Attitudes of Muslims Living in the United States Toward Long-Term Care Decisions and Diagnosis Disclosure for Elderly Family Members.

This study explored the attitudes of Muslims living in the United States toward long-term care decisions and diagnostic disclosure. Members of six mosques in New Jersey aged 40 and older agreed to participate in a telephone interview. Respondents were read medical scenarios and asked to indicate their preferences from a list of responses. Scenarios were: if they or a family member were disabled, who would they prefer to care for them; would they use a Muslim nursing home for themselves or loved one; who should be informed first if an individual had cancer or would die very soon (the individual or the individual's family); and whether these diagnoses should be disclosed to the individual's family without the individual's consent. If disabled, 62% (n = 103) of participants would prefer care at home, and 65.7% (n = 108) would prefer care at home for a disabled loved one. If there were a Muslim nursing home, 78.3% (n = 103) of participants would consider this facility for themselves and 76% (n = 127) would consider it for a loved one. Fifty-six percent (n = 93) of participants believed the individual should be informed first of a cancer diagnosis, and 54.6% (n = 89) believed the individual should be informed first if their death was imminent. Disclosing an individual's cancer diagnosis to family members without the individual's consent was acceptable to 49.7% (n = 83) and disclosing his or her imminent death was acceptable to 55.1% (n = 92). Participants were from 21 countries. Participants from Western countries were most likely to believe individuals should be informed first about their cancer diagnosis or imminent death.

The Prognostic Significance of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Patients With Multiple Myeloma.

OBJECT: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are simple, inexpensive prognostic markers for various conditions. The objective of this study was to determine the prognostic significance of NLR and PLR in patients with multiple myeloma (MM) in terms of survival. METHOD: A retrospective chart review study was conducted for 175 patients who met the criterion of diagnosis for MM between January 2004 and September 2014. RESULT: The median age of diagnosis was 69 years. Patients were divided into high and low NLR and PLR groups according to cutoff points from the receiver operating characteristic curve (2.78 and 155.58, respectively). The high NLR and PLR groups were associated with lower albumin level and higher staging. The high NLR group experienced inferior median survival compared with the low NLR group (37 vs. 66 months; log-rank P-value 0.005). However, there was no significant difference in median survival between the high and low PLR groups (45 vs. 62 months; P = 0.077). Multivariate analysis demonstrated that NLR is an independent predictor for OS of MM (HR 2.892; P = 0.009). CONCLUSION: We conclude that NLR is an independent prognostic factor for OS in MM.

Repeat colonoscopy's value in gastrointestinal bleeding.

