Medicine
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Despite the recent advancements in the treatment of acute ischemic stroke, the delayed patient arrival to emergency department or hospital serve as crucial factor for the selection of appropriate intervention program. This study was aimed to identify factors associated with late hospital arrival for patients with acute ischemic stroke in Makkah, Saudi Arabia. A prospective cross-sectional study was carried out at Al-Noor Specialist Hospital among 98 enrolled patients with the mean age of 60.4 ± 10.3 years over the period of March 2019 and June 2019. ⋯ The relationship between time of presentation and computed tomography findings showed statis,tically significant relationship between the former and early computed tomography findings (P = .017). A statistically significant relationship between time of presentation and knowledge of stroke was also observed (P = .013). Increased public awareness is important in order to minimize the time between stroke onset and emergency room presentation.
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Anaplastic lymphoma kinase (ALK) gene fusion, an important driver gene alteration leading to the development of lung cancer, occurs in 5% of nonsmall cell lung cancer (NSCLC) cases in China. In addition to echinoderm microtubule-associated protein-like 4 (EML4)-ALK, which is the most common type of ALK fusion, various fusion partner genes have been identified in recent years. However, ALK intergenic breakpoint fusions confound fusion detection and targeted treatment. ⋯ This is the first clinical evidence of advanced NSCLC due to a rare SLC8A1 downstream intergenic region ALK fusion that has been effectively treated with ceritinib. Whether this finding represents an inherent property of this fusion protein or its unique clinicopathological characteristics in patients carrying this fusion protein remains to be investigated. Moreover, the patient's durable response to ceritinib and future resistance mechanisms require further follow-up.
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Thromboangiitis obliterans (TAO) is a rare disease of unknown cause that causes segmental vasculitis in peripheral blood vessels. It is uncertain whether its presence causes serious adverse events in patients receiving external beam radiotherapy. ⋯ This is the first report of rectourethral fistula caused by external beam radiotherapy for prostate cancer in which TAO was suspected to be involved. Although little is known about the relationship between TAO and radiotherapy, it should be noted that radiotherapy itself may increase the risk of normal tissue toxicity in patients with TAO.
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The neutrophil-to-lymphocyte ratio (NLR) is used to predict the prognosis of various diseases, such as coronavirus disease 2019, community-acquired pneumonia, bacteremia, and endocarditis. However, NLR has never been reported to predict patient discharge in geriatric patients with influenza infection. This retrospective case-control study enrolled geriatric patients (≥65 years) with influenza virus infection who visited the emergency department of a medical center between January 01, 2010 and December 31, 2015. ⋯ The Hosmer-Lemeshow goodness-of-fit test was calculated as 0.36, and the adjusted area under the receiver operating characteristic was 0.75. The negative predictive value of NLR ≤ 6.5, to predict patient discharge, was 91.8%. NLR ≤ 6.5 is a simple and easy-to-obtain laboratory tool to guide the physicians to discharge geriatric patients with influenza infection in the crowded emergency department.
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High-dose insulin (HDI) therapy has been used as inotropic support for toxin-induced cardiogenic shock, but literature suggests that it can also be used in non-toxin-induced cardiogenic shock states. Its use has not been reported in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation. ⋯ While multiple interventions occurred during decannulation, HDI therapy may have assisted in transitioning off ECMO support, and HDI should be investigated as an adjunctive option in future decannulations and other non-toxin-induced cardiogenic shock states.