Category: Nevin Manimala

Oral Oncol. 2023 Apr 6;140:106391. doi: 10.1016/j.oraloncology.2023.106391. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to demonstrate the temporal trend in incidence of head and neck cancer (HNC) in Taiwan.

MATERIALS AND METHODS: Patients with a HNC were retrieved from the Taiwan’s Health Insurance Database. We identified 16,894 patients aged ≥20 years who had received a first-time diagnosis of cancer of the oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, sinonasal, salivary gland or thyroid gland between 2010 and 2018. We calculated the annual incidence rate per 100,000 population, overall, and classified by gender and cancer type. We also used the annual percent change (APC) to characterize trends in head and neck cancer rates over time.

RESULTS: The incidence rate showed a gradual decline during this period from 2010 to 2018 with an APC of -2.81% (p < 0.001). Within gender groups, the decline was not statistically significant among females (APC = -1.69, 95% CI = -3.58 ∼ 0.23, p = 0.080). Within cancer types, strikingly high magnitude and statistically significant declines were observed in respect of cancer of the nasopharynx (APC = -7.89%, 95% CI = -9.43%∼-6.31%, p < 0.001), sinonasal cancer (APC = -10.08%, 95% CI = -16.66%∼-2.99%, p = 0.012) and oropharyneal cancer (APC = -9.47%, 95% CI = -15.15%∼-3.42%, p = 0.013) over the study period. In contrast, there was a statistically significant increase in incidence on thyroid cancer over the study period with an APC of 4.75% (95% CI = -2.81%∼6.75%, p < 0.001).

CONCLUSIONS: HNCs in Taiwan are showing a decreasing trend, led by the upper respiratory and oropharyngeal cancers. However, there was a concurrent increasing trend of the incidence on thyroid cancer. These trends may be attributable to changing lifestyles and behavioral choices in Taiwan.

PMID:37030023 | DOI:10.1016/j.oraloncology.2023.106391

J Pediatr Nurs. 2023 Apr 6;71:79-87. doi: 10.1016/j.pedn.2023.03.012. Online ahead of print.

ABSTRACT

PURPOSE: A prerequisite for successful pain management is identifying the pain and assessing its intensity. The aim of this study was to describe parents’ perceptions of their child’s pain assessment in hospital care.

DESIGN AND METHODS: This study was a descriptive cross-sectional study. A questionnaire was completed by parents (n = 261) whose child was hospitalized in one of the pediatric units (n = 6) of the University Hospital in Finland. Quantitative data were analyzed using statistical methods; open-ended data were analyzed using inductive content analysis.

RESULTS: Parents reported that their children experienced moderate (36%) to severe pain (42%) during hospitalization. The most intense pain experienced by the children was associated with needle-related procedures (41%). A large proportion of parents (83%) were involved in their child’s pain assessment. Parents were satisfied with their child’s pain assessment but perceived some shortcomings. Parents hoped that a variety of methods would be used to assess their child’s pain and that the parents’ and child’s views on pain would be taken into account.

CONCLUSIONS: Most children experience moderate to severe pain during hospitalization. Parents are often involved in pain assessment but are rarely instructed to use pain scales.

PRACTICE IMPLICATIONS: Child’s pain should be assessed regularly and frequently enough. It is important that the child and parents are involved in shared decision-making about pain assessment and treatment, and they have opportunities to ask questions. Guidance should be offered to parents about the use of pain assessment scales.

PMID:37030017 | DOI:10.1016/j.pedn.2023.03.012

Schizophr Bull. 2023 Apr 8:sbad041. doi: 10.1093/schbul/sbad041. Online ahead of print.

ABSTRACT

BACKGROUND: Psychosis is related to neurochemical changes in deep-brain nuclei, particularly suggesting dopamine dysfunctions. We used an magnetic resonance imaging-based technique called quantitative susceptibility mapping (QSM) to study these regions in psychosis. QSM quantifies magnetic susceptibility in the brain, which is associated with iron concentrations. Since iron is a cofactor in dopamine pathways and co-localizes with inhibitory neurons, differences in QSM could reflect changes in these processes.

