1
|
Pakran J, Alsaberi AM, AlFalasi A, Ibrahim TMKH, Alnuaimi AAEF, Goturu S, Mohamed M, Abraham RM, Sundaramurthi VL, Parambath AK, Jose B, Kamat D, Satish TC, Syeda JT, Gul L, Mathias R, Rasheed Vattiyamveetil S, Backar S, Krishna CV, Al Dhabal L. 'Monkeypox 2.0': Case series on a reconditioned virus causing sexually transmissible disease in urban population. Int J STD AIDS 2024:9564624241244832. [PMID: 38610106 DOI: 10.1177/09564624241244832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND MPOX (Monkeypox) viral infection, a zoonotic disease previously confined to the African sub-continent, has caught attention worldwide recently due to its resurgence in a new 'avatar' among urban communities. Dermatologists in the U. A. E. started to see patients with fever and a self-limiting pustular necrotic rash that was negative for all other infectious investigations. METHODS We performed a prospective observational multicenter clinical study of the demographics, skin manifestations, and outcomes of patients presenting with necrotic pustular lesions and/or fever. RESULTS 35 cases of PCR confirmed MPOX cases, mostly in the expatriate population, were followed up and found to have high-risk heterosexual contact on an average of 1 week prior to disease onset. We found that they have characteristic annular pustular lesions with necrotic center or "Smoke ring pustules' in all cases. Lesion tenderness and predilection for the lower abdomen, pubic area, and genitalia were observed. Most cases were systemically stable, with fever lasting for an average of 4 days and elevated CRP levels. Genital lesions were prone to secondary bacterial infections. The disease was severe, with larger annular plaques in one of our patients found to be living with HIV. CONCLUSIONS The overall prognosis in healthy individuals is good, with lesions healing within an average of 2 weeks without scarring. 'New world MPOX' should be unclassified from zoonosis to a sexually transmitted infection (STI) capable of transmission in an urban population. Our findings can help in early clinical suspicion and differentiation from other STI's for primary and secondary health care physicians.
Collapse
Affiliation(s)
- Jaheersha Pakran
- Dermatology and Aesthetic center, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | | | - Amani AlFalasi
- Dermatology and Aesthetic center, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | | | | | | | | | | | | | | | - Beena Jose
- Department of Dermatology, Aster Medical Center, Dubai, UAE
| | - Divya Kamat
- Department of Dermatology, Union Medical Centre, Aster Clinic, Al Karama, Dubai
| | | | | | - Lubna Gul
- Department of Dermatology, Zulekha Hospital, Dubai
| | - Rohini Mathias
- Department of Dermatology, Aster Hospital and Aster Day Surgery Centre, Mankhool, Dubai
| | | | - Shaheela Backar
- Department of Dermatology, NMC Royal Hospital, Abudhabi, UAE
| | - C Vijay Krishna
- Department of Dermatology, Thumbay University Hospital, Ajman, UAE
| | - Laila Al Dhabal
- Department of Infectious disease, Rashid Hospital, Dubai Health Authority, Dubai, UAE
| |
Collapse
|
2
|
Sharun K, Jose B, Tiwari R, Natesan S, Dhama K. Biodetection dogs for COVID-19: an alternative diagnostic screening strategy. Public Health 2021; 197:e10-e12. [PMID: 33618893 PMCID: PMC7817409 DOI: 10.1016/j.puhe.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 12/17/2022]
Affiliation(s)
- K Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243 122, Uttar Pradesh, India.
| | - B Jose
- Division of Physiology & Climatology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243 122, Bareilly, Uttar Pradesh, India
| | - R Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go Anusandhan Sansthan (DUVASU), Mathura 281001, India
| | - S Natesan
- Department of Infectious Diseases, Indian Institute of Public Health Gandhinagar, Lekawada, Ganghinagar, Gujarat 382042, India
| | - K Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243 122, Uttar Pradesh, India.
| |
Collapse
|
3
|
PAIS P, Jose B, Iyengar A. SUN-193 "YOUR CHILD HAS END STAGE RENAL DISEASE" -FAMILY PERCEPTIONS OF ESRD, FACTORS ASSOCIATED WITH DIALYSIS MODALITY CHOICE AND OUTCOMES IN A LOW RESOURCE SETTING. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
4
|
Beste J, Mutaquiha C, Manhiça I, Jose B, Monivo C, Faria M, Creswell J, Codlin AJ, Michel C, Wagenaar B, Gloyd S, Cowan J. Effects of Xpert ® MTB/RIF testing and GxAlert on MDR-TB diagnosis and linkage to care in Mozambique. Int J Tuberc Lung Dis 2019; 22:1358-1365. [PMID: 30355417 DOI: 10.5588/ijtld.17.0901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The diagnosis of multidrug-resistant tuberculosis (MDR-TB) and gaps in linkage to care are the principal health challenges in Mozambique. Five GeneXpert machines and GxAlert, an eHealth platform, were installed in Sofala and Manica Provinces between 2012 and 2014. OBJECTIVE To test the effects of Xpert® MTB/RIF testing and GxAlert on rifampin-resistant TB (RR-TB) diagnosis and second-line treatment initiation rates. DESIGN We conducted a retrospective clinical review of patients with RR-TB from March 2012 to September 2015 at these five sites. Time-series analyses were conducted to investigate the impact of Xpert on case detection and treatment. Pre- and post- analyses were conducted to investigate the impact of GxAlert. RESULTS A total of 32 182 Xpert tests were conducted: 4010 (12.5%) detected TB without rifampin resistance, and 306 (7.1%) had RR-TB. Of the RR-TB cases, 161 (52.6%) were started on MDR-TB treatment, 6.9% had documented culture results, and time from diagnosis to treatment initiation decreased over time. The absolute number of patients diagnosed and started on MDR-TB treatment increased by 0.26 (95%CI 0.15-0.38, P < 0.001) and 0.16 (95%CI 0.089-0.24, P < 0.001) every 6 months. GxAlert did not affect treatment initiation rates. CONCLUSION Implementation of Xpert testing was associated with increases in the number of patients diagnosed and started on MDR-TB treatment.
Collapse
Affiliation(s)
- J Beste
- Health Alliance International, Seattle, Washington, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington, USA
| | - C Mutaquiha
- Health Alliance International, Seattle, Washington, Mozambican National Tuberculosis Control Programme, Maputo, Mozambique
| | - I Manhiça
- Mozambican National Tuberculosis Control Programme, Maputo, Mozambique
| | - B Jose
- Mozambican National Tuberculosis Control Programme, Maputo, Mozambique
| | - C Monivo
- Health Alliance International, Seattle, Washington
| | - M Faria
- Health Alliance International, Seattle, Washington
| | - J Creswell
- Stop TB Partnership, Geneva, Switzerland
| | - A J Codlin
- Stop TB Partnership, Geneva, Switzerland
| | - C Michel
- Health Alliance International, Seattle, Washington
| | - B Wagenaar
- Health Alliance International, Seattle, Washington, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - S Gloyd
- Health Alliance International, Seattle, Washington, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - J Cowan
- Health Alliance International, Seattle, Washington, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington, USA
| |
Collapse
|
5
|
Ng SM, Jose B, Sethi A. 115Anticoagulation in atrial fibrillation – a single-centre audit on patient education, stroke and bleeding risk assessments and use of direct oral anticoagulants (DOACs). Europace 2017. [DOI: 10.1093/europace/eux283.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
Luen S, Salgado R, Stephen F, Peter S, Jennifer EW, Emma C, Astrid K, Sandra SM, Jose B, Stefan M, Sherene L. Abstract S1-08: Prognostic associations of tumor-infiltrating lymphocytes (TIL) in metastatic HER2-positive breast cancer (BC) treated with trastuzumab and pertuzumab: A secondary analysis of the CLEOPATRA study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-s1-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The presence of stromal TILs (sTILs) is associated with a better prognosis with anti-HER2 therapy in primary HER2-positive BC. The prognostic value of TILs in the advanced setting with pertuzumab-based therapy is unknown.
