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Mayerhofer C, Sedrak MS, Hopkins JO, Li T, Tayob N, Faggen MG, Sinclair NF, Chen WY, Parsons HA, Mayer EL, Lange PB, Basta AS, Perilla-Glen A, Lederman RI, Wong AR, Tiwari A, McAllister SS, Mittendorf EA, Gibson CJ, Burstein HJ, Kim AS, Freedman RA, Miller PG. Clonal hematopoiesis in older patients with breast cancer receiving chemotherapy. J Natl Cancer Inst 2023; 115:981-988. [PMID: 37042724 PMCID: PMC10407695 DOI: 10.1093/jnci/djad065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/10/2023] [Accepted: 04/05/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The expansion of hematopoietic stem cells carrying recurrent somatic mutations, termed clonal hematopoiesis (CH), is common in elderly individuals and is associated with increased risk of myeloid malignancy and all-cause mortality. Though chemotherapy is a known risk factor for developing CH, how myelosuppressive therapies affect the short-term dynamics of CH remains incompletely understood. Most studies have been limited by retrospective design, heterogeneous patient populations, varied techniques to identifying CH, and analysis of single timepoints. METHODS We examined serial samples from 40 older women with triple-negative or hormone receptor-positive breast cancer treated on the prospective ADjuVANt Chemotherapy in the Elderly trial to evaluate the prevalence and dynamics of CH at baseline and throughout chemotherapy (6 and 12 weeks). RESULTS CH was detected in 44% of patients at baseline and in 53% at any timepoint. Baseline patient characteristics were not associated with CH. Over the course of treatment, mutations exhibited a variety of dynamics, including emergence, expansion, contraction, and disappearance. All mutations in TP53 (n = 3) and PPM1D (n = 4), genes that regulate the DNA damage response, either became detectable or expanded over the course of treatment. Neutropenia was more common in patients with CH, particularly when the mutations became detectable during treatment, and CH was significantly associated with cyclophosphamide dose reductions and holds (P = .02). CONCLUSIONS Our study shows that CH is common, dynamic, and of potential clinical significance in this population. Our results should stimulate larger efforts to understand the biological and clinical importance of CH in solid tumor malignancies. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03858322). Clinical trial registration number: NCT03858322.
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Affiliation(s)
- Christina Mayerhofer
- Department of Stem Cell and Regenerative Biology, Harvard Stem Cell Institute, Cambridge, MA, USA
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Judith O Hopkins
- Novant Health Cancer Institute/SCOR NCORP, Winston Salem, NC, USA
| | - Tianyu Li
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nabihah Tayob
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Meredith G Faggen
- Dana-Farber Brigham Cancer Center at South Shore Hospital, South Weymouth, MA, USA
| | - Natalie F Sinclair
- Dana-Farber Brigham Cancer Center at Milford Regional Medical Center, Milford, MA, USA
| | - Wendy Y Chen
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Heather A Parsons
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Erica L Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Paulina B Lange
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ameer S Basta
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Ruth I Lederman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew R Wong
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Abhay Tiwari
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Sandra S McAllister
- Department of Stem Cell and Regenerative Biology, Harvard Stem Cell Institute, Cambridge, MA, USA
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Hematology Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Harvard Medical School, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Christopher J Gibson
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Harold J Burstein
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Annette S Kim
- Brigham and Women’s Hospital, Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rachel A Freedman
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Peter G Miller
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA
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Wong AR, Amelia A, Mohd Zain MR, Sayuti KA. Left aorto-ventricular tunnel: A differential diagnosis to aortic regurgitation. Med J Malaysia 2022; 77:101-103. [PMID: 35087005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Left aorto-ventricular tunnel is a rare congenital heart disorder. A then 19-year-old young lady was referred to our clinic for chronic rheumatic heart disease with aortic regurgitation. However, because of an almost continuous murmur, and an unusual transthoracic echo, she underwent various investigations, finally revealing a rare type 2 left aorto-ventricular tunnel. She had been variously diagnosed as chronic rheumatic heart disease with aortic regurgitation, bicuspid aortic valve with aortic regurgitation, and then possibly coronary arterial (cameral) fistula (based on 2D transthoracic echo) and finally left aorto-ventricular tunnel. This is the first case described in South East Asia who is asymptomatic, apart from a murmur, and her long journey to this final diagnosis illustrates the need to "chase shadows" on echoes, to come to a proper conclusion for the patient.
