Category: Nevin Manimala

Semergen. 2023 May 12;49(5):101986. doi: 10.1016/j.semerg.2023.101986. Online ahead of print.

ABSTRACT

Survival analysis is a statistical method that assesses the time between an initial event (inclusion of the subject in the study) and a final event, which occurs when the subject presents a previously defined characteristic. Its objective is to estimate, taking into account the time variable, the probability of a certain event occurring. It has the particularity of accepting incomplete participation times and assuming that all the factors involved in the study are homogeneous. There are several methods to calculate the probability of survival, the most used are the Kaplan-Meier and the actuarial.

PMID:37182235 | DOI:10.1016/j.semerg.2023.101986

Health Econ. 2023 May 14. doi: 10.1002/hec.4698. Online ahead of print.

ABSTRACT

Using officially registered weekly mortality data, we estimate a counterfactual death count in the absence of the pandemic and we calculate the number of excess deaths in England and Wales during 2020 after the pandemic onset. We also break down those figures by region, age, gender, place of death, and cause of death. Our results suggest that there were 82,428 (95% Confidence interval [CI]: 78,402 to 86,415) excess deaths, and 88.9% (95% CI: 84.8%-93.5%) of them was due to COVID-19, suggesting that non-COVID-19 excess mortality may have been slightly higher that what has been previously estimated. Regarding deaths not due to COVID-19, persons older than 45 years old who died at their homes, mainly from heart diseases and cancer, were the most affected group. Across all causes of death, there was increased excess mortality from dementia and Alzheimer’s disease, diabetes, Parkinson’s disease and heart-related disease, while at the same period there was a reduction in deaths from pneumonia and influenza, stroke as well as infectious diseases and accidents. Supported by regional panel event estimates, our results highlight how measures to mitigate the pandemic spread and ease the pressure on healthcare service systems may adversely affect out-of-hospital mortality from other causes.

PMID:37182218 | DOI:10.1002/hec.4698

Front Oncol. 2023 Apr 27;13:1098785. doi: 10.3389/fonc.2023.1098785. eCollection 2023.

ABSTRACT

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is an uncommon variant of non-Hodgkin lymphoma (NHL) with high aggressiveness and poor prognosis. Although complete remission (CR) could be achieved with therapy, some patients remain refractory or recurrently with a worse response to salvage treatment and poor prognosis. No consensus on rescue therapy has been established currently. This study is aimed to evaluate the efficacy of radiotherapy or chemotherapy in first-time relapsed or refractory progressed PCNSL (R/R PCNSL) and analysis the prognostic factors, to explore differences between relapsed and refractory PCNSL.

METHODS: Totally 105 R/R PCNSL patients from Huashan Hospital between 1 January 2016 and 31 December 2020 were enrolled, underwent salvage radiotherapy or chemotherapy and received response assessments after each course. PFS1 was defined as the time from diagnosis to the first time of recurrence or refractory progression. Statistical analysis was performed with SPSS version 26.0.

RESULTS: Response and survival were analyzed over a 17.5months (median) follow-up. Compared to relapsed PCNSL (n = 42), refractory PCNSL (n = 63) had a shorter median PFS1 related to deep lesions. 82.4% of cases were discovered as the second relapse or progression. ORR and PFS were both higher in relapsed PCNSL than those in refractory PCNSL. ORR of radiotherapy in both relapsed and refractory PCNSL was higher than that of chemotherapy. Elevated CSF protein and ocular involvement were related to PFS and OS after recurrence respectively in relapsed PCNSL. Age ≥ 60y was unfavorable to OS-R (OS after recurrence or progression) in refractory PCNSL.

CONCLUSIONS: Our results indicate that relapsed PCNSL responds well to inducing and salvage therapy and has a better prognosis compared to refractory PCNSL. Radiotherapy is effective for PCNSL after the first relapse or progression. Age, CSF protein level, and ocular involvement could be potential factors to predict prognosis.

PMID:37182159 | PMC:PMC10174451 | DOI:10.3389/fonc.2023.1098785

Front Oncol. 2023 Apr 25;13:1105877. doi: 10.3389/fonc.2023.1105877. eCollection 2023.

ABSTRACT

OBJECTIVE: To systematically review the differences between radiofrequency ablation and partial nephrectomy in patients with early-stage renal cell carcinoma, and to provide evidence-based medical evidence for the choice of surgery for patients with early-stage renal cell carcinoma.