Methods
The CLEOPATRA trial randomly assigned 808 patients with metastatic HER2-positive BC to receive pertuzumab or placebo in combination with trastuzumab and docetaxel. We evaluated %TILs using our previously described method. For concordance evaluation, 40 slides from metastatic samples were independently analysed by two pathologists. TILs were examined for associations with clinicopathological factors, progression-free survival (PFS), overall survival (OS), and treatment interactions using Cox regression models fitting sTILs as a continuous variable (per 10%) adjusting for treatment arm, age, estrogen receptor (ER) status, PIK3CA genotype, and visceral vs. non-visceral disease at screening.
Results
Tumour samples from 678 (84%) participants were available. 519 (76.5%) were archival and 155 (22.9%) were obtained fresh, ≤45 days prior to study treatment start. Median follow-up for OS was 50 months, with 519 PFS events and 358 deaths. 54% of patients were treatment naïve i.e. had not received prior chemotherapy nor trastuzumab. The median sTIL level was 10% (1-95%). sTIL evaluation was highly concordant between pathologists (R=0.93). Fresh vs. archival samples had significantly lower sTILs (10% vs 15%, p=0.0004). sTIL levels significantly differed by ethnicity (15% Asians, 10% white, 5% African-Americans, p=0.0007), but not age (p=0.26). Higher sTILs were observed in ER-negative vs. ER-positive tumors (15% vs 10%, p<0.001).
In the whole cohort for PFS, higher sTIL levels trended towards a better outcome independent of treatment (adjusted HR:0.95, 95%CI:0.90-1.00, p=0.06). For OS, the prognostic effect of sTILs reached statistical significance, with each 10% increase in sTILs associated with an 11% reduction in the risk of death (adjusted HR:0.89, 95%CI:0.83-0.96, p=0.001). The prognostic effect was observed independent of treatment arm, ER status, PIK3CA genotype, prior treatment or presence of visceral disease at screening, and in both fresh and archival tissue samples.
There was no significant interaction (int) between pertuzumab and sTILs for PFS (Pint=0.4) nor OS (Pint=0.6). There were no significant interactions between pertuzumab and sTILs for OS in subgroups of PIK3CA mutated (Pint=0.2) or PIK3CA WT (Pin=0.2), nor treatment naive (Pint=0.3) vs prior treatment (Pint=0.5).
The 5-year estimates of OS according to median ≤10% vs >10% sTILs in the placebo arm were 26% (95%CI:19-37) vs. 39% (95%CI:32-48), while in the pertuzumab arm 42% (95%CI:33-53) vs. 56% (95%CI:47-66) respectively.
Conclusion
In advanced HER2-positive disease, sTILs are still evident, though at lower levels, but are nevertheless significantly associated with prognosis, with effects stronger for OS than PFS. This suggests that the influence of anti-tumour immunity persists in the advanced first line setting and that enhancement by immunotherapeutic approaches could potentially further improve survival.
Citation Format: Luen S, Salgado R, Stephen F, Peter S, Jennifer E-W, Emma C, Astrid K, Sandra SM, Jose B, Stefan M, Sherene L. Prognostic associations of tumor-infiltrating lymphocytes (TIL) in metastatic HER2-positive breast cancer (BC) treated with trastuzumab and pertuzumab: A secondary analysis of the CLEOPATRA study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S1-08.
Collapse
Affiliation(s)
- S Luen
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - R Salgado
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - F Stephen
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - S Peter
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - E-W Jennifer
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - C Emma
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - K Astrid
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - SM Sandra
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - B Jose
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - M Stefan
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| | - L Sherene
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Institut Jules Bordet, Brussels, Belgium; Gustave Roussy, Villejuif, France; Washington Cancer Institute, Georgetown University, Washington DC; Memorial Sloan Kettering Cancer Centre, New York; Roche Products, Welwyn, United Kingdom; Genentech, South San Francisco; Oncology Biomarker Development, Roche, Basel, Switzerland
| |
Collapse
|
7
|
Gill G, Jose B. Primum non nocere. Resist the urge to treat. QJM 2016; 109:573. [PMID: 27318365 PMCID: PMC4986443 DOI: 10.1093/qjmed/hcw098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Gill
- From the Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent ST4 6QG, UK
| | - B Jose
- From the Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent ST4 6QG, UK
| |
Collapse
|
8
|
Sindhu C, Jose B. Evaluation of antioxidant, antibacterial and cytotoxic activity, quantitative estimation of phenols, flavonoids and carotenoids in different parts of Samadera indica from South India. ACTA ACUST UNITED AC 2016. [DOI: 10.5958/0975-6892.2016.00040.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
9
|
|
10
|
Affiliation(s)
- B Jose
- Diabetes Endocrinology at Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
| | | | | | | | | |
Collapse
|
11
|
Thong KY, Jose B, Sukumar N, Cull ML, Mills AP, Sathyapalan T, Shafiq W, Rigby AS, Walton C, Ryder REJ. Safety, efficacy and tolerability of exenatide in combination with insulin in the Association of British Clinical Diabetologists nationwide exenatide audit*. Diabetes Obes Metab 2011; 13:703-10. [PMID: 21410858 DOI: 10.1111/j.1463-1326.2011.01393.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [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: 01/22/2023]
Abstract
AIM To assess the extent, safety, efficacy and tolerability of reported off-licence exenatide use through a nationwide audit. METHODS The Association of British Clinical Diabetologists hosted a password-protected, online collection of anonymized data of exenatide use in real clinical practice. Three hundred and fifteen contributors from 126 centres across UK provided data on 6717 patients. HbA1c and weight changes, exenatide discontinuation, adverse events and treatment satisfaction were compared between non-insulin and insulin-treated patients. RESULTS Four thousand eight hundred and fifty-seven patients had baseline and follow-up treatment status with mean (±s.d.) baseline HbA1c 9.45 ± 1.69% and BMI 40.0 ± 8.2 kg/m(2) . Of the 4857 patients, 1921 (39.6%) used exenatide with insulin. Comparing patients who continued insulin with exenatide with non-insulin-treated patients, mean (±s.e.) latest HbA1c and weight reduction (median 26 weeks) were 0.51 ± 0.06 versus 0.94 ± 0.04% (p < 0.001) and 5.8 ± 0.2 versus 5.5 ± 0.1 kg (p = 0.278). Insulin-treated patients had higher rates of exenatide discontinuation (31.0 vs. 13.9%, p < 0.001), hypoglycaemia (8.9 vs. 6.1%, p < 0.001), gastrointestinal side effects (28.4 vs. 25.0%, p = 0.008) and treatment dissatisfaction (20.8 vs. 5.7%, p < 0.001). However, 34.2% of the patients continuing insulin still achieved HbA1c reduction ≥1%. There was significant insulin discontinuation, dose reduction and greater sulphonylurea discontinuation among insulin-treated patients. CONCLUSIONS Addition of exenatide to obese, insulin-treated patients can improve glycaemia and weight. Adverse events were statistically but probably not clinically significantly higher, but combination treatment was less well tolerated. Overall, exenatide was less effective in lowering HbA1c among insulin-treated patients, although significant number of insulin-treated patients still achieved significant HbA1c, weight and insulin reductions. Further research into identifying obese, insulin-treated patients who will tolerate and benefit from exenatide treatment is urgently needed.
Collapse
Affiliation(s)
- K Y Thong
- Department of Diabetes, City Hospital, Birmingham, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Thong KY, Jose B, Blann AD, Cull ML, Mills AP, Sathyapalan T, Walton C, Ryder REJ. Response at 3 months to insulin dose decisions made at exenatide initiation in the Association of British Clinical Diabetologists (ABCD) nationwide exenatide audit. Diabetes Res Clin Pract 2011; 93:e87-e91. [PMID: 21636161 DOI: 10.1016/j.diabres.2011.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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] [Received: 02/20/2011] [Revised: 04/12/2011] [Accepted: 05/05/2011] [Indexed: 11/29/2022]
Abstract
It is uncertain what should be done with insulin dose if starting exenatide. In the ABCD nationwide exenatide audit, many patients with type 2 diabetes had worsened glycaemia when insulin was stopped. If starting exenatide, insulin should not be stopped but weaned off only if there is significant glycaemic response.
