Lawitz E.,University of Texas Health Science Center at San Antonio |
Mangia A.,Casa Sollievo Della Sofferenza Hospital |
Wyles D.,University of California at San Diego |
Rodriguez-Torres M.,Fundacion de Investigacion |
And 19 more authors.
New England Journal of Medicine | Year: 2013
BACKGROUND: In phase 2 trials, the nucleotide polymerase inhibitor sofosbuvir was effective in previously untreated patients with chronic hepatitis C virus (HCV) genotype 1, 2, or 3 infection. METHODS: We conducted two phase 3 studies in previously untreated patients with HCV infection. In a single-group, open-label study, we administered a 12-week regimen of sofosbuvir plus peginterferon alfa-2a and ribavirin in 327 patients with HCV genotype 1, 4, 5, or 6 (of whom 98% had genotype 1 or 4). In a noninferiority trial, 499 patients with HCV genotype 2 or 3 infection were randomly assigned to receive sofosbuvir plus ribavirin for 12 weeks or peginterferon alfa-2a plus ribavirin for 24 weeks. In the two studies, the primary end point was a sustained virologic response at 12 weeks after the end of therapy. RESULTS: In the single-group study, a sustained virologic response was reported in 90% of patients (95% confidence interval, 87 to 93). In the noninferiority trial, a sustained response was reported in 67% of patients in both the sofosbuvir-ribavirin group and the peginterferon-ribavirin group. Response rates in the sofosbuvir-ribavirin group were lower among patients with genotype 3 infection than among those with genotype 2 infection (56% vs. 97%). Adverse events (including fatigue, headache, nausea, and neutropenia) were less common with sofosbuvir than with peginterferon. CONCLUSIONS: In a single-group study of sofosbuvir combined with peginterferon-ribavirin, patients with predominantly genotype 1 or 4 HCV infection had a rate of sustained virologic response of 90% at 12 weeks. In a noninferiority trial, patients with genotype 2 or 3 infection who received either sofosbuvir or peginterferon with ribavirin had nearly identical rates of response (67%). Adverse events were less frequent with sofosbuvir than with peginterferon. (Funded by Gilead Sciences; FISSION and NEUTRINO ClinicalTrials.gov numbers, NCT01497366 and NCT01641640, respectively.) Copyright © 2013 Massachusetts Medical Society.
Dehal A.,Arrowhead Regional Medical Center |
Abbas A.,University of Florida |
Abbas A.,Tulane University |
Johna S.,Kaiser Permanente
Breast Cancer Research and Treatment | Year: 2013
To examine racial/ethnic disparities in stage of disease and comorbidity (pre-treatment), surgical treatment allocation (breast-conserving surgery versus mastectomy), and in-hospital outcomes after surgery (post-treatment) among women with breast cancer. Nationwide inpatient sample is a nationwide clinical and administrative database compiled from 44 states representing 95 % of all hospital discharges in the Unites States. Discharges of adult women who underwent surgery for breast cancer from 2005 to 2009 were identified. Information about patients and hospitals characteristics was obtained. Multivariate logistic regression analyses were used to examine the risk adjusted association between race/ethnicity and the aforementioned outcomes (pre-treatment, treatment, and post-treatment). We identified 75,100 patient discharges. Compared to Whites, African-Americans (1.17, p < 0.001), and Hispanics (1.20, p < 0.001) were more likely to present with regional or metastatic disease. Similarly, African-American (1.58, p < 0.001) and Hispanics (1.11, p 0.003) were more likely to have comorbidity. Compared to Whites, African-Americans (0.71, p < 0.001), and Hispanics (0.77, p < 0.001) were less likely to receive mastectomy. Compared to Whites, African-Americans were more likely to develop post-operative complications (1.35, p < 0.001) and in-hospital mortality (1.87, p 0.13). Other racial groups showed no statistically significant difference compared to Whites. After controlling for potential confounders, we found racial/ethnic disparities in stage, comorbidity, surgical treatment allocation, and in-hospital outcomes among women with breast cancer. Future researches should examine the underlying factors of these disparities. © 2013 Springer Science+Business Media New York.
