Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality.
e20541 Background: Palliative care is changing from just ‘end of life care’ to care delivered earlier in the disease course. Metanalysis showed that Palliative Performance Scale (PPS) is associated with increased length of survival. The Palliative Care Center (PCC) in Kuwait is the only stand-alone center in Eastern Mediterranean Region with a capacity of 92 beds. We compared clinical characteristics between patients referred from the Specialized Cancer Center and general hospitals in Kuwait to PCC. Methods: Across Sectionalsurvey was conducted since the opening of PCC in January 2011 to June 2013. Patients data on demographics, type of the cancer, PPS score and referring hospital were collected and analyzed. Results: Total number of the patients was 142. Mean agewas 61.05±14.79 years, 66 patients (47.1%) were males and 74 (52.9%) were females. The most common cancers in males were lung (n = 18, 27.3%) followed by head and neck cancers (n = 8, 12.1%) and brain tumors (n = 7, 10.6%) while in females, the most common cancers were breast cancer (n = 12, 16.7%) followed by ovarian cancer (n = 10, 13.9%) and Cancer Colon (n = 8, 11.1%). Patients with PPS score 30% were 27.9% (n = 39), 40% in 40.7% (n = 57), and 50% in 17.1% (n = 24) respectively. Patients referred from the Specialized Cancer Center had significantly higher portion of patients with PPS score > 30% (73.4%, n = 94), compared to patients coming from general hospitals (33.3%, n = 4), P value = 0.007. Conclusions: There is significant difference in PPS scores between patients referred from the Specialized Cancer Center compared to patients referred from general hospitals. We encourage that all cancer patients should be treated in Specialized Cancer Centers and earlier involvement of Palliative Care Centers to achieve better survival. Training workshops are needed for health care professionals working in general hospitals to raise awareness about earlier referral of patients to palliative care services.
OBJECTIVE:
To determine the relationship between urinary tract infection UTI on admission and ischemic strokes related to atrial fibrillation (AFib).
BACKGROUND:
Many of the inflammatory markers have been repeatedly found elevated with AFib, and been specifically linked to the hypercoaguable state of AFib and the risk of stroke. Elevated inflammatory markers are commonly seen in infections.
UTI has been adequately studied as a complication of stroke. Yet, the relationship between UTI on admission and the risk for stroke has been previously suggested, but never been thoroughly investigated.
DESIGN/METHODS:
A retrospective study of cardioembolic stroke patients who were admitted between 2011-2013. Inclusion criteria included admissions of ischemic stroke proven by imaging studies in patients who had documented AFib and urinanalysis UA on presentation. Chi-square test and t-test were used to analyze the difference of the UTI+ group versus UTI- group. UTI was defined as WBC > 5 cells in pre-catheterization UA.
RESULTS:
A total of 163 admissions met the inclusion criteria of whom 44 were found to have UTI on admission [27[percnt], 95[percnt] CI (20.16-33.8)]. Age, CHAD score and other stroke risk factors did not differ significantly between groups, but the female sex ,expectedly, was more common in the UTI+ group [0.3 in females versus 0.17 in males, p=0.15] . Mean NIHSS was slightly higher but did not differ significantly between UTI+ versus UTI- groups [9.67 vs 8.16, respectively. Mean difference 1.518, 95[percnt] CI (-4.12-1.08) p=0.25].
CONCLUSIONS:
UTI on admission is a common finding in ischemic stroke admissions secondary to Afib and may be seen in up to 27[percnt] of these cases. Although the stroke risk factors and severity, as determined by NIHSS, did not differ between groups, more studies may be warranted to compare the eventual impact of UTI in AFib-related strokes to other types of strokes. Disclosure: Dr. Zidan has nothing to disclose. Dr. A_Nasany has nothing to disclose. Dr. Bedair has nothing to disclose. Dr. Bragin has nothing to disclose. Dr. Kamel has nothing to disclose.
Accurate data on the epidemiology of stroke in Egypt is scarce. The aim of this review is to address this issue based on available community-based studies and compare the resulting findings to those of other regional and international studies.A systematic literature search was conducted to identify population-based epidemiological studies of stroke in Egyptians. Original articles published in English between 1990 and 2016 were included. Five studies from five different governorates in southern Egypt fulfilled the study criteria (Qena, Sohag, Assiut, New Valley and Red Sea).The mean and median crude prevalence rates (CPRs) across the five studies, which were conducted in southern Egypt were 721.6/100,000 and 655/100,000, respectively. The mean and median crude incidence rates (CIRs) were 187/100,000 and 180.5/100,000, respectively. The average CPR weighted by sample population size was 613/100,000 and the average CIR weighted by sample population size was 202/100,000.The incidence and prevalence of stroke in Egypt are high. More population-based studies are urgently needed in northern Egypt and in Cairo - the capital of Egypt.
