Category: Nevin Manimala

West Afr J Med. 2023 May 27;40(5):533-540.

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE) is a cause of increased morbidity and mortality in cancer patients. VTE is the second leading cause of death in cancer patients. Risk assessment models have been developed to identify patients at risk of VTE for thromboprophylaxis. Risk scores of patients in our environment have not been adequately investigated.

OBJECTIVE: The study evaluates the association of thrombotic risk assessment scores (using the modified Khorana risk assessment tool) and soluble P-selectin levels with thrombotic events in patients with lymphoid cancer.

METHODS: This is a comparative cross-sectional study conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH, Nnewi, Anambra State). Forty-five patients with lymphoid malignancy and 45 apparently healthy subjects participated in the study. The modified Khorana risk assessment score was used to assess cancer-associated thrombotic risk. Blood sample was collected for soluble P-selectin estimation. Data were analyzed with SPSS version 23.

RESULTS: The age of subjects with lymphoid neoplasm and controls were 49.1±15.8 years, and 49.6±11.1 years respectively (p = 0.548). Subjects with lymphoid neoplasm consist of 26 (57.8%) males and 19 (42.2%) females while the controls consist of 25 (55.6%) males and 20 (44.4%) females. Non-Hodgkin’s lymphoma was the most frequent of lymphoid neoplasm (18, 40.0%), followed by multiple myeloma (10, 22%), CLL (9, 20%), ALL (6, 13.0%) and Hodgkin’s lymphoma (2, 4.0%). Thirty-five (77.8%) subjects with lymphoid neoplasm had intermediate risk scores and 10 (22.2%) had high-risk scores. Nineteen (42.2%) of the controls had intermediate risk and 26 (57.8%) low risk. The differences in proportion were statistically significant (p < 0.001). The median (IQR) levels of soluble P-selectin were significantly higher in patients with lymphoid neoplasm (12.2 vs. 7.0ng/mL, p <0.001). Three (6.6%) patients with lymphoid malignancies had deep vein thrombosis confirmed by a Doppler ultrasound scan.

CONCLUSION: Lymphoid malignancy is associated with relatively higher thrombotic risk scores, sP-selectin levels, and venous thromboembolic events.

CONTEXTE: La thromboembolie veineuse (TEV) est une cause de morbidité et de mortalité accrues chez les patients atteints de cancer. La TEV est la deuxième cause de décès chez les patients atteints de cancer. Des modèles d’évaluation des risques ont été mis au point pour identifier les patients présentant un risque de TEV en vue d’une thromboprophylaxie. Les scores de risque des patients dans notre environnement n’ont pas été étudiés de manière adéquate.

OBJECTIF: L’étude évalue l’association des scores d’évaluation du risque thrombotique (en utilisant l’outil modifié d’évaluation du risque de Khorana) et des niveaux de P-sélectine soluble avec les événements thrombotiques chez les patients atteints d’un cancer lymphoïde.

MÉTHODES: Il s’agit d’une étude transversale comparative menée au Nnamdi Azikiwe University Teaching Hospital (NAUTH, Nnewi, État d’Anambra). Quarante-cinq patients atteints d’un cancer lymphoïde et 45 sujets apparemment sains ont participé à l’étude. Le score modifié d’évaluation du risque de Khorana a été utilisé pour évaluer le risque thrombotique associé au cancer. Un échantillon de sang a été prélevé pour l’estimation de la P-sélectine soluble. Les données ont été analysées avec SPSS version 23.