Twu C.,Arrowhead Regional Medical Center |
Han E.S.,City of Hope
Biologics: Targets and Therapy | Year: 2012
Epithelial ovarian cancer is typically found in its advanced stages, where a combination of surgical debulking and platinum/taxane-based chemotherapy is recommended. Although over 70%-80% of patients achieve remission, a significant proportion develop recurrence of their disease. Additional cytotoxic chemotherapy, as well as surgery, is typically used to manage disease recurrence. Therapies that target specific pathways in cancer cells are rapidly developing in the laboratory and are increasingly being studied in patients with ovarian cancer. We review the current status of novel therapies in the management of epithelial ovarian cancer. © 2012 Twu and Han, publisher and licensee Dove Medical Press Ltd.
Dehal A.,Arrowhead Regional Medical Center |
Abbas A.,Tulane University |
Johna S.,Kaiser Permanente
Breast Cancer Research and Treatment | Year: 2013
To examine the effect of comorbidity on risk of postoperative complications, prolonged hospitalization (defined as above median length of stay), non-routine disposition, and in-patient death among women with breast cancer after surgery. Nationwide in-patient sample is a nationwide clinical and administrative database. Discharges of patients aged 40 years and older who underwent surgery for breast cancer from 2005 to 2009 were identified. Information about patients and hospitals characteristics were obtained. Comorbidities were identified and used to calculate Charlson comorbidity index (CCI) score. We divided patients based on these scores into four groups: 0, 1, 2, and ≥3. Multivariate logistic regression analyses were used to examine risk adjusted association between CCI score and the aforementioned outcomes. We identified 70,536 patients' discharges. Compared to a CCI score of zero as a reference group, CCI scores of 1, 2, and ≥3 increased the risk of post-operative complications by 1.7-fold, 2.6-fold, and 4.6-fold, respectively (p < 0.001). Patients with CCI scores of 1, 2, and ≥3 had higher risk of non-routine disposition by 1.3-folds, 1.7-folds, and 2.2-folds, respectively (p < 0.001). Patients with CCI scores of 1, 2, and ≥3 had higher risk of prolonged hospitalization by 1.2-folds, 1.6-folds, and 2.3-folds, respectively (p < 0.001). Similarly, CCI scores of 1, 2, and ≥3 increased risk of in-patient death by 3.1-folds (p 0.05), 5.4-folds (p 0.008), and 15.8-folds (p < 0.001), respectively. Comorbidity associated with worse in-hospital outcomes among women with breast cancer after surgery. Effective control of comorbidity in breast cancer patients may reduce post-operative morbidity and mortality. © 2013 Springer Science+Business Media New York.
News Article | February 28, 2017
RIVERSIDE, Calif. (AP) — Three people died and two were injured when a small plane carrying them home from a cheerleading competition crashed into two Southern California homes and sparked a major fire Monday, authorities said. A husband, wife and three teenagers were on the plane that had just taken off from Riverside Municipal Airport at 4:40 p.m. intending to return to San Jose after the weekend cheerleading event at Disneyland when it crashed in the residential neighborhood, Riverside Fire Chief Michael Moore said. One of the teenagers, a girl, was thrown from a back seat of the plane on impact but had only minor injuries, Moore said. Three witnesses told TV stations she crawled from the home asking for help. She was able to talk to firefighters about what had happened as she was taken to Riverside Community Hospital, Moore said. Firefighters entered one of the burning houses and pulled out another plane passenger, who was unconscious. That victim underwent surgery at Arrowhead Regional Medical Center in San Bernardino and was in critical condition, Moore said. Three bodies, all from the plane, were found in the combined wreckage of the aircraft and the homes. "It's horrible," Moore said, especially given that they had gone to a cheer competition and it was "supposed to be a happy time." Authorities had earlier said four were dead, and that the critically injured victim was a resident of the homes, but later reduced the death toll to three and said all five victims had been on the plane. They have not given the ages or identities of the victims. All the residents of the homes have been accounted for, Moore said. Moore did not give the name of the cheerleading competition, but the Jr. USA Nationals for girls age 15 and under was held at Disney California Adventure Park over the weekend. The two homes that were hit directly were destroyed, and there was minor damage to some neighboring houses, Moore said. The plane was broken into hundreds of pieces, its propeller sitting on the roof of a nearby home, and the fire burning with jet fuel was still ablaze several hours after the crash. Firefighters found plane pieces about a half-mile away. H.L. Reyes, who lives about a quarter-mile from the crash site, told The Associated Press she felt the ground shake and saw plumes of black smoke. "I thought it was a possible earthquake, and we heard all the birds just suddenly react outside, too," Reyes said. "This was just like a nightmare coming true." Shannon Flores, a teacher at an elementary school about three blocks away, said she saw the plane out her classroom window. She said it was raining during the crash, though other witnesses said the rain was very light. "As soon as we saw it fly over, we knew it wasn't a good thing," Flores told KABC-TV. "We watched it go down very quickly ... Before we knew it, there was a loud crash and huge plumes of smoke."