METHODS: According to the search strategy recommended by the Cochrane Collaboration, Chinese databases such as CNKI, VIP Chinese Science and Technology Periodicals Database (VIP), and Wanfang Full-text Database were searched with Chinese search terms. And PubMed and MEDLINE as databases for English literature retrieval. Retrieve the relevant literature on renal cell carcinoma surgical methods published before May 2022, and further screen radiofrequency ablation and partial nephrectomy in patients with renal cell carcinoma The relevant literature on the application is analyzed. RevMan5.3 software was used for heterogeneity test and combined statistical analysis, sensitivity analysis, and subgroup analysis. Analysis, and draw forest plot, using Stata software Begger quantitative assessment of publication bias.

RESULTS: A total of 11 articles were involved, including 2958 patients. According to the Jadad scale, 2 articles were of low quality, and the remaining 9 articles were of high quality. Results of this study demonstrates the advantages of radiofrequency ablation in early-stage renal cell carcinoma. The results of this meta-analysis showed that compared with partial nephrectomy, there was significant difference in the 5-year overall survival rate between radiofrequency ablation and partial nephrectomy and there was a statistically significant difference between the two surgical methods in the 5-year relapse free survival rate of early renal cell carcinoma.

CONCLUSION: 1. Compared with partial nephrectomy, the 5-year relapse-free survival rate, the 5-year cancer specific survival rate and the overall 5-year survival rate were higher in the radiofrequency ablation group. 2. Compared with partial nephrectomy, there was no significant difference in the postoperative local tumor recurrence rate of radiofrequency ablation. 3. Compared with partial resection, radiofrequency ablation is more beneficial to patients with renal cell carcinoma.

PMID:37182152 | PMC:PMC10166822 | DOI:10.3389/fonc.2023.1105877

Front Oncol. 2023 Apr 26;13:1072652. doi: 10.3389/fonc.2023.1072652. eCollection 2023.

ABSTRACT

INTRODUCTION: Multi-professional interdisciplinary tumor boards (ITB) are essential institutions to discuss all newly diagnosed, relapsed or complex cancer patients in a team of specialists to find an optimal cancer care plan for each individual patient with regard to national and international clinical practice guidelines, patient´s preference and comorbidities. In a high-volume cancer center, entity-specific ITBs take place at least once a week discussing a large number of patients. To a high level of expertise and dedication, this also requires an enormous amount of time for physicians, cancer specialists and administrative support colleagues, especially for radiologists, pathologists, medical oncologists and radiation oncologists, who must attend all cancer-specific boards according to certification requirements.

METHODS: In this 15-month prospective German single-center analysis, we examined the established structures of 12 different cancer-specific ITBs at the certified Oncology Center and demonstrate tools helping to optimize processes before, during and after the boards for optimal, time-saving procedures.

RESULTS: By changing pathways, introducing revised registration protocols and new digital supports we could show that the workload of preparation by radiologists and pathologists could be reduced significantly by 22.9% (p=<0.0001) and 52.7% (p=<0.0001), respectively. Furthermore, two questions were added to all registration forms about the patient´s need for specialized palliative care support that should lead to more awareness and early integration of specialized help.

DISCUSSION: There are several ways to reduce the workload of all ITB team members while maintaining high quality recommendations and adherence to national and international guidelines.

PMID:37182140 | PMC:PMC10171921 | DOI:10.3389/fonc.2023.1072652

Front Oncol. 2023 Apr 25;13:1131013. doi: 10.3389/fonc.2023.1131013. eCollection 2023.

ABSTRACT

Extra-axial brain tumors are extra-cerebral tumors and are usually benign. The choice of treatment for extra-axial tumors is often dependent on the growth of the tumor, and imaging plays a significant role in monitoring growth and clinical decision-making. This motivates the investigation of imaging biomarkers for these tumors that may be incorporated into clinical workflows to inform treatment decisions. The databases from Pubmed, Web of Science, Embase, and Medline were searched from 1 January 2000 to 7 March 2022, to systematically identify relevant publications in this area. All studies that used an imaging tool and found an association with a growth-related factor, including molecular markers, grade, survival, growth/progression, recurrence, and treatment outcomes, were included in this review. We included 42 studies, comprising 22 studies (50%) of patients with meningioma; 17 studies (38.6%) of patients with pituitary tumors; three studies (6.8%) of patients with vestibular schwannomas; and two studies (4.5%) of patients with solitary fibrous tumors. The included studies were explicitly and narratively analyzed according to tumor type and imaging tool. The risk of bias and concerns regarding applicability were assessed using QUADAS-2. Most studies (41/44) used statistics-based analysis methods, and a small number of studies (3/44) used machine learning. Our review highlights an opportunity for future work to focus on machine learning-based deep feature identification as biomarkers, combining various feature classes such as size, shape, and intensity. Systematic Review Registration: PROSPERO, CRD42022306922.

