Category: Nevin Manimala

Cancer Med. 2023 Dec 1. doi: 10.1002/cam4.6690. Online ahead of print.

ABSTRACT

INTRODUCTION: Demographics are important prognostic factors in malignant diseases. A nationwide analysis concerning the prognostic impact of demographics in head and neck cancer (HNC) patients (HNCP) has not been performed previously.

METHODS: A retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) and the Federal Statistical Office (Destatis) between 2002 and 2017 was performed. A total of 212’920 HNCP were included. Incidence, tumor stage, age development, sex distribution, age-, residence-, and diagnosis-time-specific survival were examined.

RESULTS: Mean age of HNCP increased more rapidly than in the general population (slope coefficient: 0.29 vs. 0.20; p < 0.0001). Higher age and male sex were associated with a worse prognosis. Whereas overall survival (OS) increased from the early to the later observation period for HNCP <70 years, no OS improvement for HNCP >70 years was found. Furthermore, an OS disadvantage was observed for East Germany compared to West Germany (median 47 vs. 60 months; p < 0.0001). This disparity was associated with a disproportionately high ratio of men in East Germany (men/women: 4.4 vs. 3.1; p < 0.0001) and a lower mean age (61 vs. 63 years; p < 0.0001). In addition to stage, age and sex, residence in East Germany were confirmed as an independent factor for OS in a multivariate analysis.

CONCLUSION: Finally, three decades after the German reunion, a survival disadvantage for patients in East Germany still exists. This discrepancy may be a result of socioeconomic disparities.

PMID:38037808 | DOI:10.1002/cam4.6690

Diabetes Metab Res Rev. 2023 Dec 1:e3749. doi: 10.1002/dmrr.3749. Online ahead of print.

ABSTRACT

AIMS: The aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022.

MATERIALS AND METHODS: Two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person-years were calculated by country/region, sex, age, and COVID-19 pandemic period (pre-COVID-19 and pandemic).

RESULTS: The study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15-16.29) per 100,000 person-years. Finland and high-income North America had the highest IR, with 56.81 (95%CI, 55.91-57.73) and 28.77 (95%CI, 26.59-31.13) per 100,000 person-years, respectively. The IR was 13.37 (95%CI, 10.60-16.88) per 100,000 person-years in boys and 13.87 (95%CI, 11.51-16.70) per 100,000 person-years in girls. There were statistically significant differences among different age ranges: 0-4 versus 5-9 and 10-14 years old (p < 0.001); 5-9 versus 15-19 (p < 0.001) and 10-14 versus 15-19 years old (p = 0.003). Finally, during the pandemic period (2020-2022), the IR was 24.84 (95%CI, 17.16-35.96) per 100,000 person-years, which was higher but not significant compared with the prepandemic period (2017-2019) of 13.56 (95%CI, 7.49-24.56) per 100,000 person-years (p = 0.090).

CONCLUSIONS: The IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM.

PMID:38037806 | DOI:10.1002/dmrr.3749

J Orthop Surg (Hong Kong). 2023 Sep-Dec;31(3):10225536231217539. doi: 10.1177/10225536231217539.

ABSTRACT

BACKGROUND: We have previously shown that, compared with general anesthesia (GA), the procedure of peripheral nerve blocks (PNB) facilitates faster recovery of elderly patients from total knee replacement (TKR). Here, we investigated whether the faster recovery is associated with decreased perioperative stress and inflammation and decreased incidences of postoperative complications.

METHODS: After randomization, 165 patients aged ≥65 years underwent TKR under GA or PNB. The primary outcomes were the perioperative inflammation and stress levels, based on the serum C-reactive protein and interleukin-6 levels, erythrocyte sedimentation rate, white-blood cell and neutrophil counts, and blood-sugar level. The secondary outcomes were the postoperative complications, including cardiovascular, respiratory, and hepatic or renal complications, insomnia, delirium, electrolyte disturbances, and nausea and vomiting.

RESULTS: The two groups were not significantly demographically different (p > .05). Of the cytokines related to stress and inflammation, the differences of time points were statistically significant between the two groups (p < .01), but two-way ANOVA revealed no interaction between the time points and groups. Incidences of postoperative complications were far lower in PNB group than in GA group (p = .006). Incidences of postoperative respiratory complications (p = .005) and postoperative nausea and vomiting (p = .040) were significantly lower in PNB group than in GA group. There were no significant differences in other complications between the two groups (p > .05).