RÉSULTATS: L’âge des sujets atteints de néoplasme lymphoïde et des témoins était respectivement de 49,1±15,8 ans et 49,6±11,1 ans (p = 0,548). Les sujets atteints de néoplasme lymphoïde sont 26 (57,8 %) hommes et 19 (42,2 %) femmes, tandis que les témoins sont 25 (55,6 %) hommes et 20 (44,4 %) femmes. Le lymphome non hodgkinien était le néoplasme lymphoïde le plus fréquent (18, 40 %), suivi du myélome multiple (10, 22 %), de la LLC (9, 20 %), de la LAL (6, 13 %) et du lymphome hodgkinien (2, 4 %). Trente-cinq (77,8 %) sujets atteints de néoplasmes lymphoïdes présentaient un score de risque intermédiaire et 10 (22,2 %) un score de risque élevé. Dix-neuf (42,2 %) des témoins présentaient un risque intermédiaire et 26 (57,8 %) un risque faible. Les différences de proportion étaient statistiquement significatives (p < 0,001). Les niveaux médians (IQR) de P-sélectine soluble étaient significativement plus élevés chez les patients atteints de néoplasme lymphoïde (12,2 vs. 7,0 ng/mL, p <0,001). Trois (6,6 %) patients atteints de tumeurs lymphoïdes ont présenté une thrombose veineuse profonde confirmée par une échographie Doppler.

CONCLUSION: Les tumeurs malignes lymphoïdes sont associées à des scores de risque thrombotique, des taux de sP-sélectine et des événements thromboemboliques veineux relativement plus élevés.

MOTS-CLÉS: Malignité lymphoïde, Thrombose, P-sélectine soluble, Scores d’évaluation du risqué.

PMID:37247203

Ir J Med Sci. 2023 May 29. doi: 10.1007/s11845-023-03379-6. Online ahead of print.

ABSTRACT

PURPOSE: Vascular endothelial growth factor (VEGF) has a critical role in age-related macular degeneration (AMD), and intravitreal injection of anti-VEGF drugs is the mainstay of neovascular AMD treatment. Blood neutrophil-to-lymphocyte ratio (NLR) is shown to be a biomarker of inflammation in AMD. We aimed to investigate the role of NLR in predicting favorable short-term anti-VEGF treatment results in neovascular AMD patients.

METHODS: A total of 112 patients diagnosed with exudative AMD and had taken 3 monthly intravitreal bevacizumab injections were analyzed retrospectively. Medical records were reached to obtain neutrophil and lymphocyte values to calculate NLR. Best-corrected visual acuity and central macular thickness (CMT) measurements were recorded at each visit. T test or Mann-Whitney U test was used to compare continuous variables, and chi-square test was used to compare categorical variables. Receiver operating characteristics curve (ROC) analysis was performed to determine cut-off, sensitivity, and specificity values. P value of ≤ 0.05 was considered statistically significant.

RESULTS: The mean age was 68.1 ± 7.2 years, and the mean NLR was 2.11 ± 0.81. The ROC analysis revealed a cut off value of 2.0 for NLR to predict at least 100 μm CMT change (sensitivity 87.1%; specificity 87.8%) and a cut off value of 2.4 for NLR to predict at least 0.1 logMAR visual improvement (sensitivity 77.2%; specificity 64.8%) after 3 monthly IVT bevacizumab injections.

CONCLUSION: NLR can provide additional prognostic information for the identification of patients with a good initial response to anti-VEGF therapy.

PMID:37247185 | DOI:10.1007/s11845-023-03379-6

Environ Sci Pollut Res Int. 2023 May 29. doi: 10.1007/s11356-023-27854-w. Online ahead of print.