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Affiliation(s)
- A R Wong
- Universiti Sultan Zainal Abidin, Faculty of Medicine, Dept of Pediatrics, Malaysia.
| | - A Amelia
- Hospital Raja Perempuan Zainab II, Dept of Pediatrics, Malaysia
| | - M R Mohd Zain
- Universiti Sains Malaysia, School of Medical Sciences, Dept of Pediatrics, Malaysia
| | - K A Sayuti
- Universiti Sains Malaysia, School of Medical Sciences, Dept of Radiology, Malaysia
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3
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Sedrak MS, Freedman RA, Cohen HJ, Muss HB, Jatoi A, Klepin HD, Wildes TM, Le-Rademacher JG, Kimmick GG, Tew WP, George K, Padam S, Liu J, Wong AR, Lynch A, Djulbegovic B, Mohile SG, Dale W. Older adult participation in cancer clinical trials: A systematic review of barriers and interventions. CA Cancer J Clin 2021; 71:78-92. [PMID: 33002206 PMCID: PMC7854940 DOI: 10.3322/caac.21638] [Citation(s) in RCA: 201] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
Cancer is a disease of aging and, as the world's population ages, the number of older persons with cancer is increasing and will make up a growing share of the oncology population in virtually every country. Despite this, older patients remain vastly underrepresented in research that sets the standards for cancer treatments. Consequently, most of what we know about cancer therapeutics is based on clinical trials conducted in younger, healthier patients, and effective strategies to improve clinical trial participation of older adults with cancer remain sparse. For this systematic review, the authors evaluated published studies regarding barriers to participation and interventions to improve participation of older adults in cancer trials. The quality of the available evidence was low and, despite a literature describing multifaceted barriers, only one intervention study aimed to increase enrollment of older adults in trials. The findings starkly amplify the paucity of evidence-based, effective strategies to improve participation of this underrepresented population in cancer trials. Within these limitations, the authors provide their opinion on how the current cancer research infrastructure must be modified to accommodate the needs of older patients. Several underused solutions are offered to expand clinical trials to include older adults with cancer. However, as currently constructed, these recommendations alone will not solve the evidence gap in geriatric oncology, and efforts are needed to meet older and frail adults where they are by expanding clinical trials designed specifically for this population and leveraging real-world data.
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Affiliation(s)
| | | | | | - Hyman B. Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | - Tanya M. Wildes
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - William P. Tew
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin George
- City of Hope National Medical Center, Duarte, CA, USA
| | - Simran Padam
- City of Hope National Medical Center, Duarte, CA, USA
| | - Jennifer Liu
- City of Hope National Medical Center, Duarte, CA, USA
| | | | - Andrea Lynch
- City of Hope National Medical Center, Duarte, CA, USA
| | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA, USA
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4
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Zargar A, Valencia L, Wang J, Lal R, Chang S, Werts M, Wong AR, Hernández AC, Benites V, Baidoo EE, Katz L, Keasling JD. A bimodular PKS platform that expands the biological design space. Metab Eng 2020; 61:389-396. [DOI: 10.1016/j.ymben.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 01/21/2023]
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5
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Sedrak MS, Salgia MM, Decat Bergerot C, Ashing-Giwa K, Cotta BN, Adashek JJ, Dizman N, Wong AR, Pal SK, Bergerot PG. Examining Public Communication About Kidney Cancer on Twitter. JCO Clin Cancer Inform 2020; 3:1-6. [PMID: 30860867 DOI: 10.1200/cci.18.00088] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Several studies have described the content of Twitter conversations about lung, breast, and prostate cancer, but little is known about how the public uses Twitter to discuss kidney cancer. We sought to characterize the content of conversations on Twitter about kidney cancer and the participants engaged in these dialogues. METHODS This qualitative study analyzed the content of 2,097 tweets that contained the key words kidney cancer from August 1 to 22, 2017. Tweets were categorized by content domain of conversations related to kidney cancer on Twitter and user types of participants in these dialogues. RESULTS Among the 2,097 kidney cancer-related tweets analyzed, 858 (41.4%) were authored by individuals, 865 (41.2%) by organizations, and 364 (17.4%) by media sites. The most common content discussed was support (29.3%) and treatment (26.5%). Among the 2,097 tweets, 825 were unique tweets, and 1,272 were retweets. The most common unique tweets were about clinical trials (23.9%), most often authored by media sites. The most common retweets were about treatment (38.5%), most often authored by organizations. CONCLUSION Twitter dialogues about kidney cancer are most commonly related to support and treatment. Our findings provide insights that may inform the design of new interventions that use social media as a tool to improve communication of kidney cancer information. Additional efforts are needed to improve our understanding of the value and direct utility of social media in improving kidney cancer care.