McCague A.,Arrowhead Regional Medical Center |
Aljanabi H.,Arrowhead Regional Medical Center |
Wong D.T.,Arrowhead Regional Medical Center
Laryngoscope | Year: 2012
Objectives/Hypothesis: Since originally described in 1985 by Ciaglia, percutaneous dilational tracheostomy (PDT) has grown in popularity, and today is widely used for critically ill patients requiring long-term mechanical ventilation. Since the inception of PDT, obesity has been considered a relative contraindication to its use. The purpose of this study is to evaluate the risks of PDT in obese patients. Study Design: Retrospective review. Methods: A retrospective review was performed of prospectively collected data from 426 patients who underwent PDT at a single teaching institution from July 2003 to October 2009. The groups were separated into those who had a body mass index (BMI) of <30 or ≥30 kg/m 2. The following variables were collected: blood loss at the time of procedure, difficulty in tracheotomy dilation and/or tracheostomy placement, presence of tracheal ring breaks, any bleeding episodes requiring treatment by surgery or blood transfusion, pre- and postprocedure pneumonia, and stoma infection requiring antibiotics. All tracheostomies were placed using the Ciaglia Blue Rhino Introducer Kit (Cook Medical Inc., Bloomington, IN). Statistical analysis was performed with nonparametric statistics using π 2 testing with P <.05 as significant. Results: No statistically significant difference was found between the obese and nonobese groups for any of the variables studied. Similar results were found when BMI of 40 was used for grouping. Conclusions: PDT can be performed safely in obese patients. There were no statistically significant differences in measured variables found between the two study groups. This study supports the use of intensive care unit bedside PDT in the obese population. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Miulli D.E.,Arrowhead Regional Medical Center
The Journal of the American Osteopathic Association | Year: 2010
Current limitations on residency duty hours came about after the death of a patient in 1984 in a New York City hospital. This tragedy served as the catalyst for a new public awareness and subsequent change in philosophy regarding resident duty hours, fatigue factors, and risks to patients from the long and tedious shifts of residency. However, it has proven difficult to limit resident physician duty hours. To analyze the impact of resident duty hour limitation (RDHL) implementation on residents, faculty, and patients. The authors conducted a survey of faculty and resident attitudes and experiences regarding RDHLs in the graduate medical education department at Arrowhead Regional Medical Center (ARMC) in Colton, California. They also conducted a review of the literature on faculty and resident attitudes and experiences before and after implementation of RDHLs. Of 60 surveys sent to ARMC faculty members in 2009, 12 (20.0%) were returned. Of 140 surveys sent to ARMC residents, 96 (68.6%) were returned. The survey results and literature review indicated that most faculty physicians initially believed that decreasing resident duty hours would limit the time available to residents for educational experiences and participation in treatment procedures, operations, and consultations. In addition, faculty initially believed that fewer training hours would diminish the quality of residents' educational experiences. Residents also expected negative outcomes from RDHLs. However, statistical data on actual outcomes revealed that residency programs are not adversely affected by limiting resident work hours to 80 hours per week. Furthermore, benefits of RDHLs appear to include improved patient care and well-rounded and psychologically balanced residents. A survey and literature review revealed a number of benefits of RDHLs. It is unclear, however, whether additional limitations of resident work hours are necessary or could accommodate the growing amount of information and skills that are required to become a competent physician.
