, Watanabe H, Dracoulis GD, Ahmed M, Brunet M, Hashimoto T, Ishizawa S, Kondev FG, Litvinov YA, Miyatake H, Moon JY, Mukai M, Niwase T, Park JH, Podolyák Z, Rosenbusch M, Schury P, Wada M, Watanabe XY, Liang WY, Xu FR. Properties of ^{187}Ta Revealed through Isomeric Decay. PHYSICAL REVIEW LETTERS 2020; 125:192505. [PMID: 33216598 DOI: 10.1103/physrevlett.125.192505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
Mass-separated ^{187}Ta_{114} in a high-spin isomeric state has been produced for the first time by multinucleon transfer reactions, employing an argon gas-stopping cell and laser ionization. Internal γ rays revealed a T_{1/2}=7.3±0.9 s isomer at 1778±1 keV, which decays through a rotational band with perturbations associated with the approach to a prolate-oblate shape transition. Model calculations show less influence from triaxiality compared to heavier elements in the same mass region. The isomer-decay reduced E2 hindrance factor f_{ν}=27±1 supports the interpretation that axial symmetry is approximately conserved.
Collapse
|
116
|
Yock A, Ahmed M, Newman N, Ayala-Peacock D, Chakravarthy A, Price M. Dosimetric Impact and Required Clinician Time of Online Adaptive Radiotherapy Using a Newly Commercially-Available, CBCT-Based Adaptive Treatment System. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
117
|
Sanyaolu A, Okorie C, Marinkovic A, Ayodele O, Abbasi A, Prakash S, Ahmed M, Kayode D, Jaferi U, Haider N. Navigating the Diagnostics of COVID-19. Am J Clin Pathol 2020. [PMCID: PMC7665290 DOI: 10.1093/ajcp/aqaa161.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction/Objective The recent outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Hubei province, China in December 2019 and has spread worldwide at an alarming rate. With millions of individuals infected and over two hundred thousand deaths, the necessity to develop fast and efficient diagnostic methods is of high importance. Diagnostic modalities rely on a combination of epidemiology, clinical presentation, laboratory examination, and appropriate imaging to diagnose and distinguish SARS-CoV-2 from other pulmonary infections. The purpose of this paper is to report on currently available diagnostic screening methods for patients infected with SARS-CoV-2 to guide frontline healthcare workers involved with COVID-19 patient care. Methods An electronic literature search was performed for peer-reviewed articles published from January 1, 2020, until April 26, 2020. Articles were then reviewed and included based on the applicability to the topic. Results The preferred diagnostic approach is reverse transcription of the virus’ RNA followed by PCR amplification (RT-PCR). This method recognizes the gene-specific primers to target various viral protein genes, such as the envelope protein gene or the nucleocapsid protein gene, which enables this test to be both sensitive and specific toward SARS-CoV-2. However, this method has been proven to be time-consuming taking hours-to-days for the results. In order to improve the speed and efficiency of diagnostics, newer rapid diagnostic serological tests are being developed for testing SARS-CoV-2, each with its own unique advantages and disadvantages. They could potentially be used as triage tests to rapidly identify patients who are very likely to have COVID-19 in combination with other accurate diagnostic methods. Conclusion Therefore, a combination of diagnostic testing used in a timely manner may be beneficial for the rapid and accurate detection of SARS-CoV-2. This was evident in cases where despite initial negative RT-PCR tests for various patients, who later demonstrate chest CT scans with various degrees of consolidation and ground-glass opacity. Thus establishing the need for radiology diagnosis to be complementary to RT-PCR for COVID-19 patients. Hopefully, the continuous development and use of rapid diagnostic tests and the implementation of public health measures will help control the spread of the disease.