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Affiliation(s)
- Mina S Sedrak
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | | | | | | | - Nazli Dizman
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Andrew R Wong
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA
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Zargar A, Lal R, Valencia L, Wang J, Backman TWH, Cruz-Morales P, Kothari A, Werts M, Wong AR, Bailey CB, Loubat A, Liu Y, Chen Y, Chang S, Benites VT, Hernández AC, Barajas JF, Thompson MG, Barcelos C, Anayah R, Martin HG, Mukhopadhyay A, Petzold CJ, Baidoo EEK, Katz L, Keasling JD. Chemoinformatic-Guided Engineering of Polyketide Synthases. J Am Chem Soc 2020; 142:9896-9901. [DOI: 10.1021/jacs.0c02549] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amin Zargar
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
- QB3 Institute, University of California−Berkeley, 5885 Hollis Street, Fourth Floor, Emeryville, California 94608, United States
| | - Ravi Lal
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Luis Valencia
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Jessica Wang
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Tyler William H. Backman
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Pablo Cruz-Morales
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Ankita Kothari
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Miranda Werts
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Andrew R. Wong
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Constance B. Bailey
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
- QB3 Institute, University of California−Berkeley, 5885 Hollis Street, Fourth Floor, Emeryville, California 94608, United States
| | - Arthur Loubat
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Yuzhong Liu
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Yan Chen
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Samantha Chang
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Veronica T. Benites
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
- Department of Energy, Agile BioFoundry, Emeryville, California 94608, United States
| | - Amanda C. Hernández
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Jesus F. Barajas
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
- Department of Energy, Agile BioFoundry, Emeryville, California 94608, United States
| | - Mitchell G. Thompson
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Carolina Barcelos
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Rasha Anayah
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Hector Garcia Martin
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
- Department of Energy, Agile BioFoundry, Emeryville, California 94608, United States
- BCAM, Basque Center for Applied Mathematics, 48009 Bilbao, Spain
| | - Aindrila Mukhopadhyay
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
| | - Christopher J. Petzold
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
- Department of Energy, Agile BioFoundry, Emeryville, California 94608, United States
| | - Edward E. K. Baidoo
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
- Department of Energy, Agile BioFoundry, Emeryville, California 94608, United States
| | - Leonard Katz
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- QB3 Institute, University of California−Berkeley, 5885 Hollis Street, Fourth Floor, Emeryville, California 94608, United States
| | - Jay D. Keasling
- Joint BioEnergy Institute, Lawrence Berkeley National Laboratory, Emeryville, California 94608, United States
- Biological Systems and Engineering, Lawrence Berkeley National Laboratory, Berkeley, California 94710, United States
- QB3 Institute, University of California−Berkeley, 5885 Hollis Street, Fourth Floor, Emeryville, California 94608, United States
- Department of Chemical & Biomolecular Engineering, University of California, Berkeley, California 94720, United States
- Department of Bioengineering, University of California, Berkeley, California 94720, United States
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Wong AR, Sun V, George K, Liu J, Padam S, Chen BA, George T, Amini A, Li D, Sedrak MS. Barriers to Participation in Therapeutic Clinical Trials as Perceived by Community Oncologists. JCO Oncol Pract 2020; 16:e849-e858. [PMID: 32240068 DOI: 10.1200/jop.19.00662] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite considerable research on the barriers to enrollment in cancer therapeutic trials, few studies have elicited barriers from the perspective of community physicians, who provide the majority of cancer care. The purpose of this study was to characterize barriers to and facilitators of cancer therapeutic trials as perceived by oncologists in community practices. METHODS Twenty semistructured interviews were conducted with oncologists at six community sites affiliated with City of Hope National Medical Center from March to June 2018. Responses were recorded digitally and transcribed. Data were analyzed using qualitative content analysis. RESULTS Of the 20 participants, 4 (20%) were women, 13 (65%) had > 10 years of practice experience, and 16 (80%) reported that < 5% of their patients were enrolled in a therapeutic trial. Participants identified four system-level barriers: lack of appropriate trials for community-based settings, insufficient infrastructure support, restrictive eligibility criteria, and financial limitations; three physician-level barriers: lack of awareness of available trials, lack of knowledge of trial details, and lack of time; and two patient-level barriers: patient burden and negative beliefs/attitudes toward research. Efforts aimed to increase trial availability, clinical trial support personnel, and physician knowledge were identified as major facilitators. CONCLUSION Community oncologists face numerous complex, multifaceted barriers to cancer therapeutic trial enrollment. Although expanding clinical research beyond the academic setting allows access to a larger and more diverse patient population, increasing generalizability and relevance of trial findings, there remains a substantial need for new strategies to improve cancer research delivery in the community.
