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Background Breast cancer remains a pressing public health challenge in the United States, ranking as one of the most prevalent cancers and the second leading cause of cancer-related deaths among women. This study investigates the effectiveness of early mammogram screening in underserved populations. Methods Data from female patients receiving primary care at a tertiary hospital in Nashville between January 2022 and January 2023 were retrospectively analyzed. Inclusion criteria encompassed females aged 40 or older with initial mammogram screenings before turning 50. Exclusions included genetically or environmentally related risk factors, cosmetic motivations, age above 50 at first screening, and screenings prompted by physical exams. Results Of 150 eligible women aged 40-49, the majority (n=121, 80.7%) had normal findings, 18.0% (n=27) had benign lesions, and 1.3% (n=2) had suspicious/malignant lesions. About 30.7% (n=46) underwent additional testing due to suspicious masses, with ultrasounds and diagnostic mammograms being common. The breast malignancy positivity rate was 1.33% (n=2) for the study population and 4.3% among those requiring additional testing. The positivity rate for the population of Black American descent is 1% (n=2), and for the Hispanic population, it is 6.25% (n=1). Discussion Breast cancer remains a significant concern, with disparities in screening guidelines and varying age of diagnosis. Overdiagnosis and false positives are challenges, with our study highlighting potential benefits in early screening, particularly for populations with unique risk factors, such as smokers. However, the study's limitations, including a small sample size and demographic bias, necessitate larger, more diverse studies to establish stronger correlations. Shared decision-making in early mammogram screening is emphasized. Conclusion Early mammogram screening in the 40-49 age group may detect breast cancer cases, but guidelines remain inconsistent. The study recommends early screening at age 40, with awareness of potential advantages and disadvantages. Larger, more comprehensive studies are needed to inform breast cancer screening practices better.
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Intravenous tissue plasminogen activator (tPA) remains the standard of treatment for patients presenting with acute ischemic stroke within the treatment window. In most patients, this often leads to an effective and life-prolonging intervention in the acute setting. This is, however, not without complications, which sometimes could be potentially fatal. Hemorrhagic complications, such as hemorrhagic conversion and bleeding, are the most discussed; however, facial angioedema has also been reported. We present a case of a 72-year-old African American male who developed right-sided ipsilateral orolingual angioedema 20 minutes after starting a tPA infusion. He was subsequently managed with antihistamine medications and steroids with interval resolution of symptoms. This case highlights the need for close monitoring while on tPA infusion, early detection, and management of potential facial angioedema complications. It also serves as a template for further studies focusing on preventative strategies for tPA-induced angioedema.
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Chronic myelogenous leukemia (CML) is a pluripotent stem cell disease characterized by the presence of the Philadelphia chromosome and the bcr-abl gene. The discovery of tyrosine kinase inhibitors (TKIs) revolutionized therapy for CML, such that durable response, increased overall survival, and increased progression-free survival of patients in chronic phase CML is now possible. Due to resistance and intolerance to imatinib, there was need for development of second- and third-generation TKIs for the treatment of CML. This review examines the role of nilotinib, an oral second-generation TKI, in the treatment of Philadelphia positive CML. The pharmacology, efficacy, and safety of nilotinib are critically evaluated. Patient-related issues, including tolerance, drug interactions, and quality of life issues are also examined.
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BACKGROUND: Pulmonary vein isolation (PVI) has become an increasingly important therapy in the management of atrial fibrillation (AF), however, the best procedural techniques to ensure success have not been determined. We assessed the incremental benefit of complex fractionated atrial electrograms (CFAEs) ablation for AF rhythm control. METHODS: PubMed, Embase, CENTRAL, and Clinicaltrials.gov databases were searched up until May 7, 2015. Included were randomized controlled trials that compared PVI with PVI and CFAEs ablation (PVI+) with a minimum of 3 months' follow-up. Statistical analysis was performed with Review Manager version 5.3 (Cochrane Collaboration, Oxford, United Kingdom). Categorical and continuous outcomes were reported as summary risk differences and mean differences (MDs), respectively. P < 0.05 was considered statistically significant for all analyses. RESULTS: Ten randomized controlled trials randomized patients to PVI+ (n = 635) and PVI (n = 427) with follow-up ranging from 3 to 23 months. There was no significant difference in freedom from atrial tachyarrhythmias without antiarrhythmic agents after a single ablation between PVI+ and PVI (313 of 635 vs 230 of 427; risk difference, 0.01 [95% confidence interval (CI)-0.08 to 0.10]; P = 0.78; I(2) = 52%). Findings were not different for any prespecified subgroup analyses, including paroxysmal vs nonparoxysmal AF, automated vs manual detection of CFAEs, and left atrial vs biatrial ablation. PVI+ led to significantly increased procedure time (MD, 49.81 minutes [95% CI 42.86-56.76]; P < 0.001), fluoroscopy time (MD, 11.55 minutes [95% CI 8.02-15.07]; P < 0.001), and radiofrequency energy application time (MD, 19.16 minutes [95% CI 6.61-31.70]; P = 0.003) compared with PVI. CONCLUSIONS: Ablation of CFAEs in addition to PVI did not increase freedom from atrial tachyarrhythmias but procedural times were increased.