Collapse
|
118
|
Franklyn J, Abdalkoddus M, Rossi B, Limnatitou D, Ahmed M, Sokker A, Douie WJ, Smolarek S. Prognosis of non-operative management of non-metastatic colorectal cancer in octa- and nonagenarians. Ann R Coll Surg Engl 2020; 102:504-509. [PMID: 32799666 DOI: 10.1308/rcsann.2020.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of the study was to establish the natural history of elderly patients with non-metastatic colorectal cancer who underwent non-operative management in comparison with those who underwent operative management. MATERIALS AND METHODS A retrospective analysis of patients aged 80 years and above diagnosed with colorectal cancer between 2007 and 2015 in a tertiary care hospital in the Southwest of England was done. Patients were divided into non-operatively managed and operatively managed groups. Clinical demographics, Charlson Comorbidity Index, location of the tumour and overall survival between the two groups were compared. RESULTS A total of 407 patients were studied; 132 were treated non-operatively and 275 operatively. The non-operative group included fewer right-sided colon cancers (28.7% vs 54.9%), but significantly more rectal cancers were managed non-operatively (43.9 vs 23.6%, respectively). The two and five year overall survival was 38.9% and 11.3% respectively in the non-operative group, significantly lower than patients in the operative group where the two and five year survival was 78.9% and 59.6% respectively (p = .0001). The median Charlson Comorbidity Index was 7.99 for the non-operative group and 7.49 in the operative group (p = 0.109). Patients treated non-operatively were deemed unfit without objective frailty assessment and only 43/132(32.6%) had formal anaesthetic assessment before being deemed unfit for surgery. CONCLUSION The survival of octa- and nonagenarians with non-metastatic colorectal cancer managed conservatively is significantly less than counterparts managed operatively. Our present strategy of deciding and denying treatment of the elderly patient with colorectal cancer is arbitrary, highlighting the need for robust geriatric and frailty assessment.
Collapse
|
119
|
Cullivan S, Ahmed M, Weedle R, Bruzzi J, Phelan S, Da Costa M, Soo A, Breen D. The Role of Endobronchial Ultrasound in Early-Stage Non-Small Cell Lung Cancer. IRISH MEDICAL JOURNAL 2020; 113:122. [PMID: 35575042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim The aim of this study is to assess the impact of EBUS on the concordance of clinical and pathological NSCLC staging in our center. Methods Data was collected retrospectively from the hospital database regarding patients who underwent surgical resection for early stage NSCLC between 2012 and 2017. Results A total of 251 patients were included. The mean age was 67 (±9), 55% (n=137) were male and 83% (n=209) were current/former smokers. In group A (n=154, 61%) clinical nodal stage (cN) was established from a combination of CT, PET CT and mediastinoscopy. Group B underwent additional EBUS (n=97, 39%). cN and pathological nodal staging (pN) were concordant in 78% (n=120) in group A versus 62% (n=60) in group B (p=0.009). Conclusion This study demonstrated higher rates of nodal discordance in patients who underwent EBUS which contrasts existing data that demonstrates improved concordance with EBUS. We describe these findings and potential explanations further in this study.