METHODS: We scanned 83 patients with first-episode psychosis and 64 healthy subjects. We reassessed 22 patients and 21 control subjects after 3 months. Mean susceptibility was measured in 6 deep-brain nuclei. Using linear mixed models, we analyzed the effect of case-control differences, region, age, gender, volume, framewise displacement (FD), treatment duration, dose, laterality, session, and psychotic symptoms on QSM.

RESULTS: Patients showed a significant susceptibility reduction in the putamen and globus pallidus externa (GPe). Patients also showed a significant R2* reduction in GPe. Age, gender, FD, session, group, and region are significant predictor variables for QSM. Dose, treatment duration, and volume were not predictor variables of QSM.

CONCLUSIONS: Reduction in QSM and R2* suggests a decreased iron concentration in the GPe of patients. Susceptibility reduction in putamen cannot be associated with iron changes. Since changes observed in putamen and GPe were not associated with symptoms, dose, and treatment duration, we hypothesize that susceptibility may be a trait marker rather than a state marker, but this must be verified with long-term studies.

PMID:37030007 | DOI:10.1093/schbul/sbad041

Isotopes Environ Health Stud. 2023 Apr 8:1-14. doi: 10.1080/10256016.2023.2195175. Online ahead of print.

ABSTRACT

The authors studied the atmospheric radon concentration with associated meteorological parameters variation during the dust events from July to November 2017. We obtained the meteorological parameters data in weather station of Sulaymaniyah city, Iraq. In the environmental monitoring plan, the atmospheric radon fluctuated from 15 to 48 Bq m^-3 around the mean value of 31.5 ± 7 Bq m^-3 within the summer. In autumn, varied from 22 to 46 Bq m^-3 with a mean value of 34 ± 12 Bq m^-3. We employed this to determine the radon level anomalously. Using the modified statistical coefficients, such as the residual deviation (RD), residual fluctuation ratio (RFR), F-test, and p-value coefficients. Among the atmospheric radon fluctuation values, particularly one anomalous (42 Bq m^-3) on 25 July was determined because the excessive value of the RD was 1.9 σ, and the RFR value was 66 %. Corresponding to our coefficients criteria, the minimum level of atmospheric radon (22 Bq m^-3) does not consider anomalous because of increasing wind speed. Based on this, our method for determining the atmospheric radon anomalies that are influenced by the missed factors beyond the mentioned meteorological parameters is accurate.

PMID:37029986 | DOI:10.1080/10256016.2023.2195175

J Wound Care. 2023 Apr 1;32(Sup4):S5-S13. doi: 10.12968/jowc.2023.32.Sup4.S5.

ABSTRACT

OBJECTIVE: The use of negative pressure wound therapy (NPWT) is ubiquitous in the management of complex wounds. Extending beyond the traditional utility of NPWT, it has been used after reconstructive flap surgery in a few case series. The authors sought to investigate the outcomes of NPWT use on flap reconstruction in a case-control study.

METHOD: Patients who underwent flap reconstruction between November 2017 and January 2020 were reviewed for inclusion in the study, and divided into an NPWT group and a control group. For patients in the NPWT group, NPWT was used directly over the locoregional flap immediately post-surgery for 4-7 days, before switching to conventional dressings. The control group used conventional dressing materials immediately post-surgery. Outcome measures such as flap necrosis, surgical site infections (SSIs), wound dehiscence as well as time to full functional recovery and hospitalisation duration were evaluated.

RESULTS: Of the 138 patients who underwent flap reconstruction, 37 who had free flap reconstructions were excluded, and 101 patients were included and divided into two groups: 51 patients in the NPWT group and 50 patients in the control group. Both groups had similar patient demographics, and patient and wound risk factors for impaired wound healing. Results showed that there was no statistically significant difference between flap necrosis, SSIs, wound dehiscence, hospitalisation duration as well as functional recovery rates. Cost analysis showed that the use of NPWT over flaps for the first seven postoperative days may potentially be more cost effective in our setting.