PMID:37182138 | PMC:PMC10167010 | DOI:10.3389/fonc.2023.1131013

Cureus. 2023 Apr 10;15(4):e37356. doi: 10.7759/cureus.37356. eCollection 2023 Apr.

ABSTRACT

Objective This study aims to investigate the quality of life (QOL), parental stress, and perception of social support in parents of children with neurodevelopmental disorders (NDD) in Saudi Arabia. Background Studies have shown that parenting a child with NDD impacts the QOL, parental stress, and life satisfaction of parents. Those studies, however, assessed those factors separately as well as focusing on autism spectrum disorder (ASD). This study will use a mixed methods approach to gain a deeper understanding of those three factors as they related to parenting a child with NDD. Method Data about parental stress, QOL, and other related sociodemographic variables were collected from parents of children with NDD (N= 63). Next, semi-structured interviews were conducted with four of those parents to gain a deeper understanding of the parents’ QOL, parental stress, and perception of social support. Results An analysis of variance (ANOVA) test demonstrated that parents who had children with severe symptoms had poorer QOL and higher levels of parental stress compared to parents who had children who had moderate and mild symptoms. In addition, parents who had children with ASD had poorer QOL compared to all of the other disorders. There was no statistically significant difference in QOL and parental stress between mothers and fathers. The thematic analysis highlighted that the most significant challenges they face are financial, familial, and well-being worries. Conclusion In conclusion, this study shows that parents of children with NDD exhibited higher levels of parental stress and lower levels of QOL depending on the diagnosis and intensity of the child’s symptoms. In addition, the interviews highlighted some key challenges that the parents felt affected their QOL and stress levels, as well as their views on family, friends, and community social support. Implications This study can help in developing or improving supportive programs and interventions for parents with children with NDD to enhance their QOL, reduce parental stress, and create a better social support system.

PMID:37182086 | PMC:PMC10171881 | DOI:10.7759/cureus.37356

Cureus. 2023 Apr 10;15(4):e37408. doi: 10.7759/cureus.37408. eCollection 2023 Apr.

ABSTRACT

Background The clinical condition of epidemic dropsy is caused by the consumption of edible oils contaminated with Argemone mexicana oil. Two of the most toxic alkaloids found in argemone oil are sanguinarine and dehydrosanguinarine, which cause capillary dilation, proliferation, and increased permeability. Extreme cardiac decompensation leading to congestive heart failure and glaucoma resulting in blindness are the most serious consequences of epidemic dropsy. Materials and methods All patients attending the medicine department of Tezpur Medical College and Hospital with clinical features of epidemic dropsy were included in the study after obtaining informed consent. All patients, after a complete history, underwent a thorough clinical examination, and findings were recorded using a pre-formed proforma. Along with routine blood examination, patients were also evaluated with echocardiography, ECG, and chest X-ray. Cooking oil samples obtained from patients were investigated for the presence of sanguinarine in a standardized laboratory with the help of the district authority. The statistical analysis was done using MS Excel 2017. Results Out of 38 patients, 36 were male (94.7%), and only two were female (5.2%). Male to female ratio was 18:1. This difference in sex ratio may be due to the fact that only severely ill patients attended our tertiary care hospital. In contrast, moderate and mildly ill patients were treated in local hospitals. The mean age of patients was 28.1 years, and the mean length of hospital stay was eight days. Bilateral pitting type of ankle edema was the most common clinical manifestation, and all 38 patients (100%) exhibited edema. A total of 76% of patients had dermatological manifestations. Sixty-two percent of patients had gastrointestinal manifestations. In cardiovascular manifestation, persistent tachycardia was seen in 52% of patients, pansystolic murmur was best heard in the apical area in 42% of patients, and 21 percent had evidence of a raised jugular venous pressure (JVP). Five percent of patients had pleural effusion. Sixteen percent of patients had ophthalmological manifestations. Eight patients (21%) required ICU care. The in-hospital fatality rate was 10.53% (n=4). Of the expired patients, 100% were male. The most common cause of death was cardiogenic shock (75%), followed by septic shock (25%). Conclusion From our study, it was found that most of the patients were male, with an age group of 25-45 years. The most common clinical manifestation was dependent edema, along with signs of heart failure. Other common manifestations were dermatological and gastrointestinal. The severity and outcome were directly related to the delay in seeking medical consultation and diagnosis.

