Category: Nevin Manimala

Front Pharmacol. 2024 Oct 15;15:1458819. doi: 10.3389/fphar.2024.1458819. eCollection 2024.

ABSTRACT

BACKGROUND AND AIMS: Portal vein tumor thrombus (PVTT) occurs frequently in hepatocellular carcinoma (HCC) patients. However, there is currently no satisfactory treatment. Radiotherapy (RT) and tyrosine kinase inhibitors (TKI) are currently commonly used. However, whether their combined use provides a survival benefit is debatable. This retrospective study compared the efficacy and safety between radiotherapy plus lenvatinib (RT + L) and radiotherapy plus sorafenib (RT + S) in the treatment of hepatocellular carcinoma with portal vein tumor thrombus (PVTT).

METHODS: Among patients with PVTT who received RT + L or RT + S between March 2017 and September 2022, the primary endpoints were overall survival (OS) and progression-free survival (PFS). The secondary endpoints were objective response rate (ORR), disease control rate (DCR), and incidence of treatment-related adverse effects. The prognostic factors were also assessed.

RESULTS: The analysis included 152 patients (RT + L: 48; RL: 25; RT + S: 55; S: 24). Compared with the RT + S group, the RT + L group had a longer OS and PFS. Among patients with type I/II PVTT, the median OS times were 19.8 months and 13.5 months (p = 0.047) and the median PFS was 12.3 months and 7.3 months (p = 0.042), respectively. And the median OS of the patients with type I/II PVTT were 14.4 months and 8.3 months (p = 0.030) and the median PFS was 8.3 months and 6.2 months (p = 0.026). ORR and DCR in RT + L group (25.0% and 75.0%) were also little higher than those in RT + S group (20.0% and 70.9%), but not statistically significant. In univariate analysis, etiology, Type of PVTT, alpha-fetoprotein (AFP) level, Child-Pugh score, and treatment method influenced OS. Multivariate analysis confirmed that treatment method, etiology, alpha-fetoprotein (AFP) level, and Child-Pugh score were independent prognostic factors for OS. Similar safety profiles were observed in the RT + L and RT + S groups. The most common adverse events were myelosuppression, decreased liver function, fatigue, diarrhea, nausea, and vomiting. Most adverse reactions were grade 1-2.

CONCLUSION: The side effects of radiotherapy plus lenvatinib were acceptable. Compared to RT + S, RT + L had good efficacy in the treatment of hepatocellular carcinoma with PVTT. Validation is needed in prospective studies with larger sample sizes.

PMID:39474615 | PMC:PMC11518791 | DOI:10.3389/fphar.2024.1458819

Front Pharmacol. 2024 Oct 15;15:1494569. doi: 10.3389/fphar.2024.1494569. eCollection 2024.

ABSTRACT

BACKGROUND: : Increasing student numbers and logistical challenges in pharmacy education limit patient counselling and clinical placement opportunities. Computer-based simulation (CBS) offers scalable, interactive learning but faces integration barriers.

OBJECTIVE: : To explore global perceptions of CBS implementation in pharmacy education among educators and students. Methods: An online cross-sectional survey was developed based on literature review and expert feedback. The survey was distributed globally through academic pharmacy organisations, social media, and the authors’ networks. It included 20 questions targeting pharmacy educators and students.

