Prescribing Pattern of Benzodiazepine Receptor Agonists (BZRA) and Factors Associated With Duration of BZRA Use in a Malaysian Psychiatry Outpatient Clinic

@#Introduction: Benzodiazepine receptor agonist (BZRA) are among the most frequently used psychotropic medications worldwide. We aim to understand the pattern of prescription of BZRA in the government healthcare facilities and identify factors affecting the likelihood of BZRA prescription and duration of use. Method: This is a retrospective study. Data was obtained from record of outpatient clinical notes. Medications studied were midazolam, alprazolam, lorazepam, bromazepam, clonazepam, diazepam and zolpidem. Mean duration per prescription, mean dosage per prescription and duration per patient per year were calculated for each sedative hypnotic. The likelihood of factors affecting duration of prescription were also analysed. Results: The prevalence of sedative hypnotic use in psychiatry outpatient clinic was 12.16%. Clonazepam was found to have the longest duration per patient per year (306.5 days). Insomnia and anxiety are the two most common reasons for sedative hypnotic prescription. Factors found to affect duration of prescription were unemployment, borderline personality disorder, alcohol and substance use disorders. Conclusion: Implementation of effective monitoring system on sedative hypnotic prescribing and increase use of non-pharmacological interventions for insomnia and anxiety are necessary to curb prolonged use of sedative hypnotic.

Factores predictivos histológicos e inmunohistoquimícos de metástasis en ganglio no centinela en pacientes con cáncer de mama y ganglio centinela positivo / Histological and histochemical predicting factors of increased risk of metastatic compromise of non sentinel nodes, in patients with positive sentinel node biopsy

Introducción La biopsia del ganglio centinela (bgc) permite estadificar la axila en pacientes con cáncer de mama (cm) y axila clínicamente negativa. Mediante este procedimiento, se evita la linfadenectomía axilar en una proporción de pacientes. Sin embargo, frente a la positividad del ganglio centinela, una vez completada la linfadenectomía, un subgrupo de pacientes no tienen enfermedad residual en el resto de los ganglios axilares, definidos como ganglios no centinela. Objetivo Analizar los factores de predicción histológicos e inmunohistoquímicos de compromiso en ganglios no centinelas (gnc) en aquellas pacientes con bgc positiva seguida de linfadenectomía axilar, operadas por el Servicio de Patología Mamaria del Hospital Fernández en el período que transcurre entre enero de 1998 y marzo de 2016. Material y método Se realizaron 712 bgc entre los meses de enero de 1998 y marzo de 2016, en el Servicio de Patología Mamaria del Hospital Fernández. Del total, 140 resultaron positivas. Se analizó retrospectivamente la vinculación entre diversas características y la existencia de enfermedad axilar en gnc en 119 casos. Resultados Cuando la bgc resultó positiva, se encontró enfermedad en gnc en el 53,8% de los casos. El análisis univariable demostró correlación estadísticamente significativa entre presencia de metástasis en gnc y la presencia de 2 o más gc positivos, el tamaño tumoral mayor a 2 cm, el compromiso por macrometástasis del gc, la presencia del receptor her2 en el tumor y el alto grado mitótico y el compromiso de la cápsula ganglionar. Conclusiones Los factores independientes de compromiso de gnc son los siguientes: el alto grado mitótico, la presencia del receptor her2, la existencia de 2 o más gc positivos, el compromiso de la cápsula ganglionar.

Introduction The sentinel node biopsy can stage breast cancer patients with negative axillary lymph node examination. Using this procedure it is possible to avoid axillary lymph node dissection in some patients. However, when sentinel node biopsy results positive, once achieved the axillary node dissection, some patients do not have residual disease in the non sentinel nodes. Objective To study histological and histochemical predicting factors of increased risk of metastatic compromise of non sentinel nodes, in patients with positive sentinel node biopsy and subsequent axillary lymph node dissection, treated in the Breast Disease Division of Hospital Fernandez between January 1998 and March 2016. Materials and method Between January 1998 and March 2016, 712 patients underwent to node sentinel biopsy in the Breast Disease Division of Hospital Fernández. This study assessed, in a retrospective way, the association between the histological and histochemical predicting factors and non sentinel node disease in 119 cases. Results When sentinel node biopsy was positive, there was non sentinel lymph node metastasis in 53,8% of cases. The following variables were found to be potentially associated with non-sentinel node metastases in the univariated analysis: number of positive sentinel lymph node, size of the tumor, size of the metastasis in the sentinel lymph node, presence of her2 receptor in the tumor, high mitotic rate and extracapsular perinodal spread. Conclusions Independent factors for involvement of non sentinel nodes are: the high mitotic rate, the presence of her2 receptor in the tumor, the number of positive sentinel lymph nodes and the extracapsular perinodal spread.

