Category: Nevin Manimala

ARP Rheumatol. 2022 Jan-Mar;1(1):42-48.

ABSTRACT

BACKGROUND: Axial spondyloarthritis (axSpA), particularly ankylosing spondylitis was historically considered a male’s disease and has been under-recognized in women. Emerging evidence reveals sex differences in pathophysiology, disease presentation and therapeutic efficacy.

OBJECTIVE: To identify differences between sexes in a Portuguese cohort of patients with axSpA regarding clinical manifestations, disease activity, functional capacity, patient related outcomes and presence of sacroiliitis on x-ray or magnetic resonance imaging.

METHODS: Patients with ≥18 years fulfilling the ASAS- Assessment of Spondyloarthritis International Society classification criteria for axSpA registered in the electronic Rheumatic Diseases Portuguese Register (Reuma.pt) were included in this multicentric cross-sectional study. Sociodemographic data, clinical features and imaging were collected from the first record in Reuma.pt. These variables were compared between sexes using Mann-Whitney test and Chi-Square test. Variables with a significant association with variable sex were considered in the multiple variable analysis to adjust the sex effect on the outcome variables. Statistical analysis was performed with R version 4.0.2 and p <0.05 was considered statistically significant.

RESULTS: A total of 1995 patients were included, 1114 (55.9%) men and 881 (44.1%) women. Men had an earlier disease onset (25.1 vs 28.4, p <0.001), were younger at diagnosis (26.9 vs 30.4, p<0.001) and were more frequently smokers (32.1% vs 15.7%, p <0.001). Comparing to women, men had worse Bath Ankylosing Spondylitis Metrological Index scores (4.0 vs 3.4, p<0.001), higher levels of C-Reactive Protein (10.5 vs 6.9 mg/L, p <0.001) and were more often Human Leukocyte Antigen-B27 positive (67.8% vs 54%, p <0.001). In contrast, women more frequently had inflammatory bowel disease (8.8% vs 4.9%, p =0.004), higher levels of erythrocyte sedimentation rate (25.0 vs 21.0mm/h, p=0.003) and worse patient-related outcomes- Bath Ankylosing Spondylitis Disease Activity Index (5.7 vs 4.5, p<0.001), Patient Global Assessment (60.0 vs 50.0, p <0.001) and fatigue (6.2 vs 5.0, p <0.001).

DISCUSSION: In this large multicentric study from a Portuguese axSpA cohort, we confirmed sex differences in patients with axSpA. This work brings awareness to these differences, resulting in less underdiagnosis and misdiagnosis, optimizing treatment strategies, and improving outcomes in axSpA.

PMID:35633576

Asian Pac J Cancer Prev. 2022 May 1;23(5):1785-1790. doi: 10.31557/APJCP.2022.23.5.1785.

ABSTRACT

OBJECTIVE: Breast cancer (BC) in non-Caucasian females is understudied and its management is based on Caucasian data. 30 % of the West Midlands females are non-Caucasian. We aimed to elucidate the pathologic features, molecular profile, and outcome of non-Caucasian breast cancer.

METHODS: Breast cancers (BCs) of different ethnic origins diagnosed at a large Birmingham tertiary referral hospital between 2000 and 2016 were identified. Detailed clinical and histological data were collected and statistically analyzed.

RESULTS: Out of 7554 BC cases, 749 were of ethnic ancestry and median age of 51 years. These comprised 47 in-situ and 702 invasive carcinomas of presenting symptomatically in 86.2% of patients. 53.4% of the invasive carcinomas measured >20 mm. Cancers were predominantly of grade 3 (45%), and grade 2 (42.4%). Median NPI was 4.35. 65.1% of the ethnic carcinomas were of luminal subtype, 18.6% were Her2 positive and 16.2% triple-negative. Median overall survival was 62 months. Five and ten-year survival was 81.7% & 68.4% respectively. Ethnicity correlated with higher NPI (p <0.001), larger tumour size (p= 0.001) and larger number of positive axillary nodes (p=0.007). Negative correlations were found between age at diagnosis and both invasive tumour size & grade (p< 0.001) and between tumour grade and overall survival (p= 0.006).

CONCLUSION: Compared with Caucasian breast cancer, non-Caucasian tumours presented predominantly symptomatically at younger age, were of larger size, higher grade with more unfavorable phenotypes and shorter survival. This is important in counselling, planning management and follow up of non-Caucasian patients.

PMID:35633565 | DOI:10.31557/APJCP.2022.23.5.1785

Asian Pac J Cancer Prev. 2022 May 1;23(5):1769-1776. doi: 10.31557/APJCP.2022.23.5.1769.