AIM: To assess the diagnostic yield and clinical value of early repeat colonoscopies for indications other than colorectal cancer (CRC) screening/surveillance. METHODS: A retrospective review of patients who had more than one colonoscopy performed for the same indication within a three year time frame at our tertiary care referral hospital between January 1, 2000 and January 1, 2010 was conducted. Exclusion criteria included repeat colonoscopies performed for CRC screening/surveillance, poor bowel preparation, suspected complications from the index procedure, and incomplete initial procedure. Primary outcome was new endoscopic finding that led to an endoscopic therapeutic intervention or any change in clinical management. Clinical parameters including age, sex, race, interval between procedures, indication of the procedure, presenting symptoms, severity of symptoms, hemodynamic instability, duration between onset of symptoms and when the procedure was performed, change in endoscopist, withdrawal time, location of colonic lesions and improvement of quality of bowel preparation were analyzed using bivariate analysis and logistic regression analysis to examine correlation with this primary outcome. RESULTS: Among 19  772 colonoscopies performed during the above mentioned period, 947 colonoscopies (4.79%) were repeat colonoscopies performed within 3 years from the index procedure. Out of these repeat colonoscopies, 139 patient pairs met the inclusion criteria. The majority of repeat colonoscopies were for lower gastrointestinal bleeding (88.4%), change in bowel habits (6.4%) and abdominal pain (5%). Among 139 eligible patient pairs of colonoscopies, only repeat colonoscopies that were done for lower gastrointestinal bleeding and abdominal pain produced endoscopic findings that led to a change in management [25 out of 123 (20.33%) and 2 out of 7 (28.57%), respectively]. When looking at only recurrent lower gastrointestinal bleeding cases, new endoscopic findings included 8 previously undetected hemorrhoid lesions (6.5%), 7 actively bleeding lesions requiring endoscopic intervention, which included 3 bleeding arterio-venous malformations (2.43%), 2 bleeding radiation colitis (1.6%), and 2 bleeding internal hemorrhoids (1.6%), 5 previously undetected tubular adenomas [4 were smaller than 1 cm (4.9%) and 1 was larger than 1 cm (0.8%)], 3 radiation colitis (2.43%), 1 rectal ulcer (0.8%), and 1 previously undetected right sided colon cancer (0.8%). Of the 25 new endoscopic findings, 18 (72%) were found when repeat colonoscopy was done within the first year after the index procedure. These findings were 1 rectal ulcer, 3 radiation colitis, 4 new hemorrhoid lesions, 3 previously undetected tubular adenomas, and 7 actively bleeding lesions requiring endoscopic intervention. Of all parameters analyzed, only the interval between procedures less than one year was associated with higher likelihood of finding a clinically significant change in repeat colonoscopy (odds ratios of interval between procedures of 1-2 year and 2-3 year compared to 0-1 year were 0.09; 95%CI 0.01-0.74, P = 0.025 and 0.26; 95%CI 0.09-0.72, P = 0.010 respectively). No complications were observed among all 139 colonoscopy pairs. CONCLUSION: There is clinical value of repeating a colonoscopy for recurrent lower gastrointestinal bleeding, especially within the first year after the index procedure.

The effect of diabetes on oxaliplatin-induced peripheral neuropathy.

INTRODUCTION: Chemotherapy-induced neurotoxicity is a significant source of morbidity for cancer patients. This study aimed to assess the relationship between preexisting diabetes and clinically significant (National Cancer Institute Common Toxicity Criteria grades 2 and 3) OXIPN; between diabetes, and the cumulative dose at onset of OXIPN; and between other preexisting medical conditions and the development of OXIPN. MATERIALS AND METHODS: We reviewed medical records of all patients with stage II-IV colon cancer treated in the Albert Einstein Cancer Center, Philadelphia, with oxaliplatin from 2005 to 2009. Exclusion criteria included preexisting neuropathy, previous neurotoxic chemotherapy exposure, and incomplete medical records. The NCI Common Toxicity Criteria was used to grade sensory neuropathy. Univariate analysis was used to estimate odds ratios and confidence limits for prevalence of OXIPN in patients with and without diabetes. The mean level and cumulative doses were compared using the t test. RESULTS: Sixty-two patients met the study criteria; 23 oxaliplatin-treated patients were excluded. The crude incidence of any OXIPN was 65%. There was no relationship found between development of OXIPN and the presence of diabetes, smoking, hypertension, or statin use. However, the mean cumulative dose of oxaliplatin was significantly lower for patients with diabetes who developed neuropathy, compared with those without diabetes (388 vs. 610 mg/m(2); P = .021). CONCLUSION: Although the presence of diabetes did not appear to affect the severity of OXIPN, patients with diabetes developed OXIPN at a lower cumulative dose of oxaliplatin (P < .05). The results may have implications for treatment of patients with diabetes and colon cancer.

Statins decrease the occurrence of venous thromboembolism in patients with cancer.

