Diseases Commons^™

Novel Oral Anticoagulants For Stroke Prophylaxis And Venous Thromboembolism Prevention And Treatment, Laith G. Alsayegh

Journal of Patient-Centered Research and Reviews

Novel oral anticoagulants (NOACs) are becoming popular management options for stroke prophylaxis in nonvalvular atrial fibrillation as well as deep vein thrombosis and pulmonary embolism treatment and prophylaxis. NOACs have similar efficacy to warfarin along with noninferior safety profiles. Patient comorbidities, size, renal and hepatic function, and concomitant drug regimen play a role in which NOAC a physician may choose.

My Time With E, Alyssa Mohorek

Journal of Patient-Centered Research and Reviews

Poignant encounters with a dying patient and her family are described. These reflections explore one aspect of the maturation process of a medical intern.

Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada

Journal of Patient-Centered Research and Reviews

Purpose

Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads.

Methods

We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 [n=168]; …

Breast Cancer Screening: Early Detection Is Not Enough, Judy A. Tjoe

Journal of Patient-Centered Research and Reviews

N/A

The Clinical Breast Examination: A Useful Screening Tool?, Jennifer Lo

Journal of Patient-Centered Research and Reviews

The standardization of the clinical breast examination as a screening tool for breast cancer has been a topic of controversy. Current recommendations vary significantly from organization to organization without consensus. There currently does not seem to be sufficient evidence regarding overall survival benefit of the clinical breast exam. However, as adjunct screening with mammography, it may help find earlier breast cancers and the up to 5–10% of cancers missed by mammography. The most appropriate standardized protocol may be that the clinical breast exam can be performed at the discretion of the provider and patient, with more inclination toward use in …

What Are The Recommended Timing And Screening Modalities For Women At Higher Risk Of Developing Breast Cancer? A Clin-Iq, Summer Jatala, Shawn Fitzgerald, Pamela Tietze, Kalyanakrishnan Ramakrisnan, Laine H. Mccarthy, Elizabeth Wickersham

Journal of Patient-Centered Research and Reviews

Early detection of breast cancer is desirable to prevent progression to advanced disease. This subject has been one of significant study and debate for women at normal risk, and recommendations continue to evolve. However, with regard to women at high risk, the recommendations from various health care professional organizations, including the U.S. Preventive Services Task Force, are different and also inconsistent concerning when to begin screening and which modalities should be used. We review several randomized controlled trials and consensus opinions regarding when to begin screening for breast cancer and how to best screen women at high risk. Specifically, we …

Clinical Guidelines: Where Environment Meets Medicine, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

N/A

Association Between Body Surface Area And Outcomes After Percutaneous Coronary Intervention, Kambiz Shetabi, Tonga Nfor, Fengyi Shen, Anjan Gupta, Tanvir Bajwa, Suhail Allaqaband

Journal of Patient-Centered Research and Reviews

Purpose

Obesity is a well-known risk factor for adverse cardiovascular events, but some studies suggest higher body mass index (BMI) is associated with better outcomes after ST-segment elevation myocardial infarction (STEMI). We sought to determine the effect of body surface area (BSA) on adverse events after primary percutaneous coronary intervention (PCI) for STEMI and how this relates to the reported obesity paradox theory.

Methods

We analyzed a prospective registry of patients with STEMI who underwent primary PCI at a tertiary care hospital from 2003 to 2009. Post-PCI complications and 1-year all-cause mortality were compared across BSA quartiles. Relationship with 1-year …

What Is Pfapa And Why Does It Matter?, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

PFAPA, the syndrome of periodic fever, aphthous stomatitis, pharyngitis and cervical lymphadentitis, is an uncommon disease of episodic immune dysregulation that usually begins in early childhood. Symptoms occur at regular, predictable intervals, with healthy periods in between, and generally include the namesake signs and various other constitutional symptoms such as fever and fatigue. The etiology is unknown and there is no definitive diagnostic test or treatment. Uncertainty during the period of searching for a diagnosis may be disconcerting to the family and the clinician. Single-dose prednisone is effective for resolving the fever of PFAPA episodes within just a few hours, …

Recurrent Aphthous Stomatitis: Diagnosis And Management In Primary Care, Jillian Hudson

Journal of Patient-Centered Research and Reviews

Recurrent aphthous stomatitis (canker sores) is a very common oral condition that remains incompletely understood. Presentation has been well-classified into minor, major or herpetiform subcategories based on clinical features, but exact etiology is unknown. Because etiology is unclear, treatments are primarily empiric and aimed at symptom reduction rather than prevention or cure. However, there are several methods, both topical and systemic, that can be easily and affordably utilized in the primary care setting.