PMID:37182084 | PMC:PMC10172017 | DOI:10.7759/cureus.37408

Cureus. 2023 Apr 11;15(4):e37444. doi: 10.7759/cureus.37444. eCollection 2023 Apr.

ABSTRACT

Background Otorhinolaryngology (ENT) illnesses commonly affect all individuals with a broad range of symptoms, and most causes are preventable. According to the WHO, more than 278 million people have bilateral hearing loss. Locally, a previously published study done in Riyadh showed that most participants (79.4%) had a poor level of knowledge on common ENT-related diseases. The current study aims to investigate and explore the knowledge of and attitudes toward common ENT problems among students in Makkah City, Saudi Arabia. Method This descriptive, cross-sectional study used an Arabic-language electronic questionnaire to assess knowledge of common ENT problems. It was distributed to medical students at Umm Al-Qura University and students attending Makkah City high schools in Saudi Arabia between November 2021 and October 2022. The sample size was calculated to be 385 participants. Results Overall 1080 respondents were enrolled in this survey from Makkah City. Participants with good knowledge of common ENT diseases were over 20 years of age with a p-value <0.001. Furthermore, females also had a significant p-value of <0.004, and those with bachelor’s or university degrees showed a statistically significant p-value of <0.001. Conclusion Female participants with bachelor’s or university degrees and participants aged 20 and older showed superior knowledge. Our findings indicate that students need educational implications and awareness campaigns to increase their knowledge, practice, and perception toward common otorhinolaryngology-related issues.

PMID:37182080 | PMC:PMC10174595 | DOI:10.7759/cureus.37444

Cureus. 2023 Apr 10;15(4):e37366. doi: 10.7759/cureus.37366. eCollection 2023 Apr.

ABSTRACT

Background Baska Mask (BM) is a third-generation supraglottic airway device with a self-inflating cuff. This study aimed to evaluate the efficacy of the BM compared to ProSeal laryngeal mask airway (PLMA) regarding insertion time, ease of insertion, and oropharyngeal seal pressure in patients undergoing elective surgeries under general anesthesia for less than two hours. Methods This prospective, randomized, double-blind comparative study was done on 64 patients randomly divided into two groups, with 32 patients in the PLMA group (Group A) and 32 in the BM group (Group B). Individuals with a body mass index (BMI) of more than 30, a history of nausea/vomiting, or pharyngeal pathology were excluded from the trial. After induction with propofol 3-4 mg/kg, fentanyl 1-2 mcg/kg, and the neuromuscular blockade was achieved with atracurium 0.5 mg/kg, patients were inserted with either BM (n= 32) or PLMA (n= 32). The primary outcome measure was the time taken for insertion and ease of insertion. Secondary outcome measures included the number of attempts, oropharyngeal seal pressure (OSP), and laryngopharyngeal morbidity (trauma to lips, blood staining, and sore throat) immediately and 24 hours postoperatively. Results Demographic data were comparable and statistically insignificant. Regarding time and ease of insertion, the BM could be inserted in a lesser time of 24±1.136 seconds compared to PLMA which took 28.59±1.682 seconds, with a high success rate in the first attempt which was statistically significant. The BM provided a higher OSP (31.34 +1.638 cmH2O) when compared to PLMA (24.81±1.469 cmH2O) and was statistically significant. Complications associated with insertion trauma to the lip, blood staining, and sore throat were more in PLMA (15.6%, 15.6 %, 9.4%, respectively) compared to the BM (6.3%, 3.1%, 3.1%, respectively), and statistically insignificant. Conclusion BM had higher first-attempt successful insertion with better OSP compared to PLMA in patients under controlled ventilation.

PMID:37182077 | PMC:PMC10170866 | DOI:10.7759/cureus.37366