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Guddati A.K.,Massachusetts General Hospital | Kumar N.,Medical College of Wisconsin | Segon A.,Medical College of Wisconsin | Joy P.S.,University of Iowa | And 2 more authors.
Medical Oncology | Year: 2013

Prompt identification and treatment of lifethreatening oncological conditions is of utmost importance and should always be included in the differential diagnosis. Oncological emergencies can have a myriad of presentations ranging from mechanical obstruction due to tumor growth to metabolic conditions due to abnormal secretions from the tumor. Notably, hematologic and infectious conditions may complicate the presentation of oncological emergencies. Advanced testing and imaging is generally required to recognize these serious presentations of common malignancies. Early diagnosis and treatment of these conditions can significantly affect the patient's clinical outcome. © Springer Science+Business Media New York 2013.


Sheikh S.I.,Ohio State University | Long F.R.,Ohio State University | Long F.R.,Childrens Radiological Institute | Mccoy K.S.,Ohio State University | And 3 more authors.
Clinical Otolaryngology | Year: 2015

Background: Most patients with Cystic fibrosis (CF) have chronic sinus disease which may require multiple sinus surgeries and antibiotic courses. Ivacaftor can improve lung function, lower sweat chloride levels and improve weight by targeting the primary defect, a faulty gene and its protein product, cystic fibrosis transmembrane conductance regulator (CFTR) in patients with the G551D mutation. Its role in improving sinus disease has not been evaluated. Objective: The objective of this study was to evaluate efficacy of ivacaftor in improving CF related sinus disease. Design: Observational study. Participants: Twelve patients with cystic fibrosis and a G551D-CFTR mutation. Methods: Twelve patients with a G551D-CFTR mutation were monitored for at least one year before and after starting ivacaftor. Outcome Measures: Sinus disease progression was monitored by comparing computed tomography (CT) of sinuses before and at one year on therapy. Hospital admissions, pulmonary exacerbations, weight, BMI and lung function were also compared. Results: Median age was 17 years (range 10-44). Weight, BMI, FEV1 significantly increased and sweat chloride significantly decreased by six months on ivacaftor therapy. CT of the sinuses in all patients improved. Seven patients had severe sinus disease, improved to moderate in three and mild in remaining four. Four patients had moderate disease which improved to mild in all. One patient had normal sinus CT before and after the therapy. Conclusions: Patients with CF and G551D mutation, within 6 months of starting ivacaftor had significant improvements in weight, BMI and mean % FEV1. Significant lessening of underlying sinus disease measured by CT scan was noted, suggesting a disease modifying effect. © 2014 John Wiley & Sons Ltd.


Tan S.K.M.,University of the Philippines | Benedicto J.P.,Section of Pulmonary Medicine | Santiaguel J.M.,Quirino Memorial Medical Center
Phillippine Journal of Internal Medicine | Year: 2015

Background: One under-explored area in chronic obstructive pulmonary disease (COPD) patients is anxiety and/or depression, which may have negative impact in the patients’ condition. This is possibly the first study to possibly assess the burden of anxiety and depression in COPD patients in the Philippines. Study Design: This is a prospective descriptive survey in three tertiary care hospitals in Manila, Philippines. Participants: A total of 204 patients were enrolled in the study with the following inclusion criteria: Filipino patients who are aged more than or equal to 40 years with a diagnosis of COPD (documented post-bronchodilator FEV1/FVC ratio less than 0.7) by a physician seen at the outpatient clinics of three tertiary care hospitals with no primary diagnosis of asthma, no previous lung volume reduction surgery, lung transplantation or pneumonectomy and at least finished Grade 2 education. Exclusion criteria include pregnant patients and patients previously diagnosed to have an anxiety, depression, or on any anti-depressant medications. Methods: Descriptive statistics was obtained with frequency and percentages of the demographic and physiologic variables in the study by tabulation and graph. The prevalence of anxiety and depression was determined by calculating the percentage of each patient with a score of 8 or higher on the Hospital Anxiety and Depression Scale (HADS) with validated Tagalog version, respectively. Results: The prevalence of anxiety in Filipino COPD patients is 47.55%. The prevalence of depression in Filipino COPD patients is 31.37%. Conclusion: The prevalence of depression in Filipino COPD patients is comparable to the prevalence of depression from other general medical conditions nationwide according to the study of Batar (31.37% vs. 31%). Anxiety is slightly more prevalent in COPD from other general medical conditions (47.55% vs. 36%). A study on the risk factors of anxiety and depression among Filipino COPD patients is recommended. © 2015, Philippine College of Physicians. All rights reserved.


