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ABSTRACT: Background: In Muslim countries, end-of-life practices in Muslim brain-dead patients are unknown. We conducted this study to evaluate this issue. RESULTS: We identified 42 brain-dead patients between 2001 and 2011. The expectant terminal extubation occurred only in 5. Largely due to family opposition, 2 patients remained "full code," and rests were "do not attempt resuscitation" with varying usage of "life-sustaining" therapies. Only 2 out of 24 eligible patients donated organs. There was minimal involvement of social worker, palliative team, or Muslim chaplain in the end-of-life discussions. Conclusion: In Muslim patients, the concept of terminal withdrawal and organ donation after brain death is still not well accepted. Future multicenter studies, involving palliative teams, should focus on improving these issues.
The American journal of hospice & palliative care 07/2012;
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ABSTRACT: Different formulas have been proposed to exclude restriction based on spirometry, however none of them have specifically tested the patients whose spirometry show both obstruction and a low forced vital capacity (FVC).
The study was designed to create an algorithm that would better predict the absence of restriction in such patients.
Retrospective analysis of prospectively collected data.
A cohort of consecutive adults that underwent complete pulmonary function testing from 2002-2004 was analyzed. The data was randomly split into two groups to allow for derivation and then validation of a predictive formula. Patients were randomly assigned into either a "derivation" or "validation" group. In the derivation group, stepwise logistic regression was used to determine a formula and optimal cut-off value for the variable with the best discriminative capacity. The formula was applied subsequently to the validation group to test the results and compared to previously published formula.
The study group contained 766 patients. We determined that the variable with the highest association with TLC was [(FEV(1)/FVC) % predicted/FVC % predicted]. A value of ≥1.11 was found to be the maximal cutoff to predict the absence of restriction. The formula was applied to a validation group (n=397) and performed better than prior published algorithm with a sensitivity, specificity, positive predictive value and negative predictive value of 95%, 44%, 22%, and 98%, respectively.
Our formula performs superior to the previously published algorithms in patients with concomitant low FVC and obstruction to exclude restriction.
The Open Respiratory Medicine Journal 01/2011; 5:44-50.
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ABSTRACT: Placement of a single new-generation nitinol stent resulted in acute pericardial tamponade in a 70-year-old man with superior vena cava syndrome.
Asian cardiovascular & thoracic annals 06/2010; 18(3):294-6.
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ABSTRACT: We report a case of severe restless legs syndrome (RLS) that occurred as a side effect of olanzapine therapy. It was refractory to treatment with 2 mg of clonazepam and 3 mg ropinirole. There was partial relief with propoxyphene, however, it was stopped because of side effects. The symptoms disappeared once olanzapine was switched to another antipsychotic medication. Only two prior published reports associate olanzapine usage with development of RLS. In one report, low-dose benzodiazepines and ropinirole were associated with resolution of RLS symptoms stating dopamine depletion as the likely etiology. In our patient, however, RLS due to olanzapine was refractory to the trial of both high-dose benzodiazepine and ropinirole. This suggests that RLS occurring as a side effect of olanzapine therapy may have additional causative mechanisms beyond simple dopamine depletion as postulated before. High-dose narcotics, if tolerated, may be an alternative in such refractory cases.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 03/2009; 5(1):68-9. · 3.23 Impact Factor
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ABSTRACT: Pneumosiderosis or Welder's lung is an occupational lung disease which is usually seen after chronic exposure to iron dust. We present a case of a 64-year-old welder in whom the diagnosis of pneumosiderosis was made by lung biopsies. We also briefly review the literature regarding the disease, its prognosis and association with development of lung cancer. Avoidance of iron dust exposure and implementing prevention strategies in people at risk are the mainstay of therapy.