Collapse
Affiliation(s)
- K Y Thong
- City Hospital, Birmingham, United Kingdom.
| | - B Jose
- City Hospital, Birmingham, United Kingdom
| | - A D Blann
- City Hospital, Birmingham, United Kingdom
| | - M L Cull
- City Hospital, Birmingham, United Kingdom
| | - A P Mills
- City Hospital, Birmingham, United Kingdom
| | | | - C Walton
- Hull Royal Infirmary, Hull, United Kingdom
| | | |
Collapse
|
13
|
Saharan S, Jose B, Seth R, Iyer VK, Kabra SK. Langerhans cell histiocytosis presenting as recurrent air leaks in young children. Acta Paediatr 2010; 99:488. [PMID: 20064140 DOI: 10.1111/j.1651-2227.2009.01660.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Saharan
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | |
Collapse
|
14
|
|
15
|
Claudia O, Andrea B, Del Valle PM, Jose B, Silvia C, Guillermo C. Preliminary Report of Patients Admitted to a Chest Pain Unit of an Acute General Hospital of Buenos Aires. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2006.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
16
|
Jose B, James A. Challenges of treating thyroid disease: the need for a revisit. J R Soc Med 2007. [DOI: 10.1258/jrsm.100.2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
17
|
Shafi PM, Jose B, Radhamani KT, Clery RA. Influence of pH on essential oil composition ofZanthoxylum rhetsa seeds obtained by steam distillation. FLAVOUR FRAG J 2006. [DOI: 10.1002/ffj.1598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
18
|
Jirovetz L, Buchbauer G, Wobus A, Shafi MP, Jose B. Medicinal used plants from lndia: analysis of the essential oil of air-dried Biophvtum sensitivum (L.) DC. Sci Pharm 2004. [DOI: 10.3797/scipharm.aut-04-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The essential oil of the air-dried plant Biophytum sensitivum (L.) DC. (Oxalidaceae) from Southern lndia was investigated by gas chromatographic-spectroscopic (GC-FID and GC-MS) and olfactoric methods to identify compounds responsible for the characteristic odor as well as partly for the folk medicinal use of this plant. Especially benzene derivatives, such as 1,4-dimethoxy benzene (24.9%), 1,2-dimethoxy benzene (10.6%) and 2-methoxy-4-methyl phenol (3.5%), the monoterpenes (Z)-linalool oxide (8.1%), (E)-linalool oxide (5.2%) and linalyl acetate (3.4%) as well as l-octen-3-ol (9.5%) and isophorone (3.1%) were found to be main constituents (concentrations higher than 3%, calculated as relative %-peak area of GC-FID analysis using an apolar column) of this essential oil, with totally 69 compounds identified. In addition, the odor impression of the sample is described and the possible biological activity of single volatiles discussed.
Collapse
|
19
|
Jose B, Ryu JH, Lee BG, Lee H, Kang YS, Kim HS. Effect of phthalates on the stability and performance of AgBF4-PVP membranes for olefin/paraffin separation. Chem Commun (Camb) 2001:2046-7. [PMID: 12240157 DOI: 10.1039/b105656p] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The presence of a phthalate in dry polymer membranes consisting of polyvinylpyrrolidone (PVP) and AgBF4, AgBF4-PVP, provides long-term stability and better performance for the separation of propylene/propane gas mixtures.
Collapse
Affiliation(s)
- B Jose
- CFC Alternatives Research Center, Korea Institute of Science and Technology, 39-1, Hawolgokdong, Seongbukgu, Seoul 136-791, Korea
| | | | | | | | | | | |
Collapse
|
20
|
|
21
|
Abstract
AIMS Drug scenes (social and spatial drug-using and drug-selling environments) have complex role structures. Many drug injectors earn money or drugs as drug or syringe sellers, hit doctors (people who help others to inject) commercial sex workers, or in other roles. This paper aims to measure "role behaviors" of drug injectors; describe which drug injectors are more likely to engage in such role behaviors; and to determine whether roles are related to elements of HIV risk. DESIGN Cross-sectional study of drug injectors. SETTING Bushwick, a section of Brooklyn, New York, a major location for injection drug use and drug sales. PARTICIPANTS Seven hundred and sixty-seven street-recruited drug injectors. MEASUREMENTS Participants were interviewed about their roles, behaviors, socio-demographics and risk networks; sera were collected and assayed for HIV and hepatitis B core antibody. FINDINGS Socio-demographic variables are related to role-holding in complex ways. Economic need is generally associated with engaging in drug-scene role behaviors. Holders of these roles are at greater behavioral and network risk for HIV and other blood-borne infections than are other drug injectors. They also engage in extensive communication with other drug users, including discussion of HIV risk reduction. CONCLUSION Role behaviors can be measured in quantitative studies, and seem to be related to HIV risk. Role-holders may be strategic targets for risk-reduction campaigns. It seems feasible and advisable to measure drug scene role-holding in research on drug users.
Collapse
Affiliation(s)
- S R Friedman
- National Development and Research Institutes, Inc., New York 10048, USA.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
|
23
|
Paone D, Des Jarlais DC, Caloir S, Jose B, Shi Q, Friedman SR. Continued risky injection subsequent to syringe exchange use among injection drug users in New York City. AIDS Educ Prev 1997; 9:505-510. [PMID: 9451478] [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: 05/22/2023]
Abstract
Although the vast majority of injection drug users (IDUs) attending syringe exchange programs in New York City have stopped risky injection (injecting with syringes used by someone else), there remains a subgroup of IDUs who continue to engage in high-risk injecting behaviors despite access to sterile syringes. Subjects were randomly recruited from five legally authorized syringe exchange programs in New York City between October 1992 and August 1994. Participants were asked about drug and sexual risk behavior 30 days prior to their first use of the syringe exchange as well as during the 30-day period prior to the interview while using the exchange. Of the 2,465 participants, 77.4% reported no risky injection during the 30 days prior to using syringes exchange. For this analysis we included only those who reported risky injection for the 30-day period prior to using syringe exchange (N = 556). We compared sociodemographics and behavioral characteristics of a group who continued risky injection while using the syringe exchange, "continuers," N = 158 (28.8%) with a group who reported risky injection prior to using the exchange and then ceased risky injection while using the exchange, "stoppers," N = 391(71.2%). Continuers were significantly more likely to report passing on dirty syringes to social network members and to inject cocaine at least daily. We present other predictors of continued risk and discuss the implications for interventions and make recommendations for syringe exchange programs.
Collapse
Affiliation(s)
- D Paone
- Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Friedman SR, Neaigus A, Jose B, Curtis R, Goldstein M, Ildefonso G, Rothenberg RB, Des Jarlais DC. Sociometric risk networks and risk for HIV infection. Am J Public Health 1997; 87:1289-96. [PMID: 9279263 PMCID: PMC1381088 DOI: 10.2105/ajph.87.8.1289] [Citation(s) in RCA: 258] [Impact Index Per Article: 9.6] [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] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study examined whether networks of drug-injecting and sexual relationships among drug injectors are associated with individual human immunodeficiency virus (HIV) serostatus and with behavioral likelihood of future infection. METHODS A cross-sectional survey of 767 drug injectors in New York City was performed with chain-referral and linking procedures to measure large-scale (sociometric) risk networks. Graph-theoretic algebraic techniques were used to detect 92 connected components (drug injectors linked to each other directly or through others) and a 105-member 2-core within a large connected component of 230 members. RESULTS Drug injectors in the 2-core of the large component were more likely than others to be infected with HIV. Seronegative 2-core members engaged in a wide range of high-risk behaviors, including engaging in risk behaviors with infected drug injectors. CONCLUSIONS Sociometric risk networks seem to be pathways along which HIV travels in drug-injecting peer groups. The cores of large components can be centers of high-risk behaviors and can become pockets of HIV infection. Preventing HIV from reaching the cores of large components may be crucial in preventing widespread HIV epidemics.