RESULTS: : Responses from 152 educators across 38 countries and 392 students from 46 countries, spanning six WHO regions (AFRO, AMRO, EMRO, EURO, SEARO, and WPRO) were analysed using descriptive and inferential statistics. The majority of educators (90.1%, n = 137) and students (84.2%, n = 330) expressed comfort with using CBS and implementing it in their curriculum. Despite this, CBS was perceived as underutilised by 53.5% (n = 81) of educators and 63.7% (n = 250) of students. Students valued CBS for enhancing communication and problem-solving skills, while educators highlighted its relevance to community pharmacy practice. Both groups supported CBS use in assessments. All educators (100%) identified workload reduction as a key priority, hoped CBS could assist in this area. Educators also reported barriers such as financial constraints (56.6%, n = 86) and insufficient technical support (53.3%, n = 81). On the other hand, students were less optimistic about institutional support, with only a few (7.4%, n = 29) believed institutional leaders would actively support CBS adoption. Regional differences emerged, with SEARO (Southeast Asia) and AFRO (Africa) showing the lowest CBS usage rates. Educators in SEARO, AFRO, and EMRO (Eastern Mediterranean) raised concerns about technical support, while those in SEARO, AFRO, and WPRO (Western Pacific, including Australia, New Zealand, and Singapore) expressed financial concerns. Educators in AFRO and WPRO, however, reported being 100% comfortable with using CBS.

CONCLUSION: : Both students and educators recognised the potential of CBS in pharmacy education, with strong support for its integration. Addressing barriers such as educator workload, financial constraints, and technical support is crucial for broader adoption. Improved resource allocation and targeted training for educators are essential to effectively incorporate CBS into the pharmacy curriculum.

PMID:39474610 | PMC:PMC11518731 | DOI:10.3389/fphar.2024.1494569

Front Pediatr. 2024 Oct 15;12:1426588. doi: 10.3389/fped.2024.1426588. eCollection 2024.

ABSTRACT

OBJECTIVE: The aim of this quality improvement project is to identify children with rheumatologic conditions to prevent delayed or missed diagnosis in underserved pediatric populations. Our focus is on prompt and accurate identification and subsequent treatment of rheumatologic symptoms in pediatric patients referred from Atrium Health safety-net primary care clinics that deliver care to families without private insurance, including those lacking insurance entirely.

METHODS: We collaborated with providers at one safety-net clinic to improve the processes of identification and subspecialty referral, resulting in an increase in the number of identified pediatric patients and referrals for these patients with potential rheumatologic disease. We used the Model for Improvement framework with rapid Plan-Do-Study-Act cycles and evaluated improvement with run and statistical process control charts.

RESULTS: We achieved improvement, with zero referrals in the previous 5 years for the targeted population increasing to 15 patient referrals within 1 year of project initiation. Despite this increase in referrals, the rheumatology clinic was able to see all priority patients within 20 business days from referral.

CONCLUSION: An awareness of concerning rheumatologic symptoms in safety-net primary care clinics, combined with the use of both visual and decision aids, allows care teams to efficiently recognize and accurately refer patients needing specialty care.

PMID:39474606 | PMC:PMC11518760 | DOI:10.3389/fped.2024.1426588

Cureus. 2024 Oct 29;16(10):e72642. doi: 10.7759/cureus.72642. eCollection 2024 Oct.

ABSTRACT

Introduction This study evaluated the impact of Class II composite resin and amalgam restorations on alveolar bone loss in diabetic patients, a population more susceptible to periodontal complications. The main objective was to determine whether the choice of restorative material impacts periodontal health, providing insights to optimize dental care for this high-risk group. Materials and methods This observational, comparative. cross-sectional study included 64 diabetic patients, divided into two groups based on their Class II restorations. Group 1 had 32 patients with composite resin restorations, while Group 2 comprised 32 patients with amalgam restorations. Both groups were matched for age and diabetes duration to ensure comparability. Periodontal health, specifically alveolar bone loss, was assessed through clinical and radiographic evaluations. The study analyzed the impact of the two materials on alveolar bone levels. Results Data from 64 diabetic patients (32 in Group 1 and 32 in Group 2) were statistically analyzed using PASW Statistics for Windows, Version 18.0 (Released 2009; SPSS Inc., Chicago, United States). Three statistical tests, descriptive statistics, two-sample t-test, and analysis of covariance (ANCOVA), were used. The results showed significant differences between the two groups, with composite resin restorations linked to greater alveolar bone loss. Conclusion The choice of restorative material significantly influences periodontal health in diabetic patients. Composite resin restorations were associated with a higher risk of alveolar bone loss and periodontal disease, emphasizing the need for careful material selection and regular periodontal monitoring in diabetic patients.