Collapse
|
120
|
Wang Y, Gellatly K, Strassner J, Essien K, Ahmed M, Murphy R, Coffin-Schmitt A, Fan X, Ding X, Frisoli M, Kim E, Abbas Z, Derr A, McDonel P, Rashighi M, Harris J, Garber M. 093 Comparison of skin autoimmune diseases by single-cell RNA sequencing. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
121
|
Haque A, Khalilullah I, Ahmed M, Haque MM, Nancy C, Ullah MF, Tusher SM, Jahan K, Abedin S. A Comparative Study Between 20% Mannitol and 3% Hypertonic Saline for Brain Oedema Reduction during Elective Brain Tumour Surgery. Mymensingh Med J 2020; 29:646-651. [PMID: 32844807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cerebral oedema is an important manifestation of brain tumour. The significant reduction of cerebral oedema can show rapid improvement of the patients. Hypertonic saline solution and mannitol both are commonly used for this action. It is now time to choose the better one. This was a prospective randomized comparative study designed to evaluate the efficacy of 3% hypertonic saline (NaCl) in reduction of brain oedema during brain tumour surgery and compare it with that of 20% Mannitol. The study was conducted in the department of Anaesthesiology, Combined Military Hospital, Dhaka, Bangladesh from July 2016 to December 2016. A total number of 47 patients for brain tumour surgery were selected. After screening 40 patients were finalized. Then the patients were divided into 2 equal groups 20 patients in each. Patients of Group A received 3% hypertonic saline and Group B 20% mannitol. Uniform anaesthetic technique applied for all patients, fixed surgeon/group of surgeons carried out the surgery. Heart rate and noninvasive blood pressure were monitored and kept with in ±20% baseline values different means. ETCO2 were kept in between 28-32mm of Hg by adjusting ventilator setting. Reduction of brain oedema was monitored by subjective assessment of surgeons using a 3 point scale of brain relaxation. The data were recorded in preformed data sheet. The results were tested by chi-square test to see their level of significance i.e. p value <0.05 was considered as significant. At the opening of dura, the number of brain conditions classified as soft, adequate and tight were statistically non-significant between groups. After 0.5 hour and 1.0 hour 10% patient's brain was tight in Group A whereas it was 35% and 40% in Group B respectively. Reduction of brain oedema or brain relaxation was significantly better in Group A compared to Group B (p<0.05). Urine output was higher with mannitol than hypertonic saline (p<0.05). Duration of ICU and hospital stay in both Group A and Group B were statistically similar (p>0.05). Compared to mannitol, hypertonic saline caused an increase in serum sodium concentration over time (p<0.05). From the available data, use of 20% mannitol and 3% hypertonic saline for brain oedema reduction, it is suggested that hypertonic saline significantly reduces the risk of tight brain and produce the brain more soft than mannitol during brain tumour surgery.
Collapse
|
122
|
Abstract
Much anticipation awaits the results of the SOUND trial, (Gentilini and Veronesi in Breast 21:678-681, 2012) which may prove the futility of performing sentinel node biopsy (SNB) in low-risk breast cancer patients. However, do we really not know the answer to the questions that the SOUND trial poses already? Consideration must be taken of the very much overlooked trials predating the sentinel node era, which risk stratified patients according to the absence of palpable lymphadenopathy and without dependence upon ultrasound imaging (clinically negative axilla). This automatically selects a low-risk group of patients for axillary disease (low axillary burden) and the relevance of these critical trials is discussed.
Collapse
|
123
|
Ahmed M, Soliman S, Noman SA, Ali S. Computer-guided contouring of craniofacial fibrous dysplasia involving the zygoma using a patient-specific surgical depth guide. Int J Oral Maxillofac Surg 2020; 49:1605-1610. [PMID: 32381374 DOI: 10.1016/j.ijom.2020.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/05/2020] [Accepted: 04/15/2020] [Indexed: 01/10/2023]
Abstract
The aim of this study was to introduce a new computer-guided technique for contouring and shaving of craniofacial fibrous dysplasia involving the zygoma. Computer-guided contouring was performed for five patients with unilateral craniofacial fibrous dysplasia involving the zygoma, using a patient-specific surgical depth guide. This patient-specific guide with depth holes was virtually designed for each patient based on mirroring of the unaffected side. The guide was printed using rapid prototyping. In the surgical theatre, the guide was seated in place and implant drills were inserted through the guide holes, creating depth holes according to the preoperative planning. Bone removal was then continued using surgical burs and/or bone chisels, connecting the guiding depth holes. Satisfaction with facial aesthetics was evaluated by the patients using a Likert scale, and by the surgeons using the Whitaker rating scale. All patients were satisfied with the postoperative facial aesthetics. Four patients were rated category I on the Whitaker rating scale, and one patient as category II. In conclusion, this patient-specific surgical depth guide appears to offer a solution for the unpredictability of conventional bone removal in unilateral craniofacial fibrous dysplasia, especially in three-dimensional multiplanar areas such as the zygoma. Further investigations are required.