Collapse
Affiliation(s)
- S R Friedman
- National Development and Research Institutes Inc, New York, NY 10048, USA
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Friedman SR, Curtis R, Jose B, Neaigus A, Zenilman J, Culpepper-Morgan J, Borg L, Kreek J, Paone D, Des Jarlais DC. Sex, drugs, and infections among youth. Parenterally and sexually transmitted diseases in a high-risk neighborhood. Sex Transm Dis 1997; 24:322-6. [PMID: 9243738 DOI: 10.1097/00007435-199707000-00003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES To determine the extent to which youth who reside in households in a neighborhood with large numbers of drug injectors 1) are infected with parenterally or sexually transmitted agents, and 2) engage in high-risk behaviors. STUDY DESIGN A multistage probability household sample survey was conducted in Bushwick, Brooklyn from 1994 to 1995. All households in 12 randomly selected primary sampling units were screened for age-eligible youth. One hundred eleven English-speaking 18- to 21-year-olds were interviewed. One hundred three sera were tested for human immunodeficiency virus type 1 (HIV-1), Hepatitis B virus, hepatitis C virus (HCV), human T-cell lymphotrophic virus types I and II (HTLV-I/II), herpes simplex virus type 2 (HSV-2), or syphilis. Urines were tested for chlamydial infection, and for opiate and cocaine metabolites. RESULTS Eighty-nine percent had sex in the past year, 45% with two or more partners. Only 19% of the sexually active always used condoms. Two (of 95) had had sex with a crack smoker. Thirty percent of women reported being coerced the first time they had sex, and 23% of women and 3% of men reported having been sexually abused. Only 3% reported ever using heroin, and 9% cocaine. Only one reported ever having injected drugs or smoked crack. Some underreporting of stigmatized behaviors occurred: two "nonreporters" had opiate-positive urines and two had cocaine-positive urines. Marijuana use was common, with 48% using it in the past year. No subjects tested positive for HIV-1, HIV-II, or syphilis; 2% tested positive for HTLV-I and 3% for hepatitis C; 3% had hepatitis B markers, 12% had chlamydial infection, and 50% serologic HSV-2 markers. CONCLUSIONS Population-representative samples of high-risk communities can provide important knowledge. Although heroin and cocaine use, during drug injection, and rates of infection with parenterally transmitted infectious agents appear to be lower among these youth, sexual risk behaviors and chlamydial and HSV-2 infection are widespread. Sexually transmitted disease screening and outreach strategies are needed both to prevent sexually transmitted disease sequelae (including potential increased susceptibility to HIV infection) and to prevent transmission to partners.
Collapse
Affiliation(s)
- S R Friedman
- National Development and Research Institutes, New York, New York 10048, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Butler D, Buchino JJ, Jose B, Lindberg RD, Spanos WJ, Paris KJ. Wilms' tumor in an adult: a case report and review of the literature. J Ky Med Assoc 1997; 95:191-6. [PMID: 9149498] [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: 02/04/2023]
Abstract
Wilms' tumor in an adult is extremely rare, with less than 250 cases reported in the world literature. Treatment guidelines for pediatric Wilms' tumor are well established; those for adults are not. This article presents the case of a 19-year-old male diagnosed with Wilms' tumor after complaints of hematuria. He was categorized as Stage IV after nephrectomy and received post-operative radiotherapy and chemotherapy consisting of Vincristine, Adriamycin, and Actinomycin-D. Two years later he was found to have metastases to brain and lungs. He was treated with radiotherapy and bone marrow transplantation, and died of septic shock. The literature regarding Wilms' tumor in adults is reviewed, and current therapy is discussed.
Collapse
Affiliation(s)
- D Butler
- Department of Radiation Oncology, James Graham Brown Cancer Center, School of Medicine, University of Louisville, Kentucky 40292, USA
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
BACKGROUND There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants. METHODS We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n = 280), in which multiple interviews and saliva samples were collected from participants at exchange sites; the Vaccine Preparedness initiative cohort (n = 133 continuing exchanges and 188 non-exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n = 1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe exchanges. FINDINGS HIV incidence among continuing exchange-users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95% CI 0.54, 4.65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1.38 per 100 person-years at risk (0.23, 4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (2.41, 11.49), and in the NADR cities, 6.23 per 100 person-years at risk (4.4, 8.6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3.35 (95% CI 1.29, 8.65) for incident HIV infection compared with using the exchanges. INTERPRETATION We observed an individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.
Collapse
Affiliation(s)
- D C Des Jarlais
- Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Cornett MS, Paris KJ, Spanos WJ, Lindberg RD, Jose B. Radiation therapy for pituitary adenomas. A retrospective study of the University of Louisville experience. Am J Clin Oncol 1996; 19:292-5. [PMID: 8638544 DOI: 10.1097/00000421-199606000-00017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A retrospective analysis of treatment outcome was performed on patients treated with radiation for pituitary adenomas at the University of Louisville from January 1988 to December 1992. The study population included 27 patients. Twenty received radiation as a component of their initial treatment while seven received radiation as part of their treatment for recurrent disease. Nineteen patients were treated with post-operative radiation, and eight were treated with radiation alone. Follow-up interval ranged from 1 month to 109 months, with a median of 28 months. All three patients with stage I disease were controlled with radiation alone (1/3) or combined surgery and postoperative radiation (2/3), whereas six of eight stage II patients had disease control following surgery and postoperative radiation. Both patients with stage III adenomas treated with radiation alone had local control, whereas local control was achieved in six of seven with post-operative radiation. Three of five patients with recurrent disease had local control with radiation alone, whereas both patients undergoing surgery and postoperative radiation had local control. This retrospective analysis supports previous findings that radiation therapy alone or combined with transphenoidal resection is effective in long-term control of pituitary adenomas. It further suggests that immediate radiation therapy may be superior to radiation for surgical or medical failures.
Collapse
Affiliation(s)
- M S Cornett
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, KY 40202, USA
| | | | | | | | | |
Collapse
|
29
|
Neaigus A, Friedman SR, Jose B, Goldstein MF, Curtis R, Ildefonso G, Des Jarlais DC. High-risk personal networks and syringe sharing as risk factors for HIV infection among new drug injectors. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 11:499-509. [PMID: 8605596 DOI: 10.1097/00042560-199604150-00011] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In a cross-sectional study of 174 new injecting drug users (IDUs) in New York City who had injected for < or = 6 years, we examined whether those who both share syringes and have personal risk networks that include high-risk injectors are particularly likely to be infected with HIV. Subjects were street recruited between July 1991 and January 1993, were interviewed about their risk behaviors in the prior 2 years and their personal risk networks with other IDUs in the prior 30 days, and were tested for HIV; 20% were HIV seropositive. Among those who both shared syringes and had a personal risk network member who injected more than once a day, 40% were HIV seropositive (versus 14% for others, p < 0.001). In simultaneous multiple logistic regression, the interaction of both sharing syringes and having a personal risk network member who injected more than once a day remained independently and significantly associated with being HIV seropositive (OR, 3.57; 95% CI, 1.22, 10.43; p < 0.020), along with Latino race/ethnicity and exchanging sex for money or drugs. These findings suggest that the combination of sharing syringes with having a high-risk personal network is a risk factor for HIV infection among new IDUs. Studies of risk factors for HIV infection among new IDUs and interventions to reduce the spread of HIV among them should focus on their risk networks as well as their risk behaviors.
