Category: Nevin Manimala

Med Clin (Barc). 2024 Oct 29:S0025-7753(24)00556-6. doi: 10.1016/j.medcli.2024.08.004. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The COVID-19 pandemic significantly increased the global burden of respiratory morbidity and mortality. In Spain, 2020 saw a 68.5% surge in deaths from respiratory diseases compared to 2019, largely due to COVID-19. This study aims to describe respiratory disease mortality in Spain from 2019 to 2022, focusing on the intersection of COVID-19, pre-existing respiratory conditions, and specific health determinants.

MATERIALS AND METHODS: We analyzed mortality data from the Spanish National Institute of Statistics (INE), covering 102 causes of death, including tuberculosis, COVID-19, and lung cancer as respiratory-related conditions. The analysis considered absolute death counts and proportions by sex, age, and region, along with percentage changes in proportional mortality. Logistic regression models were used to identify factors potentially associated with COVID-19 and respiratory-specific mortality.

RESULTS: In 2022, Spain reported 98,128 deaths from respiratory diseases, accounting for 21.1% of all deaths and ranking as the second leading cause of death after cardiovascular diseases. Although deaths due to COVID-19 decreased in 2021 and 2022, there was a notable rise in other respiratory causes, indicating a lasting post-pandemic impact. Factors linked to higher mortality included male gender, older age, being divorced, and residing in urban areas, with significant regional variability.

CONCLUSIONS: Despite overall mortality returning to pre-pandemic levels, this study highlights a significant increase in respiratory disease deaths in Spain in 2022 compared to 2019.

PMID:39477760 | DOI:10.1016/j.medcli.2024.08.004

Ultrasound Med Biol. 2024 Oct 29:S0301-5629(24)00370-3. doi: 10.1016/j.ultrasmedbio.2024.09.025. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a comprehensive nomogram to predict the histological grading of breast cancer and further examine its clinical significance by integrating both intra-tumoral and peri-tumoral ultrasound radiomics features.

METHODS: In a retrospective study 468 female breast cancer patients were analyzed from 2017 to 2020 at the Second Affiliated Hospital of Harbin Medical University. Patients were grouped into high-grade (n = 215) and low-grade (n = 253) categories based on pathological evaluation. Tumor regions of interest were defined and expanded automatically to peri-tumor regions of interest. Ultrasound radiomics features were extracted independently. To ensure rigor, cases were randomly divided into 80% training and 20% test sets. Optimal features were selected using statistical and machine learning methods. Intra-tumor, peri-tumor, and combined radiomics models were constructed. To determine the best predictors of breast cancer histological grading, we screened the features using single- and multi-factor logistic regression analyses. Finally, a nomogram was developed and evaluated for its predictive value in this context.

RESULTS: By applying logistic regression, we integrated ultrasound, clinicopathologic, and radiomics features to generate a nomogram. The combined model outperformed others, achieving areas under the curve of 0.934 and 0.812 in training and test sets. Calibration curves also showed high accuracy and reliability.

CONCLUSION: A nomogram constructed through the integration of combined intra-tumor-peri-tumor ultrasound radiomics features along with clinicopathologic characteristics exhibited remarkable performance in distinguishing the histologic grades of invasive breast cancer.

PMID:39477745 | DOI:10.1016/j.ultrasmedbio.2024.09.025

Injury. 2024 Oct 16:111938. doi: 10.1016/j.injury.2024.111938. Online ahead of print.

ABSTRACT

BACKGROUND: Survivors of a major trauma experience a range of difficulties in relation to the reduction in physical, psychosocial, and cognitive functions, which can result in a reduced health-related quality of life. This study aims to explore lived experiences of major trauma survivors in the German healthcare system.

METHODS: Semi-structured exploratory interviews were performed with nine major trauma survivors (18-55 years; Injury Severity Score ≥16). For exploratory analyses, an artificial intelligence-based coding software was used. Further, results were clustered by using the International Classification of Functioning, Disability and Health framework (ICF).

RESULTS: Communication was one of the major topics concerning amongst others diverting opinions between different healthcare disciplines and a general lack of information. The participants showed a high demand for a contact person. Furthermore, social support was essential during recovery for those interviewed. Social network was not only important as emotional and physical support but also for overcoming of gaps in the healthcare system. The support by employers and colleagues seemed to be beneficial for our participants in relation to returning to work. Further, psychological consequences of trauma, and that mobility is a key factor for quality of life, self-efficacy and return to work were discussed.