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Affiliation(s)
- Andrew R Wong
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Virginia Sun
- Department of Population Science, City of Hope, Duarte, CA
| | - Kevin George
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Jennifer Liu
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Simran Padam
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Brandon A Chen
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Thomas George
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, CA
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
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8
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Sedrak MS, Mohile SG, Sun V, Sun CL, Chen BT, Li D, Wong AR, George K, Padam S, Liu J, Katheria V, Dale W. Barriers to clinical trial enrollment of older adults with cancer: A qualitative study of the perceptions of community and academic oncologists. J Geriatr Oncol 2020; 11:327-334. [DOI: 10.1016/j.jgo.2019.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/27/2022]
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Abstract
IMPORTANCE Social media campaigns have been successfully implemented in nontherapeutic trials. However, evidence to support their utility in cancer therapeutic trials is limited. OBJECTIVE To examine physician attitudes toward and perceptions of social media use for therapeutic trial recruitment of patients with cancer. DESIGN, SETTING, AND PARTICIPANTS This qualitative study engaged 44 physicians (24 academic based and 20 community based) at the main academic and 6 affiliated community sites of City of Hope in Duarte, California. Semistructured interviews were conducted in person or by telephone from March to June 2018. An interview guide was developed to explore perceptions of social media use for accrual of cancer therapeutic trials. Responses were recorded digitally and transcribed. Data were analyzed using qualitative content analysis. MAIN OUTCOMES AND MEASURES Physicians' perceptions of the advantages and disadvantages of using social media for clinical trial recruitment, strategies to improve uptake of social media in clinical trials, and the barriers and facilitators to social media use for professional purposes in general. RESULTS Of the 44 participants, 16 (36%) were women, 30 (68%) had more than 10 years of practice experience, 24 (55%) practiced in academia, and 20 (45%) practiced in the community. Physicians most commonly cited increased trial awareness and visibility as an advantage of using social media for trial recruitment. Cited disadvantages were increased administrative burden and risk of misinformation. Physicians also reported a need for institutional-level interventions (eg, restructuring of clinical trial offices to include personnel with social media expertise), increased evidence-based approaches to social media use, and more physician training on the use of social media. Perceived facilitators to professional social media use were networking and education; barriers included lack of time and lack of evidence of benefit. CONCLUSIONS AND RELEVANCE In this qualitative study, physicians recognized the benefits of using social media for clinical trial recruitment but noted that barriers, including increased administrative burden, increased time, and the risk of misinformation, remain. Future interventions to address these concerns are a required first step in increasing digital engagement for clinical trial accrual purposes.
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Affiliation(s)
- Mina S. Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Virginia Sun
- Department of Population Science, City of Hope, Duarte, California
| | - Jennifer Liu
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Kevin George
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Andrew R. Wong
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, California
| | - Don S. Dizon
- Lifespan Cancer Institute, Department of Hematology/Oncology, Brown University, Providence, Rhode Island
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10
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Wong AR, Zilfalil BA, Bhuiyan ZA. Clinical and genetic analysis of long QT syndrome in two Malay children. Med J Malaysia 2019; 74:341-343. [PMID: 31424047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Long QT syndrome (LQTS) is predominantly a genetic cardiac arrhythmia disorder. We report here our study on long QT syndrome from two children from Kelantan, Malaysia. Clinical and genetic findings of these two unrelated Malay children with LQTS is discussed. We found a Long QT, type 1 causal mutation, p.Ile567Thr in the KCNQ1 gene in the first child. A pathogenic mutation could not be detected in the second child, explaining the heterogeneity of this disease.