Collapse
Affiliation(s)
- A Neaigus
- National Development and Research Institutes, New York, NY 10013, USA
| | | | | | | | | | | | | |
Collapse
|
30
|
Grund JP, Friedman SR, Stern LS, Jose B, Neaigus A, Curtis R, Des Jarlais DC. Syringe-mediated drug sharing among injecting drug users: patterns, social context and implications for transmission of blood-borne pathogens. Soc Sci Med 1996; 42:691-703. [PMID: 8685737 DOI: 10.1016/0277-9536(95)00193-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Drug injectors are at risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens through the exchange of (infected) blood resulting from unhygienic injecting practices. Research attention and public discussion have focused primarily on the sharing of syringes and needles. While the focus on syringe sharing has sparked important interventions (bleach distribution, syringe exchange) it may have obscured the social relationship in which injecting equipment is used. Drug sharing plays a crucial role in the social organization of the drug using subculture. In this paper, various drug sharing practices and other distinguishable aspects of the injecting process-collectively termed Syringe-Mediated Drug Sharing (SMDS)-are described. All of these behaviors may put injecting drug users (IDUs) at risk for infection. The purpose of this paper is to stimulate scientific inquiry into SMDS behaviors and the social contexts which shape them. Descriptions are based primarily on field studies in Rotterdam and New York City. Recommendations for safer injecting training and education are proposed, as are directions for future research.
Collapse
Affiliation(s)
- J P Grund
- Lindesmith Center, New York, NY 10106, USA
| | | | | | | | | | | | | |
Collapse
|
31
|
Friedman SR, Jose B, Deren S, Des Jarlais DC, Neaigus A. Risk factors for human immunodeficiency virus seroconversion among out-of-treatment drug injectors in high and low seroprevalence cities. The National AIDS Research Consortium. Am J Epidemiol 1995; 142:864-74. [PMID: 7572963 DOI: 10.1093/oxfordjournals.aje.a117726] [Citation(s) in RCA: 113] [Impact Index Per Article: 3.9] [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] [Indexed: 01/26/2023] Open
Abstract
From 1988 to 1991, 6,882 drug injectors in 15 US cities were interviewed and had serum samples collected. The interviews and samples were analyzed for determination of significant predictors of human immunodeficiency virus (HIV) seroconversion in the 10 low seroprevalence cities and the five high seroprevalence cities. The unit of analysis was the period of observation between consecutive paired interviews/blood samples. In Cox proportional hazards regression, significant predictors of seroconversion in the low seroprevalence cities were: not being in drug treatment, injecting in outdoor settings or abandoned buildings, using crack cocaine weekly or more frequently, engaging in woman-to-woman sex, being of non-Latino race/ethnicity, and city seroprevalence. Predictors in high seroprevalence cities were: injecting with potentially infected syringes, not being in drug treatment, and having a sex partner who injected drugs. These findings suggest that HIV may be concentrated in sociobehavioral pockets of infection in low seroprevalence cities. For reducing HIV transmission, these results suggest: 1) in low seroprevalence cities, localized monitoring to detect specific emerging sociobehavioral pockets of infection, and quick implementation of appropriate targeted interventions if necessary; 2) in high seroprevalence cities, relatively more emphasis on locality-wide outreach and syringe-exchange projects to reduce risky behavior; and 3) in both types of cities, considerable expansion of drug treatment programs.
Collapse
Affiliation(s)
- S R Friedman
- National Development and Research Institutes, Inc., New York, NY 10013, USA
| | | | | | | | | |
Collapse
|
32
|
Seither RB, Jose B, Paris KJ, Lindberg RD, Spanos WJ. Results of irradiation in patients with high-grade gliomas evaluated by magnetic resonance imaging. Am J Clin Oncol 1995; 18:297-9. [PMID: 7625369 DOI: 10.1097/00000421-199508000-00005] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Evidence shows that most high-grade gliomas are a diffuse process. Prior studies reported a median survival with surgery and postoperative radiotherapy of 8.6 months for glioblastoma multiforme (GBM) and 36.2 months for anaplastic astrocytoma (AA). Since MRI delineated the glioma better than CT scan, using MRI-based radiotherapy treatment planning allows for more precise treatment volumes. We retrospectively reviewed the records of the first 36 patients with malignant glioma, who had a presurgery MRI-based radiotherapy treatment planning. These patients were diagnosed between January 1986 and February 1991. Minimum follow up was 14 months and median survival was 15.4 months for GBM (7-42 months) and 27.4 months for AA (7-53 months). We feel that the trend for increased median survival in GBM (15.4 vs 8.6 months) is partly due to better definition of the tumor volume by using MRI. Larger studies are needed to confirm this finding.
Collapse
Affiliation(s)
- R B Seither
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, School of Medicine, KY 40202, USA
| | | | | | | | | |
Collapse
|
33
|
Abstract
While most studies of AIDS risk behavior rely on self-reports, few studies have assessed the reliability of these reports. The present study examines self-reports of drug-related and sexual risk behavior among pairs of injecting drug users (IDUs) recruited from the streets in New York City. Since both members of the pair were interviewed, it was possible to compare their responses in order to assess reliability. Subjects reported on their contacts' demographic data (age, gender, race/ethnicity) and on shared risk behaviors, including syringe sharing. Despite the private and/or illegal nature of AIDS risk behaviors, IDU subjects were generally reliable in their reports of both demographic and AIDS risk behaviors.
Collapse
Affiliation(s)
- M F Goldstein
- National Development and Research Institutes, Inc., New York, New York 10013, USA
| | | | | | | | | | | |
Collapse
|
34
|
Tisdale BA, Paris KJ, Lindberg RD, Jose B, Spanos WJ. Radiation therapy for pancreatic cancer: a retrospective study of the University of Louisville experience. South Med J 1995; 88:741-4. [PMID: 7597479 DOI: 10.1097/00007611-199507000-00009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although multiple regimens and approaches have been used in attempts to treat pancreatic cancer, the 5-year disease-free survival is dismal. With an increase in incidence of pancreatic cancer over the past 35 years, researchers continue their efforts to find an effective treatment for this aggressive disease. Between January 1983 and January 1993, we treated 77 patients with radiotherapy for pancreatic cancer. Only 35 of these patients had localized adenocarcinoma and were treated for cure. In this group of 35 patients, 5 received < 4,000 cGy (mean survival of 5.6 months) and 30 received > or = 4,000 cGy (mean survival of 14.7 months). Twenty-four of these 30 received > or = 5,000 cGy, resulting in a mean survival of 15.4 months, and 17 of these 24 received > or = 6,000 cGy, with a mean survival of 15.7 months. Some palliation of symptoms was achieved in 57% of all patients. These results at the University of Louisville Brown Cancer Center are comparable to other published results, but the prognosis for patients with pancreatic cancer remains bleak.
Collapse
Affiliation(s)
- B A Tisdale
- Department of Radiation Oncology, University of Louisville, KY, USA
| | | | | | | | | |
Collapse
|
35
|
Paone D, Des Jarlais DC, Caloir S, Clark J, Jose B. Operational issues in syringe exchanges: the New York City tagging alternative study. J Community Health 1995; 20:111-23. [PMID: 7642778 DOI: 10.1007/bf02260333] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
It is estimated that 50% of the approximate 200,000 intravenous drug users (IDUs) in New York City (NYC) are infected with HIV. Syringe exchange, a common method of HIV prevention in many countries was legalized in NYC in 1992. As syringe exchange has gained public support and the number of functioning exchangers has grown in the country, more attention has been given to the study of operational characteristics of syringe exchanges. Syringe exchanges may be considered health service delivery organizations, and the specific methods of service delivery may greatly influence their effectiveness in reducing HIV risk behavior among injecting drug users. Improving operational characteristics of syringe exchanges requires both careful data collection, in order to reduce ambiguity in interpretation, and methods for cumulating knowledge, so that previous learning experiences need not be repeated with each new exchange. We report here on the practice of marking ("tagging") syringes distributed by exchanges in NYC during the period from 1990 through 1994. During this period the NYC exchanges operated illegally as underground exchanges, and then received legal status and expanded greatly. Developing regulations that reflect the reality of the program operations while allowing for monitoring and oversight is a complicated process, especially when implemented in states that maintain paraphernalia and prescription laws and where "unauthorized" possession of injection equipment remains a criminal activity under existing legal statutes. The particular situation in NYC which required the revision of existing regulations during a period of rapid program expansion and implementation of a large system of syringe exchange further illustrates the multiple pressures which accompany such a process. In order to implement meaningful regulations which maximize the public health benefits of syringe exchange programs on an individual and community level, recommendations are made.
