Effects of a Disease Management Program in Individuals with Alpha-1 Antitrypsin Deficiency

Disease management programs improve outcomes in subjects with chronic obstructive pulmonary disease (COPD), but their effect in subjects with alpha-1 antitrypsin deficiency (AATD) has not been evaluated. To assess the impact of a disease management program, applicable to subjects with AATD-associated COPD throughout the United States, on exacerbations, healthcare resource utilization and health-related quality of life (HRQoL). The Alpha-1 Disease Management and Prevention Program (ADMAPP) consisted of comprehensive written educational patient-directed material for self-study and treatment plans. Program reinforcement was performed through monthly phone calls by specialized coordinators. Outcomes were collected prospectively for 12 months before, and 12 months after enrollment into the program. Exacerbations and healthcare resource utilization were recorded monthly. HRQoL was measured with the St George's Respiratory Questionnaire (SGRQ) every 6 months and the Short Form- 36 (SF-36) every 12 months. A total of 878 subjects completed the 2-year study. During the intervention year, there was a significant increase in the use of long-acting bronchodilators, better compliance with oxygen therapy, and more use of steroid courses during exacerbations. Total exacerbation rates, unscheduled physician visits and emergency room visits significantly decreased. There was also a statistically significant slowing in the deterioration of the SGRQ's activity domain, while total SGRQ scores remained stable during the study. Significant improvements were observed in some of the SF-36 domains, particularly in the general health domain. The ADMAPP improved health outcomes in subjects with AATD-associated COPD

مدى تطبيق المعيار المحاسبي الإسلامي رقم (2) المرابحة والمرابحة بالشراء في البنوك الإسلامية الكويتية ومعوقات تطبيقها = The extent of application of Islamic Accounting Standard No. (2) Murabaha and Murabaha to the purchase orderer In Islamic Kuwaiti Banks and the obstacles to their application

هدفت هذه الدراسة إلى التعرف على مدى تطبيق المعيار المحاسبي الإسلامي رقم (2) المرابحة والمرابحة بالشراء في البنوك الإسلامية الكويتية ومعوقات تطبيقها. واعتمد الباحث على عينه من مديري الإدارات العليا والإدارات الوسطى، والمديرين الماليين والمحاسبين العاملين في الدائرة المالية في البنوك الإسلامية الكويتية مكونة (91) مبحوثا، واعتمد الباحث على مصدرين رئيسين لجمع المعلومات والبيانات هما: البيانات الأولية والبيانات الثانوية، واستخدم عددا من أساليب الإحصاء الوصفي والاستدلالي. وتوصلت الدراسة إلى أن البنوك الإسلامية الكويتية تطبق المعيار المحاسبي الإسلامي رقم (2) عمليات المرابحة الداخلية. وتبين أن قسم الائتمان في البنك يقوم بحساب التكاليف التقديرية وبيان نسبة الأرباح المتوقعة من القيام بإجراء عملية المرابحة. وتبين أن هناك مجموعة من المعوقات تحول دون تطبيق المعيار المحاسبي الإسلامي رقم (2) المرابحة والمرابحة بالشراء في البنوك الإسلامية الكويتية. وفي ضوء ذلك قدمت الدراسة مجموعة من التوصيات أهمها: قيام قسم الائتمان في البنوك الإسلامية بتوفير التشريعات والإجراءات اللازمة لضمان شراء البضاعة بثمن المبيع مضافا إليه هامش ربح محدد حسب سياسة البنك. *************************************************************************** The study aims to identify the extent of application of Islamic accounting standard No. (2) murabaha and murabaha to the purchase orderer In Islamic Kuwaiti banks and the obstacles to their application. The researcher relied on two main sources to collect information and data: primary data and secondary data, and used a number of descriptive and explanatory statistics methods. The study concluded that the Islamic banks in Kuwait apply Islamic accounting standard No. (2) internal Murabaha transactions. It was found that the Bank's credit department calculates the estimated costs and the percentage of profits expected from conducting the Murabaha transaction. It was found that there are a number of obstacles that prevent the application of Islamic Accounting Standard No. (2) Murabaha and Murabaha in Kuwaiti Islamic Banks. In light of this, the study presented a number of recommendations, the most important of which is: The credit department of Islamic banks provides the necessary legislation and procedures to guarantee the purchase of the goods at the selling price plus a profit margin specified in accordance with the Bank's policy

The application level of institutional governance in the Islamic institutions and banks in Kuwait

