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Purpose Multiple myeloma (MM) treatment has changed tremendously, with significant improvement in patient out-comes. One group with a suboptimal benefit is patients with high-risk cytogenetics, as tested by conventional karyotyping or fluorescence in situ hybridization (FISH). Methodology for these tests has been published, but not necessarily standardized. Methods We address variability in the testing and reporting methodology for MM cytogenetics in the United States using the ongoing African American Multiple Myeloma Study (AAMMS). We evaluated clinical and cytogenetic data from 1,221 patients (1,161 with conventional karyotyping and 976 with FISH) tested between 1998 and 2016 across 58 laboratories nationwide. Results Interlab and intralab variability was noted for the number of cells analyzed for karyotyping, with a significantly higher number of cells analyzed in patients in whom cytogenetics were normal (P 5.0025). For FISH testing, CD138-positive cell enrichment was used in 29.7% of patients and no enrichment in 50% of patients, whereas the remainder had unknown status. A significantly smaller number of cells was analyzed for patients in which CD138 cell enrichment was used compared with those without such enrichment (median, 50 v 200; P, .0001). A median of 7 loci probes (range, 1-16) were used for FISH testing across all laboratories, with variability in the loci probed even within a given laboratory. Chromosome 13-related abnormalities were the most frequently tested abnormality (n5956; 97.9%), and t(14;16) was the least frequently tested abnormality (n 5 119; 12.2%). Conclusions We report significant variability in cytogenetic testing across the United States for MM, potentially leading to variability in risk stratification, with possible clinical implications and personalized treatment approaches.Purpose Medication shortages in US hospitals are ongoing, widespread, and frequently involve antineoplastic and supportive medications used in cancer care. The ways shortages are managed and the ways provider-patient communication takes place are heterogeneous, but the related preferences of oncology patients are undefined. This study sought to qualitatively evaluate patient preferences. Methods A cross-sectional, semi-structured interview study was conducted from January to June 2019. Participants were adult oncology inpatients who received primary cancer care at the University of Chicago, had undergone treatment within 2 years, and had 1 or more previous hospitalizations during that period. Participants (n = 54) were selected consecutively from alternating hematology and oncology services. The primary outcome was thematic saturation across the domains of awareness of medication shortages, principle preferences regarding decision makers, preferences regarding allocation of therapy drugs, and allocation-relatvalent substitutions. Conclusion In a tertiary-care center with medication shortages, few oncologic inpatients were aware of shortages. Participants preferred having multiple decision makers involved in principle-driven allocation of scarce medications. Disclosure was preferred when their usual medications needed to be substituted with equivalent alternatives. These preliminary data suggest that preferences do not align with current management practices for medication shortages.Introduction Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse and severe skin reaction due to patients' susceptibility to medications, including phenytoin. The objective was to explore the characteristics of patients with DRESS secondary to phenytoin through a systematic review. Methods We describe a case of DRESS syndrome secondary to phenytoin in a patient with previous exposure to this drug. A systematic literature review of cases of phenytoin-induced DRESS syndrome was conducted in PubMed/Medline, Scopus and Web of Science until May 2019. Results 37 articles describing 40 cases of DRESS syndrome were selected. Mean age of onset was 33 years, without gender difference. Symptoms started between two and 90 days (mean ± 23 days). Liver and respiratory tract were most frequently involved, and eosinophilia was a common feature, it was presented with an average value of 9.7%. A discussion of the case and qualitative synthesis of the evidence reported in the literature were made. Conclusion Patients and presentation characteristics will mostly be presented according to the criteria used by RegiSCAR. It is recommended to consider adequate monitoring of adverse reactions to antiepileptic drugs such as DRESS syndrome, given its severity and high lethality.The purpose of this investigation was to enhance our understanding of the effects the current British Columbia Wildfire Service (BCWS) firefighting schedule have on the development of fatigue and sleep deprivation. This was a cohort study that objectively and subjectively measured sleep quantity, sleep quality, and fatigue throughout a 17-day British Columbia wildland firefighting deployment. Wildland firefighters (n = 30) conducted daily testing of sleep and fatigue measures during 14 days of activity on the fire line and three days immediately post deployment during their three-day rest period, for a total of 17 days of data collection. Sleep was assessed using wrist-worn actigraphy (ActiGraph LLC, Pensacola, FL) and subjective sleep questionnaires. Fatigue was assessed using subjective fatigue questionnaires and cognitive performance through the psychomotor vigilance test. Total sleep time was less on fire days (M = 6.6 h ± 49.2 min) compared to non-fire days (M = 6.8 h ± 92.2 min). Participants performed poorer on cognitive performance tests, (p = 0.288), and reported being significantly sleepier, (p = 0.038), toward the end of their 17-day deployment compared to day 1. Participants continued to report high levels of sleepiness, fatigue, and poor quality of sleep on their rest days compared to their fire line days. Working 14 consecutive days was associated with increased levels of objective fatigue and suboptimal sleep in wildland firefighters. Wildland