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Affiliation(s)
- A R Wong
- Universiti Sultan Zainal Abidin, Faculty of Medicine, Department of Paediatrics, Kuala Terengganu, Terengganu, Malaysia.
| | - B A Zilfalil
- Universiti Sains Malaysia, Human Genome Centre, Kota Bharu, Kelantan, Malaysia
| | - Z A Bhuiyan
- University Hospital of Lausanne, Molecular Diagnostic Laboratory, Lausanne, Vaud, Switzerland
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11
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Sedrak MS, Hurria A, Li D, George K, Padam S, Liu J, Wong AR, Vargas N, Eskandar J, Katheria V, Mortimer JE, Mohile SG, Dale W. Barriers to clinical trial enrollment of older adults with cancer: A systematic review. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18130 Background: Despite the disproportionate impact of cancer on older adults, older patients are vastly underrepresented in clinical trials that set the standards for cancer treatment. To better understand the reasons for this disparity, we conducted a systematic review of studies that have specifically examined barriers and interventions to improve clinical trial enrollment of older adults with cancer. Methods: We conducted a comprehensive two-step search strategy. First, we consulted an information specialist to develop an electronic search for the following databases from inception to January 15, 2019: PubMed, Ovid/Medline, Embase, Scopus, PsycINFO, and Cochrane library. Second, references of retrieved key articles were screened for relevant studies. Two authors then independently reviewed all titles and abstracts (N = 10,985) and examined studies for full text eligibility (N = 221). Inclusion criteria were: 1) original research; 2) study assessed barriers and/or interventions to enrollment in oncology clinical trials; 3) included patients ≥ 60 years with cancer. Narrative reviews and abstracts without full text were excluded. Data was extracted by independent raters and summarized using a qualitative analysis software, NVivo v12. Results: 12 observational studies examining barriers and 1 randomized intervention were included. Barriers were assessed at the patient level (N = 5 studies), healthcare professional (HCP) level (N = 5), and both patient and HCP levels (N = 2). Stringent eligibility criteria (N = 7) and oncologists’ concerns for toxicity (N = 7) were the most common barriers cited. Patient barriers included transportation (N = 6), time/burden (N = 6), and awareness (N = 6). Although caregiver barriers (N = 4) were identified, none of the studies examined caregiver perceptions. One study evaluated a physician-directed educational intervention and found no significant impact on accrual of older adults. Conclusions: Although several studies have examined the barriers to accrual of older adults with cancer, only one intervention study has attempted to address these barriers. Given the aging of the cancer population, new strategies for including older adults in cancer clinical trials are critically needed.
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Affiliation(s)
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
| | - Daneng Li
- City of Hope National Medical Center, Duarte, CA
| | - Kevin George
- City of Hope National Medical Center, Duarte, CA
| | - Simran Padam
- City of Hope National Medical Center, Duarte, CA
| | - Jennifer Liu
- City of Hope National Medical Center, Duarte, CA
| | | | - Noel Vargas
- City of Hope National Medical Center, Duarte, CA
| | - Joy Eskandar
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA
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12
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Wong AR, Hurria A, Sun V, Li D, George K, Liu J, Padam S, Katheria V, Waisman JR, Mortimer JE, Mohile SG, Dale W, Sedrak MS. Barriers and facilitators to oncology clinical trial accrual: Comparing perceptions of community and academic oncologists. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18131 Background: Multiple studies have described the barriers and facilitators to oncology clinical trial accrual in academic practices. However, few studies have been done in community settings, even though the majority of patients with cancer receive their care in the community. We examined and compared community and academic oncologists’ perceptions of the barriers and facilitators to cancer clinical trial accrual. Methods: Semi-structured interviews were conducted from March to June 2018 with 44 medical oncologists at City of Hope (24 in academia; 20 in community sites). Purposive sampling was used to ensure participant diversity. Primary measures were oncologists’ self-reported perceptions of the barriers and facilitators to clinical trial accrual. Responses were recorded digitally, transcribed, and de-identified. Data was managed using NVivo v12. Two analysts coded the interview data using thematic content analysis (kappa = 0.74). A third analyst adjudicated discrepancies. Results: Of the 44 participants, 36% were women, and 68% had > 10 years of experience. Compared to academic oncologists, community oncologists more often cited barriers due to the lack of protocols suitable for community patients’ histology and stage (13% vs. 6%) and insufficient trial personnel support (13% vs. 9%). Compared to community oncologists, academic oncologists more often cited barriers due to limited time (14% vs. 8%) and overly stringent eligibility criteria (14% vs. 9%). Community oncologists more commonly reported extrinsic facilitators (e.g. reminders of available protocols from trial support staff) (91% vs. 76%) while academic oncologists more commonly reported intrinsic facilitators for offering clinical trials (e.g. self-motivation to prioritize clinical trials) (24% vs. 9%). Conclusions: Community oncologists more often reported facing barriers to accrual due to limited suitable trials and insufficient personnel support compared to academic oncologists. Additionally, community oncologists cite the need for more infrastructure to support accrual. Interventions to increase trial accrual must be tailored to address the unique needs of both community and academic practices.