BACKGROUND: Recent data suggest a reduction in the occurrence of venous thromboembolism in select groups of patients who use statins. The objective of this study is to evaluate the impact of statin use on the occurrence of venous thromboembolism in patients with solid organ tumor. METHODS: We conducted a retrospective, case-control study reviewing 740 consecutive patients with a diagnosis of solid organ tumor who were admitted to the Albert Einstein Medical Center, Philadelphia, Penn, between October 2004 and September 2007. Patients treated with anticoagulation therapy before their first admission were excluded. The occurrence of venous thromboembolism, risk factors for venous thromboembolism, and statin use were recorded. Patients who never used statins or had used them for less than 2 months were relegated to the control group. RESULTS: The mean age of the study population was 65 years, and 52% of the patients were women and 76% were African American. The occurrence of venous thromboembolism was 18% (N=132), and 26% (N=194) were receiving statins. Among patients receiving statins, 8% (N=16) developed a venous thromboembolism compared with 21% (N=116) in the control group (odds ratio 0.33; 95% confidence interval, 0.19-0.57). A logistic regression analysis including risk factors for venous thromboembolism (metastatic disease, use of chemotherapy, immobilization, smoking, and aspirin use) along with statin use yielded the same results. CONCLUSION: This study suggests that the use of statins is associated with a significant reduction in the occurrence of venous thromboembolism. This pleiotropic effect warrants further investigation.

Reduced risk of bone metastasis for patients with breast cancer who use COX-2 inhibitors.

PURPOSE: We hypothesize that the use of cyclooxygenase (COX)-2 inhibitors in early disease phases could protect against the development of bony metastases. PATIENTS AND METHODS: The medical charts of patients with stage II-III breast cancer diagnosed between 1999 and 2005 were reviewed. Patients were subdivided according to the use of COX-2 inhibitors after the diagnosis and for > or = 6 months. Bivariate analyses were undertaken, and statistically significant variables were included in a multivariate logistic regression model. RESULTS: Eleven percent of patients (74 of 644) who did not use COX-2 inhibitors developed bone metastases compared with 2% (1 of 48) of those who did use COX-2 inhibitors (Fisher exact test, P = .05). Significant predictors for bone metastases in a multivariate logistic regression model included: > or = 3 positive nodes (odds ratio [OR], 3.26 [95% CI, 1.79-5.93]; P < .001), stage IIB-IIIC disease (OR, 3.89 [95% CI: 1.74-8.69]; P = .001) and use of COX-2 inhibitors (OR, 0.12 [95% CI, 0.02-0.88]; P = .037). Adjusting for TNM stage, of the 327 patients with stages IIB-IIIC disease, 22% (63 of 293) had bone metastases in the non-COX-2 group versus 3% (1 of 34) in the COX-2 inhibitors consumers (Fisher exact test, P = .006). In this high-risk group of patients, the calculated OR associated with COX-2 inhibitors was 0.10 (95% CI, 0.01-0.78). CONCLUSION: The use of COX-2 inhibitors could reduce the risk of bone metastases in stage II-III breast cancer.

Oral health in the elderly with non-insulin-dependent diabetes mellitus.

Non-insulin-dependent diabetes mellitus (NIDDM) is a common endocrine disease affecting the elderly in particular. Long-term complications involve the vasculature; vision, renal, and neural function; and the periodontium. Knowledge about the oral health of the elderly and the effects of NIDDM is limited. The objective of this study was to compare the oral health of patients aged 60+ years, who have NIDDM, with patients who do not have NIDDM. To evaluate oral health, we recorded retention and condition of the teeth, periodontal health, and condition of the oral mucosa. We also assessed oral hygiene, smoking history, regularity of dental checkups, and medication use. The study group was selected from among patients who came to the ambulatory care clinic at University of Medicine and Dentistry, New Jersey, Center for Aging with a diagnosis of NIDDM. The control group, which did not have NIDDM, was selected from among the same patient group and was matched for age and gender. Patients with severe dementia, those having fewer than 10 teeth or those who were in need of antibiotic prophylaxis were excluded from the study. Patients underwent a short interview and a clinical evaluation. Our study involved 32 elderly adults with NIDDM and 40 elderly adults who did not have NIDDM. Both groups had similar oral hygiene levels and regularity of professional dental care. In addition, the plasma glucose levels among the study group were well controlled. This study did not show statistically significant differences in oral health parameters between participants with diabetes and those in a control group.