DISCUSSION: The qualitative analyses highlight several topics such as communication, burden of sickness, support systems that the participants mentioned as important along their journey through the German healthcare system during recovery. Through the ICF model the interplay of certain components that influenced the outcome of the major trauma survivors was visualized.

IMPLICATIONS: These results might offer a deepened understanding of modifiable components of a patient pathway in recovery process such as improvements of patient communication, provision of a contact person and others.

PMID:39477709 | DOI:10.1016/j.injury.2024.111938

Clin Lymphoma Myeloma Leuk. 2024 Oct 2:S2152-2650(24)02356-5. doi: 10.1016/j.clml.2024.09.011. Online ahead of print.

ABSTRACT

BACKGROUND: Prognostic models in peripheral T cell lymphoma (PTCL) have identified biological factors including age, performance status, LDH, and BM involvement as prognostic for survival. The association of social determinants of health (SDH), on PTCL outcomes remains unexplored.

METHODS: To evaluate the impact of actionable SDH on PTCL mortality across race groups, we conducted a retrospective cohort study that included all White, Hispanic, Asian/Pacific Islander (PI) and Black adult patients with nodal PTCLs , diagnosed 2000-2020, in California. We utilized Chi² and Wilcoxon rank-sum tests for descriptive metrics and Kaplan-Meier statistics for mortality estimation. Regression models included patient- (age, sex, race, stage, Charlson Comorbidity Index, histology, treatment, academic center treatment, payer), and neighborhood-level factors (socioeconomic (SES) quintile, proportion without a high school diploma, and rural/urban). Risk factors significant in univariate regression of P < .10 were incorporated into the multivariable model.

FINDINGS: Our analysis included 6158 patients: 51.8% White, 25.8% Hispanic, 14.7% Asians/PI, and 7.6% Black. Hispanics exhibited the longest median survival (33 months) followed by Whites, Blacks, and Asian/PI (25, 20, and 14 months, respectively; P = .011). Risk factors independently associated with inferior lymphoma-specific survival (LSS) included Asian/PI compared with NH Whites (HR, 1.23; 95% CI, 1.10-1.34; P = .0002), AITL/ALCL compared with PTCL, NOS (AITL HR, 1.14; 95% CI, 1.02-1.25; P = .011; ALCL HR, 1.15; 95% CI, 1.04-1.26; P = .004), academic compared to nonacademic facility-type (HR 0.71; 95% CI, 0.64-0.77; P < .01), Medicare compared with uninsured (HR 1.48, 95% CI, 1.25-1.73; P < .01), and the lowest 3 compared to the highest education quartiles (Q2 HR 1.13; 95% CI, 1.01-1.25; P = .021; Q3 HR 1.14; 95% CI, 1.02-1.26; P = .018; Q4 HR 1.22; 95% CI, 1.08-1.36; P < .001). In the least resourced patients, histology, treatment, treatment facility-type, payer and education were independently prognostic for LSS. Academic center treatment was associated with a striking improvement in LSS (academic institution: yes = 101 months, no = 17 months; P < .01).

INTERPRETATION: Treatment facility-type, payer and education, areindependent actionable SDH for PTCL mortality. Treatment center-type had the strongest prognostic association with LSS, conferring a risk reduction of PTCL mortality by nearly 30%.

PMID:39477702 | DOI:10.1016/j.clml.2024.09.011

Clin Lymphoma Myeloma Leuk. 2024 Oct 9:S2152-2650(24)02358-9. doi: 10.1016/j.clml.2024.09.014. Online ahead of print.

ABSTRACT

INTRODUCTION: Obinutuzumab is hypothesized to improve progression-free survival (PFS) combined with bendamustine induction in mantle cell lymphoma (MCL). Measurable-residual disease (MRD) testing may predict benefit from maintenance therapy.

METHODS: Adults (≥ 18 years) with untreated MCL ineligible for intensive therapies received 4 to 6 cycles of bendamustine + obinutuzumab (BO) followed by consolidation obinutuzumab (CO). Restaging after CO included MRD assessment by next-generation sequencing of bone marrow aspirate (BMA) and peripheral blood (PB). Maintenance obinutuzumab (MO) was omitted for patients with imaging complete response (CR) and MRD-negativity in PB/BMA. All other patients received 8 cycles MO. Primary endpoint is PFS; secondary endpoints are response rates, overall survival, and estimation of MRD status.

