B of Medicine and B of Surgery, Manipal Academy of Higher Education (2004)
Master of Science, Columbia University (2006)
Acute lymphoblastic leukemia (ALL) in adults is an uncommon but devastating malignant proliferation of lymphoid precursors. Treatment programs for adult patients are largely based on pediatric regimens. However, cure rates in adults have been limited to 30-40% for the past several decades as opposed to the 80% cure rate in children. Treatment of adolescents and young adults is evolving with the adoption of more aggressive "pediatric-inspired" treatment programs. The role of allogeneic stem cell transplant is first remission remains controversial in spite of recent data suggesting improved outcomes in patients younger than 35. Kinase inhibitors in combination with standard chemotherapy have significantly improved outcomes in ALL associated with the Philadelphia chromosome. The treatment of ALL in the elderly remains challenging. Promising new agents such as nelarabine and clofarabine may improve the outlook. This article reviews the current state of the art for the treatment of ALL in adults.
View details for DOI 10.1016/j.critrevonc.2011.01.014
View details for Web of Science ID 000299581000009
View details for PubMedID 21353591
Sunitinib is an oral tyrosine kinase inhibitor, which is indicated for the treatment of renal cell carcinoma and gastrointestinal stromal tumors. The authors report the case of a patient who underwent treatment for renal cell carcinoma and noted additional benefit by improvement in his psoriatic skin lesions. This may be attributed to the antiangiogenic activity of sunitinib by inhibition of vascular endothelial growth factor receptors.
View details for DOI 10.1097/MAJ.0b013e3181dd1aa5
View details for Web of Science ID 000278464300018
View details for PubMedID 20421784
Clinical trials have assessed the effectiveness of nicotine-dependence treatments (NDTs), alone or in combination, and reported that men and women have variable responses to these treatments. The variations in therapeutic responses highlight the need to explore gender-specific preferences for NDTs, including complementary and alternative medicine (CAM), which has become increasingly popular in the US population for the cessation of tobacco use.The aim of this study was to assess gender differences in the self-reported use, perceived efficacy, and interest in future use of NDTs, including CAM, in an outpatient setting.This cross-sectional survey was conducted in men and women at a tertiary care NDT clinic. The primary inclusion criterion was the willingness and ability of the patients to participate in the survey.Data from 1171 patients were included (599 men, 572 women; mean age: men, 46.2 years; women, 46.5 years). Of these, 68% of women and 65% of men reported use of nicotine-replacement therapy (NRT), other prescription medication, or counseling/group support. In men and women, NRT was the most commonly used type of pharmacologic treatment, of which the patch was the most popular (77% and 75%). A significantly greater proportion of women than men perceived the nicotine inhaler to be efficacious (67% vs 50%; P = 0.027). No other significant gender differences were found among NRTs. Among non-NRT methods, bupropion sustained release (SR) and counseling/group support were used by significantly more women than men (53% vs 43% [P = 0.007] and 16% vs 11% [P = 0.026], respectively). Compared with men, significantly greater proportions of women reported current or previous use of CAM for nicotine abstinence and expressed an interest in future use of CAM (34% vs 22% [P < 0.001] and 71% vs 64% [P = 0.006]).In this sample of patients at an NDT clinic, significantly more women than men reported previous use of bupropion SR, counseling, and CAM. More women than men expressed an interest in the future use of CAM. Based on these findings, an improved understanding of gender-based differences in the use of conventional and nonconventional NDTs might improve the rates of success of nicotine-cessation efforts among women.
View details for DOI 10.1016/j.genm.2009.06.002
View details for Web of Science ID 000269139400005
View details for PubMedID 19682663
Sleep-related breathing disorders are increasingly recognized as an important cause of morbidity and mortality. Women with obstructive sleep apnea-hypopnea syndrome (OSA) are less likely to be assessed or to receive a diagnosis, and they may have poorer survival rates.This study assessed gender-specific differences in patients with OSA.Data were collected with a prospective, point-of-care, anonymous 25-question survey about basic medical information and therapies for patients undergoing polysomnography at the sleep center of a US tertiary care center from January 1 through March 31, 2005.Of the 646 consecutive patients who received the survey, 522 (80.8%) patients completed it, and 406 subsequently received a diagnosis of OSA. Of those 406 patients, 267 (65.8%) were men. Overall mean age was 57 years (56.4 years for men; 56.7 years for women). Alcohol use was more common in men (132 [49.4%]) than in women (43 [30.90,6]) (P < 0.001). Women were more likely to have the following associated comorbidities: obesity (body mass index > or =30) (P = 0.047), fibromyalgia (P < 0.001), migraine (P < 0.001), depression (P = 0.01), and irritable bowel syndrome (P = 0.01). The 4 most frequently reported sleep-related symptoms in both sexes were snoring (279 [68.7%]), lack of energy (235 [57.9%]), difficulty staying asleep (206 [50.7%]), and daytime sleepiness (204 [50.2%]). Lack of energy (P = 0.01), difficulty falling asleep (P = 0.02), and night sweats (P = 0.01) were observed more frequently in women than in men. There was no significant gender difference in the recalled duration of sleep-related symptoms. The mean (SD) apnea-hypopnea index (AHI) was 26.6 (26.6) for men and 22.1 (26.5) for women (P = 0.02). Conventional medications (including prescription and over-the-counter medications) for sleep-related problems were used more by women (35 [25.2%]) than by men (29 [10.9%]) (P < 0.001).The majority of patients who received a diagnosis of OSA were men (male-female ratio, 2:1), and the mean AHI was higher in men than in women. However, women presented with more nonspecific symptoms than did men, although there was no significant gender-specific difference in the recalled duration of symptoms. In addition, women reported more comorbidities and used significantly more conventional medications for sleep-related problems.
View details for Web of Science ID 000252542500005
View details for PubMedID 18215724
To assess the proportion of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) reporting previous or current use and interest in future use of complementary and alternative medicine (CAM) therapies.Cross-sectional, point-of-care, anonymous survey.Sleep disorders center at a Midwest tertiary care center.Six hundred forty-six consecutive patients undergoing polysomnography.The survey instrument comprised 45 items specifically related to CAM therapies, in addition to obtaining baseline data.Response rate was 81% (522/646). A total of 406/522 (78%) patients were diagnosed with OSAHS. Mean age +/- SD was 57 +/- 14 years, and 267 participants (66%) were men. Overall, 237 (58%) participants reported ever using CAM. Ever and current CAM use specifically for improving sleep was reported by 20% and 7% of the participants, respectively. Twenty-six percent of participants reported ever using biologic products, and 52% reported ever using nonbiologic CAM treatments. A high proportion (58%) of the participants showed interest in future CAM use for improving sleep.A high proportion of patients with OSAHS report previous or current use, and interest in future use, of CAM treatments. This underscores the need to conduct further research in this field.
View details for PubMedID 17993037