CONCLUSIONS: PNB does not alleviate the stress and inflammation in elderly patients post TKR but significantly reduces the incidences of postoperative complications, especially respiratory complications, and nausea and vomiting. (ClinicalTrials.gov Identifier: NCT01871012).

PMID:38037804 | DOI:10.1177/10225536231217539

Int Psychogeriatr. 2023 Dec 1:1-13. doi: 10.1017/S1041610223004374. Online ahead of print.

ABSTRACT

OBJECTIVES: We examined the association between perceived discrimination and the risk of cognitive impairment with no dementia (CIND) and Alzheimer’s disease and related dementias (ADRD) while considering the potential effects of nativity status.

DESIGN: A prospective analysis of discrimination and nativity status with dementia and cognitive impairment was conducted among Latinx adults aged 51 years and older who participated in the Health and Retirement Study.

SETTING: A national representative sample.

PARTICIPANTS: A sample of 1,175 Latinx adults aged 51 years and older.

MEASUREMENTS: Demographics, cognitive functioning, perceived discrimination, and nativity status (US-born vs. non-US born) were assessed. Traditional survival analysis methods (Fine and gray models) were used to account for the semi-competing risk of death with up to 10 years of follow-up.

RESULTS: According to our results, neither everyday discrimination nor nativity status on their own had a statistically significant association with CIND/ADRD; however, non-US-born Latinx adults who reported no discrimination had a 42% lower risk of CIND/ADRD (SHR = 0.58 [0.41, 0.83], p = .003) than US-born adults.

CONCLUSIONS: These results highlight the need for healthcare providers to assess for discrimination and provide support and resources for those experiencing discrimination. It also highlights the need for better policies that address discrimination and reduce health disparities.

PMID:38037791 | DOI:10.1017/S1041610223004374

Niger Postgrad Med J. 2023 Oct-Dec;30(4):305-309. doi: 10.4103/npmj.npmj_226_23.

ABSTRACT

INTRODUCTION: Tracheostomy is a life-saving procedure; the benefits and frequency of procedures being performed have led to frequent reviews of indication in many regions of the world. The aim is to establish the indications, diagnosis and complications of tracheostomy performed in the past 10 years in a tertiary hospital in Lagos.

METHODS: This is a 10-year retrospective study of all patients who had tracheostomies for various indications from 2010 to 2019. Patient medical records were analysed for demographic profile, diagnosis, indication, elective or emergency tracheostomy, surgeon’s rank, technique of decannulation and type of complications. All the variables in the data were imputed and analyzed using the IBM Statistical Package for the Social Sciences version 27. Continuous variables were presented as mean and standard deviation, whereas categorical variables were presented as frequency and percentage.

RESULTS: Four hundred and eighty-six tracheostomies were carried out during the period under review, and 440 patients had complete data retrieved. The age group of 0-9 years constituted the most common age for tracheostomy (18%). The most common indication for tracheostomy was for relief of upper airway obstruction in 53.4%. Neoplasms (40%) and trauma (30.7%) constituted primary diagnosis requiring tracheostomies. Amongst the paediatric age group with upper airway obstruction, infections (31.8%) and foreign body inhalation (24.3%) constituted the most common primary diagnosis. Stoma infection and peristomal granulation tissue were the most common early complication (21.8%) and late complication (43.4%), respectively.

CONCLUSION: Relief of upper airway obstruction from neoplasm remains the most common indication for tracheostomy, and peristomal granulation infection was the most common complication.

PMID:38037787 | DOI:10.4103/npmj.npmj_226_23

Niger Postgrad Med J. 2023 Oct-Dec;30(4):293-298. doi: 10.4103/npmj.npmj_104_23.

ABSTRACT

BACKGROUND: Lingual nerve injury is a known complication of mandibular third molar (M3M) surgery, and retraction of the lingual flap is reported to reduce the incidence of this complication. However, there is no global consensus on the routine retraction of lingual flap.

AIM: The aim of the study was to assess the perception and practice of lingual flap retraction amongst oral and maxillofacial surgeons in Nigeria.