PMID:39474594 | PMC:PMC11521317 | DOI:10.7759/cureus.72642

Psychooncology. 2024 Nov;33(11):e70010. doi: 10.1002/pon.70010.

ABSTRACT

OBJECTIVE: Cancer patients generally have high stress levels, which often leads to depression, anxiety and other psychological problems. Laughter therapy has been used to relieve stress, depression and anxiety in cancer patients, but its efficacy is uncertain. The study aims to summarize evidence on the efficacy of laughter therapy on psychological symptoms of people with cancer.

METHODS: A search was conducted in 10 electronic databases for randomized controlled trials (RCTs) reported before May 2023. This systematic review was reported based on the PRISMA 2020 statement. The evaluation of methodological quality and risk of biases were conducted by the Cochrane Risk of Bias Assessment tool version 2, and evidence evaluation was conducted using the GRADE pro online assessment tool. Statistical analysis adopted the Review Manager version 5.4 software.

RESULTS: A total of eight studies were included involving 543 participants. Meta-analysis showed that laughter therapy plus routine nursing produced more positive effects than routine nursing in relieving stress (SMD = -1.18, 95% CI -1.73, -0.62, p < 0.0001), depression (SMD = -1.05, 95% CI -1.30, -0.81, p < 0.00001) and anxiety (SMD = -0.81, 95% CI -1.20, -0.43, p < 0.0001).

CONCLUSIONS: Laughter therapy could effectively relieve stress, depression and anxiety of cancer patients. Future studies should improve the methodological quality of randomized controlled trials, conduct appropriate follow-up, and report details of follow-up. Additionally, it should perform multi-center and large-sample studies, and combine both subjective and objective outcome indications to enhance the persuasiveness of evidence supporting the effectiveness of laughter therapy.

TRIAL REGISTRATION: PROSPERO register: CRD 42023452739.

PMID:39472305 | DOI:10.1002/pon.70010

Musculoskeletal Care. 2024 Dec;22(4):e70004. doi: 10.1002/msc.70004.

ABSTRACT

BACKGROUND: Access to general practitioner (GP) services is essential for managing musculoskeletal pain. This study investigates the relationship between patient demographics, co-morbidities, health behaviours and difficulty in accessing GP services in the United Kingdom. Significant associations were explored between age, co-morbidities and ease of securing GP appointments. This analysis provides insights into the barriers patients face and suggests targeted interventions for improving access to primary care.

METHODS: A cross-sectional study was conducted using survey data from participants of various ages, ethnicities and socioeconomic statuses with either localised or generalised musculoskeletal pain. Relationships between key variables, such as age, co-morbidities and difficulty in accessing GP services, were examined using chi-square tests (for nominal variables) and Kruskal-Wallis tests (for nominal and ordinal variables).

RESULTS: A total of 503 respondents participated in the online questionnaire. In all, 66% of the respondents were female. The majority of participants were Caucasian (69%), followed by South Asians (19%), with the remainder identifying as Black or of mixed ethnicity. Most respondents (62%) reported experiencing musculoskeletal pain for over 2 years. Significant associations were found between the age of the participants and difficulty in accessing GP services (χ²(20) = 39, p = 0.006), co-morbidities and the impact of delayed GP reviews on patients’ musculoskeletal pain (χ²(10) = 31, p = 0.001), employment status and alternative care choices (χ²(4) = 10.99, p = 0.027).

CONCLUSION: These results highlight the multifaceted nature of healthcare access for patients of various ages with musculoskeletal pain. Age, co-morbidities and employment status significantly influence access to GP services. Future studies should explore additional systemic healthcare barriers and develop personalised interventions to improve access for high-risk populations.

PMID:39472287 | DOI:10.1002/msc.70004

Physiol Rep. 2024 Nov;12(21):e70117. doi: 10.14814/phy2.70117.

