Category: Nevin Manimala

Int J Gynecol Cancer. 2024 Jul 16:ijgc-2024-005489. doi: 10.1136/ijgc-2024-005489. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of our study was to evaluate the feasibility of the modified International Germ Cell Cancer Collaborative Group risk classification system in Chinese female patients with malignant ovarian germ cell tumors and to identify predictive factors to enhance the risk classification system.

METHODS: In this retrospective cohort analysis, patients with malignant ovarian germ cell tumors who received surgery with/without chemotherapy were included. These patients had been followed-up by Peking Union Medical College Hospital between 2011 to 2020. Patients without complete medical records or no follow-up information were excluded.

RESULTS: The study enrolled a total of 271 patients. The risk model classified 106 (39.1%) patients as good-, 84 (31%) as intermediate-, and 81 (29.9%) as poor-risk. With a median follow-up time of 34 months (range 2-147), 48 (17.7%) recurrence and 16 (5.9%) deaths were observed. The risk classification significantly correlated with 3 year disease-free survival and overall survival (log rank p<0.001 and p=0.003, respectively). The survival outcomes of disease-free survival and overall survival were not statistically different among risk groups in patients who received neoadjuvant chemotherapy (log rank p=0.77 and 0.41, respectively). Univariate and multivariable analysis showed that tumor stage (p=0.033, hazard ratio (HR) 2.05, 95% confidence interval (CI) 1.06 to 3.96) was significantly associated with relapse or progression of disease. Patients over age 40 years exhibited a poor prognosis.

CONCLUSION: The modified International Germ Cell Cancer Collaborative Group risk classification system was efficacious in patients with malignant ovarian germ cell tumors and was significantly associated with disease-free survival and overall survival. Risk assessment after neoadjuvant chemotherapy may be more predictive than stratification at initial diagnosis. Age and tumor stage were definitive prognostic factors for germ cell tumors, which may need to be incorporated in the stratification system.

PMID:39019492 | DOI:10.1136/ijgc-2024-005489

Klin Padiatr. 2024 Jul 17. doi: 10.1055/a-2367-9190. Online ahead of print.

ABSTRACT

English Abstract: Abstract Purpose: The most important cause of mortality and morbidity in acute rheumatic fever (ARF) is carditis and rheumatic heart disease (RHD). The aim of this study was to identify markers that may be indicators of chronic inflammation in whole blood analyses in pediatric patients with RHD who regularly received secondary deposilin prophylaxis.

METHODS: In our study, 100 children with ARF aged between 4 and 18 years were followed up in the pediatric cardiology outpatient clinic of the patient group. The control group consisted of 100 healthy children of the same sex and age as the patient group. All children in the patient group regularly received deposilin prophylaxis every 21 days. Our study included many whole blood parameters that are reported in the literature to represent changes in chronic inflammatory diseases. These parameters were CRP, RDW, PDW, MPV and leukocyte subtypes, neutrophil, lymphocyte, monocyte counts and their ratios (neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte).

RESULTS: Leukocyte count, lymphocyte count, basophil count, MLR and basophil count were significantly lower in the patient group than in the control group (p: 0.047, p: 0.023, p: 0.006). In addition, eosinophil count and RDW value were significantly higher in the patient group than in the control group (p: 0.043; p: 0.001).

CONCLUSION: In our study, low leukocyte, lymphocyte, basophil, MLR and higher eosinophil counts indicated that RDW could be effectively used as a marker for regular depositilin prophylaxis in pediatric patients with RHD. German Abstract: Zusammenfassung Zweck: Die wichtigste Ursache für Mortalität und Morbidität bei akutem rheumatischem Fieber (ARF) sind Karditis und rheumatische Herzkrankheit (RHD). Ziel dieser Studie war es, Marker zu identifizieren, die bei Vollblutanalysen bei pädiatrischen Patienten mit RHD, die regelmäßig eine sekundäre Deposilin-Prophylaxe erhielten, Indikatoren für chronische Entzündungen sein können.

