52 research outputs found

    Prophylactic use of carvedilol to prevent ventricular dysfunction in patients with cancer treated with doxorubicin

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    Objective: Deterioration in ventricular function is often observed in patients treated with anthracyclines for cancer. There is a paucity of evidence on interventions that might provide cardio-protection. We investigated whether prophylactic use of carvedilol can prevent doxorubicin-induced cardiotoxicity and whether any observed effect is dose related. Methods: A prospective, randomized, double-blind study in patients treated with doxorubicin, comparing placebo (n = 38) with different doses of carvedilol [6.25 mg/day (n = 41), 12.5 mg/day (n = 38) or 25 mg/day (n = 37)]. The primary endpoint was the measured change in left ventricular ejection fraction (LVEF) from baseline to 6 months. Results: LVEF decreased from 62 ± 5% at baseline to 58 ± 7% at 6-months (p = 0.002) in patients assigned to placebo but no statistically significant changes were observed in any of the 3 carvedilol groups. At 6 months, only one of 116 patients (1%) assigned to carvedilol had an LVEF < 50% compared to four of the 38 assigned to placebo (11%), (p = 0.013). No significant differences were noted between carvedilol and placebo in terms of the development of diastolic dysfunction, clinically overt heart failure or death. Conclusions: Carvedilol might prevent deterioration in LVEF in cancer patients treated with doxorubicin. This effect may not be dose related within the studied range

    CYP1B1 and myocilin gene mutations in Egyptian patients with primary congenital glaucoma

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    Purpose: Primary congenital glaucoma (PCG) accounts for 26–29% of childhood blindness in Egypt. The identification of disease causing mutations has not been extensively investigated. We aimed to examine the frequency of CYP1B1 and MYOC mutations in PCG Egyptian patients, and study a possible genotype/phenotype correlation.Methods: Ninety-eight patients with PCG diagnosed at the Ophthalmology department ofAlexandria Main University Hospital were enrolled. Demographic and phenotypic characteristics were recorded. Patients and 100 healthy subjects (control group) were screened for two mutations in CYP1B1 gene (G61E, R368H) and one mutation in MYOC gene (Gln48His) using polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP). Phenotypic characteristics pertaining to disease severity were compared.Results: Nineteen patients (19%) with PCG were found positive for one or more of the mutations screened for. Seven patients (7%) were homozygous for the G61E mutation. Ten patients (10%) were heterozygous; 6 for the G61E mutation, 2 for the R368H mutation and 2 for the Gln48His mutation. Two patients (2%) were double heterozygotes harboring a R368H as well as a Gln48His mutation. The most common mutation observed was the G61E in 13 patients; 7 homozygotes and 6 heterozygotes for the mutation. The control group were negative for all mutations screened for. No significant correlations between the mutations and phenotype severity were detected. A statistically significant positive correlation however was found between the different mutations andeach of the IOP and the cup/disk ratio.Conclusion: The current study further endorses the role of CYP1B1 mutations in the etiology of PCG among Egyptian patients and is the first study to report MYOC gene mutation in Egyptian patients with PCG

    Gender Differences in Presentation, Management, and In-Hospital Outcomes for Patients with AMI in a Lower-Middle Income Country: Evidence from Egypt

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    BACKGROUND: Many studies in high-income countries have investigated gender differences in the care and outcomes of patients hospitalized with acute myocardial infarction (AMI). However, little evidence exists on gender differences among patients with AMI in lower-middle-income countries, where the proportion deaths stemming from cardiovascular disease is projected to increase dramatically. This study examines gender differences in patients in the lower-middle-income country of Egypt to determine if female patients with AMI have a different presentation, management, or outcome compared with men. METHODS AND FINDINGS: Using registry data collected over 18 months from 5 Egyptian hospitals, we considered 1204 patients (253 females, 951 males) with a confirmed diagnosis of AMI. We examined gender differences in initial presentation, clinical management, and in-hospital outcomes using t-tests and χ(2) tests. Additionally, we explored gender differences in in-hospital death using multivariate logistic regression to adjust for age and other differences in initial presentation. We found that women were older than men, had higher BMI, and were more likely to have hypertension, diabetes mellitus, dyslipidemia, heart failure, and atrial fibrillation. Women were less likely to receive aspirin upon admission (p<0.01) or aspirin or statins at discharge (p = 0.001 and p<0.05, respectively), although the magnitude of these differences was small. While unadjusted in-hospital mortality was significantly higher for women (OR: 2.10; 95% CI: 1.54 to 2.87), this difference did not persist in the fully adjusted model (OR: 1.18; 95% CI: 0.55 to 2.55). CONCLUSIONS: We found that female patients had a different profile than men at the time of presentation. Clinical management of men and women with AMI was similar, though there are small but significant differences in some areas. These gender differences did not translate into differences in in-hospital outcome, but highlight differences in quality of care and represent important opportunities for improvement