ABSTRACT

Previous studies based on animal models have raised concerns about salbutamol use in ozone air pollution with regard to ozone related lung injury. We conducted a double-blind, randomized, placebo-controlled crossover study including 18 subjects diagnosed with EIB by a eucapnic voluntary hyperpnea (EVH) test. Participants completed 30 min of standardized moderate to vigorous exercise in four conditions: ozone plus salbutamol; room air plus salbutamol; ozone plus placebo medication; and room air plus placebo medication. Spirometry, fraction of exhaled nitric oxide, and symptoms were measured before, immediately after, 30 min after and 1 h after exercise. Measurements between the four conditions were compared using percent change from pre to post exercise. There was a statistically significant difference between the salbutamol and placebo medication groups for spirometric variables including FEV1 (Estimate = 6.3, 95% CI: 4.23-8.37, p < 0.001). No differences were observed between ozone and room air exposures. There were no significant differences in FeNO response between experimental conditions. We found that salbutamol improved pulmonary function in individuals with EIB when exercising in ozone and did not increase eosinophilic airway inflammation as indicated by FeNO. This evidence suggests that it is safe for people with EIB to continue to use salbutamol as proscribed when ozone levels are elevated.

PMID:39472279 | DOI:10.14814/phy2.70117

Surgery. 2024 Oct 28:S0039-6060(24)00832-8. doi: 10.1016/j.surg.2024.08.054. Online ahead of print.

ABSTRACT

BACKGROUND: Inguinal hernia repair is one of the most common surgical procedures in the world. Each repair technique, open, laparoscopic, and robotic, has its advantages and advocates. Prior studies have compared 2 techniques, but there are little data comparing all 3 approaches with long-term follow-up.

METHODS: Prospectively collected data for unilateral inguinal hernia repair between 2007 and 2022 were reviewed. Using more than 3,300 inguinal hernia repairs, a 1:1:1 propensity score match was performed for open inguinal hernia repair, laparoscopic inguinal hernia repair, and robotic inguinal hernia repair based on patient age, sex, body mass index, and laterality. Standard descriptive and comparative statistics were performed. Data below is reported consistently as open inguinal hernia repair versus laparoscopic inguinal hernia repair versus robotic inguinal hernia repair.

RESULTS: A total of 420 patients were matched, with 140 in each group. There was no difference in age, body mass index, or smoking status between groups. Open inguinal hernia repair had significantly more comorbidities (2.8 vs 2.6 vs 2.3; P = .035), including higher rates of chronic obstructive pulmonary disease (5.0% vs 0.0% vs 1.4%; P = .013), cirrhosis (4.3% vs 0.0% vs 1.4%; P = .032), and congestive heart failure (5.0% vs 0.7% vs 0.7%; P = .023). American Society of Anesthesiologists scores differed significantly between groups (stage III and IV: 35.0% vs 20.0% vs 28.6%; P = .004). Open inguinal hernia repair were more often recurrent (48.6% vs 27.9% vs 17.1%; P < .001). The mean operative time was significantly different between groups (88.0 vs 86.1 vs 101.4 minutes; P < .001). There was no difference in wound infection (0.7% vs 0.0% vs 0.0%; P > .99), hematoma (1.4% vs 0.7% vs 1.4%; P > .99), seroma requiring intervention (2.9% vs 0.7% vs 0.7%; P = .377), or readmission (0.0% vs 2.1% vs 1.4%; P = .378). The rate of prolonged discomfort, requiring more than 2 pain medication refills, was similar between groups (2.9% vs 2.1% vs 2.1%; P = .903). Robotic inguinal hernia repair was significantly more expensive than laparoscopic inguinal hernia repair and open inguinal hernia repair ($10,005 ± $7,050 vs $17,155 ± $6,702 vs $31,173 ± $8,474; P < .001). With follow-up of at least 2.4 years in each group (3.6 vs 4.8 vs 2.4 years; P < .001), the recurrence rate was comparable (3.6% vs 0.7% vs 0.7%; P = .226).