firefighters reported significantly higher levels of fatigue and decreased alertness with increasing days on deployment and these levels did not improve following a three-day rest period.We studied the characteristics of acute blocking of supination of the distal radioulnar joint caused by triangular fibrocartilage complex injuries. Twenty-four patients who were treated for acute blocking of supination were retrospectively assessed. Supination was suddenly blocked after minor trauma to the wrist. Active and passive supination was severely restricted with a mean preoperative range of motion (11°), whereas pronation was almost normal. The cause was identified arthroscopically or at open operation. It was found to be a result of avulsion of the dorsal or palmar portion of the radioulnar ligament, which blocked movement of the ulnar head. Blocking was reduced manually in four cases, by arthroscopic surgery in eight cases and by open surgery in 12 cases. After treatment, forearm supination improved to 84° of the mean range of motion. Distal radioulnar joint blocking from a ruptured triangular fibrocartilage complex should be considered in the differential diagnosis of loss of forearm supination. Level of evidence IV.Aortic surgery is a complex procedure posing high risks in comparison to other adult cardiac surgeries. Novel surgical approaches including minimally invasive procedures, sutureless aortic valve replacement, and transcatheter aortic valve implantation have been found to be acceptable alternatives to conventional surgeries. In addition, novel endovascular repair techniques and hybrid procedures have been introduced for the management of patients with thoracoabdominal aortic pathologies. However, these modalities are not readily available in every center, and such novel procedures impose a learning curve for surgeons and high costs for affected patients. In this review, we discuss the challenges of setting up an aortic service, having regard to the Iranian experience.A sound knowledge of the functional anatomy of the mitral valve and the alterations caused by different diseases is indispensable for surgeons treating patients with mitral valve disease. Rheumatic mitral valve disease remains the most common heart valvular disorder in developing countries, whereas mitral regurgitation due myxomatous degeneration of the valve is the most common in developed countries. The mitral valve should be repaired whenever possible, as long as the outcome is predictably better than that of replacement. The intraoperative decision to repair or replace is not always simple and depends on the experience of the surgeon and the pathological changes that caused mitral valve dysfunction.Sex workers are an 'at-risk' population facing stigmatisation, marginalisation and poorer health outcomes. Their multiple vulnerabilities include substance misuse, mental illness, homelessness, violence, unique health challenges and importantly, barriers to accessing healthcare. Little is known about the opinions of medical students towards sex workers. A 21-item questionnaire was electronically distributed to all medical students at the University of Sheffield in November 2019. The aim was to investigate the knowledge, perceptions, and attitudes of medical students towards sex workers in Sheffield, in the hope of identifying gaps in the medical curriculum and encouraging further research in the area. One hundred and seventy-seven students participated. Students showed a basic awareness of the occurrence of prostitution in Sheffield but lacked detailed knowledge. The vast majority hope that prostitution is legalised in the UK, primarily for the sake of the health and protection of sex workers involved. A significant number of medical students (29% and 23%, respectively) expressed that their attitudes towards treatment of sex workers would not be without pre-judgement or differential treatment. Clearly, this needs to be addressed. Nonetheless, students expressed a desire for further teaching and training to supplement their current knowledge and to better understand the issues related to sex work.Abbreviations UK United Kingdom; GMC General Medical Council.This study explored victim responses to sexual assault within a military context. Victim behavior was identified in forensic case files of service members charged with sexual assault (N = 58) and referred for forensic evaluation or consultation. The identified victim behavior was coded and quantified for description. Of the sample 87.9% of victims were female and 12.0% of victims were male; 37.9% of the victims reported their assault in less than 1 month. PR-619 datasheet Forceful resistance to the assault occurred in 15.5% of the cases. Physical injury associated with the sexual assault was absent in 96.5% of the cases. The description of victim behavior can inform forensic expert testimony on victim behavior within the military justice system while also offering empirical evidence to better understand this public health problem in the U.S. military.This study examined the severity of intimate partner violence (IPV) experienced by men in their ongoing relationships and their help-seeking behavior with the criminal justice system and other professional agencies. This study also examined the extent to which socio-demographic variables predicted formal help seeking among male victims of IPV. Data were drawn from 2009 and 2014 cycles of the Canadian General Social Survey on Victimization with a nationally representative sample of 52,400 respondents. It is estimated that about 655,400 men in Canada reported having experienced physical and/or sexual victimization due to IPV in married/common-law relationships at the time of the surveys between 2004 and 2014. The latent class analysis generated four types of IPV victimization among men. Among male victims of physical and/or sexual IPV, about 64,000 men experienced the most severe type of IPV characterized by chronic and severe physical and psychological violence with a high probability of injuries and negative emotional effects of IPV.
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