METHODEN: In unserer Studie wurden 100 Kinder mit ARF im Alter zwischen 4 und 18 Jahren in der pädiatrischen kardiologischen Ambulanz der Patientengruppe nachbeobachtet. Die Kontrollgruppe bestand aus 100 gesunden Kindern desselben Geschlechts und Alters wie die Patientengruppe. Alle Kinder in der Patientengruppe erhielten regelmäßig alle 21 Tage eine Deposilin-Prophylaxe. Unsere Studie umfasste viele Vollblutparameter, von denen in der Literatur berichtet wird, dass sie Veränderungen bei chronischen Entzündungskrankheiten darstellen. Diese Parameter waren CRP, RDW, PDW, MPV und Leukozytensubtypen, Neutrophilen-, Lymphozyten-, Monozytenzahlen und ihre Verhältnisse zueinander (Neutrophilen/Lymphozyten, Thrombozyten/Lymphozyten und Monozyten/Lymphozyten). Ergebnisse: Leukozytenzahl, Lymphozytenzahl, Basophilenzahl, MLR und Basophilenzahl waren in der Patientengruppe signifikant niedriger als in der Kontrollgruppe (p: 0,047, p: 0,023, p: 0,006). Darüber hinaus waren Eosinophilenzahl und RDW-Wert in der Patientengruppe signifikant höher als in der Kontrollgruppe (p: 0,043; p: 0,001). Schlussfolgerung: In unserer Studie wiesen niedrige Leukozyten-, Lymphozyten-, Basophilen-, MLR- und höhere Eosinophilenzahlen darauf hin, dass RDW als Marker für eine regelmäßige Depositilinprophylaxe bei pädiatrischen Patienten mit RHD wirksam eingesetzt werden könnte.

PMID:39019479 | DOI:10.1055/a-2367-9190

Bone Jt Open. 2024 Jul 18;5(7):592-600. doi: 10.1302/2633-1462.57.BJO-2024-0033.R1.

ABSTRACT

AIMS: Patient dissatisfaction is not uncommon following primary total knee arthroplasty. One proposed method to alleviate this is by improving knee kinematics. Therefore, we aimed to answer the following research question: are there significant differences in knee kinematics based on the design of the tibial insert (cruciate-retaining (CR), ultra-congruent (UC), or medial congruent (MC))?

METHODS: Overall, 15 cadaveric knee joints were examined with a CR implant with three different tibial inserts (CR, UC, and MC) using an established knee joint simulator. The effects on coronal alignment, medial and lateral femoral roll back, femorotibial rotation, bony rotations (femur, tibia, and patella), and patellofemoral length ratios were determined.

RESULTS: No statistically significant differences were found regarding coronal alignment (p = 0.087 to p = 0.832). The medial congruent insert demonstrated restricted femoral roll back (mean medial 37.57 mm; lateral 36.34 mm), while the CR insert demonstrated the greatest roll back (medial 42.21 mm; lateral 37.88 mm; p < 0.001, respectively). Femorotibial rotation was greatest with the CR insert with 2.45° (SD 4.75°), then the UC insert with 1.31° (SD 4.15°; p < 0.001), and lowest with the medial congruent insert with 0.8° (SD 4.24°; p < 0.001). The most pronounced patella shift, but lowest patellar rotation, was noted with the CR insert.

CONCLUSION: The MC insert demonstrated the highest level of constraint of these inserts. Femoral roll back, femorotibial rotation, and single bony rotations were lowest with the MC insert. The patella showed less shifting with the MC insert, but there was significantly increased rotation. While the medial congruent insert was found to have highest constraint, it remains uncertain if this implant recreates native knee kinematics or if this will result in improved patient satisfaction.

PMID:39019478 | DOI:10.1302/2633-1462.57.BJO-2024-0033.R1

Appl Clin Inform. 2024 Jul 17. doi: 10.1055/a-2368-3514. Online ahead of print.