This study aims to identify Islamic banks' governance principles and measures the application level of these principles in Islamic banks in Kuwait. The descriptive-analytical approach was used by designing a questionnaire consisting of 29 questions, covering most of Islamic bank governance principles, and commensurate with the nature of distinguishing them from other conventional banks.The study showed that the application level of Islamic banks' governance principles wasat a medium level, noting that there were deficiencies in some aspects, which is the absence of disclosure and transparency requirements ofIslamic financial operations that distinguish Islamic banks from other conventionalbanks. In addition, the study showed that there is a lack of equity in the system of salaries and workers' wages compared to competitive banks and institutions in Kuw

Influenza Vaccination in Subjects With α1-Antitrypsin Deficiency

Influenza vaccination is recommended for all subjects with COPD, including α1-antitrypsin deficiency (AATD), but immunization practices are below US national goals. Influenza vaccination practices and their relation to respiratory outcomes in AATD are unknown. Nine hundred thirty-nine subjects with AATD were followed up prospectively by monthly telephone interviews during the 2003 to 2004 influenza season. Vaccination status, exacerbation rates, and health-care utilization were documented. Residence zip codes were used to group subjects as living in high or low influenza-like illness (ILI) prevalence areas according to published Centers for Disease Control and Prevention data for the same influenza season. Overall, 81.6% of subjects received influenza vaccination, with no differences noted by gender, age (median age 52 years), Global Initiative for Chronic Obstructive Lung Disease stage, or ILI prevalence area. No significant differences were noted in the overall acute exacerbation rates using two different criteria between vaccinated and unvaccinated subjects (mean, 1.5 ± 1 exacerbations per subject). Similarly, no differences were noted in either the severity of exacerbations or the monthly exacerbation rates between the two groups. Unvaccinated subjects had more unscheduled physician visits than vaccinated subjects, but there were no significant differences in scheduled visits, emergency department visits, or hospitalizations between the two groups. Older age (> 60 years) or residence in a high ILI prevalence area had no effect on outcomes. Subjects with AATD in the United States receive adequate influenza vaccination regardless of age. However, we did not observe a significant impact of the vaccination on disease exacerbations and other respiratory outcomes during the 2003 to 2004 influenza season

Exacerbations in subjects with alpha-1 antitrypsin deficiency receiving augmentation therapy

The frequency, characteristics and impact of acute exacerbations in patients with alpha-1 antitrypsin deficiency (AATD) and COPD who are on intravenous alpha-1 antitrypsin augmentation therapy have not been described. 922 subjects with AATD and COPD on augmentation therapy (mean age 54.5 years) were followed with monthly telephone surveys to record exacerbation characteristics, as well as healthcare resource utilization and health-related quality of life (HRQoL). Exacerbations were defined by symptom-based and healthcare resource utilization (HRU) criteria. During the 1-year follow-up, 91.5% of participants experienced at least one exacerbation (mean 2.4 exacerbations per subject, median 2, and mean duration 17 days per episode, regardless of the definition used). Most exacerbations were categorized as severe by symptoms and moderate by HRU criteria. Subjects who had 3 or more exacerbations (48.6%) were younger, had higher medication use and had higher tobacco consumption compared with subjects with less exacerbations. Subjects with frequent exacerbations had the worst baseline HRQoL scores, as well as more physician visits, emergency room visits, and hospitalizations. Although most subjects received augmentation therapy on a weekly basis, other infusion schedules were more commonly observed in subjects with fewer exacerbations. COPD exacerbations occur frequently and are associated with significant disease burden in subjects with AATD receiving augmentation therapy

Stauffer's Syndrome Variant with Cholestatic Jaundice A Case Report

Cholestasis is a common feature of several malignant diseases, including pancreatic, hepatic, gallbladder, and ampullary carcinomas. It is usually secondary to main bile duct obstruction or widespread hepatic metastasis, but it can also be a paraneoplastic syndrome of other underlying malignancies. Stauffer's syndrome is a rare paraneoplastic manifestation of renal cell carcinoma (RCC) that is characterized by elevated alkaline phosphatase, erythrocyte sedimentation rate, α-2-globulin, and γ-glutamyl transferase, thrombocytosis, prolongation of prothrombin time, and hepatosplenomegaly, in the absence of hepatic metastasis and jaundice. A rare variant of this syndrome with jaundice has recently been described in 3 cases in the literature. We report a patient who presented with abdominal pain and cholestatic jaundice in whom RCC was incidentally found during initial workup. Jaundice and liver dysfunction resolved completely after surgical resection of the tumor. This case illustrates the protean manifestations of RCC, and the importance of considering Stauffer's syndrome and its variant in the differential diagnosis of anicteric and icteric cholestasis, which may allow early recognition and treatment of an underlying malignancy