Collapse
Affiliation(s)
- D Paone
- Chemical Dependency Institute, Beth Israel Medical Center, N.Y., NY 10003, USA
| | | | | | | | | |
Collapse
|
36
|
Jose B, Lindberg R, Spanos W, Paris K. Use of magnetic resonance imaging in central nervous system tumors. J Ky Med Assoc 1995; 93:88-92. [PMID: 7730730] [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: 05/21/2023]
Abstract
MRI provides additional information about tumor location, extent, and margins. MRI was used in 158 patients with CNS tumors for treatment planning from 1985-89 and they were studied in a prospective manner. The most common site was cerebrum (73 pts), then extradural spinal axis (21 pts) posterior fossa (17 pts), brain stem (14 pts) and pituitary (13 pts), etc. The most common histological primary tumor was glioblastoma multiform (25 pts), then low grade astrocytoma (22 pts), anaplastic astrocytoma (14 pts), pituitary tumor (13 pts), medulloblastoma (9 pts), ependymoma (7 pts), and germ cell tumors (6 pts). Twenty-nine patients had metastasis to the brain. A majority of the patients with CNS tumors had the studies using Gadolinium-DTPA. Of the patients with CNS tumors, 120 (76%) had better information based on the MRI, which improved the treatment planning (using the three dimensional images) and field arrangement. In 89 patients (56%) the MRI was very decisive in the treatment volume and field arrangement. In 31 patients (20%) the MRI was beneficial and confirmed the treatment plan. MRI provides important additional information for radiation therapy planning.
Collapse
Affiliation(s)
- B Jose
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, KY 40292, USA
| | | | | | | |
Collapse
|
37
|
Butler D, Jose B, Summe R, Paris K, Bertolone S, Patel CC, Spanos W, Lindberg R. Pediatric astrocytomas. The Louisville experience: 1978-1988. Am J Clin Oncol 1994; 17:475-9. [PMID: 7977163] [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: 01/28/2023]
Abstract
PURPOSE The purpose of this study is to retrospectively analyze all pediatric patients with the diagnosis of astrocytoma treated either definitively or postoperatively in our department from 1978 through 1988. Grade, age, T-stage, tumor location, and extent of resection are individually analyzed as prognostic indicators of overall survival. MATERIALS AND METHODS Pediatric astrocytoma patients (grades I-IV) diagnosed by CT-guided biopsy or surgical resection were assessed. Patients were treated with external beam radiotherapy to involved fields using 4- or 6-MV photons. Daily doses ranged from 1.5 to 2.0 Gy; total doses from 41.4 to 66 Gy. Treatment was given to 17 patients (9 male, 8 female), aged 18 years and younger: 11 patients had low-grade (I & II) astrocytoma with incomplete margins; 3 patients had anaplastic astrocytoma; and 3 patients had glioblastoma multiforme. RESULTS Overall survival at 140 months was 63%. Median follow-up of patients living NED was 69 months, with a range of 39-140 months. Nine of the eleven (82%) low-grade patients survived NED; 1 of 3 anaplastic patients is NED at 44 months follow-up; 1 died of intercurrent disease at 80 months; the third died of disease at 49 months. All three glioblastomas succumbed to local disease at 9, 15, and 27 months from diagnosis. Univariate analysis showed only grade to be prognostically significant (p < .03) in determining overall survival. CONCLUSION Postoperative radiotherapy for unresected or partially resected low-grade astrocytomas produces excellent local control. Higher grade astrocytomas require further investigational studies to improve survival and local control. Grade is prognostically significant with respect to overall survival.
Collapse
Affiliation(s)
- D Butler
- Department of Radiation Oncology, Kosair Children's Hospital, University of Louisville, Kentucky
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
From 1982 through 1989, 56 patients with Stage III epithelial carcinoma of the ovary received intraperitoneal chromic phosphate following chemotherapy and second look (52 pts) or as the only postsurgical management (4 pts). Median follow-up was 48 months (range of 24 to 108 months). The 4 patients treated following primary surgery with P-32 without chemotherapy had microscopic abdominal disease (3 pts) or complete reduction of gross abdominal disease (1 pt), and their 5-year survival was 100%. Of the 52 patients treated with P-32 following PAC chemotherapy, 23 were pathologic negative, 15 had microscopic residual, and 14 had gross residual at second look. The 5-year survival following second look was 75% for negative, 48% for microscopic, and 32% for gross residual. There were 4 Grade 3 GI complications (7%). There were no complications in the 38 patients who received the P-32 within 12 hr of surgery. The use of P-32 as an adjuvant for Stage I and II epithelial carcinoma of ovary has been found to be effective in prior GOG trials. We have expanded the selection criteria in patients with Stage III carcinoma to include those who can be surgically reduced to microscopic residual at primary surgery or second look following chemo reduction. Because of multiple prognostic variables affecting survival in Stage III ovarian cancer, a randomized study with control arm would be necessary to draw firm conclusions regarding the effectiveness of P-32. The 5-year survival in this group of patients compares favorably to published reports.
Collapse
Affiliation(s)
- W J Spanos
- Department of Radiation Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Kentucky 40292
| | | | | | | | | |
Collapse
|
39
|
Friedman SR, Jose B, Neaigus A, Goldstein M, Curtis R, Ildefonso G, Mota P, Des Jarlais DC. Consistent condom use in relationships between seropositive injecting drug users and sex partners who do not inject drugs. AIDS 1994; 8:357-61. [PMID: 8031514 DOI: 10.1097/00002030-199403000-00010] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [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] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To study how condom use in injecting drug users' (IDU) relationships differs according to whether they are HIV-infected, and to whether their sex partner is an IDU. DESIGN AND METHODS A total of 317 street-recruited IDU were HIV-antibody tested and interviewed about 421 relationships with particular sex partners. RESULTS Condoms were consistently (100%) used in sex between partners (during the previous 30 days) in 33% of these relationships, and their use was significantly more frequent in relationships of seropositive IDU and in relationships with non-IDU partners. In relationships between seropositive IDU and non-IDU, consistent condom use was reported to be high (68%); this remained unchanged under multivariate controls. CONCLUSIONS Self-reported condom use by IDU in New York, with its relatively mature epidemic, appears to be concentrated where it may most reduce the spread of HIV to non-IDU heterosexuals, i.e., in relationships between infected IDU and non-IDU partners. Differential condom use by serostatus and by partners' drug injection should be incorporated into mathematical models of the HIV epidemic. Causes of the high level of condom use in this subset of relationships may include drug injector altruism and pressure by sex partners; prevention programs should develop ways to use both of these factors to motivate increased condom use.