CONCLUSIONS: All techniques are safe and effective in qualified hands. Open inguinal hernia repair was more commonly used in comorbid patients and recurrent hernias, but the techniques had comparable rates of wound complications, postoperative prolonged discomfort, and recurrence.

PMID:39472265 | DOI:10.1016/j.surg.2024.08.054

Int Dent J. 2024 Oct 28:S0020-6539(24)01544-2. doi: 10.1016/j.identj.2024.09.031. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study is to investigate risk factors for external root resorption (ERR) of second molars (M2) associated with impacted third molars (M3), and to develop a prediction model that can offer dentists a reliable and efficient tool for predicting the likelihood of ERR.

METHODS: A total of 798 patients with 2156 impacted third molars were collected from three centres between 1 December 2018 and 15 December 2018. ERR was identified by cone beam computed tomography examinations. The effects of different risk factors on the presence/absence of ERR and its severity were analysed using Chi-square or Fisher test. Multivariate logistic regressive analysis with stepwise variable selection methods was performed to identify factors which were significant predictors for ERR and its severity. Subsequently, a prediction model was developed, and the model performance was validated internally and externally.

RESULTS: The overall incidence of ERR of second molars was 16.05%. The prediction model was established using six factors including position (upper/lower jaw), impact type, impact depth (PG: A-B-C), contact position, root number of M3, and age. In terms of internal validation, the prediction model demonstrated satisfactory performance, achieving an area under curve of 0.961 and a prediction accuracy of 0.907. As for external validation, the area under curve remained high at 0.953, with a prediction accuracy of 0.892.

CONCLUSION: A risk prediction model for ERR was established in the present study. Position (upper or lower jaw), impact type, impact depth (PG: A-B-C), contact position, root number of M3, and age were identified as influencing variables which were significant predictors in the development of this predictive model. The prediction model showed great discrimination and calibration.

CLINICAL RELEVANCE: This prediction model has the potential to aid dentists and patients in making clinical decisions regarding the necessity of M3 extraction.

PMID:39472249 | DOI:10.1016/j.identj.2024.09.031

Oral Surg Oral Med Oral Pathol Oral Radiol. 2024 Aug 9:S2212-4403(24)00401-2. doi: 10.1016/j.oooo.2024.07.008. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients exposed to a combination of antiresorptive medication and radiotherapy of the head and neck area developing necrosis of the jaw in the course of treatment are extremely rare. Therefore, the aim of this study was to identify the outcome and complications in this highly vulnerable patient cohort.

STUDY DESIGN: Seventeen patients who received both antiresorptive treatment and radiotherapy (medication-related osteonecrosis of the jaw/osteoradionecrosis = the [MRONJ/ORN] group) in the head and neck area were enrolled in this study. Included patients were treated in our department between 2005 and 2022. Four hundred twenty-four patients with MRONJ (the MRONJ group) and 138 patients with ORN of the jaw were enrolled as two control groups (the ORN group). Demographic data, lesion localization, date of primary diagnosis, clinical symptoms, type of therapy (surgical or non-surgical), details on antiresorptive treatment, outcome, and complications were recorded.

RESULTS: Pathological fractures, continuity resection, and recurrence appear more often in patients who receive a combination of antiresorptive treatment and radiotherapy in the head and neck area compared with patients undergoing only one of these treatments. There was a statistically significant difference (P < .001) between the MRONJ/ORN group and the MRONJ group and the MRONJ/ORN group and the ORN group considering recurrence, fracture, and continuity resection. Patients with ORN combined with MRONJ have a 4-times higher risk for developing recurrence compared with patients with MRONJ and a 1.5-times higher risk for recurrence compared with patients with ORN. Jaw fracture and continuity resection appear more often in patients with MRONJ/ORN.

CONCLUSIONS: Patients under antiresorptive therapy in combination with radiation therapy in the head and neck area have a higher risk for developing complications in case of osteonecrosis of the jaw. Therefore, a strict follow-up care schedule is highly recommended.

PMID:39472248 | DOI:10.1016/j.oooo.2024.07.008