ABSTRACT

Sustainable diets and food production systems are important for healthy life and future generations. This goal should be reachable by consumer motivations. The study aim is the evaluation of awareness and knowledge of sustainability and logo/claims related with sustainability.Participants’ knowledge about sustainability definition and logos/claims related to sustainability were assessed by an online-questionnaire. The questionnaire involved the calculation of annual dietary carbon emissions (kg), nitrogen waste (g), and water consumption (L).Four hundred-two volunteers participated in the study (male: 24.9%; female: 75.1). Only 44 participants (10.9%) explained what sustainable nutrition definition, correctly. The rates of knowledge about logos were quite low; 29.4% for organic product logo; 26.6% for Good farming practice logo; 86.1% for Recycle logo; and 8.0% for Eco-label logo, respectively. The education status of participants affected to knowledge of logo/claim ratio (p < 0.05). Ethic production and environmental impact statement information were care of participants’ ratio of 33.6% and 34.1%, respectively. The mean dietary carbon emission of participants was 551.0 ± 343.6 kg/year, which was 81% of the upper limit (680 kg/year). The mean nitrogen waste was 3238.8 ± 4620.9 g/year and mean water consumption was 91,538.7 ± 157,537.9 L/year. Mediterranean diet model carbon emission and nitrogen waste were higher than other diet models, omnivore diet models had more water consumption than other diet models. But these differences were not found statistically significant (p > 0.05).Sustainable nutrition can be achieved via consumers’ awareness. Food industry and government should encourage the people about promotion of sustainable food preferences.

PMID:37247143 | DOI:10.1007/s11356-023-27854-w

Int J Comput Assist Radiol Surg. 2023 May 29. doi: 10.1007/s11548-023-02965-4. Online ahead of print.

ABSTRACT

BACKGROUND: Current artificial intelligence studies for supporting CT screening tasks depend on either supervised learning or detecting anomalies. However, the former involves a heavy annotation workload owing to requiring many slice-wise annotations (ground truth labels); the latter is promising, but while it reduces the annotation workload, it often suffers from lower performance. This study presents a novel weakly supervised anomaly detection (WSAD) algorithm trained based on scan-wise normal and anomalous annotations to provide better performance than conventional methods while reducing annotation workload.

METHODS: Based on surveillance video anomaly detection methodology, feature vectors representing each CT slice were trained on an AR-Net-based convolutional network using a dynamic multiple-instance learning loss and a center loss function. The following two publicly available CT datasets were retrospectively analyzed: the RSNA brain hemorrhage dataset (normal scans: 12,862; scans with intracranial hematoma: 8882) and COVID-CT set (normal scans: 282; scans with COVID-19: 95).

RESULTS: Anomaly scores of each slice were successfully predicted despite inaccessibility to any slice-wise annotations. Slice-level area under the curve (AUC), sensitivity, specificity, and accuracy from the brain CT dataset were 0.89, 0.85, 0.78, and 0.79, respectively. The proposed method reduced the number of annotations in the brain dataset by 97.1% compared to an ordinary slice-level supervised learning method.

CONCLUSION: This study demonstrated a significant annotation reduction in identifying anomalous CT slices compared to a supervised learning approach. The effectiveness of the proposed WSAD algorithm was verified through higher AUC than existing anomaly detection techniques.

PMID:37247113 | DOI:10.1007/s11548-023-02965-4

Lasers Med Sci. 2023 May 29;38(1):130. doi: 10.1007/s10103-023-03790-6.

ABSTRACT

Solar lentigo (SL) commonly occurs as hyperpigmented macules in areas exposed to ultraviolet radiation. It typically shows an increased number of melanocytes in the basal cell layer of the skin, with or without elongated rete ridges. This retrospective study aimed to evaluate the characteristic dermoscopic patterns, reflecting different histopathological features, which might be valuable in predicting the possibility of postinflammatory hyperpigmentation (PIH) occurring after laser treatment. In total, 88 Korean patients diagnosed with biopsy-proven SL (a total of 90 lesions were diagnosed) between January, 2016 and December, 2021 were included. Histopathological patterns were classified into six categories. Dermoscopic features were classified into six categories. Pseudonetwork pattern and rete ridge elongation showed a statistically significant negative correlation. This means that a flatter epidermis is likely to manifest as a pseudonetwork pattern. The erythema pattern showed a significant positive correlation with interface changes and inflammatory infiltration. Bluish-gray granules (peppering), a characteristic dermoscopic finding, showed significant positive correlations with interface changes, inflammatory infiltration, and dermal melanophages. Clinicians considering laser treatment for patients with SL should perform dermoscopic tests before treatment. The pseudonetwork relates to flattened epidermis and fewer Langerhans cells; thus, a lower remission of PIH after laser treatment might be expected. If bluish-gray granules or erythema are observed, inflammatory conditions are likely to be involved. In such cases, regression of the inflammatory response through drug therapy, such as topical corticosteroids, should be a priority option before laser treatment.