RESULTS: Twenty-one patients enrolled, with median age 70 years and stage IV disease in 95%. Twenty patients completed BO; 10 patients received MO per protocol. Six patients did not complete MO due to progression (n = 4), infection (n = 1) and carcinoma (n = 1). Overall response is 95% (75% CR, 20% partial response). Concordance rate between post-consolidation MRD testing in PB and BMA was 70%. After a median follow-up of 43.9 months, median PFS is 46.5 months. The observed difference between 2-year PFS in groups receiving MO versus observation was not statistically significant (HR 0.45, 95% CI, 0.10-1.91). Most common grade 3/4 toxicities were neutropenia, leukopenia, and infections.

CONCLUSIONS: BO is a tolerable induction regimen with higher rates of CR compared with historical rates with bendamustine + rituximab. Omission of MO did not worsen outcomes in patients achieving MRD-negative status after nonintensive induction/consolidation therapy.

PMID:39477701 | DOI:10.1016/j.clml.2024.09.014

Pharmacoepidemiol Drug Saf. 2024 Nov;33(11):e70044. doi: 10.1002/pds.70044.

ABSTRACT

AIM: Benzodiazepine prescription is a growing phenomenon among the elderly population. However, information related to the frequency of these drugs among the elderly population attending in emergency departments (ED) and its impact over prognosis is scarce. The aim of this study is to assess the prevalence of benzodiazepine prescription and to analyze its association with short-term prognosis in elderly patients attended in ED.

METHODS: A retrospective analysis of the EDEN (Emergency Department Elderly in Need) cohort was conducted. This registry included all elderly patients attending in 52 Spanish EDs for any condition, between April 1st and 7th in 2019. Socio-demographic data, comorbidities, and medication were recorded by consulting the patient’s electronic health records. The assessed outcomes consisted on new ED visit, hospitalization, and mortality at 30 days after the first ED visit, associated with the use of benzodiazepines at baseline in comparison with no prescription of benzodiazepines. Crude and adjusted logistic regression analyses including patient’s comorbidities were performed. Two sensitivity analyses were performed considering concomitant prescription of other central nervous system depressants as well as direct discharge from the ED.

RESULTS: 25 557 patients were evaluated (mean age 78 [IQR: 71-84]). 7865 (30.8%) patients were taken benzodiazepines at admission. After adjustment for comorbidities and other central nervous system drugs, benzodiazepine prescription was associated with ED revisit [OR: 1.10 (95%CI: 1.03-1.18)]. Similar results were found in the sensitivity analysis, eliminating patients with central nervous depressors [OR: 1.11 (1.03-1.25)] and patients discharged to home [OR: 1.13 (1.04-1.23)]. No association was found between the use of these drugs and new hospitalizations [OR: 0.90 (0.77-1.05)] or mortality 30 days after discharge [OR: 1.01 (0.88-1.18)]. The results held for all three outcomes in the sensitivity analyses.

CONCLUSION: The use of benzodiazepines is a frequent phenomenon among the elderly population attended in the ED, being associated with an increased risk of new visits to the emergency room, but not with an increased risk of 30-day hospitalization or mortality.

PMID:39477694 | DOI:10.1002/pds.70044

Pharmacoepidemiol Drug Saf. 2024 Nov;33(11):e70024. doi: 10.1002/pds.70024.

ABSTRACT

PURPOSE: Accurate identification of hepatic decompensation is essential for pharmacoepidemiologic research among patients with chronic liver disease.

METHODS: An algorithm using ≥ 1 inpatient or ≥ 2 outpatient International Classification of Diseases, 10th revision (ICD-10) codes for hepatic decompensation was developed in Veterans Health Administration data from October 2015 through July 2019. Medical records were reviewed by hepatologists to confirm cases. The positive predictive value (PPV) of the coding algorithm for confirmed hepatic decompensation was calculated.

RESULTS: Hepatic decompensation was confirmed in 149/185 records meeting the algorithm (PPV 81%; 95% CI, 70%, 90%). The most common hepatic decompensation diagnosis was ascites. Only 56% of confirmed cases had an accompanying diagnosis code for cirrhosis.

CONCLUSIONS: Our ICD-10-based coding algorithm identified hepatic decompensation with high PPV in Veterans Health Administration data.