ABSTRACT

BACKGROUND: Health informatics (HI) is a growing field of study, yet sparse data is available on the characteristics of undergraduate health informatics programs in the United States (U.S.). The lack of a central location for U.S. HI undergraduate program data has led to a gap in information to support current efforts to promote academic standards in the field and attract potential students.

OBJECTIVES: The objective of this study was to perform an environment scan of colleges and universities within the U.S. and Puerto Rico to identify undergraduate programs in HI including majors, minors, and undergraduate level certificates.

METHODS: Potential institutions offering HI programs were identified from the National Center for Education Statistics (NCES), Commission for Accreditation of Health Informatics and Health Information Management Education (CAHIIM), the Association of University Programs in Health Administration (AUPHA), the Healthcare Information and Management Systems Society (HIMSS), and the American Health Information Management Association (AHIMA). Publicly available materials for these institutions were reviewed, and data were captured for identified HI programs including geographic location; college or school in which the program was offered; type of degree (if applicable); program title; total credits to complete the program; delivery format; and source of data.

RESULTS: 83 HI programs were identified from 60 institutions and 26 states. The primary finding of this environment scan was that inconsistencies exist among U.S. HI undergraduate programs including variations in offering college/school, title of program, number of credits required, delivery formats, CIP codes, and the type of information published on university/college websites.

CONCLUSION: This environment scan was a first step in exploring the characteristics of undergraduate HI programs within the U.S. Further research is needed on the curricular similarities and differences among the programs, the administrative methods of these interdisciplinary programs, and the information most needed by current and potential undergraduate students.

PMID:39019476 | DOI:10.1055/a-2368-3514

J Am Acad Orthop Surg. 2024 Jul 15. doi: 10.5435/JAAOS-D-24-00164. Online ahead of print.

ABSTRACT

PURPOSE: Physician and surgeon involvement in industry has received considerable attention in recent decades. In this study, we outline the perspective of the general US population regarding (1) disclosure, (2) ownership, and (3) compensation between physicians/surgeons and industry. We hypothesize that the general population would be largely supportive of the physician/surgeon-industry relationship.

METHODS: An online, survey-based, descriptive study was conducted through a crowdsourcing platform, Amazon Mechanical Turk. Survey respondents were presented with a seven-item questionnaire inquiring about the physician/surgeon and industry relationship. An “attention check” question was included; those who failed this question were excluded. Descriptive statistics were used to assess the data and a McNemar chi-squared test for paired, dichotomous data.

RESULTS: A total of 993 respondents were included. Survey responses are summarized in Table 1. 70.6% of respondents stated that it was “important” or “extremely important” to disclose that the patient be informed whether implants used in surgery had been developed by the operating surgeon. 71.1% of respondents reported that it was “important” or “extremely important” to disclose partial ownership within industry. Seventy-one percent of respondents stated it was “important” or “extremely important” to disclose royalty payments pertaining to surgical implants. 95.6% of respondents suggested that it was acceptable for surgeons to accept free airfare and lodging, and 95.2% of respondents stated that it was acceptable for the surgeon to be compensated for time away from practice to learn about new equipment.

DISCUSSION: In our survey of 993 respondents, we found that relationships with industry are considered acceptable if appropriate disclosure is given to patients. We also found that although respondents suggested that physicians and surgeons may be influenced by a free meal, compensation for trips to try new equipment and time spent away from practice is considered appropriate.

LEVEL OF EVIDENCE: 2c, Ecological studies.

PMID:39018577 | DOI:10.5435/JAAOS-D-24-00164

Appl Physiol Nutr Metab. 2024 Jul 17. doi: 10.1139/apnm-2024-0142. Online ahead of print.