Walbolt T.D.,Arrowhead Regional Medical Center |
Lalezarzadeh F.,Arrowhead Regional Medical Center
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2011
Duplication of the gallbladder is a rare entity. This case highlights a 36-year-old woman who presented to Arrowhead Regional Medical Center after referral from an outside institution with gallstone pancreatitis. Ultrasound, computed tomography scan, and magnetic resonance cholangiopancreatography showed evidence of a biliary anomaly preoperatively concerning for a duplicated gallbladder or choledochal cyst. Subsequent laparoscopic cholecystectomy and intraoperative cholangiogram confirmed the presence of a duplicated gallbladder. A second intrahepatic gallbladder with connection to the right hepatic duct was identified and the first gallbladder's connection to the common hepatic duct was noted. Both gallbladders contained hundreds of small stones. The patient did well postoperatively and has had no adverse sequelae. A literature review revealed an incidence of 1 in 4000 autopsies with a duplicated gallbladder. Sixty-seven case reports have been published and only 20 cases were managed laparoscopically. Copyright © 2011 by Lippincott Williams & Wilkins.
McCague A.,Arrowhead Regional Medical Center
Scandinavian journal of trauma, resuscitation and emergency medicine | Year: 2011
Sodium acetate has been shown to cause hemodynamic instability when used as a hemodialysis buffer. The pattern of hemodynamic response to injury will be evaluated between those who received sodium acetate and those who did not.The primary purpose of the study is to analyze the effect of sodium acetate on hemodynamic parameters. Secondarily we looked at the effects on prevention and treatment of hyperchloremic metabolic acidosis. The study arm was comprised of patients who had received sodium acetate infusions in place of normal saline between March 2005 and December 2009. A control arm was created based on matching three pre-treatment variables: injury severity score (ISS), pH (+/- 0.03) and base deficit (+/- 3). A retrospective chart review was performed for patients in both arms. Blood pressure, arterial blood gas data and chemistry values were recorded for the time points of -6, -1, 0, 1, 6, 12, 24, 48, and 72 hours from start of sodium acetate infusion. Patients were excluded based on the following criteria: patients who were given sodium bicarbonate within 48 hours of starting sodium acetate, those given sodium acetate as a bolus, non-trauma patients, burn patients, patients who expired within 24 hours of arrival to the ICU, patients diagnosed with rhabdomyolysis and patients whose medical record could not be obtained. A total of 78 patients were included in the study, 39 in the study arm and 39 in the control arm. There were no statistically significant drops in blood pressure within either group. The median pH between the two groups at the start of infusion was equal. Both groups trended towards normal pH with the study arm improving faster than the control arm. The median serum bicarbonate at start of sodium acetate infusion was 19 mmol/L and 20 mmol/L at time zero for the study and control arms respectively with both trending upward during the study period. Chloride trended up initially in both groups but the study arm began to correct sooner at 24 hours compared to 48 hours for the control arm. We analyzed the use of sodium acetate as an alternative to normal saline or lactated ringers during resuscitation of critically ill trauma patients at a single center. Our data shows that the hemodynamic profile remained favorable, without evidence of instability at any point during the study period. Normalization of hyperchloremia and metabolic acidosis occurred faster in the patients who received sodium acetate.
Neeki M.M.,Arrowhead Regional Medical Center
Pediatric Emergency Care | Year: 2016
PURPOSE: We aimed to describe a case of an incarcerated adolescent with acute disseminated encephalomyelitis (ADEM) presenting as acute psychosis. METHODS: This was a retrospective case report followed with chart and literature review. MAIN FINDINGS: An adolescent with ADEM presented with drastic behavior and personality changes that led to her incarceration for serious charges. Acute disseminated encephalomyelitis leads to neuropsychiatric effects and can be seen with magnetic resonance imaging as a large mass effect that may result in a poor prognosis. This adolescent made a full recovery from her left facial droop, slurred speech, and left-sided hemiplegia, and her personality changes were reverted. CONCLUSIONS: Acute disseminated encephalomyelitis can present as acute psychosis; therefore, clinical suspicion is important when treating patients who have a history of past infectious brain diseases, especially encephalitis. Given the rapid onset of disease, physicians must be knowledgeable of the diagnosis and treatment of ADEM and be vigilant in finding organic causes of acute psychosis. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.