Collapse
Affiliation(s)
- S R Friedman
- National Development and Research Institutes (NDRI), Inc., New York, NY 10013
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Neaigus A, Friedman SR, Curtis R, Des Jarlais DC, Furst RT, Jose B, Mota P, Stepherson B, Sufian M, Ward T. The relevance of drug injectors' social and risk networks for understanding and preventing HIV infection. Soc Sci Med 1994; 38:67-78. [PMID: 8146717 DOI: 10.1016/0277-9536(94)90301-8] [Citation(s) in RCA: 239] [Impact Index Per Article: 8.0] [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] [Indexed: 01/29/2023]
Abstract
Focusing on the social environment as well as the individual should both enhance our understanding of HIV transmission and assist in the development of more effective prevention programs. Networks are an important aspect of drug injectors' social environment. We distinguish between (1) risk networks (the people among whom HIV risk behaviors occur) as vectors of disease transmission, and (2) social networks (the people among whom there are social interactions with a mutual orientation to one another) as generators and disseminators of social influence. These concepts are applied to analyses of data from interviews with drug injectors in two studies. In the first study drug injectors' risk networks converge with their social networks: 70% inject or share syringes with a spouse or sex partner, a running partner, or with friends or others whom they know. Qualitative data from interviews with injectors in the second study also show that the social relationships between drug injectors and members of their risk network are often based on long-standing and multiplex relationships, such as those based on kinship, friendship, marital and sexual ties, and economic activity. In the first study the vast majority of injectors, over 90%, have social ties with non-injectors. Injectors with more frequent social contacts with non-injectors engage in lower levels of injecting risk behavior. Risk settings may function as risk networks: injectors in this study who inject at shooting galleries are more likely than those who do not to rent used syringes, borrow used syringes and inject with strangers. Since the adoption of a network approach is relatively new, a number of issues require further attention. These include: how to utilize social networks among drug injectors to reduce risk through peer pressure; how to promote risk reduction by encouraging ties between injectors and non-injectors; and how to integrate biographical and historical change into understanding network processes. Appropriate methodologies to study drug injectors' networks should be developed, including techniques to reach hidden populations, computer software for managing and analyzing network data bases, and statistical methods for drawing inferences from data gathered through dependent sampling designs.
Collapse
Affiliation(s)
- A Neaigus
- National Development and Research Institutes, Inc., New York City 10013
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Curtis R, Friedman SR, Neaigus A, Jose B, Goldstein M, Des Jarlais DC. Implications of directly observed therapy in tuberculosis control measures among IDUs. Public Health Rep 1994; 109:319-27. [PMID: 8190855 PMCID: PMC1403496] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Tuberculosis (TB) is a rapidly growing problem among injecting drug users (IDU), especially those infected with human immunodeficiency virus. The authors review IDUs' responses to current TB control strategies and discuss the implications of their findings for the proposed implementation of directly observed therapy (DOT), a method for ensuring that patients take prescribed medication. Field workers carried out 210 ethnographic interviews with 68 IDUs in a Brooklyn, NY, community during 1990-93. Case studies suggested that many IDUs are uninformed about TB and often misinformed about their personal TB status. Ethnographic interviews and observations indicated that the threat of TB-related involuntary detainment may lead IDUs to avoid TB diagnostic procedures, treatment for TB, or drug abuse treatment, and to avoid AIDS outreach workers and other health-related services. IDUs who tested positive for the purified protein derivative (PPD) of TB sometimes have left hospitals before definitive diagnoses were made, because of a perceived lack of respectful treatment, fear of detention, or lack of adequate methadone therapy to relieve the symptoms of withdrawal from drugs. Current TB diagnosis and treatment systems are, at best, inadequate. The threat of TB-related detention discourages some IDUs from seeking any type of health care. There is an urgent need to educate IDUs about TB and to educate and sensitize health care providers about the lifestyles of IDUs. DOT may help in servicing this difficult-to-serve population, particularly if techniques are incorporated that have been developed for other successful public health interventions for IDUs.
Collapse
|
42
|
Jose B, Friedman SR, Neaigus A, Curtis R, Grund JP, Goldstein MF, Ward TP, Des Jarlais DC. Syringe-mediated drug-sharing (backloading): a new risk factor for HIV among injecting drug users. AIDS 1993; 7:1653-60. [PMID: 8286076 DOI: 10.1097/00002030-199312000-00017] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.3] [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] [Indexed: 01/29/2023]
Abstract
BACKGROUND In syringe-mediated drug-sharing (backloading), injecting drug users (IDU) use their syringes to mix drugs and to give measured shares to other IDU by squirting drug solution into the syringes of other IDU. Backloading has been discussed as a potential HIV risk factor, but its role as an HIV transmission route has not been established empirically. METHODS Six hundred and sixty IDU who had injected drugs in the previous 2 years were street-recruited from Bushwick, New York City through chain referral, tested for HIV antibody and interviewed about sexual and drug-risk behaviors. RESULTS Receiving drugs via backloading in the previous 2 years was reported by 24.5% of the subjects. These subjects had significantly higher HIV seroprevalence than those who did not receive drugs by backloading (odds ratio, 2.2; 95% confidence interval, 1.5-3.1). Backloading remained positively and significantly associated with HIV seropositivity in stepwise logistic regression, and in a series of simultaneous logistic models controlling for sociodemographic variables and for sexual and drug risk variables. CONCLUSIONS Backloading can be a route of HIV transmission among IDU and should be incorporated into risk-factor studies and HIV transmission modeling. Many IDU who avoid other high-risk drug-injection practices may overlook the risk of backloading. HIV prevention programs should warn IDU against syringe-mediated drug-sharing and work together to develop ways to avoid it.
Collapse
Affiliation(s)
- B Jose
- National Development and Research Institutes, Inc., New York, New York 10013
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Paris KJ, Spanos WJ, Lindberg RD, Jose B, Albrink F. Phase I-II study of multiple daily fractions for palliation of advanced head and neck malignancies. Int J Radiat Oncol Biol Phys 1993; 25:657-60. [PMID: 7681051 DOI: 10.1016/0360-3016(93)90012-k] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To assess palliation of advance head and neck malignancies with the use of rapid hyper fractionation studies similar to the RTOG 85-02. MATERIALS AND METHODS 37 patients with 39 lesions were entered into the non-randomized Phase I-II protocol, between 1984 and 1991. Previously untreated malignancies were present in 24 lesions, primary recurrent diseases in six patients, metastasis to the head and neck in five patients and skin primaries in the remaining two cases. At presentation 15 of 37 patients (or 17 of 39 lesions) were in operable due to poor medical status, eight patients were considered technically in operable due to extent of disease, 10 patients had distant metastasis and four patients refused surgery. The protocol uses twice a day fraction (370 cGy per fraction) for 2 consecutive days totalling 1,480 cGy per course. Three courses were given at 3-week intervals for a final tumor dose of 4,440 cGy in twelve fraction over 8-9 weeks. RESULTS Eleven of 39 lesions had complete response; 19 lesions had partial response; 4 lesions had no response; 3 lesions progressed under treatment. Response could not be assessed in two patients. The average survival after completion of therapy was 4.5 months ranging from 2 weeks to 31 months. Palliation was achieved in 33 of 39 lesions. The acute reactions were minimal and no late or long term complications were noted. CONCLUSION The absence of significant complications with reasonable response in the high rate of palliation suggests that this rapid hyper fractionation palliation study should be studied for further evaluation.
Collapse
Affiliation(s)
- K J Paris
- Department of Radiation Oncology, University of Louisville, KY 40292
| | | | | | | | | |
Collapse
|
44
|
Abstract
From 1982 through 1989, 94 patients at the University of Louisville with ovarian neoplasm had abdominal instillation of 15 mCi chromic 32P as part of their management. The timing of the 32P was immediately postoperative in 55 patients and delayed greater than 24 hr in 39 patients. This is an analysis of factors contributing to gastrointestinal (GI) complications. GI complications were graded according to RTOG guidelines. There was a total of 11 GI complications grade 3 or worse for an overall incidence of 12%. Factors analyzed include timing of 32P delivery, age, stage, number of previous surgeries, use of Hyskon at surgery, addition of external beam radiation, and subsequent use of chemotherapy. There were significantly fewer complications when 32P was given on the same day as surgery than when 32P administration was delayed more than 12 hr following surgery (4% vs 21%), P = 0.007. This difference held significance when adjusted for the number of previous surgeries, use of Hyskon, external beam radiation, and stage. None of the other factors had a significant effect on complication rate. There have been no incidences of contamination even though 32P instillation in the immediate post-operative period had increased risk of contamination due to wound leakage or reoperation. In our experience, the delivery of 32P in the immediate postoperative period resulted in a significant reduction in abdominal complications.