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Affiliation(s)
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
| | - Virginia Sun
- City of Hope National Medical Center, Duarte, CA
| | - Daneng Li
- City of Hope National Medical Center, Duarte, CA
| | - Kevin George
- City of Hope National Medical Center, Duarte, CA
| | - Jennifer Liu
- City of Hope National Medical Center, Duarte, CA
| | - Simran Padam
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA
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13
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Sedrak MS, Hurria A, Sun V, Li D, Liu J, George K, Wong AR, Padam S, Katheria V, Mohile SG, Waisman JR, Dale W, Mortimer JE, Dizon DS. Social media for oncology clinical trial recruitment: Oncologists’ attitudes and perceptions. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18066 Background: Social media may be an effective strategy to improve public awareness of oncology clinical trials and increase accrual. How oncologists perceive the role of social media in clinical trials now and in the future remains unknown. We explored oncologists’ attitudes and perceptions related to social media and clinical trial recruitment. Methods: Semi-structured interviews were conducted with 44 medical oncologists at City of Hope from March to June 2018. Primary measures were oncologists’ self-reported benefits, concerns, and future interventions to leverage social media for trial recruitment. Secondary measures were facilitators and barriers to social media use for professional purposes. Responses were recorded digitally, transcribed, and de-identified. Data was managed using NVivo v12. Two analysts coded interview data using thematic content analysis (kappa = 0.7). Results: Of the 44 participants, 55% were academic and 45% were community oncologists, 36% were women, and 68% had > 10 years of experience. The most commonly cited benefit was increased awareness and visibility (63%). The most commonly cited concerns were: lack of time or support (31%), misinformation or oversimplification (31%), and lack of guidance (regulatory/ethical oversight) (28%). Oncologists reported a desire for an institutional-level intervention (e.g., personnel support with social media expertise) to facilitate trial recruitment using social media (50%). Oncologists’ perceptions of the facilitators to social media use for professional purposes were centered on networking (40%) and staying up to date in the field (33%). Perceived barriers were clustered around lack of comfort, training, time (38%), and lack of evidence of benefit (25%). No differences were identified between academic and community oncologists. Conclusions: Oncologists are hopeful that social media can increase awareness and visibility of cancer clinical trials. However, they have numerous concerns about the application of social media in clinical trials due to lack of time, support, and risk of misinformation. Further research is needed to examine whether social media can facilitate recruitment to oncology clinical trials.
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Affiliation(s)
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
| | - Virginia Sun
- City of Hope National Medical Center, Duarte, CA
| | - Daneng Li
- City of Hope National Medical Center, Duarte, CA
| | - Jennifer Liu
- City of Hope National Medical Center, Duarte, CA
| | - Kevin George
- City of Hope National Medical Center, Duarte, CA
| | | | - Simran Padam
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | - William Dale
- City of Hope National Medical Center, Duarte, CA
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14
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Ibrahim NNIN, Jaafar H, Rasool AH, Wong AR. Arterial stiffness during acute and recovery phases of children with rheumatic fever. Med J Malaysia 2016; 71:23-25. [PMID: 27130739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Acute rheumatic fever (ARF) is associated with systemic inflammation and arterial stiffness during the acute stage. It has not been reported if arterial stiffness remains after recovery. The aim of this study was to determine the arterial stiffness during acute stage and 6 months after recovery from ARF. Arterial stiffness was assessed by carotid femoral pulse wave velocity (PWV) in 23 ARF patients during the acute stage of ARF and 6 months later. Simultaneously, erythrocyte sedimentation rate (ESR) and other anthropometric measurements were taken during both stages. There was a significant reduction in PWV; 6.5 (6.0, 7.45) m/s to 5.9 (5.38, 6.48) m/s, p=0.003 6 months after the acute stage of ARF. Similarly, ESR was also significantly reduced from 92.0 (37.5, 110.50) mm/hr to 7.0 (5.0, 16.0) mm/hr, p=0.001. In conclusion, arterial stiffness improved 6 months after the acute stage with routine aspirin treatment; this correlates well with the reduction in systemic inflammation.