ABSTRACT

BACKGROUND: Cancer survivors frequently experience of unmet demands that are linked to psychological illness, anxiety, and quality of life. Cholangiocarcinoma (CCA) survivors, on the other hand, still lack of validated tool to assess their particular requirements. The aims of this study were to adjust the Cancer Survivors’ Unmet Need Scale (CaSUN) to a shorter form and to examine its psychometric scale-specific features for the Thai CCA survivors.

METHODS: This cross-sectional study recruited 231 CCA survivors and randomly split them into 2 groups (group 1, n =115, and group 2, n =116). Firstly, we modified and translated the CaSUN to ensure Thai cultural adaptation. Secondly, we used the statistical methods to reduce some items, then an exploratory factor analysis (EFA) using group 1 to explore the factor structure of the T-CaSUN was done. Finally, a confirmatory factor analysis (CFA) using group 2 was conducted to confirm the modified structure suggested by the EFA and to test for the construct validity of the T-CaSUN.

RESULTS: Participants consisted of 231 CCA survivors. EFA and CFA organized the four components construct T-CaSUN, which included intensive care, information, relationship, and medical care. The T-CaSUN’s internal reliability was good (Cronbach’s alpha was 0.75). Furthermore, construct validity was linked to bodily consequences, anxiety and depression, support care needs, stage of cancer, and age. For assessing unmet needs among CCA survivors in Thailand, the T-CaSUN exhibited acceptable reliability and validity.

CONCLUSION: The T-CaSUN demonstrated acceptable reliability and validity for assessing unmet needs among CCA caregivers in Thailand. This short form measurement can assist healthcare practitioners in providing successful individualized care by focusing on the particular requirements of these survivors.

PMID:35633563 | DOI:10.31557/APJCP.2022.23.5.1769

Asian Pac J Cancer Prev. 2022 May 1;23(5):1719-1723. doi: 10.31557/APJCP.2022.23.5.1719.

ABSTRACT

PURPOSE: The aim of this study is to describe our experience in laparoscopic partial nephrectomy and to compare the differences between off-clamp and on-clamp techniques in terms of clinical characteristics and outcomes.

METHODS: A retrospective study was utilized. A purposeful sampling method was used to select the patients. The inclusion criteria for kidney tumors were as follows: exophytic, maximum diameter 3 cm, RENAL score 4 or more, solid or cystic, and suspected of malignancy. Around 32 participants were selected. The data were collected from patient files.

RESULTS: There were no statistically significant differences between the mean of the off-clamp group and the on-clamp group in terms of tumor size, size of the kidney, and the position of the tumor. The average expected blood loss in the off-clamp group was 150.15 +/- 60.25 mL and in the on-clamp group was 75.25+/- 40.11 mL, with a p-value of less than 0.001. There was no statistically significant difference between the two groups in terms of the most common surgical complications, postoperative drainage, overall operation time, renorrhaphy time, and postoperative bedtime.

CONCLUSION: The off-clamp group was shown to have a higher tumor resection duration as well as a higher rate of expected blood loss. The functional result of alterations in the estimated glomerular filtration rate seemed to be better in the off-clamp group. We expect to understand its long-term safety and oncological efficacy better as we continue to use this method.

PMID:35633557 | DOI:10.31557/APJCP.2022.23.5.1719

Asian Pac J Cancer Prev. 2022 May 1;23(5):1761-1768. doi: 10.31557/APJCP.2022.23.5.1761.

ABSTRACT

BACKGROUND: Ovarian cancer is the fifth leading cause of cancer-related deaths among women worldwide. Unfortunately, early detection tests are relatively lacking. Diagnosis in the late stages of the disease carries a poor prognosis.

OBJECTIVE: To evaluate the relationship between miR-196a-2 rs11614913 polymorphism and ovarian cancer risk and prognosis in Egyptian females.

METHODS: In this case-control study, the participants were classified into 2 groups. Group A is the control group which included 50 healthy females. Group B included 50 patients newly diagnosed with ovarian carcinoma confirmed by histopathological analysis. Immunohistochemistry for P53 and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for miR-196a-2 genotypes detection were performed. Results: There was a statistically significant difference among ovarian cancer cases and controls regarding genotypes (P = 0.003). However, the distribution of the T and C alleles in both studied groups showed no significant difference (P = 0.17). There was a statistically significant increase of CA 125 levels among CT and CC genotypes carriers of ovarian cancer cases (p = 0.04). Besides, there was a statistically significant correlation between miR-196a-2 polymorphism and each of tumor grade (P <0.001), p53 immunohistochemical expression (P= 0.002), and Figo classification (P <0.001).

CONCLUSION: There was a statistically significant increase of CA 125 levels among C allele carriers of ovarian cancer cases. Besides, there was a statistically significant association between the miR-196a-2 polymorphism and each of tumor grade, p53 immunohistochemical expression, and Figo classification. So, miR-196a-2 polymorphism can be a possible prognostic factor in ovarian cancer.