Objectives: The study purpose is to evaluate the clinical outcomes of mechanical thrombectomy in acute stroke management regardless the administration of intravenous or intra-arterial tissue plasminogen activator. Methods: We retrospectively reviewed medical records of the patients from 2014 to 2019 at our single center in Dubai, UAE. A total of 150 patients who underwent mechanical thrombectomy for acute ischemic stroke were identified. The mechanical thrombectomy was performed within 6 h after the onset of stroke symptoms. Both stent retriever and/or thrombus aspiration techniques were used. Patients who have been treated with or without intravenous or intra-arterial alteplase were included also. All patients were confirmed to have proximal anterior circulation occlusion. Patients with large infarct on neuroimaging (ASPECT score 6 or more) were excluded from the study. The primary endpoint was to assess the severity of clinical disability at 72 h and at the time of discharge using the National Institutes of Health Stroke Scale score and modified Rankin scale. Results: This is an ongoing study with preliminary results showing that mechanical thrombectomy reduced the severity of disability over the range of the National Institutes of Health Stroke Scale score and modified Rankin scale. Conclusion: Mechanical thrombectomy has reduced the severity of poststroke disability and increased the rate of functional independence.
INTRODUCTION Medullary thyroid cancers (MTC) constitute about 5% of all thyroid cancers. The 10-year overall survival (OS) rate of patients with localized disease in thyroid for this pathology is 80% to 90% which is comparable with differentiated thyroid cancers, figures drop to 75% for cases with nodal metastases. Only 20% of patients with distant metastases at diagnosis survive for 10 years. In metastatic disease there are variations with smoldering less active disease to progressive active disease. Surgery is cornerstone of the management with total thyroidectomy and nodal dissection as main treatment. Adjuvant treatment with radiotherapy is case selective, varies from case to case. The management of residual, recurrent disease is possible re-surgery with external beam radiation therapy. The development of targeted therapy has brought in a major advantage in management of metastatic disease. Two drugs -vandetanib and cabozantinib- have been approved for use in metastatic MTC. The optimum management in this group of patients is a challenge and long-term use of TKI needs to be balanced with monitoring side effects of TKI and dose adjustments of TKI. MATERIALS AND METHODS A retrospective review of cases with diagnosis of medullary thyroid cancers treated or registered at Kuwait Cancer Control Center was conducted. The data of patients registered between 1987 till 2017 was analyzed. The data was collected and analyzed using SPSS (version 20) software program. For analysis we considered date of surgery as the date of diagnosis. Final state of disease along with emphasis on prognostic factors was correlated with Kaplan Meyer survival curves. RESULTS There were total 31 cases out of which 15(48.4%) were male and 16(51.6%) females. The median age at presentation was 51.6 years (range-28years-77years). MEN syndrome was diagnosed in 6(19.4%) patients. Staging revealed Stage I - 7/31 (22.58%), Stage II-3/31(9.67%), Stage III-7/31(22.58%), Stage IVA (nonmetastatic) -12/31 (38.70%), Stage IVC (metastatic) - 2/31 (6.45%). Total thyroidectomy and central compartment neck dissection was optimum surgery (29%). Total thyroidectomy with central compartment neck dissection and unilateral neck dissection was done in 38.7% patients, comprehensive neck dissection and total thyroidectomy was done in 32.2% patients. External beam radiotherapy (EBRT) with conformal or IMRT technique was used in 13 out of 31 patients. One patient was treated for bony metastasis with palliative intent. Four patients were treated by TKI for metastatic disease or at progression. Median follow up was 79 months. Median overall survival was 93 months. Median progression free survival irrespective of stage was 62 months. At the end of 5 years 61% patients were alive irrespective of stage of disease. Due to the small sample size and natural history of advanced MTC the observed p-value for several pathological variables in relation with survival was not significant. CONCLUSION Stage I and stage II cases of our study did well and were all alive and disease free till our last follow up. EBRT in our cohort of patient did not revealed any added benefits in survival. The use of TKI in metastatic disease was associated with many issues including availability of drug. Elevated serum calcitonin and CEA levels in absence of measurable disease should be dealt cautiously.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)