Differentiated thyroid cancer in Iran – initial observations, histological features, management of the disease, and tumor recurrence: A review of 1689 cases.

AIM: The main objective of this study was to define some histopathological aspects of differentiated thyroid cancer (DTC), describe the disease management, and evaluate potential predicting factors for tumor recurrence in Iran. MATERIALS AND METHODS: Medical records of 1689 patients of DTC treated over a 15‑year period at a referral hospital located in the central region of Iran were reviewed retrospectively. RESULTS: The female/male ratio was 3.78. The mean size of tumors was 23.35 mm. Most patients had papillary thyroid cancer (PTC) followed by follicular thyroid cancer (FTC) (83% and 5.5%, respectively). Lymph node involvement was seen in 27.6% of patients, and 3.6% of them had distant metastasis. Tumor recurrence was reported in 36.4% of patients. Higher stages of cancer, presence of lymph node involvement, presence of distant metastasis, larger tumor size, history of goiter, and higher doses of 131‑Iodine at the first admission were associated with more chance of recurrence (P < 0.05). Comparing features of PTC and FTC, we found a more invasive behavior in FTC patients, including more capsular and near tissue invasion, higher stages of cancer, more frequent distant metastasis, and larger tumor size. CONCLUSION: This study provides useful information on characteristics of DTC, its management, and some prognostic factors. Our findings suggest that higher stages of cancer at diagnosis, presence of lymph node involvement, presence of distant metastasis, larger tumor size, history of goiter, and higher doses of 131‑iodine administered at the first admission are associated with more chance of tumor recurrence. Furthermore, we found that FTC follows a more aggressive behavior and recommends clinicians to handle FTC patients more cautiously.

Predictive Capability of Anorectal Physiologic Tests for Unfavorable Outcomes Following Biofeedback Therapy in Dyssynergic Defecation

The purpose of this study is to evaluate the predictive capability of anorectal physiologic tests for unfavorable outcomes prior to the initiation of biofeedback therapy in patients with dyssynergic defecation. We analyzed a total of 80 consecutive patients who received biofeedback therapy for chronic idiopathic functional constipation with dyssynergic defecation. After classifying the patients into two groups (responders and non-responders), univariate and multivariate analyses were performed to determine the predictors associated with the responsiveness to biofeedback therapy. Of the 80 patients, 63 (78.7%) responded to biofeedback therapy and 17 (21.3%) did not. On univariate analysis, the inability to evacuate an intrarectal balloon (P=0.028), higher rectal volume for first, urgent, and maximal sensation (P=0.023, P=0.008, P=0.007, respectively), and increased anorectal angle during squeeze (P=0.020) were associated with poor outcomes. On multivariate analysis, the inability to evacuate an intrarectal balloon (P=0.018) and increased anorectal angle during squeeze (P=0.029) were both found to be independently associated with a lack of response to biofeedback therapy. Our data show that the two anorectal physiologic test factors are associated with poor response to biofeedback therapy for patients with dyssynergic defecation. These findings may assist physicians in predicting the responsiveness to therapy for this patient population.

Predicting Factors for Trial of Labor in Women Attempting Vaginal Birth after Cesarean Delivery / 대한산부인과학회잡지

OBJECTIVE: To determine predicting factors associated with successful trials of labor in women attending vaginal birth after cesarean delivery. METHODS: A retrospective chart review from January 1998 through December 2001 of 330 patients (sucess group n=282, failure group n=48) undergoing trials of labor after cesarean delivery at Chonnam National University Hospital. Data were tested for statistical significance with the Student's t-test and the Chi-square test. RESULTS: The following characteristics were found to be statistically significant positive prognostic indicators: lower gestational age (274.0+/-20.6 vs. 281.1+/-7.9 days, p<0.01); higher gravity (1.3+/-0.5 vs. 1.0+/-0.2, p<0.01); higher maternal weight gain during pregnancy (3238+/-543 vs. 3458+/-497 gram, p<0.01); lower birth weight (7.8+/-2.7 vs. 6.6+/-2.5, p<0.01); history of prior trial of labor success (0.17 vs. 0.02, p<0.01), lower birth weight at prior cesarean section (3257+/-460 vs. 3838+/-411 gram, p<0.05). CONCLUSIONS: The characteristics associated with successful trials of labor after cesarean delivery-Bishop score at admission, history of prior vaginal delivery will provide information that may be helpful to the physician and the patient. Trial of labor (probability)=e(13.48+0.14Bishop score+1.06vaginal delivery history-0.001birth weight-0.259gestational age)/1+e(13.48+0.14Bishop score+1.06vaginal delivery history-0.001birth weight-0.259gestational age)

