Conclusions : These findings suggest that in high risk populations continuous surveillance of fluoroquinolone resistance should be maintained. In addition, programs should be implemented for the management of patients with MDR‐TB and more complicated TB, so as to minimize the further spread of fluoroquinolone resistance and XDR‐TB.
Ramadan, the ninth month of the Islamic calendar, marks the period when Muslims fast during daylight hours to learn patience, humility, sacrifice, self-restraint and, above all, God-consciousness. It is a time of increased devotion to God and spiritual renewal. During the month, Muslims should not eat, drink (any liquid) or smoke from dawn to dusk. In the United Kingdom, there is a national smoking cessation service that has ambitious targets for throughput and a responsibility to reach all ethnic groups.
Many public health authorities have used the start of Ramadan as a spur to encourage smoking cessation, using several lines of reasoning. Enforced abstinence from smoking during daylight will engender withdrawal for many regular smokers. With sustained abstinence withdrawal will subside, but not with continued smoking during darkness, so the period of Ramadan is uncomfortable for many smokers unless they become totally abstinent.
Secondly, lapsing during a quit attempt makes achieving prolonged abstinence much less likely, and the prohibition against smoking during the day and the absence of others smoking could assist the quit attempt.
Thirdly, the element of spiritual renewal could lead to changes in a person's sense of self that might bolster cessation success. Gonzales et al. reported that nine out of 10 smokers in Oregon, United States, had previously believed or currently recognized some higher power. ...
The routine use of modern computed tomography scanners has led to an increased detection of incidental pulmonary embolism (PE), in particular in patients with cancer. The clinical relevance of these incidental findings is unknown.
PATIENTS AND METHODS : In this retrospective cohort study, oncology patients in whom PE was objectively proven between 2004 and 2010 and anticoagulant treatment was started, were included. Fifty-one patients with incidental PE and 144 with symptomatic PE were observed for 1 year to compare the risks of recurrent venous thromboembolism (VTE), bleeding complications, and mortality. Kaplan-Meier and Cox survival analyses were performed.
RESULTS : Incidental and symptomatic patients did not differ with respect to mean age, sex, cancer type and stage, and risk factors for VTE. As a result from evolving treatment guidelines, approximately half of the patients in both groups received long-term treatment with vitamin K antagonists in stead of currently recommended low-molecular-weight heparin. The 12-month cumulative incidence of recurrent VTE was 13.3% in the incidental group versus 16.9% in the symptomatic group (P = .77). Notably, 20% VTE events recurred after premature termination of anticoagulant therapy. The risk of major bleeding complications was also comparable in the two groups (12.5% for incidental patients and 8.6% for symptomatic patients; P = .5). The respective 12-month mortality risks were 52.9% and 53.3% (P = .7).
CONCLUSION : Our findings suggest that oncology patients diagnosed with and treated for incidental PE, have similar high rates of recurrent VTE, bleeding complications, and mortality, as compared with oncology patients who develop symptomatic PE.
OBJECTIVE. The purpose of this study was to evaluate an electromagnetic navigation system for CT-guided biopsy of small lesions.
MATERIALS AND METHODS. Standardized CT anthropomorphic phantoms were biopsied by two attending radiologists. CT scans of the phantom and surface electromagnetic fiducial markers were imported into the memory of the 3D electromagnetic navigation system. Each radiologist assessed the accuracy of biopsy using electromagnetic navigation alone by targeting sets of nine lesions (size range, 8–14 mm; skin to target distance, 5.7–12.8 cm) under eight different conditions of detector field strength and orientation (n = 117). As a control, each radiologist also biopsied two sets of five targets using conventional CT-guided technique. Biopsy accuracy, number of needle passes, procedure time, and radiation dose were compared.
RESULTS. Under optimal conditions (phantom perpendicular to the electromagnetic receiver at highest possible field strength), phantom accuracy to the center of the lesion was 2.6 ± 1.1 mm. This translated into hitting 84.4% (38/45) of targets in a single pass (1.1 ± 0.4 CT confirmations), which was significantly fewer than the 3.6 ± 1.3 CT checks required for conventional technique (p < 0.001). The mean targeting time was 38.8 ± 18.2 seconds per lesion. Including procedural planning (~5.5 minutes) and final CT confirmation of placement (~3.5 minutes), the full electromagnetic tracking procedure required significantly less time (551.6 ± 87.4 seconds [~9 minutes]) than conventional CT (833.3 ± 283.8 seconds [~14 minutes]) for successful targeting (p < 0.001). Less favorable conditions, including nonperpendicular relation between the axis of the machine and weaker field strength, resulted in statistically significant lower accuracy (3.7 ± 1 mm, p < 0.001). Nevertheless, first-pass biopsy accuracy was 58.3% (21/36) and second-pass (35/36) accuracy was 97.2%. Lesions farther from the skin than 20–25 cm were out of range for successful electromagnetic tracking.
CONCLUSION. Virtual electro mag netic tracking appears to have high accuracy in needle placement, potentially reducing time and radiation exposure compared with those of conventional CT techniques in the biopsy of small lesions.
OBJECTIVE. The purpose of this study was to retrospectively evaluate appropriate and inappropriate application of nodule management guidelines in radiology reports of pulmonary nodules seen at CT.
MATERIALS AND METHODS. The CT reports of 181 patients examined in July and August 2007 (94 males, 87 females; age range, 2–88 years; mean, 60.3 ± 13.0 years) and 177 patients examined in March 2009 (106 men, 71 women; age range, 24–91 years; mean, 60.7 ± 14.0 years) were retrospectively reviewed to assess whether nodule management guidelines were inappropriately applied. The exclusion criteria for the 2007 cases included multiple nodules, stable nodules, potential metastatic disease, probable infectious or inflammatory cause, and age younger than 35 years. The exclusion criteria for the 2009 cases were all of the 2007 criteria except multiple nodules.
RESULTS. Guidelines were inappropriately applied 105 times in 2007 and 25 times in 2009. Reasons for inappropriate use in 2007 were multiple nodules in 70 of the 105 cases (67%), potential metastatic disease in 25 cases (24%), age younger than 35 years in four cases (4%), stable nodules in two cases (2%), probable infectious or inflammatory cause in two cases (2%), and protocol not included despite absence of exclusion criteria in two cases (2%). The reasons in 2009 were potential metastatic disease in 15 of the 25 cases (60%), age younger than 35 years in four cases (16%), stable nodules in three cases (12%), probable infectious or inflammatory cause in one case (4%), and protocol not included despite absence of exclusion criteria in two cases (8%). The percentage of cases with at least one error was 48.1% in 2007, significantly higher than the 13.6% in 2009 (p < 0.001).
CONCLUSION. Inappropriate application of guidelines for management of pulmonary nodules seen at CT was significantly reduced by removing multiple nodules from the exclusion criteria. Otherwise, causes for inappropriate application remained stable.