ABSTRACT
BACKGROUND AND AIMS: Heart failure is one of the leading causes of morbidity and mortality in the United States. The advent of left ventricular assist devices (LVAD) has improved the survival and quality of life in patients with end stage heart failure. Gastrointestinal bleeding (GIb) remains one of the limitations of LVADs. METHODS: A single center, retrospective review of records was performed for patients who underwent LVAD implantation between 2010 and 2015. All patients who survived more than 30 days were followed till March 2016 and are described below. RESULTS: A total of 79 patients were included in the study. The rate of GIb was 34.1% (27 patients) with a mean time to bleed of 267 days. Older patients were more likely to bleed. Upper GI bleeding was the source of bleeding in 54% patients. Arteriovenous malformations (AVM) were the source of bleeding in 74% bleeders and 80% of these patients had de novo AVM formation. 14/27 (51%) patients had a re-bleeding event. Thrombotic events were 4.5 times more likely to occur in patients who also had a GI bleed. CONCLUSIONS: GI bleeding in LVAD patients is common with the source of bleeding more commonly being in the upper GI tract. GI bleeding may occur as early as 10 days post procedure, despite previous negative screening endoscopies. There is an increased risk of thrombotic events in patients who have experienced a GI bleed.
ABSTRACT
Although male breast cancer represents only 0.5%-1% of all breast cancer cases in the United States, the incidence of this disease is slowly rising [1]. Because of its extremely low prevalence, screening and treatment guidelines are not well established. Thus, analyzing cases of male breast cancer can accelerate this process. We present a case of a 52-year-old man, initially diagnosed with biopsy-confirmed intraductal papilloma without atypia, who presented 3 years later with progression of this benign lesion to ductal carcinoma in situ and development of de novo invasive ductal carcinoma. This report stresses the importance of symptom detection and risk factor modification with the goal of decreasing the incidence of this disease.
ABSTRACT
Isolated bilateral fractures of the coronoid processes of the mandible occurred in this patient without any significant trauma. The definite etiology of this case is unknown, but possible causes or contributing factors may include acute reflex contraction of the patient's temporalis muscles leading to bilateral stress fractures, coronoid process hyperplasia, or the patient's long-term use of omeprazole. The planned treatment for this patient included pain control with Mobic and tramadol and splint fabrication followed by arch bar placement with training elastics for six weeks.
ABSTRACT
This study aims to explore the independent predictors of physicians' emigration from Iraq and the emigration temporal trends of Iraqi doctors. We used a convenience sample of Iraqi physicians, extracting their e-mail addresses from public records of Iraqi Medical Association websites and asking them to complete an online survey. Of the 1,395 Iraqi physicians contacted, 599 responded and 567 were eligible for inclusion. Of these, 202 reside in Iraq and the rest live abroad. Doctors abroad describe better work atmospheres, job satisfaction, and training quality. The majority live in English-speaking countries. Of these, 60 percent left Iraq for security reasons, 99 percent left when they were juniors, and 66 percent of those completed their specialty training and settled abroad forever. Of doctors abroad, 17 percent want to return to Iraq, while 50 percent of doctors in Iraq want to leave. Iraqi doctors' rate of emigration peaked in 2006; these figures have since declined, but remain relatively high. Iraq has lost many of its doctors, and emigration is ongoing. The predictors of emigration shifted from financial issues during the 1990s to security and training concerns after 2003. The mass exodus will impact the health care system in the long term.