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Affiliation(s)
- N N I N Ibrahim
- Universiti Sains Malaysia, School of Medical Sciences, Department of Pharmacology, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - H Jaafar
- KPJ Kluang Utama Specialist Hospital, Kluang, Johor, Malaysia
| | - A H Rasool
- Universiti Sains Malaysia, School of Medical Sciences, Department of Pharmacology, 16150 Kubang Kerian, Kelantan, Malaysia
| | - A R Wong
- Hospital Raja Perempuan Zainab II, Department of Paediatrics, Kota Bharu, Kelantan, Malaysia
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15
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Salmi AA, Nor Aliza AG, Nik Zaki NM, Wong AR, Aida HR. Older Age Group in Pregnancy is Associated with Increased Arterial Stiffness. Med J Malaysia 2010; 65:115-118. [PMID: 23756794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Arterial stiffness is an index of vascular health; normal pregnancy is associated with reduced arterial stiffness. This cross sectional study compared arterial stiffness in older (≥35 years) and the younger (≤34 years) age groups of pregnant women. Arterial stiffness was assessed noninvasively in 66 pregnant women between 23 - 32 weeks gestation (41 women ≤ 34 years, 25 women ≥ 35 years) using the parameters pulse wave analysis and pulse wave velocity. Blood pressure (BP), body mass index (BMI), serum total cholesterol (TC) and fasting blood glucose (FBS) were also recorded. Mean ages of the younger and older age groups were 27.6±0.62 and 39.3±0.58 years; no significant difference was seen between the groups in their BMI, TC, FBS, SBP, DBP and gestational age. The older age group of women have increased arterial stiffness (augmentation index 19.4±1.9% vs 13.2±1.6%, p=0.015) and aortic stiffness (pulse wave velocity 8.7±0.3 vs 7.7±0.2 m/s, p=0.004) compared to the younger women. Linear regression analysis showed a positive significant correlation between age and augmentation index (R=0.278, p=0.026), and pulse wave velocity (R=0.350, p=0.004). We conclude that older pregnant women has increased arterial stiffness compared to a younger age group of pregnant women suggesting that vascular changes due to ageing occurs in pregnancy despite cardiovascular adaptations occurring in pregnancy.
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Affiliation(s)
- A A Salmi
- Universiti Sains Malaysia, School of Medical Sciences, 16150 Kota Bharu, Malaysia.
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16
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Wong AR, Suhaimi H, Ridzuan MAR, Rizal MMZ, Saedah A. "Fishing for lines": removal of endovascular catheters from the cardiovascular system. Singapore Med J 2009; 50:e358-e361. [PMID: 19907875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We present two infants whose endovascular lines were accidentally cut or fractured, and had to be retrieved via transcatheter means in the cardiac catheterisation laboratory. The first case was a two-month-old infant with transposition of the great arteries, requiring an emergency balloon atrial septostomy. An indwelling vascular catheter that was placed in the right femoral vein was accidentally cut and had migrated into the inferior vena cava, before being retrieved. The second case was a one-week-old neonate who presented with pneumonia at birth, and had a long intravenous catheter placed in the left saphenous vein, which became fractured, and subsequently migrated into the heart. This case presented as a pulmonary embolus with haemodynamic instability, as the catheter had partially obstructed the right ventricular outflow tract. This was later retrieved via transcatheter means.
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Affiliation(s)
- A R Wong
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia
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17
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Wong AR, Noor ASS, Rasool AHG, Quah BS, Roberton D. Pulmonary haemosiderosis with juvenile idiopathic arthritis in a Malaysian child. Med J Malaysia 2007; 62:352-354. [PMID: 18551948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A rare case of childhood pulmonary haemosiderosis with juvenile idiopathic arthritis is discussed, with particular reference to treatment with hydroxychloroquine and sildenafil for pulmonary hypertension which occurs secondary to this disease.
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Affiliation(s)
- A R Wong
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan
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18
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Abstract
Pulse-wave analysis (PWA) combined with pharmacological challenges has recently been used as a method to measure endothelial function. This involved administration of glyceryl trinitrate (GTN), followed by salbutamol as endothelium-independent and -dependent vasodilators, respectively. The duration of GTN effect needs to be established before the administration of salbutamol. Baseline augmentation index (AIx) and pulse-wave velocity (PWV) measurements were taken in 11 healthy female subjects (mean age 23.27 +/- 3.66 years). Sublingual GTN 0.5 mg was administered for 3 min, followed by AIx and PWV measurements every 5 min till 20 min and then every 10 min until 40 min post-GTN. Maximum change in AIx post-GTN was at 3 min with a mean change from the baseline of -17.86% +/- 4.40% (p < 0.001). There were no significant changes noted after 30 and 40 min with mean change being -0.82% +/- 2.61% and 0.14% +/- 3.20%, respectively (p > 0.05). Significant changes in PWV were noted at 5 and 10 min with the mean change of -0.33 +/- 0.36 m/s and -0.33 +/- 0.35 m/s, respectively (p = 0.01). There were no further changes noted at 15 min and thereafter (p > 0.05). A duration of at least 30 min after GTN is required for AIx and PWV values to reach their baseline. Thus, the administration of salbutamol should be given only after 30 min of sublingual GTN for the assessment of endothelial function.