ABSTRACT

This randomized, placebo-controlled, double-blind, parallel trial investigated whether generally healthy adult, non-elite runners would have a greater time-to-exhaustion during submaximal treadmill running with probiotic versus placebo supplementation. It was hypothesized that the probiotic would impact training progression by reducing gastrointestinal (GI) and cold/flu symptoms. Participants who typically ran ≥24 km/week, ran or cross-trained 3-5 days per week, and had a maximal oxygen intake (VO2 max) in the 60-85th percentile were enrolled. VO2 max was used to establish individualized workload settings (85% of VO2 max) for the submaximal endurance tests at baseline and following 6 weeks of supplementation with a probiotic (Lactobacillus helveticus Lafti L10, 5×109 CFU/capsule/day) or placebo. Participants self-reported GI and cold/flu symptoms and physical activity via daily and weekly questionnaires. Outcomes were tested using a linear model to determine if mean response values adjusted for baseline differed between groups. Twenty-eight participants (n=14/group), aged 255 years (meanSD) with a body mass index of 233 kg/m2, completed the study. At the final visit the probiotic group had a lower time-to-exhaustion versus the placebo group (P=0.01) due to an increase in time-to-exhaustion with the placebo (1344±188 to 1565±219 seconds, P=0.01) with no change with the probiotic (1655±230 to 1547±215 seconds, P=0.23). During the intervention, the probiotic group completed fewer aerobic training sessions per week (P=0.02) and trained at a lower intensity (P=0.007) versus the placebo group. Few GI and cold/flu symptoms were reported with no differences between groups. Time-to-exhaustion increased in the placebo group, possibly due to differences in training habits.

PMID:39018571 | DOI:10.1139/apnm-2024-0142

Am J Respir Crit Care Med. 2024 Jul 17. doi: 10.1164/rccm.202405-0958LE. Online ahead of print.

NO ABSTRACT

PMID:39018563 | DOI:10.1164/rccm.202405-0958LE

JMIR Form Res. 2024 Jul 17;8:e48434. doi: 10.2196/48434.

ABSTRACT

BACKGROUND: Multiple chemical sensitivity (MCS) develops in response to repeated small-level chemical exposures or a major exposure in a subset of people, who then experience symptoms that can range from mild to debilitating when exposed to chemicals. The arrival of the COVID-19 pandemic and the stringent health measures put in place may have increased the burden for those living with MCS, as it became more challenging to avoid chemicals that trigger their condition.

OBJECTIVE: This study aimed to better understand the lived experience of Canadians living with MCS during the first year of the COVID-19 pandemic.

METHODS: An online questionnaire was created to ask participants to compare daily living during the pandemic to before March 11, 2020. Data were collected in January and February 2021. Three areas were investigated: (1) environmental exposures to chemical triggers from ambient air (pollution from industry, farming, and traffic) and indoor air (the smell of cleaning products, cooking odors, and smoke); (2) access to, and satisfaction with, health care visits; and (3) how people experiencing MCS rated contact with their social network.

RESULTS: In all, 119 Canadians who had lived with MCS for more than a year completed the questionnaire. The participant sample was mostly female (86.6%, n=103) and highly educated, with 57.1% (n=68) having a university degree. Slightly more than half (57.1%, n=68) were older than 55 years. McNemar chi-square and Wilcoxon signed rank tests were used to evaluate if there were statistically significant changes before (“prepandemic period”) and after (“postpandemic period”) March 11, 2020. Perceived exposure to pollution from a highway or a road was significantly decreased from the prepandemic to postpandemic period (z=-3.347; P<.001). Analysis of industry or power plants also suggested a significant decrease in the perceived exposure from the prepandemic to postpandemic period (z=-2.152; P=.04). Participants reported an increase in exposure to odors from disinfectants or sanitizers that entered their living environment (P<.001). There was a significant decrease between prepandemic and postpandemic levels of satisfaction when attending in-person meetings with a physician (z=-2.048; P=.04), yet there were no significant differences between prepandemic and postpandemic levels of satisfaction for online or telephone meetings with a physician. Although people with MCS experienced increased social isolation (P<.001), they also reported an increase in understanding from family (P=.03) and a decrease in stigma for wearing personal protective equipment (P<.001).