CONCLUSION: In this study, the appropriate use of NPWT over flaps was safe and efficacious in the immediate postoperative setting, and was not inferior to the conventional dressings used for reconstructive flap surgery. The main benefits of NPWT over flaps include better exudate management, oedema reduction and potential cost savings. Further studies would be required to ascertain any further benefit.

PMID:37029982 | DOI:10.12968/jowc.2023.32.Sup4.S5

J Wound Care. 2023 Apr 1;32(Sup4):S29-S38. doi: 10.12968/jowc.2023.32.Sup4.S29.

ABSTRACT

AIM: To identify the lifestyle factors preventing and predisposing to the development of pressure injuries (PIs) in individuals with spinal cord injury (SCI) living in the community in Bangladesh.

METHODS: A quantitative cross-sectional survey was conducted using a convenient sampling method. An equal number of participants, both with PIs and without, were recruited from the community, and a face-to-face interview was conducted. The standard outcome measure used to identify lifestyle factors in SCI was the Spinal Cord Injury Lifestyle Scale. The odds ratio (OR) was used to measure the associated difference between both groups and with sociodemographic variables. A p-value of ≤0.05 was considered statistically significant.

RESULTS: The study cohort comprised 80 participants-40 with PIs and 40 without. The study findings showed that lifestyle factors that were strongly associated with the occurrence of PIs (p<0.01, OR: <1) were: smoking; regular exercise; weight-bearing activity; body position on wheelchair; joint contracture; skin examination; pressure relief technique; wearing a protective device; accessibility; bladder and bowel management (p=0.03, OR: 0.32). Whereas, bladder incontinence appeared as a strong risk factor (p=0.04, OR: 2.5) for developing PIs in people with SCI.

CONCLUSION: The outcome of this study suggests that people with SCI should be aware of, and review, their lifestyle factors to reduce their chance of developing PIs.

PMID:37029981 | DOI:10.12968/jowc.2023.32.Sup4.S29

J Wound Care. 2023 Apr 1;32(Sup4):S14-S21. doi: 10.12968/jowc.2023.32.Sup4.S14.

ABSTRACT

OBJECTIVES: Diabetic foot ulcers (DFUs) cause high morbidity and mortality despite best treatment. Thus, new products are urgently needed to treat DFUs. Intralesional epidermal growth factor (EGF) (Heberprot-p) is considered to be an adjuvant therapy to standard of care (SOC) in DFUs. In the present study, the effect of Heberprot-p treatment on wound healing is compared to standard treatment.

METHODS: The data of patients with DFUs were retrospectively analysed. The patients who had had DFUs of at least four weeks’ duration and who had been treated in the wound clinic between January 2014 and 2017 were included in the study. The patients were divided into study and control groups. The study group consisted of patients in whom intralesional recombinant human EGF, Heberprot-p 75μg, was applied; the control group consisted of the remaining patients in whom EGF was not applied. The efficacy of Heberprot-p treatment in Wagner 2 and 3 DFUs were retrospectively investigated.

RESULTS: The study group (n=29 patients) who received Heberprot-p treatment was found to have shorter treatment times and higher rates of wound healing than the control group (n=22 patients). Although the amputation rate in the study group was less than the control group, the difference was not statistically significant.

CONCLUSION: Heberprot-p therapy is a promising treatment in DFUs, which can be routinely used as an adjunct to standard care.

PMID:37029977 | DOI:10.12968/jowc.2023.32.Sup4.S14

Port J Card Thorac Vasc Surg. 2023 Apr 4;30(1):31-36. doi: 10.48729/pjctvs.249.

ABSTRACT

OBJECTIVES: In recent years, a correlation between prognosis of various cancers and inflammation has been emphasized in many studies. Uric acid which is a purine metabolite is one of the serum inflammation markers. Albumin is a major component of serum protein and it is used as a parameter reflecting nutritional status and cancer aggressiveness. Here, we have investigated whether preoperative serum uric acid levels, albumin levels, and uric acid to albumin ratio predict lymph node metastasis in non-small cell lung cancer treated surgically by VATS.