MATERIALS AND METHODS: This cross-sectional national survey was conducted amongst 122 oral and maxillofacial surgeons in Nigeria from January 2023 to March 2023 using a validated, structured, self-administered questionnaire. The questionnaire had three sections and 14-item questions. Section A consists of the sociodemographic questions, Section B comprises questions on perception towards lingual flap retraction, whereas Section C consists of questions on the practice of lingual flap retraction. These questionnaires were deployed as an online survey and as hard copies. Both qualitative and quantitative data were analysed. A critical probability level (P < 0.05) was used as the cut-off level for statistical significance.

RESULTS: Most of the participants (47.6%) belong to the age group of 31-40 years. The male-to-female ratio was 6:1. Only 12 (9.8%) participants had a positive perception towards routine lingual flap retractions following M3M surgery. Perception of lingual flap retraction was found not to be associated with the demographic variables of the participants (P > 0.05). A total of 95 participants (77.9%) did not raise nor retract the lingual flap during lower third molar surgery. The rate of practice of lingual flap retraction during third molar surgery was not influenced by any of the factors studied (P > 0.05).

CONCLUSION: The majority of oral and maxillofacial surgeons in Nigeria do not agree that routine retraction of the lingual flap is necessary to reduce lingual nerve injury and majority, too, do not practice this in their management of impacted lower third molar.

PMID:38037785 | DOI:10.4103/npmj.npmj_104_23

Niger Postgrad Med J. 2023 Oct-Dec;30(4):269-274. doi: 10.4103/npmj.npmj_144_23.

ABSTRACT

BACKGROUND: Infertility is a global public health issue affecting couples. Trace metals have been implicated in effective reproductive functions in males but less studied in females.

OBJECTIVE: To compare the serum levels of copper (Cu), zinc (Zn), selenium (Se) and copper/zinc ratio in women with unexplained infertility and fertile women.

SUBJECTS AND METHODS: This was a cross-sectional analytical study that compared 75 consenting women who had unexplained infertility with 74 fertile women that were controls. Both groups were seen within 1 year of delivery and were recruited from the family planning unit, at the University College Hospital, Ibadan. Data were obtained through a semi-structured questionnaire, after which 10 mL of venous blood was collected. Analysis of selected trace elements were done by atomic absorption spectrophotometry. IBM SPSS version 23 was utilized for data analysis and the levels of statistical significance was set at <0.05.

RESULTS: The mean (± SD) serum concentrations of Cu (93.11 ± 16.55 μg/dL), Zn (72.04 ± 15.03 μg/dL) and Se (28.28 ± 8.33 μg/dL) amongst the women with unexplained infertility were lower when compared to the control group (all with P < 0.001). The serum Cu/Zn ratio was higher among the fertile women, though not statistically significant (P < 0.62). Age of <35 years was associated with normal serum levels of Cu (P < 0.01), while women with normal body mass index had low serum concentrations of Cu (P = 0.04), amongst the fertile group.

CONCLUSION: Serum copper, zinc and selenium concentrations are significantly lower in women with unexplained infertility, therefore diets or supplements containing these trace elements may be helpful in their management.

PMID:38037782 | DOI:10.4103/npmj.npmj_144_23

Pharmeur Bio Sci Notes. 2023;2023:81-111.

ABSTRACT

An international collaborative study was run within the framework of the Biological Standardisation Programme (BSP) of the Council of Europe and the Commission of the European Union to establish replacement batches for European Pharmacopoeia (Ph. Eur.) Heparin Low-Molecular-Mass (LMM) for calibration Chemical Reference Substance batch 3 (CRS3) used for the characterisation of LMM heparins by high performance size-exclusion chromatography. Two candidate batches (A, cCRS4 and B, cCRS5) were filled using the same material as the existing official calibrants, adopted with either an assigned number-average molecular mass (Mna) or a broad standard table (BST). Fifteen laboratories evaluated the suitability of these candidate batches for use as calibrants with the pharmacopoeial dual refractive index/ultraviolet (RI/UV) detector calibration method, as well as with a modified mobile phase and the BST calibration method. Seven preparations of LMM heparin were tested. The results confirmed that the proposed batches are suitable for use with the same characteristic Mna as CRS3 and with the BST established for the World Health Organization (WHO) 2^nd International Standard (IS). The BST calibration method gave comparable results to the RI/UV method, while showing better reproducibility, being easier to perform and requiring no calibrant with UV absorbance. The modified mobile phase had no impact on the calculated values while improving separation between the calibrant and salt peaks. The two candidate batches were adopted as Ph. Eur. Heparin LMM for calibration CRS batches 4 and 5, respectively, with the assigned Mna value of 3800 and a BST. In anticipation of the depletion of the calibrant required for use with the RI/UV method, and taking into account the unlikely procurement of a new lot of suitable starting material, it was recommended to include the BST method in Ph. Eur. monograph 0828, Heparins, low-molecular-mass. In order to improve peak separation, it was also recommended to include the use of ammonium acetate solution as mobile phase in the monograph, both for the Ph. Eur. RI/UV and the proposed BST calibration methods. Further to this study, Ph. Eur. monograph 0828 was revised to replace the RI/UV method by the BST method. This contributed to the harmonisation of methods across regions, thereby facilitating a concerted global action for the development and establishment of the next batches of calibrants for the quality control of LMM heparins.

