Stoma formation is believed to have a more significant effect on quality of life in Asian patients than in non-Asian patients, but this has never been formally demonstrated. This study examined factors which may influence quality of life following stoma formation with particular reference to ethnicity.Quality of life was measured (using an established questionnaire) in consecutive patients undergoing stoma formation under the care of two colorectal surgeons.Quality of life is poorer in Asian than in non-Asian patients 46 ± 13 vs 60 ± 12 (P = 0.007). This difference is restricted to those born outside the UK and to those who cannot speak English (P = 0.0008 and P = 0.0001, respectively).The association between stoma formation and poor quality of life in Asian patients is more complicated than previously assumed. Selected patient groups can be targeted with information and support.
TPS7075 Background: A novel genomically defined subset of higher-risk MDS (HR-MDS) patients with an actionable target characterized by overexpression of RARA has been identified (McKeown 2017). Approximately 30% of HR-MDS patients are RARA-positive (RARA+) by a blood-based biomarker test (Vigil, 2017). Biologically targeted therapy with tamibarotene, an oral selective RARα agonist, has potential to provide clinical benefit for RARA+ HR-MDS patients, irrespective of mutation or cytogenetic risk. Initial clinical data in RARA+ R/R HR-MDS patients treated with tamibarotene showed myeloid differentiation, improved blood counts, and reduced bone marrow blasts, including one patient who achieved marrow complete remission with hematologic improvement (Jurcic 2017). Tamibarotene in combination with azacitidine (aza) showed high complete response rates (CR) with rapid onset of response in RARA+ newly diagnosed (ND) unfit AML patients, including those with low blast count (≤ 30%) AML, and a majority of patients achieved or maintained transfusion independence (de Botton 2020). Tamibarotene/aza was generally well tolerated with no increase in myelosuppression compared to aza alone (de Botton 2020). Historical precedent demonstrating similar clinical outcomes in HR-MDS and AML, particularly low blast count AML (Estey 2021), supports further development of tamibarotene/aza in HR-MDS to improve clinical outcomes of standard of care treatment with hypomethylating agents (HMAs). Methods: This Phase 3, multi-center, randomized, double-blind, placebo-controlled study will compare activity of tamibarotene/aza to placebo/aza in RARA+ patients with ND HR-MDS. The primary objective is to characterize and compare the CR rate of tamibarotene/aza vs placebo/aza, with secondary objectives to characterize ORR, EFS, OS, transfusion independence rate, time to and duration of initial and complete responses, and safety. Approximately 190 patients will be randomized 2:1, providing 90% power to detect the difference in CR rates between the experimental and control arms, with a one-sided alpha of 0.025. Patients must be RARA+ based on the investigational biomarker test, ND with HR-MDS by WHO classification (Arber 2016), classified by IPSS-R risk category as very high, high, or intermediate risk with a blast count > 5% at study entry. Patients suitable for transplant at screening, or with prior treatment for MDS with any HMA, chemotherapy or transplant are excluded. Aza will be administered at 75 mg/m 2 IV/SC daily on days 1-7 (or 1-5, 8-9) followed by tamibarotene/placebo at 6 mg BID orally days 8-28 of each 28-day cycle. Response will be assessed per modified IWG MDS criteria (Cheson 2006). The SELECT-MDS-1 trial opened in February 2021, recruitment is ongoing, with sites located in North America, Israel, and Europe. Clinical trial information: NCT04797780.
Journal Article Food Poisoning - A Major Threat to Airline Operations Get access CAROLE D. BURSLEM, CAROLE D. BURSLEM British Airways Medical ServiceLondon (Heathrow) Airport, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar MICHAEL J. KELLY, MICHAEL J. KELLY British Airways Medical ServiceLondon (Heathrow) Airport, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar FRANK S. PRESTON FRANK S. PRESTON British Airways Medical ServiceLondon (Heathrow) Airport, UK Requests for reprints should be addressed to: Dr Frank S. Preston OBE, 2 Ravensmead, Chalfont St Peter, Bucks SL9 0NB, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar Occupational Medicine, Volume 40, Issue 3, AUTUMN 1990, Pages 97–100, https://doi.org/10.1093/occmed/40.3.97 Published: 01 October 1990
The aim of this study was to identify the mode of presentation of patients with clinical anastomotic leaks following restorative colorectal resection for carcinoma.Prospective information was collected on all patients having restorative resection of colorectal cancer. These data were reviewed for a five-year period (1994-1998) to identify all patients who had suffered a clinical anastomotic leak and their notes were retrieved and reviewed.Three hundred and seventy-nine patients underwent restorative resection for colorectal cancer during the study period (178 female, 201 male), mean age 70 years (range 36-94). There were 22 (6%) clinical anastomotic leaks. Seven (32%) patients presented with obvious abdominal peritonitis. The remaining 15 (68%) were initially misdiagnosed. Thirteen (59%) patients were treated for cardiac symptoms, 1 (5%) patient for obstruction and 1 (5%) for ascites. The delay in diagnosis ranged from 0 to 11 days (mean 4 days). For the whole series of 379 there were 30 patients who suffered cardiac symptoms (8%) 13(43%) of whom had an anastomotic leak.Patients who develop cardiac symptoms following restorative colorectal resection for carcinoma should have a water soluble enema as there is a 40% chance that they will have an anastomotic leak.
November to December.hMPV was associated with conjunctivitis, rash and a shorter duration of fever. ConclusionsA combination of clinical signs and symptoms and temporal patterns could help improve diagnostic precision of common viral respiratory infections in children in primary care and direct more appropriate antibiotic management.
trimethoprim has remained the same (260" ) in the six months before the change and in the six months afterwards.Resistance to sulphon- amides has dropped from 40°' to 37°0.Between 1983 and 1984 the total amount of trimethoprim prescribed in the hospital in- creased by 3100.These findings are in accord with our previous data that there is no evidence that adding a sulphonamide to trimethoprim discourages resistance.We would like to invite Dr Maskell to per- form the following experiments: select cul- tures of either fully sensitive or sulphonamide resistant (trimethoprim sensitive) entero- bacteriaceae, expose them to trimethoprim of the sort of concentration-for example, 256 ,ug/ml-to which strains are highly resis- tant, and see if any resistant variants can be selected.She will find few such variants from either type of culture, and the few bacteria that may struggle through will be grossly defective and probably not pathogenic.Surely the time has come to withdraw co- trimoxazole for urinary and many other infections, such as typhoid.The major active component of co-trimoxazole is trimethoprim.It is effective and safe.It should be used alone unless reliable evidence is presented that sulphonamides have a contribution.
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