Autoantibodies To The Ny-Eso-1 Tumor Antigen In Metastatic Melanoma: Sialylation Of The Fc Region Of Immunoglobulin G Induces Differential Expression Signatures Of Inflammatory Molecules During Dendritic Cell Differentiation And Maturation, Martin Oaks, Nathaniel Rein, John O. Richards, James Shaffer

Journal of Patient-Centered Research and Reviews

Purpose: We tested the hypothesis that different glycoforms of antibodies from patients with metastatic melanoma have different functional effects on human dendritic cell differentiation and maturation.

Methods: Antibodies to the cancer antigen NY-ESO-1 were affinity-purified from patients with melanoma and further fractionated into different glycoforms by lectin chromatography. Sialic acid-rich and sialic acid-poor fractions of these immunoglobulin G antibodies (IgG) were added to dendritic cell cultures during both differentiation and maturation, and the resulting cellular messenger RNA (mRNA) and culture supernatants were tested by microarray and enzyme-linked immunoassay for molecules related to inflammatory pathways.

Results: We identified unique mRNA and …

Which Clinical Guidelines Should Be Implemented For Management Of Osteopenia In Primary Care? A Clin-Iq, Turia Hollingsworth

Journal of Patient-Centered Research and Reviews

Literature review was conducted to determine clinical guidelines for osteopenia management of immunocompetent patients in the primary care setting. It was concluded that pharmacological treatment should be offered to patients with osteopenia if they are considered high risk, which can be determined by utilizing the World Health Organization Fracture Risk Assessment Tool (FRAX^®) to evaluate 10-year risk. Patients with a calculated hip fracture probability of at least 3% or those with probability of 20% or more for all osteoporotic fractures may be offered bisphosphonate therapy.

Discordant Documentation Of Obesity Body Mass Index And Obesity Diagnosis In Electronic Medical Records, Jennifer T. Fink, George L. Morris Iii, Maharaj Singh, David A. Nelson, Renee E. Walker, Ron A. Cisler

Journal of Patient-Centered Research and Reviews

Purpose: This study examined concordance between presence of obesity body mass index (BMI), defined as BMI ≥ 30, in the patient’s electronic medical record (EMR) and a documented diagnosis of obesity.

Methods: We conducted a retrospective review of the EMR in a large health care system for a 1-year period (2012). A total of 397,313 patients met the study criteria of having at least one physician visit, being at least 18 years of age, and not being pregnant. Of those, 158,327 (40%) had a recorded BMI ≥ 30. We examined the EMR of these obese patients to determine whether a …

Cardio-Oncology: Success Breeds New Challenges, Opportunities, Charles A. Bomzer, Bijoy K. Khandheria

Journal of Patient-Centered Research and Reviews

N/A

Clinical Outcomes Of Unprotected Left Main Coronary Artery Stenting In Nonsurgical Patients: A Single-Center Experience, John-Paul Pham, Abdelazim Hashim, Naoyo Mori, Mohamed Taha, Mohamed Djelmami-Hani, Joaquin Solis, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta

Journal of Patient-Centered Research and Reviews

Purpose: Coronary artery bypass graft is the standard treatment for unprotected left main disease; however, some patients are poor surgical candidates due to comorbidities. We assessed the safety and clinical outcome of elective, unprotected left main coronary artery stenting in nonsurgical patients.

Methods: Between October 2004 and June 2006, 50 consecutive patients underwent elective, unprotected left main coronary artery stenting at our institution. Patients were followed for a median of 16 and 96 months and clinical outcomes monitored.

Results: Median logistic euroSCORE was 28.6 (interquartile range: 14.6-43.4). Median baseline left ventricular ejection fraction (LVEF) was 50%. Procedural success rate was …

An Uncommon Presentation For Cardiac Melanoma, Burcu Gul, Michael N. Young, David A. Slosky, Mark A. Lawson, Jeffrey N. Rottman

Journal of Patient-Centered Research and Reviews

A 66-year-old man with locally advanced malignant melanoma, which was surgically resected, presented with a 3-week history of dizziness, recurrent near-syncopal episodes and generalized weakness. He was found to have sustained polymorphic ventricular tachycardia in the setting of cardiac melanoma. We draw attention to an unusual presentation of malignant melanoma with cardiac metastasis and discuss both its etiology and treatment options.

Bedbugs Biting Back? A Multifactorial Consideration Of Bedbug Resurgence, Vanessa L. Abejuela-Matt

Journal of Patient-Centered Research and Reviews

Bedbugs, previously thought to be eradicated during the mid-20th century, have reemerged in the new millennium with unforeseen furor. Affected patients and families frequently present in primary care settings, not only with complaints of pruritus or rash, but with anxiety and shame regarding the condition. Changes in eradication techniques and resistance, as well as lack of reporting – from both patients and lodging institutions – have hindered control. The increased mobility of goods and the human population has provided further avenues for bedbug spread. While current literature thoroughly describes the clinical presentation of bedbugs and the increasingly problematic effects on …