Sheikh S.I.,Ohio State University | Long F.R.,Ohio State University | Long F.R.,Childrens Radiological Institute | McCoy K.S.,Ohio State University | And 3 more authors.
Journal of Cystic Fibrosis | Year: 2015

Background: Ivacaftor corrects the cystic fibrosis transmembrane conductance regulator (CFTR) gating defect associated with G551D mutation and is quickly becoming an important treatment in patients with cystic fibrosis (CF) due to this genetic mutation. Methods: A single-center study was performed in CF patients receiving ivacaftor to evaluate the usefulness of high resolution computed tomography (HRCT) of the chest as a way to gauge response to ivacaftor therapy. Results: Ten patients with CF were enrolled for at least one year before and after starting ivacaftor. At time of enrollment, mean age was 20.9. ±. 10.8 (range 10-44) years. There were significant improvements from baseline to 6. months in mean %FVC (93. ±. 16 to 99. ±. 16) and %FEV1 (79. ±. 26 to 87. ±. 28) but reverted to baseline at one year. Mean sweat chloride levels decreased significantly from baseline to one year. Mean weight and BMI improved at 6. months. Weight continued to improve with stabilization of BMI at one year. Chest HRCT showed significant improvement at one year in mean modified Brody scores for bronchiectasis, mucous plugging, airway wall thickness, and total Brody scores. Elevated bronchiectasis and airway wall thickness scores correlated significantly with lower %FEV1, while higher airway wall thickness and mucus plugging scores correlated with more pulmonary exacerbations requiring IV and oral antibiotics respectively. Conclusions: Based on our findings, HRCT imaging is a useful tool in monitoring response to ivacaftor therapy that corrects the gating defect associated with the G551D-CFTR mutation. © 2014 European Cystic Fibrosis Society.


Hayes D.,Ohio State University | Hayes K.T.,Section of Pulmonary Medicine | Hayes H.C.,Section of Pulmonary Medicine | Tobias J.D.,Ohio State University
Lung | Year: 2015

Background: Survival after lung transplantation (LTx) for patients with occupational lung disease (OLD) is not well studied. Methods: The United Network for Organ Sharing (UNOS) database was queried from 2005 to 2013 to assess survival after LTx in patients with silicosis and non-silicotic OLD compared to non-OLD patients. Results: Of 7273 adult LTx recipients, 7227 (24 with silicosis and 29 with non-silicotic OLD) were included in our univariate and Kaplan–Meier function analysis and 6370 for multivariate Cox models. Univariate Cox models did not identify survival differences in silicosis (HR 0.717; 95 % CI 0.358–1.435; p = 0.347) and non-silicotic OLDs (HR 0.934; 95 % CI 0.486–1.798; p = 0.839). Kaplan–Meier function analysis did not identify a survival disadvantage for either silicosis or non-silicotic OLD (log-rank test: χ2 0.93, p = 0.627). Patients with non-silicotic OLD were at risk for worse survival for the first 2.5 years post-transplant; however, at the conclusion of the study, this group had the highest survival rate. Multivariate Cox models confirmed no increased risk for mortality for silicosis (HR 1.264; 95 % CI 0.631–2.534; p = 0.509) and non-silicotic OLD (HR 1.114; 95 % CI 0.578–2.147; p = 0.747). Conclusion: Long-term survival for adult patients with silicosis and non-silicotic OLD after LTx is not significantly different compared to the general lung transplant population. © 2015, Springer Science+Business Media New York.

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