METHODS: The medical records of patients underwent VATS lobectomy-segmentectomy for non-small cell lung cancer between January 2015 and December 2020, were reviewed retrospectively. Cut-off values of preoperative serum uric acid, albumin and uric acid to albumin ratio were determined by Receiver Operating Characteristics (ROC) analysis. Groups with and without lymph node metastasis were created according to hilar and/or mediastinal lymph node metastasis. In addition, high and low groups were created according to preoperative uric acid levels and uric acid to albumin ratio. Pearson chi-square test was used investigate whether any significant correlation between the groups.

RESULTS: A total of 115 patients were included in the study. Lymph node metastasis in N1 and N2 stations was detected in 11 and 18 patients, respectively. Cut-off values for uric acid and uric acid to albumin ratio were 5.97 mg/dL and 1.28×10-3, respectively. There was a statistically significant correlation between lymph node metastasis and high uric acid levels (p=0.008, OR: 3.2) and high uric acid to albumin ratio (p=0.03, OR: 2.6).

CONCLUSION: Preoperative serum uric acid and uric acid to albumin ratio can predict the lymph node metastasis in non-small cell lung cancer treated surgically by video assisted thoracic surgery.

PMID:37029947 | DOI:10.48729/pjctvs.249

Infect Dis (Lond). 2023 Apr 8:1-10. doi: 10.1080/23744235.2023.2192287. Online ahead of print.

ABSTRACT

PURPOSE: Streptococcus pyogenes (Group A Streptococcus, GAS) is an important human pathogen that can cause severe invasive (iGAS) infections. Throat carriage has been assumed to possibly lead to hematogenous seeding. Retrospective studies may estimate the incidence of throat carriage in iGAS patients inaccurately. In this study we aimed to gather data on the presence of GAS in the throat among iGAS patients in a prospective setting.

METHODS: We conducted a prospective clinical study covering iGAS infections in adult patients in two university hospitals in Finland from June 2018 to July 2020. Recruited patients’ throats were swabbed for culture and isothermal amplification tests (IAT) to search for GAS. The study was registered at ClinicalTrials.gov as ID NCT03507101.

RESULTS: We enrolled 45 patients. Throat swabs were obtained from 39/45 (87%) patients. Ten patients (22%) had a positive IAT for GAS. They were statistically significantly more likely to be male (9/10 [90%] vs 13/29 [45%], p = .024). Several different emm types caused the iGAS infections.

CONCLUSIONS: GAS was frequently observed in throat swabs of patients with iGAS infection. This may suggest that hematogenous seeding from the nasopharynx is a possible portal of entry.

PMID:37029930 | DOI:10.1080/23744235.2023.2192287

Intern Med J. 2023 Apr 8. doi: 10.1111/imj.16083. Online ahead of print.

ABSTRACT

BACKGROUND: Despite being one of the largest medical specialty training programs in Australasia, there is no standardised method for selection into Basic Physician Training (BPT) and limited data exist regarding current practices.

AIMS: To address existing knowledge gaps, we aimed to create a ‘snapshot’ of current BPT selection practices and explore the perspectives of Directors of Physician Education (DPEs) regarding trainee selection.

METHODS: An electronic survey of DPEs from adult and paediatric medicine BPT sites in Australia and New Zealand was undertaken in January-February 2022. A combination of free text, multiple choice and yes/no answers were analysed using descriptive statistics and qualitative content analysis.

RESULTS: A total of 70 responses were received, achieving a response rate of 35% (70/198). Selection practices were found to be heterogenous across BPT sites. Respondents had varying opinions regarding the utility of selection tools and desirable candidate attributes. A heavy reliance upon interviews and the reported use of subjective assessments raise concern for selection process bias. BPT sites should critically evaluate their selection methods and more research in this field is needed to establish best practice. This article is protected by copyright. All rights reserved.

PMID:37029925 | DOI:10.1111/imj.16083