Collapse
|
124
|
Page S, Milner-Watts C, Perna M, Janzic U, Vidal N, Kaudeer N, Ahmed M, McDonald F, Locke I, Minchom A, Bhosle J, Welsh L, O'Brien M. Systemic treatment of brain metastases in non-small cell lung cancer. Eur J Cancer 2020; 132:187-198. [PMID: 32380429 DOI: 10.1016/j.ejca.2020.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
Brain metastases (BrMs) are associated with significant morbidity and are found in up to 50% of patients with advanced non-small cell lung cancer (NSCLC). Most of the literature focuses on symptomatic BrMs, with a lack of baseline brain imaging in asymptomatic patients. Unfortunately, much of the data on local treatments with or without systemic treatment is retrospective. Clinical trials of systemic treatments largely exclude patients with BrMs. Chemotherapy is an active treatment for BrM with response rates in the brain similar to other sites of disease. Targeted systemic treatments in patients with driver mutations (EGFR and ALK-MET to date) have impressive central nervous system (CNS) penetrance and response rates. Unfortunately, no prospective data can currently guide the timings or modality of local therapies with systemic treatments in these patients who have a high incidence of CNS disease, but retrospective data suggest that early local therapies may give better intracranial progression-free survival (ICPFS). Recent immunotherapy trials have included patients with BrMs. These patients have largely been pre-treated with local therapies and are asymptomatic. Thus, the current standard is becoming, early local therapies before or in conjunction with immunotherapy agents. The approach seems to be safe. Prospective studies are needed in NSCLC BrMs patients to make sure any benefit from local therapies on the ICPFS and quality of life is not overlooked. Here we report what we think are reasonable conclusions from the available data and make suggestions for future clinical trials in the management of NSCLC BrMs.
Collapse
|
125
|
Ahmed M, Meier F, Beissert S. Multimodiale Therapie von Hirnmetastasen. AKTUELLE DERMATOLOGIE 2020. [DOI: 10.1055/a-1130-5982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungDas Langzeitüberleben hat sich für Patienten mit metastasiertem Melanom durch die Etablierung der zielgerichteten Therapien sowie Immuntherapien mit 5-Jahres-Überlebensraten von ca. 50 % deutlich verbessert. Hirnmetastasen stellen jedoch weiterhin eine therapeutische Herausforderung dar. In der Vergangenheit lag das mediane Überleben für Patienten mit neu diagnostizierten Hirnmetastasen bei 2 – 6 Monaten 1. Retrospektive Analysen sprechen für einen Überlebensbenefit unter multimodaler Therapie mit einer 5-Jahres-Überlebensrate von über 20 % 1.Wir berichten über einen 50-jährigen Patienten mit multiplen symptomatischen Hirnmetastasen bei Erstdiagnose. Nach Exstirpation einer symptomatischen Metastase wurde bei BRAF-V600E-Mutation eine Systemtherapie mit dem BRAF-Inhibitor Dabrafenib in Kombination mit dem MEK-Inhibitor Trametinib eingeleitet. Hierunter zeigte sich ein rascher deutlicher Regress der zerebralen und extrazerebralen Metastasen. Nach 8 Wochen wurde die Systemtherapie auf eine Immuntherapie mit Nivolumab plus Ipilimumab umgesetzt. Kurz nach Therapieeinleitung trat ein epileptischer Anfall auf und die Hirnmetastasen zeigten sich wieder progredient. Zwei symptomatische Hirnmetastasen wurden reseziert, eine Ganzhirnradiatio mit Hippocampusschonung wurde eingeleitet und die Immuntherapie fortgesetzt. Aktuell erfolgt eine zielgerichtete Therapie mit Encorafenib und Binimetinib. 17 Monate nach Erstdiagnose befindet sich der Patient in gutem Allgemeinzustand ohne neurologische Defizite. Dieser Fallbericht bestätigt den retrospektiv beobachteten Überlebensbenefit für Patienten mit Hirnmetastasen unter multimodaler Therapie.
Collapse
|