PMID:35633562 | DOI:10.31557/APJCP.2022.23.5.1761

Asian Pac J Cancer Prev. 2022 May 1;23(5):1699-1709. doi: 10.31557/APJCP.2022.23.5.1699.

ABSTRACT

OBJECTIVE: The study was aimed at understanding the survival of metastatic ovarian cancer spheroids in the malignant ascites microenvironment.

METHODS: All the assays were performed using aseptically collected patient samples. The cells were characterized for the expression of ovarian and cancer stem cell markers using immunocytochemistry. The presence of lipid in the primary metastatic cancer spheroids were confirmed by neutral fat staining using Oil Red-O and transmission electron microscopy. The mRNA expression of autophagy and lipid metabolism genes was analyzed using RT-PCR. The lipid content was analyzed using lipidomics analysis. Etomoxir and chloroquine were used to study the effect of inhibition of autophagy in the metastatic cells. The data were analyzed using appropriate statistical tools and a p-value <0.05 was considered to be statistically significant.

RESULTS: Metastatic ovarian cancer spheroids exhibit cancer stem like properties and undergo a metabolic reprogramming when they disseminate from the primary tumor. We report here the accumulation of numerous cytoplasmic lipid droplets and lipophagic vesicles in the metastatic cells in contrast to their primary tumors. In addition we also report that these cells depend on lipophagy for the utilization of lipids rather than the conventional lipolytic pathway. The lipidomics analysis data reveals that the metastatic cells possess high levels of unsaturated fatty acids. We have also reported the occurrence of distinct accumulation of multiple nuclei in the patient derived metastatic cells. Inhibition of beta-oxidation and autophagic machinery using etomoxir and chloroquine resulted in cell death suggesting a potential mode to suppress metastatic cancer cells.

CONCLUSION: Metabolic reprogramming is a characteristic feature of the metastatic ovarian cancer cells that are persisting in the malignant ascites. Targeting of the metastatic by gaining an insight into the various metabolic and molecular changes that occur in the metastatic niche provides a promising therapeutic approach in management of the disease.

PMID:35633555 | DOI:10.31557/APJCP.2022.23.5.1699

Asian Pac J Cancer Prev. 2022 May 1;23(5):1611-1618. doi: 10.31557/APJCP.2022.23.5.1611.

ABSTRACT

OBJECTIVE: Oral cancer causes a significant disease burden and financial distress, especially among disadvantaged groups. While Malaysia has achieved universal health coverage via its highly subsidized public healthcare, patient and family expenditure for treatment of oral potentially malignant disorders (OPMD) and oral cancer remains a concern in the equitability of care. This study thus aims to estimate household out-of-pocket (OOP) expenditures and the extent of catastrophic healthcare expenditure (CHE) while identifying its predictors.

METHODS: This three-part study consists of a cross-sectional survey to collect sociodemographic and health utilization data of patients, a retrospective medical record abstraction to identify resources consumed, and cost modeling to simulate expenditures in two tertiary public hospitals. Loss of productivity was calculated based on absenteeism related to disease management in the hospital. OOP payments for transport, care in public healthcare facilities, and other healthcare expenditures were tallied. A CHE was defined as OOP spendings of more than 10% from total annual household income. Multivariable logistic regression was further applied to identify the association between sociodemographic factors and the incidence of CHE.

RESULTS: A total of 52 patients with OPMD and 52 with oral cancer were surveyed and medical records were abstracted. A Kruskal-Wallis test showed a statistically significant difference in OOP share over household income between OPMD, early- and late-stage cancer, χ2(2)=51.05, p<0.001, with the mean percentage of 9%, 22%, and 65% respectively. This study found that the prevalence of CHE in the first year of diagnosis was 86.5% for oral cancer and 19.2% for OPMD. Indian ethnicity (OR=6.24, p=0.046) and monthly income group ‘less than USD 2,722’ (OR=14.32, p=0.023) were shown as significant predictors for CHE.

CONCLUSIONS: Our study demonstrated the provision of subsidies may not be adequate to shield the more vulnerable group from CHE when they are diagnosed with OPMD and oral cancer.

PMID:35633545 | DOI:10.31557/APJCP.2022.23.5.1611

Asian Pac J Cancer Prev. 2022 May 1;23(5):1547-1553. doi: 10.31557/APJCP.2022.23.5.1547.

ABSTRACT

OBJECTIVE: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20-item scale (EORTC QLQ-CIPN20) is the common method for determining taxane-induced peripheral neuropathy (TIPN) symptoms. However, there have been no studies on the psychometric properties of the Thai Version of EORTC QLQ-CIPN20. The aim of this study was to evaluate the test-retest reliability, concurrent validity, and contrasting group validity of the Thai Version of EORTC QLQ-CIPN20 among women with breast cancer who received taxane-based chemotherapy.