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Affiliation(s)
- N N I N Ibrahim
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
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19
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Wong AR, Mokhtar SAI, Rasool AHG. Anomalous right pulmonary artery from the aorta. Images Paediatr Cardiol 2006; 8:1-4. [PMID: 22368658 PMCID: PMC3232560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Anomalous origin of the right pulmonary artery is a rare form of congenital heart disease. It usually presents in early infancy with heart failure and rapid development of pulmonary hypertension. There are about 131 cases reported in the literature and we report one such case.
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Affiliation(s)
- AR Wong
- Senior lecturer and paediatric cardiologist, School of medical sciences, Universiti Sains Malaysia, Kelantan, Malaysia,Contact information: Dr. Abdul Rahim Wong, Dept. of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia Tel: 609-7663625 Fax: 609-7653370
| | - SAI Mokhtar
- Consultant paediatric cardiologist, Penang General Hospital (formerly Assoc. Professor, School of Medical Sciences, Universiti Sains Malaysia)
| | - AHG Rasool
- Senior lecturer in pharmacology, School of Medical Sciences, Universiti Sains Malaysia
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20
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Goy JJ, Stauffer JC, Yusoff Z, Wong AR, Owlya R, Perret F, Siegenthaler M, Savcic M, Ménétrey R, Seydoux C. Percutaneous closure of atrial septal defect type ostium secundum using the new Intrasept occluder: Initial experience. Catheter Cardiovasc Interv 2006; 67:265-7. [PMID: 16416474 DOI: 10.1002/ccd.20607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report the first experience obtained with the new Intrasept device. We attempted to treat 35 patients with a mean age of 43 +/- 21 years. The mean size of the defect was 17/15 mm. It was successfully closed in 31 patients. In the remaining four the device could not be stabilized because of excessive defect size. A small residual shunt was present immediately following implantation in three patients. No complications occurred during the procedure and at 6 months, 31 patients had an uneventful outcome. Only one patient had a small residual shunt. No thrombus, embolization, or device fracture was documented during a mean follow-up of 17 +/- 11 months. Percutaneous closure of ASD ostium secundum is feasible with the Intrasept device with a high success rate and very good medium-term outcome. Our initial experience and results were excellent with small to medium size defects, however, large defects (>20 mm) remain challenging.
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Affiliation(s)
- J J Goy
- Cardiology Service, Clinique Cecil, Lausanne, Switzerland.
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21
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Wong AR, Rasool AHG. Hydroxyzine-induced supraventricular tachycardia in a nine-year-old child. Singapore Med J 2004; 45:90-2. [PMID: 14985850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Hydroxyzine is a first generation antihistamine widely used in the paediatric population for a variety of conditions. A nine-year-old girl presented with supraventricular tachycardia while on clinical doses of hydroxyzine for pruritus. On arrival at the hospital, she was diaphoretic, with cool peripheries, poor peripheral pulses and a heart rate of 250/minute. There was a history of three palpitation episodes with chest tightness during the five months she was taking hydroxyzine. The supraventricular tachycardia eventually reverted to sinus rhythm with intravenous verapamil. Relevant cardiac examination and investigations had not shown any cardiac abnormalities. After discontinuing hydroxyzine, she had no further episodes of supraventricular tachycardia. To our knowledge, this is the first report of hydroxyzine induced-supraventricular tachycardia in the medical literature.
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Affiliation(s)
- A R Wong
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kelantan, Malaysia
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22
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Abstract
We present an unusual neonatal fungal infection, Hansenula anomala in a very low birthweight infant who underwent abdominal surgery for an omphalocele. Despite treatment with adequate doses of amphotericin B, the yeast continued to grow from the blood culture, and was only eradicated with the use of oral ketoconazole.
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Affiliation(s)
- A R Wong
- Department of Paediatrics, School of Medical Sciences, University Sains Malaysia, Kelantan.
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