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Dutt N.,All India Institute of Medical Sciences | Janmeja A.K.,Government Medical College and Hospital | Mohapatra P.R.,All India Institute of Medical Sciences | Singh A.K.,Unity Hospital
Lung India

Background: Several studies have demonstrated considerable impairment of quality of life (QOL) in obstructive sleep apnea (OSA) patients, but its relation with severity of OSA is yet unclear. Study Objectives: To investigate the effects of OSA on the QOL and its association with the disease severity. Design and Setting: Observational, prospective case-control study. Materials and Methods: QOL of 69 OSA patients and 41 healthy controls were assessed using the Calgary sleep apnea quality of life index (SAQLI) on the morning following the polysomnography (PSG) study. Statistics: All statistical analyses were performed using the SPSS 17.0 (SPSS Inc., Chicago). Differences between sleep-related symptoms and SAQLI subscales scores were assessed with the Chi-square test and the Student t-test. Due to non-normal distribution, differences between SAQLI scores of controls and OSA patients were evaluated using a non-parametric Mann-Whitney test. Spearman correlation and backward multiple regression analysis were used to analyze the association between SAQLI scores and sleep indices and anthropometric variables and PSG variables. Results: Study included 69 cases (57 male and 12 females) with a mean age, weight, height, neck circumference, and body mass index 48.45 ± 10.12 years, 83.03 ± 16.48 kg, 159.75 ± 28.29 cm, 44.01 ± 3.23 cm and 30.77 ± 6.71 kg/m 2. Mean apnea-hypopnea index was 26.39 ± 16.62. The median score of four SAQLI domains daily function, social interaction, emotional, symptoms and total mean SAQLI score were 3.64 (3.46-3.90), 3.77 (3.51-3.88), 3.64 (3.53-3.83), 4.80 (4.68-5.11), 4.09 (3.88-4.09) ,and 1.36 (1.29-1.71), 1.38 (1.24-1.62), 1.45 (1.23-1.62), 2.00 (1.78-2.26), 1.55 (1.46-1.73) for patients and controls respectively. All the individual domain scores and the mean SAQLI scores of patients were significantly higher than the controls. Conclusion: OSA causes significant impairment of QOL, but the severity of impairment is not directly proportional to the severity of OSA. Source

Turek T.,University of South Dakota | Wigton A.,Unity Hospital
American Journal of Health-System Pharmacy

Purpose. The use of calcitonin to relieve severe, treatment-refractory phantom limb pain (PLP) is reported. Summary. After an above-knee leg amputation, a 29-year-old pregnant woman (at eight weeks gestation) reported severe PLP (consistent scores of 9 or 10 on a 10-point pain severity scale). The pain persisted for more than two weeks and was not relieved by multiple regimens of opioid and nonopioid medications, including extremely high doses of i.v. fentanyl. On postamputation day 16, a 30-minute i.v. infusion of 200 IU of calcitonin (salmon) was administered; the woman reported transient excruciating pain during the final 5 minutes of the infusion. There was little overall change in her pain status over the next three days. On postinfusion day 4, the patient reported reductions in the frequency and severity of PLP episodes, and a trend of improved PLP symptom control was noted over the next 48 hours, allowing the pain management team to begin tapering some medication dosages and thus reduce the woman's overall narcotic exposure. The patient was discharged to a nursing facility several weeks later with relatively stable pain (scores of <7) on a regimen of carbamazepine, gabapentin, and oxycodone. She eventually delivered a healthy full-term baby. Conclusion. A reduction in the frequency of PLP attacks and a lessening of pain intensity were observed after administration of calcitonin (salmon) by i.v. infusion in a pregnant patient. Calcitonin therapy was not associated with any apparent long-term adverse effects to the patient or infant. Copyright © 2012, American Society of Health-System Pharmacists, Inc. All rights reserved. Source

Wojtovich A.P.,University of Rochester | Williams D.M.,University of Rochester | Karcz M.K.,Unity Hospital | Lopes C.M.B.,University of Rochester | And 3 more authors.
Circulation Research

RATIONALE: The mitochondrial ATP sensitive potassium channel (mKATP) is implicated in cardioprotection by ischemic preconditioning (IPC), but the molecular identity of the channel remains controversial. The validity of current methods to assay mKATP activity is disputed. OBJECTIVE: We sought to develop novel methods to assay mKATP activity and its regulation. METHODS AND RESULTS: Using a thallium (Tl+)-sensitive fluorophore, we developed a novel Tl+ flux based assay for mKATP activity, and used this assay probe several aspects of mKATP function. The following key observations were made. (1) Time-dependent run down of mKATP activity was reversed by phosphatidylinositol-4,5-bisphosphate (PIP2). (2) Dose responses of mKATP to nucleotides revealed a UDP EC50 of ≈ 20 μmol/L and an ATP IC50 of ≈5 μmol/L. (3) The antidepressant fluoxetine (Prozac) inhibited mKATP (IC50 =2.4 μmol/L). Fluoxetine also blocked cardioprotection triggered by IPC, but did not block protection triggered by a mKATP-independent stimulus. The related antidepressant zimelidine was without effect on either mKATP or IPC. CONCLUSIONS: The Tl flux mKATP assay was validated by correlation with a classical mKATP channel osmotic swelling assay (R 2=0.855). The pharmacological profile of mKATP (response to ATP, UDP, PIP2, and fluoxetine) is consistent with that of an inward rectifying K+ channel (KIR) and is somewhat closer to that of the KIR6.2 than the KIR6.1 isoform. The effect of fluoxetine on mK ATP-dependent cardioprotection has implications for the growing use of antidepressants in patients who may benefit from preconditioning. © 2010 American Heart Association. All rights reserved. Source

Thawait S.K.,Yale University | Akay A.,Marshfield Clinic | Jhirad R.H.,Health Park | El-Daher N.,Unity Hospital
Yale Journal of Biology and Medicine

Mycotic aneurysm of the aorta is an uncommon condition, and Group B Streptococcus (GBS†) is exceedingly rare in this setting. We present the first reported case of a GBS-infected abdominal aortic aneurysm (AAA) in North America. Key clinical and imaging findings and pathologic correlation are highlighted. A relevant review of the literature is discussed, which will bring the reader up to date with this specific disease entity. © 2012. Source

Khoury T.,Roswell Park Cancer Institute | Kulkarni S.,Roswell Park Cancer Institute | Morrison C.,Roswell Park Cancer Institute | Bshara W.,Roswell Park Cancer Institute | And 2 more authors.
Applied Immunohistochemistry and Molecular Morphology

Background: The concordance rate between immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) for human epidermal growth factor receptor-2 (HER2) is still a major clinical concern. We describe a new criteria evaluating HER2 IHC. Materials and Methods: We expanded the equivocal category to include the American Society of Clinical Oncology and College of American Pathologists equivocal category and cases with 3+ between 30% to 90% of tumor cells and 2+ in 1% of tumor cells. Then, we prospectively evaluated 106 cases with FISH. Results: There were 2 categories that were not required to be tested by FISH based on American Society of Clinical Oncology and College of American Pathologists criteria. The first category, cases with 2+staining between 1% and <10%. In this category, there were 15 cases, 2 (13.3%) had HER2 amplification by FISH. The second category, cases with 3+ staining between 30% and 90%. In this category, there were 16 cases, 5 (31.3%) were not amplified and 1 (6.3%) was borderline. Conclusions: Expanding the equivocal category could increase the concordance rate between IHC and FISH with minimal additional cost. Copyright © 2011 by Lippincott Williams & Wilkins. Source

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