METHODS: Twenty-eight breast cancer patients and 28 healthy controls participated in the study. Internal consistency, test-retest reliability, and inter-rater reliability were assessed using Cronbach α and the intraclass correlation coefficient (ICC). Concurrent validity was assessed via the Spearman correlation coefficient of the total scale of the EORTC QLQ-CIPN20 and the Total Neuropathy Score clinical version (TNSc), and contrasting group validity was assessed via the Mann-Whitney U test.

RESULTS: The internal consistency, test-retest reliability, and inter-rater reliability of the Thai Version of EORTC QLQ-CIPN20 was high to excellent (Cronbach α = 0.89, ICC = 0.84-0.95 and 0.78-0.94, respectively). However, the concurrent validity between the Thai Version of EORTC QLQ-CIPN20 and TNSc was not considered statistically significant. Contrasting group validity demonstrated statistically significant differences between breast cancer patients and healthy controls.

CONCLUSIONS: The results support that the Thai Version of EORTC QLQ-CIPN20 is reliable and valid in measuring TIPN symptoms in Thai women with breast cancer. The findings suggest that the Thai Version of EORTC QLQ-CIPN20 may be used to distinguish TIPN symptoms between healthy controls and women with breast cancer undergoing taxane-based chemotherapy.

PMID:35633537 | DOI:10.31557/APJCP.2022.23.5.1547

Asian Pac J Cancer Prev. 2022 May 1;23(5):1523-1528. doi: 10.31557/APJCP.2022.23.5.1523.

ABSTRACT

OBJECTIVE: The previous systematic reviews evaluating the association between diabetes history and gastric cancer risk showed inconsistent results. The aim was to check through a meta-epidemiological study that the conclusions of systematic reviews evaluating the association between diabetes history and gastric cancer risk might differ by the type of follow-up study.

METHODS: The potential study subjects were follow-up studies selected from the seven systematic reviews obtained by searching PubMed using diabetes and gastric cancer keywords. The selection criterion was defined as a follow-up study for evaluating the association between the history of type 2 diabetes mellitus and the incidence of gastric cancer. And the values of RR and its 95%CI, which adjusted for the most confounders in each paper, were extracted for meta-analysis. A random-effects model meta-analysis by types of the follow-up study and sex group was performed.

RESULTS: A total of 25 follow-up studies were finally selected for meta-analysis. They were classified into 16 retrospective and 9 prospective studies in types of follow-up study. The statistical significance between diabetes history and gastric cancer risk was found in retrospective studies (sRR=1.17, 95%CI: 1.02-1.34, I-squared =91.0%) but disappeared in prospective studies (sRR=1.09, 95%CI: 0.91-1.29, I-squared = 68.6%). Even in the analysis of subgroups by sex, statistical significance was not found in the prospective study, consistently.

CONCLUSION: The main reason for the previous meta-analysis’s diverse results for the association between diabetes history and gastric cancer risk was that the type of follow-up study was not reflected. According to the meta-analysis of prospective cohort studies, it could be concluded that there is no association between diabetes history and gastric cancer risk.

PMID:35633534 | DOI:10.31557/APJCP.2022.23.5.1523

Vet Rec. 2022 May 28:e1731. doi: 10.1002/vetr.1731. Online ahead of print.

ABSTRACT

BACKGROUND: On dairy farms, the prophylactic use of antibiotics at drying-off is being increasingly challenged. The objective of this study was to examine the effect of antibiotic dry-cow therapy (DCT) or non-antibiotic DCT on dairy cow performance and udder health.

METHODS: Holstein cows (n = 285) with low risk of intramammary infection (<200,000 cells/ml) were assigned to one of two treatments, either antibiotic DCT (A + TS; antibiotic treatment in combination with internal and external teat sealants) or non-antibiotic DCT (TS; internal and external teat sealant only).

RESULTS: There was no statistically significant (p > 0.05) difference between treatments for mean cow milk yield, composition or energy corrected milk yield. Mean somatic cell count was 0.16 log_e higher in the TS treatment (95% confidence interval [CI]: -0.00 log_e to -0.33 log_e ) compared to A + TS treatment (p = 0.047). A 50% increase in the number of mastitis cases was observed in the A + TS treatment compared to TS treatment (odds ratio = 1.5, 95% CI: 0.80%-3.01%), although this was not significant. There was no statistical evidence (p > 0.05) that treatment had any effect on colostrum quality and composition.

CONCLUSION: Results indicate that non-antibiotic DCT can be adopted in ‘low-risk’ cows who were offered grass silage-based diets in cubicle accommodation, with low risk of adverse effects on performance or udder health.

PMID:35633519 | DOI:10.1002/vetr.1731