PMID:38037758

Scand J Pain. 2023 Dec 1. doi: 10.1515/sjpain-2023-0043. Online ahead of print.

ABSTRACT

OBJECTIVES: This study explored changes in pain-related parameters, occupational function, occupational balance, lifestyle factors, and self-perceived health status in adults with chronic high-impact pain participating in an occupational therapy lifestyle intervention.

METHODS: This one-group longitudinal feasibility study was performed in three continuous feasibility rounds. The occupational therapists-led intervention targeted meaningful occupations, regular physical activity, and a healthy diet. The intervention contained individual and group sessions and was added to the standard multidisciplinary chronic pain treatment. Outpatients (n=40, 85 % females, 46.6 ± 10.9 years old) participated in the study between April 2019 and December 2021. The analysis includes data for 31 participants. Analysis of pre-post changes assessed after each feasibility round were performed for the outcomes: pain intensity, pain sensitivity and pain modulation (pressure pain threshold and tolerance, temporal summation of pain and conditioned pain modulation), pain self-efficacy, pain catastrophizing, motor and process skills, occupational balance, daily wake-time movement, daily walking steps, body mass index, waist circumference, blood pressure, and self-perceived health status.

RESULTS: Improvements in motor skills (assessment of motor and process skills score=0.20 (1.37; 1.57), 95 % CI 0.01; 0.38) and temporal summation of pain (-1.19 (2.86; -1.67), 95 % CI -2.16; -0.22), but a decrease in pain tolerance (-7.110 (54.42; 47.32), 95 % CI -13.99; -0.22) were observed. Correlation analysis suggested moderate-to-very strong statistically significant relationships in several outcomes related to pain, health, pain coping, occupational balance, occupational functioning, body anthropometrics, and pain sensitivity.

CONCLUSIONS: This study suggested that the lifestyle intervention would benefit motor skills while effects on other outcomes were unclear in adults with chronic pain. To confirm the findings, a randomized trial evaluating effectiveness is needed. Ethical committee number: SJ-307 Reg. Clinicaltrials.gov: NCT03903900.

PMID:38037749 | DOI:10.1515/sjpain-2023-0043

Mol Oncol. 2023 Dec 1. doi: 10.1002/1878-0261.13557. Online ahead of print.

ABSTRACT

Several studies have demonstrated the prognostic value of circulating tumor DNA (ctDNA); however, the correlation of mean tumor molecules (MTM)/ml of plasma and mean variant allele frequency (mVAF; %) with clinical parameters is yet to be understood. In this study, we analyzed ctDNA data in a pan-cancer cohort of 23,543 patients who had ctDNA testing performed using a personalized, tumor-informed assay (Signatera^TM , mPCR-NGS assay). For ctDNA-positive patients, correlation between MTM/ml and mVAF was examined. Two sub-analyses were performed: 1) to establish the association of ctDNA with tumor volume, and 2) to assess the correlation between ctDNA dynamics and patient outcomes. On a global cohort, a positive correlation between MTM/ml and mVAF was observed. Among 18,426 patients with longitudinal ctDNA measurements, 13.3% had discordant trajectories between MTM/ml and mVAF at subsequent timepoints. In metastatic patients receiving immunotherapy (N=51), changes in ctDNA levels expressed both in MTM/ml and mVAF showed a statistically significant association with progression-free survival; however, the correlation with MTM/ml was numerically stronger.

PMID:38037739 | DOI:10.1002/1878-0261.13557