PMID:37247095 | DOI:10.1007/s10103-023-03790-6

Clin Oral Investig. 2023 May 29. doi: 10.1007/s00784-023-05028-9. Online ahead of print.

ABSTRACT

OBJECTIVES: This clinical study aimed to compare the performance of various virtual articulator (VA) mounting procedures in the participants’ natural head position (NHP).

MATERIALS AND METHODS: Fourteen participants with acceptable dentitions and jaw relationships were recruited in this study registered in the Clinical Trials Registry (#NCT05512455; August 2022). A virtual facebow was designed for virtual mounting and hinge axis measurement. Intraoral scans were obtained, and landmarks were placed on each participant’s face to register the horizontal plane in NHP. Six virtual mounting procedures were performed for each participant. The average facebow group (AFG) used an indirect digital procedure by using the average facebow record. The average mounting group (AMG) aligned virtual arch models to VA’s average occlusal plane. The smartphone facial scan group (SFG) and professional facial scan group (PFG) used facial scan images with Beyron points and horizontal landmarks, respectively. The cone-beam computed tomography (CBCT) scan group (CTG) used the condyle medial pole, and horizontal landmarks were applied. The kinematic facebow group (KFG) served as the control group, and a direct digital procedure was applied using a kinematic digital facebow and the 3D skull model. Deviations of the reference plane and the hinge axis between the KFG and other groups were calculated. The inter-observer variability in virtual mounting software operation was then evaluated using the interclass correlation coefficient (ICC) test.

RESULTS: In virtual condylar center deviations, the CTG had the lowest condylar deviations. The AFG showed larger condylar deviations than PFG, SFG, and CTG. There was no statistically significant difference between the AFG and the AMG and between the PFG and the SFG. In reference plane deviations, the AMG showed the largest angular deviation (8.23 ± 3.29°), and the AFG was 3.89 ± 2.25°. The angular deviations of PFG, SFG, and CTG were very small (means of each group < 1.00°), and there was no significant difference among them. There was no significant difference between the researchers, and the ICC test showed moderate to excellent reliability for the virtual condylar center and good to excellent reliability for the reference plane in the operation of the virtual mounting software.

CONCLUSIONS: CBCT scan provided the lowest hinge axis deviation in virtual mounting compared to average mounting, facebow record, and facial scans. The performance of the smartphone facial scanner in virtual mounting was similar to that of the professional facial scanner. Direct virtual mounting procedures using horizontal landmarks in NHP accurately recorded the horizontal plane.

CLINICAL RELEVANCE: Direct digital procedures can be reliably used for virtual articulator mounting. The use of a smartphone facial scanner provides a suitable and radiation-free option for clinicians.

PMID:37247089 | DOI:10.1007/s00784-023-05028-9

Clin Oral Investig. 2023 May 29. doi: 10.1007/s00784-023-05093-0. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate changes on root canal morphology in patients with different ages using micro-CT technology.

MATERIALS AND METHODS: Mandibular first molars (n = 150) were scanned at a pixel size of 13.68 µm, categorized into 3 groups according to patient’s age and analyzed regarding configuration, orifices, apical foramina, root length, canal volume, and surface area. Morphological 2D and 3D parameters were evaluated in distal roots with Type I configuration (n = 109) as well as the morphology of isthmuses Types I and III in 68 mesial roots. One-way ANOVA post hoc Tukey and Kruskal-Wallis tests were used for statistical analyses (α = 5%).