Analysis of Factors Predicting Recurrence and the Result of Treatment in PSVT Patients at the Emergency Department

PURPOSE: The purpose of this research was to evaluate the factors predicting recurrence and the characteristics of patients who recurred after the treatment of spontaneous paroxysmal supraventricular tachycardia (PSVT) with adenosine. METHODS: From January 1999 to December 2001, 62 patients with PSVT were enrolled in this study. The conversion group included patients who had had a therapeutic response, which was defined as the occurrence of a change in the sinus rhythm after adenosine administration. The recurred group consisted of all patients who had not had a therapeutic response. Clinical features, the results of treatment, ECG findings, and the hemodynamic statuses were analyzed. RESULTS: The treatments were vagal maneuver (5 pts, 7.5 %), adenosine 6 mg (37 pts, 55.2 %), adenosine 12 mg (14 pts, 20.9 %), verapamil 5 mg (9 pts, 13.4 %), and cardioversion (2 pts, 3.0 %). Twenty-five of the 62 patients failed to have a therapeutic response, yielding a recurrence rate of 40.3 %. Atrioventricular reentrant tachycardia (AVRT) was more prevalent in the recurred group. The most common symptom at presentation was chest pain. The recurred group had increased heart rate, and increased blood pressure. When patients were monitered after adenosine, unifocal premature ventricular complex was the most common rhythm encountered in the conversion group, but atrial fibrillation, and multifocal premature ventricular complex was the most common rhythm encountered. CONCLUSION: Age, heart rate, difference in systolic blood pressure from presentation to discharge, previous history of heart disease, and rhythms encountered after adenosine administration were factors predicting recurrence.

Clinical Analysis of Repeated Lumbar Disc Surgery

Results from lumbar disc operation in general are favorable in 70% to 90% of patients. The rate of necessary reintervention of the primary discectomy, however, may be as high as one fifth of cases even though diagnostic and technical standards have been improved. The purpose of this study was to analyse the reasons for failure of primary discectomy and which factors might have influenced the outcome of revisions in 53 patients with failed back surgery syndrome from the years 1989 to 1993. Mean follow up duration was 11.4 months with range of 1 to 69 months. Before revisions, all patients had one or more lumbar disc operations in whom disabling pain, neurologic deficits, and/or lumbar instabilities have been persisted or newly developed. The most common intraoperative findings of patients with revision were recurrent or persistent disc material(35.9%) followed by incomplete decompression from previous operations(24.5%), and disc lesions at new level(11.3%). In overall, 77.3% of total patients showed satisfactor y results(fair, good, and excellent) but this figure drops to 39.6% when those with at least good or excellent outcomes are only considered as definitively improved. Moreover only 22.9% good results were obtained among 35 patients with those less than 6 months of symptom duration. As for the total number of operations undertaken, it can not be conclusively stated due to small numbers in each categories, but less favorable results have been observed in those with more than one revisions. The factors predicting good outcome from revisions in our series were:1) greater than 6 months of pain relief after primary operation, 2) sciatica more prominent than lower back pain, 3) fewer operations.

A Case Report of Recurrent and Disseminated Cerebellar Hemangioblastoma

The authors present a rare case of recurrence and dissemination following total removal of solitary cerebellar hemangioblastoma. A 48-year-old male patient who had been diagnosed as having cerebellar hemangioblastoma was admitted to our hospital. After two consecutives successful removal of the tumor, there were several years in which he was free from symptoms, but recurrence and dissemination was found on both cerebellar hemispheres and brain stem. Using previous reports, we will demonstrate the clinical and pathological factors which are responsible for recurrence or dissemination of cerebellar hemangioblastoma. So we suggest that in cases the possibility of recurrence and dissemination are associated with the preidictors, it may be necessary to have follow up examinations routinely for a prolonged period.