    Understanding the Emergent Structure of Competency Centers in Post-implementation Enterprise Systems

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    Part 3: Structures and NetworksInternational audiencePrior research provides conflicting insights about the link between investment in enterprise systems and firm value and in the ES governance mechanisms. The literature generally suggests that management should cultivate its technical and organizational expertise to derive value from currently deployed Enterprise Systems (ES) [8]. In the realm of practice, ERP vendors and configuration/integration partners strongly recommend the creation of an organizational structure to govern the ERP implementation and post-implementation process to improve project success and extract greater value from the ES investment. The ES literature, while unclear on the formation, and functioning of ES governance units, suggests the need for formal and fixed governance structures. This research utilizes Deleuze’s assemblage theory and emergence theory to explain the genesis and evolution of the governing ‘structure’ known as the Competency Center (CC). Our results illustrate the business needs driving the structuring processes behind the CC, are also those that lead to unintended and destabilizing outcomes. Whether the CC ‘assemblage’ survives to provide value depends on how the emergent issues are handled and how the assemblages are “positioned”. This research suggests effective ES governance is not derived from a prescribed step-wise process yielding formal structures, but rather form an organic process of assemblage

    ESC guidelines for percutaneous coronary interventions

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    Stage – Specific predictive models for main prognosis measures of breast cancer

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    Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a group of cancer cells that can grow into near tissues or invading the distant areas of the body. The disease occurs almost entirely in women, but men can get it, too. Survival rate, recurrence detection and disease-free survival rate (DFS) are the main patient\u27s outcome and prognosis measures. Breast cancer outcomes are vary among different stages of the disease. There are five stages of breast cancer named as 0, 1, 2, 3, and 4. Prognosis helps doctors to save patients\u27 lives by estimating how patient will progress in the therapy plan by comparing the patient\u27s results with another patient\u27s has the same disease characteristics and completed his therapy plan. In Egypt breast cancer represented 21.6% of 33,000 women cancer deaths Ibrahim et al.,2014, with incidence rate (48.8/100,000) and mortality rate (19.2/100,000). We selected a sample about 1692 cases were diagnosed as breast cancer patients at the period from 2010 to 2012 taken from the cases recorded in the Tumors Hospital and Institute of First Settlement one of the National Cancer Institute “NCI” cancer hospitals in Egypt. NCI is the central cancer institute in Egypt. We select the main sufficient attributes to building a prognosis predictive model 0.1471 records have been selected form the whole sample. The data set we select is used to compute and predict the three main outcome of prognosis measure at two level, data level for the complete data set, stage level for every stage of breast cancer separately. The study uses efficient five prediction models with highest accuracy. Results shows that the 5-years survival rate and local recurrence was in continuous decreasing since 2010 to 2012. Metastatic as a type of breast cancer recurrence was 20.74% in 2010, 17.59% in 2011 and 22.35% in 2012.The DFS (Disease-Free Survival) have the worst rate ever in 2012 as 7.13% after it was 30.37% in 2010.Prognosis predictive models results shows that the SVM classifiers is the most accurate model to predict the three prognosis measures at the two data level

    Adaptive Concept Map Approach for Software Requirements Validation

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    Requirements validation is one of the most significant and critical parts of the requirements engineering. This activity ensures that the set of requirements is accurate, right, complete, and consistent. Requirements validation is considered as the key activity because mistakes found in a software requirements document can lead to extensive rework costs when they are discovered either during development or after the system is in service. There are some commonly used bases to validate user requirements such as: Natural language, Design description languages, Graphical notations and Mathematical specification languages. Whereas the graphical notations are the most suitable means to be used in software requirements validation because it is easy to understand, and it can be easily created by analyst and time took. Therefore, this paper adopts the map concept which is a graphical technique for discovering the hidden flaws in software requirements in the early phases of software development lifecycle
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