CONCLUSIONS: During the first year of the COVID-19 pandemic, people with MCS were impacted by inaccessibility, loss of social support, and barriers to accessing health care. This study highlights unique challenges and possible benefits associated with the COVID-19 pandemic public health measures for individuals living with MCS. These findings can guide decision makers to improve policies on accessibility through appropriate accommodation measures.

PMID:39018551 | DOI:10.2196/48434

Health Rep. 2024 Jul 17;35(7):14-27. doi: 10.25318/82-003-x202400700002-eng.

ABSTRACT

BACKGROUND: Mental health disparity is associated with diverse characteristics, such as gender, socioeconomic status, Indigenous identity, immigrant status, race, disability, and sexual orientation. However, intersectional studies on women’s mental health have been rare, particularly during the COVID-19 pandemic period.

METHODS: Using data from two cycles of the Canadian Community Health Survey (2019 annual data and data from September to December 2020), self-reported mental health outcomes before the COVID-19 pandemic (sample size was 64,880) and during the second wave of the pandemic in the fall of 2020 (sample size of 27,246) were analyzed.

RESULTS: After sociodemographic factors were controlled for, women and girls had higher odds of poorer self-perceived mental health and worsened mental health compared with before the COVID-19 pandemic than men and boys. Compared with 2019, the gender gap in negative self-perceived mental health increased during the pandemic. The number and type of intersections of specific socioeconomic characteristics also had an impact on mental health outcomes. During the pandemic, women and girls with the following characteristics were more likely to report low self-perceived mental health, compared with women and girls with no intersections: those with a disability (7.8 times); or who are lesbian, gay, or bisexual or have another sexual orientation than heterosexual (5.6); or who are Indigenous (3.6).

INTERPRETATION: The intersections of gender and other sociodemographic characteristics increased the odds of negative self-perceived mental health.

PMID:39018524 | DOI:10.25318/82-003-x202400700002-eng

Health Rep. 2024 Jul 17;35(7):3-13. doi: 10.25318/82-003-x202400700001-eng.

ABSTRACT

BACKGROUND: Most individuals prefer to spend their final moments of life outside a hospital setting. This study compares the places of care and death of long-term care (LTC) home residents in Ontario in the last 90 days of life, according to LTC home rurality.

DATA AND METHODS: This retrospective cohort study was conducted using health administrative data from ICES (formerly known as the Institute for Clinical Evaluative Sciences). The study population, which was identified through algorithms, included all Ontario LTC home residents with a dementia diagnosis who died between April 1, 2014, and March 31, 2019. The location of death was categorized as in an acute care hospital, an LTC home, a subacute care facility, or the community. Places of care included emergency department visits and hospitalizations in the last 90 days of life. Statistical tests were used to evaluate differences in location of death and places of care by rurality.

RESULTS: Of the 65,375 LTC home residents with dementia, 49,432 (75.6%) died in an LTC home. Residents of LTC homes in the most urban areas were less likely to die in an LTC home than those in more rural homes (adjusted relative risk: 0.84; 95% confidence interval: 0.83 to 0.85). A higher proportion of residents of the most urban LTC homes had at least one hospitalization in the last 90 days of life compared with rural residents (23.7% versus 9.9% palliative hospitalizations and 28.3% versus 15.9% non-palliative hospitalizations [p ⟨ 0.001]).

INTERPRETATION: Individuals with dementia residing in urban LTC homes are more likely to receive care in the hospital and to die outside a LTC home than their counterparts living in rural LTC homes. The findings of this work will inform efforts to improve end-of-life care for older adults with dementia living in LTC homes.

PMID:39018523 | DOI:10.25318/82-003-x202400700001-eng