PMID:39477692 | DOI:10.1002/pds.70024

Pharmacoepidemiol Drug Saf. 2024 Nov;33(11):e70025. doi: 10.1002/pds.70025.

ABSTRACT

PURPOSE: Uncontrolled hypertension causes significant morbidity and mortality worldwide. Several prescribing guidelines have been created to address this, however, prescriber adherence to guidelines is influenced by various sociodemographic patient factors. This study aims to determine the effects of these patient factors on prescriber adherence to antihypertensive prescription guidelines.

METHODS: A secondary analysis of data from the first wave of The Irish Longitudinal Study on Ageing (TILDA), was conducted. Participants were included if they reported previous hypertension diagnoses. Antihypertensive medication regimes were compared with the prescribing guidance in the 2011 NICE hypertension guidelines. The effects of patient sociodemographic factors on prescriber adherence to guidelines, and the effect of prescriber adherence on blood pressure control (≥ 140/90 mmHg), were determined using binomial logistic regression models.

RESULTS: A total of 2992 participants were included in this analysis; 54.9% female with mean age 65.7 years (±9.23). Male sex and older age, and lower socioeconomic status were associated with increased prescriber guideline adherence. Prescribers were less likely to adhere to guidelines in female patients ≥ 55 years (Relative Risk [RR] 0.75 [0.62, 0.91]), and female patients across all age groups (RR 0.80 [0.67, 0.95]). Better blood pressure control was seen with medication regimes adherent to prescription guidelines (140.38 (±18.98)/83.09 (±11.02) mmHg adherent vs. 141.66 (±19.86)/84.77 (±11.71) mmHg non-adherent).

CONCLUSIONS: This study highlights the effect of patient sex on prescriber adherence to antihypertensive prescription guidelines, emphasizing a larger issue of systemic undertreatment of females observed within healthcare. Further research is needed to determine the reasons for such differences in hypertensive care.

PMID:39477691 | DOI:10.1002/pds.70025

Pestic Biochem Physiol. 2024 Nov;205:106112. doi: 10.1016/j.pestbp.2024.106112. Epub 2024 Aug 31.

ABSTRACT

The carmine spider mite, Tetranychus cinnabarinus (Boisduval), is an important agricultural arthropod pest. This study investigated acaricide susceptibility differences between sexes to determine the biochemical mechanisms potentially involved in these differences. The susceptibility of females and males to seven acaricides (pyridaben, cyflumetofen, abamectin, chlorpyrifos, propargite, profenofos and fenpropathrin) was compared with laboratory bioassays. Males were more susceptible than females for each acaricide. Differences in the lethal concentration 50 % (LC₅₀) values between the sexes were observed to range from 2.04-fold to 6.05-fold. The surface area was markedly greater for females than males (by 1.87-fold) and the weight was significantly greater for females compared to males (by 4.67-fold). The specific surface area of male was 2.61-fold higher than that of female. There were no differences in the cuticle structure, whereas the thickness of females was 1.63-fold than that of males. The penetration rate of males was statistically significantly higher than that of females, both in pyridaben and cyflumetofen. Synergism experiments and biochemical assays suggested the involvement of the three detoxification enzyme systems in the sexual susceptibility of T. cinnabarinus. The activities of cytochrome P450 monooxygenases (P450s) (p < 0.01), glutathione-S-transferase (GSTs) (p < 0.05) and carboxylesterase (CarEs) (p < 0.05) in females were significantly higher than that in males. The results reveal that the individual size (specific surface area), cuticle thickness, and detoxification enzyme activity were involved in the sexual susceptibility to acaricides of T. cinnabarinus.

PMID:39477574 | DOI:10.1016/j.pestbp.2024.106112

Nurs Clin North Am. 2024 Dec;59(4):577-592. doi: 10.1016/j.cnur.2024.07.006. Epub 2024 Aug 30.

ABSTRACT

This scoping review delves into psychometric measures assessing the strong Black woman and superwoman constructs among African American women. It evaluates various scales, emphasizing their clinical relevance and implications for women’s health. By recognizing and addressing unique stressors faced by Black women, health care interventions can be tailored to promote holistic well-being and mitigate adverse health outcomes. The review underscores the necessity for culturally relevant stress measures in clinical practice to ensure equitable health care access and outcomes for this population.

PMID:39477565 | DOI:10.1016/j.cnur.2024.07.006