Collapse
Affiliation(s)
- W J Spanos
- Department of Radiation Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Kentucky 40292
| | | | | | | | | | | |
Collapse
|
45
|
Paris KJ, Spanos WJ, Day TG, Jose B, Lindberg RD. Incidence of complications with mini vaginal culpostats in carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1991; 21:911-7. [PMID: 1917619 DOI: 10.1016/0360-3016(91)90729-n] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Between 1980 and 1987, 298 patients with carcinoma of the uterine cervix were treated at the University of Louisville Department of Radiation Oncology. Of these, 197 (66.1%) were treated for cure by radiotherapy alone: 36 by external beam alone and 161 by external beam and tandem and ovoid applications. The F.I.G.O. staging of the 161 patients was 82 (50.1%) Stage IB, 9 (5.6%) Stage IIA, 40 (24.9%) Stage IIB, and 30 (18.6%) Stage III. The usual treatment was whole pelvis irradiation followed by two intracavitary applications using the Fletcher Suit Applicators of tandem and ovoids in 79/161 patients (49%), a 3-M Mini Applicator (Fletcher Suit Delcos Applicator) in 52/161 patients (32.3%), and a 3-M Mini Applicator with Caps in 30/161 patients (18.6%). The incidence of grade 3-4 gastrointestinal or genitourinary complications as defined by the RTOG was 19.3% (31/161). Various treatment parameters were analyzed to define possible contributing factors. Grade 3-4 complications were seen in 7.6% (6/79) of patients treated with the standard ovoid Fletcher system, 26.9% (14/52) treated with the mini-ovoid system, and 36.6% (11/30) treated with the mini-ovoid system with caps (p = .0006). Although trends were noted, neither the vaginal surface dose (VSD) from the ovoids nor the addition of the external beam dose to the VSD (total vaginal surface dose = TVSD) were significant independent variables (p = 0.19 and = 0.133, respectively). The TVSD was significant when comparisons were made between different ovoid systems (p = 0.05 for less than 12,000 cGy and p = 0.004 for greater than 12,000 cGy). In this study, the 3-M mini applicator was associated with a significant increase in grade 3-4 complications as compared to the Standard Fletcher Suit Applicator.
Collapse
Affiliation(s)
- K J Paris
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, KY 40292
| | | | | | | | | |
Collapse
|
46
|
Abstract
The aim of this study was to analyze the effects of surgery, irradiation, and free tissue transfer in locally advanced head and neck cancer patients. Forty-one patients with head and neck cancer were treated with surgery, irradiation, and free tissue transfer for reconstruction from 1977 to 1987. The age range was 38 to 78 years with a median age of 61. Patients were staged using the AJCC (1978) staging system. Eighty-four percent of the patients were in stage III or IV. The common sites of primary tumors were the oral cavity (22) and oropharynx (10). Forty patients had squamous cell carcinoma and 1 patient had basal cell carcinoma. Six patients had preoperative irradiation, and the rest had postoperative irradiation. The most common surgical procedures were partial glossectomy and neck dissection (17 patients) and wide excision of the primary and neck dissection (17 patients). The most common types of free tissue transfer were dorsalis pedis (13 patients) and scapular flaps (6 patients). The primary site was controlled in 22 patients (54%) and the neck in 36 patients (88%). Three patients (7.3%) had flap failure which required further surgical management. Eighteen patients are living with no evidence of disease with a median follow-up of 18 months (5-101 months), 10 patients are living with disease with a median follow-up of 9 months (3-40 months), 9 patients are dead of disease with a median survival of 13 months (6-54 months), and 4 patients are lost for follow-up. This study shows that free tissue transfer before or after irradiation is of benefit with few complications.
Collapse
Affiliation(s)
- B Jose
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, KY 40202
| | | | | | | | | | | | | |
Collapse
|
47
|
Jose B, Duncan A, Paris K, Lindberg RD, Spanos WJ. Glioblastoma multiforme in adults: results of treatment. J Ky Med Assoc 1990; 88:650-2. [PMID: 2177493] [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: 12/30/2022]
Abstract
One hundred and thirty adult patients with brain tumors were treated in the Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine from 1973 to 1980. Forty-one patients (39%) were diagnosed with glioblastoma multiforme. Forty-two percent of the patients were in the age group of 51-60 years. There were 24 males and 27 females. Forty-seven percent of the patients had partial resection, 27% had total excision and 26% had biopsy only. The radiation dose ranged from 4400 to 6600 rad with a median dose of 5500 rad. The median survival was 8.5 months, (range 3 to 120 months), 38% of patients survived one year or more and 10% survived 2 years or more. A detailed review of the current policy of treatment and of the ongoing clinical trials is done in this paper.
Collapse
Affiliation(s)
- B Jose
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, KY 40292
| | | | | | | | | |
Collapse
|
48
|
Jose B, Duncan A, Lindberg RD, Spanos WJ, Paris KJ. Medulloblastoma: results of treatment. J Ky Med Assoc 1989; 87:269-71. [PMID: 2500493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fourteen patients with a diagnosis of medulloblastoma were treated in the Department of Radiation Oncology, University of Louisville School of Medicine from 1973 to 1979. The age of these patients ranged from 2 to 47 years with a median of 9 years. Twelve of them were 15 years or younger. All patients received craniospinal radiation after surgery, with a boost to the primary site by reduced field. The median dose to the primary was 4736 rads (range 3600 to 5600 rad). The median follow-up was 29.5 months. Six patients have died, and four of those six patients lived more than two years. Eight patients are alive to the last follow-up with a median survival of 29 months. Eight of 14 patients had local control and one patient developed distant metastasis. A brief review of the literature is done in this paper.
Collapse
|
49
|
Jose B, Narayan PI, Pietsch JB, Nagaraj HS, Patel CC, Bertolone SJ, Spanos WJ, Lindberg R, Paris KJ. Budd-Chiari syndrome secondary to hepatic vein thrombus from Wilm's tumor. Case report and literature review. J Ky Med Assoc 1989; 87:174-6. [PMID: 2542421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We describe a case of Budd-Chiari Syndrome in a 6-year-old boy secondary to Wilm's tumor. The patient had a right nephrectomy and mediastinotomy with removal of the tumor from the right atrium, inferior vena cava, and hepatic vein. Postoperatively, the patient had chemotherapy consisting of Actinomycin-D to be followed by radiation to the tumor bed to a total dose of 2000 rads in 10 fractions by using AP/PA field on 6 MeV Linear Accelerator. Currently, the child is receiving combination chemotherapy.
Collapse
|
50
|
Lindberg RD, Jones K, Garner HH, Jose B, Spanos WJ, Bhatnagar D. Evaluation of unplanned interruptions in radiotherapy treatment schedules. Int J Radiat Oncol Biol Phys 1988; 14:811-5. [PMID: 3350733 DOI: 10.1016/0360-3016(88)90103-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
One of the major radiobiological interests has been to maximize the effectiveness of the time-dose relationship in the clinical setting. Current explorations include altered fractionation schedules, multiple daily fractions and hypofractionation. Patient compliance to standard radiotherapy treatment schedules is taken for granted. To evaluate the true rate of compliance, the charts of all new patients treated from July 1, 1984 through June 30, 1985 were reviewed. The overall incidence of unplanned interruptions was 54% (361/668). The frequency of interruptions is significantly higher in patients treated to the primary site as compared to those treated for metastasis (59.8% and 35.6% respectively). The duration of the interruptions varied: 12.7% of the patients missed only 1 day, 25% missed 2 to 5 days, 38% had interruptions totalling 6-15 days, and in 24% the total exceeded 15 days. The most frequent cause of the unplanned interruptions was a rest resulting from unusually adverse tissue reactions (46.8%-169/361). Although this study has documented that unplanned interruptions are a major problem, the impact on local control and survival cannot be determined from our data. A retrospective review of multi-institutional studies such as those conducted by the Patterns of Care or RTOG might show that one of the major causes of failure is unplanned interruptions.
Collapse
Affiliation(s)
- R D Lindberg
- Department of Radiation Oncology, University of Louisville, Brown Cancer Center, KY 40202
| | | | | | | | | | | |
Collapse
|