RESULTS: A great variation in the canal configuration was found. No difference was observed in roots’ length (p > 0.05). Canal volume reduced with age (p < 0.05), while surface area increased (p < 0.05) in patients ≤ 30 years. There was no difference in canal/root length, area, and from foramen to the apex in distal roots with Type I configuration (p > 0.05), but 2D and 3D parameters significantly decreased with age (p < 0.05). Overall, the diameter of the isthmuses’ roof reduced with age (p < 0.05). In patients ≥ 31 years with Type III isthmus the distance from the isthmus floor to the foramen of the mesiolingual canal also decreased (p < 0.05).

CONCLUSION: Overall, the internal morphology of the mesial roots of mandibular first molars was more affected by aging than distal canals. The most relevant tested parameter that significantly reduced in both roots was the volume of the root canal systems.

CLINICAL RELEVANCE: A detailed evaluation of fine anatomical aspects of the root canal system of mandibular first molars of patients with different ages showed that the internal morphology of mesial roots is more affected by aging than distal canals.

PMID:37247087 | DOI:10.1007/s00784-023-05093-0

J Cancer Res Clin Oncol. 2023 May 29. doi: 10.1007/s00432-023-04882-0. Online ahead of print.

ABSTRACT

PURPOSE: The potential role of epithelium-specific genes through the adenoma-carcinoma sequence in the development of colorectal cancer (CRC) remains unknown. Therefore, we integrated single-cell RNA sequencing and bulk RNA sequencing data to select diagnosis and prognosis biomarkers for CRC.

METHODS: The CRC scRNA-seq dataset was used to describe the cellular landscape of normal intestinal mucosa, adenoma and CRC and to further select epithelium-specific clusters. Differentially expressed genes (DEGs) of epithelium-specific clusters were identified between intestinal lesion and normal mucosa in the scRNA-seq data throughout the adenoma-carcinoma sequence. Diagnostic biomarkers and prognostic biomarker (the risk score) for CRC were selected in the bulk RNA-seq dataset based on DEGs shared by the adenoma epithelium-specific cluster and the CRC epithelium-specific cluster (shared-DEGs).

RESULTS: Among the 1063 shared-DEGs, we selected 38 gene expression biomarkers and 3 methylation biomarkers that had promising diagnostic power in plasma. Multivariate Cox regression identified 174 shared-DEGs as prognostic genes for CRC. We combined 1000 times LASSO-Cox regression and two-way stepwise regression to select 10 prognostic shared-DEGs to construct the risk score in the CRC meta-dataset. In the external validation dataset, the 1- and 5-year AUCs of the risk score were higher than those of stage, the pyroptosis-related genes (PRG) score and the cuproptosis-related genes (CRG) score. In addition, the risk score was closely associated with the immune infiltration of CRC.

CONCLUSION: The combined analysis of the scRNA-seq dataset and the bulk RNA-seq dataset in this study provides reliable biomarkers for the diagnosis and prognosis of CRC.

PMID:37247080 | DOI:10.1007/s00432-023-04882-0

Dysphagia. 2023 May 29. doi: 10.1007/s00455-023-10595-w. Online ahead of print.

ABSTRACT

This study aims to compare the effectiveness of conventional dysphagia therapy (CDT), neuromuscular electrical stimulation (NMES), and transcranial direct current stimulation (tDCS) in the treatment of post-stroke dysphagia. A single-blind randomized controlled trial was conducted with 40 acute stroke patients – 18 females and 22 males with a mean age of 65.8 ± 11.9. The subjects were grouped into 4, with 10 individuals in each. The procedures administered to groups were as follows: the first group, sham tDCS and sham NMES; the second group, tDCS and sham NMES; the third group, NMES and sham tDCS; and the fourth group, all therapy procedures. CDT was applied to all groups either as a standalone procedure or combined with one or two of the instrumental techniques. Gugging Swallowing Screen (GUSS) and Videofluoroscopic Swallowing Study (VFSS) were employed to determine the severity of dysphagia and the effectiveness of treatment modalities. Additionally, the Penetration Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Dysphagia Severity Rating Scale (DSRS) were administered to interpret VFSS data. Pre- and post-treatment comparisons of all groups have revealed a statistically significant difference for all parameters except for the PAS scores at International Dysphagia Diet Standardization Initiative (IDDSI)-Level 4 consistencies. However, the differences between pre- and post-treatment scores of the fourth group across all parameters were significant – GUSS (p = 0.005), FOIS (p = 0.004), DSRS (p = 0.005), PAS IDDSI-4 (p = 0.027), PAS IDDSI-0 (p = 0.004). Inter-group comparisons, on the other hand, pointed out that the difference between pre- and post-treatment GUSS, FOIS, DSRS, and PAS scores at IDDSI Level-0 consistencies was statistically significant for all groups – GUSS (p = 0,009), FOIS (p = 0,004), DSRS (p = 0,002), PAS IDDSI-0 (p = 0,049). Closer examination of treatment groups indicated that the tDCS + CDT group, the NMES + CDT group, and the group that underwent the combination of three modalities made better progress than the one that was treated with only CDT. Though not statistically significant, the NMES + CDT group achieved better improvement than the tDCS + CDT group. This study has yielded that the group in which NMES, tDCS, and CDT were applied in combination has achieved better results than all the other groups. All treatment modalities applied to accelerate the general recovery process in acute stroke patients with dysphagia were found to be effective for the treatment of post-stroke swallowing disorders. The use of instrumental treatments such as NMES and tDCS enhanced the effectiveness of the treatment and provided more significant progress. Furthermore, combining treatment modalities such as NMES and tDCS was more effective when compared to using only conventional therapy. As a result, the most effective treatment outcomes were obtained by the group receiving CDT, NMES, and tDCS in combination. Therefore, the use of combined approaches has been recommended in appropriate patients; yet the provisional results should be tested in randomized trials with more participants.

PMID:37247074 | DOI:10.1007/s00455-023-10595-w

Support Care Cancer. 2023 May 29;31(6):360. doi: 10.1007/s00520-023-07825-0.

ABSTRACT

PURPOSE: To investigate the fear of falling, physical activity, and functionality in patients with lymphedema in the lower extremities.

METHODS: Sixty-two patients who developed stage 2-3 lymphedema in the lower extremities due to primary or secondary causes (age: 56.03 ± 7.83 years) and 59 healthy controls (age: 54.61 ± 5.43 years) were included in the study. The sociodemographic and clinical characteristics of all individuals included in the study were recorded. In both groups, fear of falling was evaluated with the Tinetti Falls Efficacy Scale (TFES), lower extremity functionality with the Lower Extremity Functional Scale (LEFS), and physical activity with the International Physical Activity Questionnaire-Short Form (IPAQ-SF).

RESULTS: There was no statistically significant difference between the demographic characteristics of the groups (p > 0.05). The primary and secondary lymphedema groups had similar LEFS (p = 0.207, d = 0.16), IPAQ (p = 0.782, d = 0.04), and TFES (p = 0.318, d = 0.92) scores. However, the TFES score of the lymphedema group was significantly higher than that of the control group (p < 0.01, d = 0.52), while the LEFS (p < 0.01, d = 0.77) and IPAQ scores (p = 0.001, d = 0.30) were significantly higher in the latter. There was a negative correlation between LEFS and TFES (r = -0.714, p < 0.001) and between TFES and IPAQ (r = -0.492, p < 0.001). LEFS and IPAQ were positively correlated (r = 0.619, p < 0.001).

CONCLUSION: It was determined that individuals with lymphedema developed a fear of falling, and their functionality was negatively affected. This negative effect on functionality can be attributed to reduced physical activity and an increased fear of falling.

PMID:37247048 | DOI:10.1007/s00520-023-07825-0