Category: Nevin Manimala

Semin Liver Dis. 2021 Jun 23. doi: 10.1055/s-0041-1730924. Online ahead of print.

ABSTRACT

Accurate risk prediction for hepatocellular carcinoma (HCC) among patients with chronic hepatitis B (CHB) may guide treatment strategies including initiation of antiviral therapy and also inform implementation of HCC surveillance. There have been 26 risk scores developed to predict HCC in CHB patients with (n = 14) or without (n = 12) receiving antiviral treatment; all of them invariably include age in the scoring formula. Virological biomarkers of replicative activities (i.e., hepatitis B virus DNA level or hepatitis B envelope antigen status) are frequently included in the scores derived from patients with untreated CHB, whereas measurements that gauge severity of liver fibrosis and/or reserve of hepatic function (i.e., cirrhosis diagnosis, liver stiffness measurement, platelet count, or albumin) are essential components in the scores developed from treated patients. External validation is a prerequisite for clinical application but not yet performed for all scores. For the future, higher predictive accuracy may be achieved with machine learning based on more comprehensive data.

PMID:34161993 | DOI:10.1055/s-0041-1730924

Seizure. 2021 May 31;91:150-158. doi: 10.1016/j.seizure.2021.05.022. Online ahead of print.

ABSTRACT

PURPOSE: Inflammation plays a crucial role in epileptogenesis. We analyzed inflammatory cytokines in plasma and saliva from children with seizures and healthy controls and measured their associations with HHV6 and EBV infection.

METHODS: We analyzed plasma from 36 children within 24 h of seizures (cases) and 43 healthy controls and saliva from 44 cases and 44 controls with a multiplex immunoassay. Saliva from all controls and 65 cases and blood from 26 controls and 35 cases were also analyzed by PCR for viral DNA. Primary outcome was cytokine levels in cases vs. controls. Secondary outcomes included detection of HHV-6 and EBV viral DNA in cases vs. controls and viral loads in cases vs. controls. Statistical analysis included the Wilcoxon Rank Sum test, Fisher’s exact test, ANOVA, and Spearman correlation.

RESULTS: Compared to controls, patients had higher levels of CCL11 (p = 0.0018), CCL26 (p<0.001), IL10 (p = 0.044), IL6 (p<0.001), IL8 (p = 0.018), and MIP1β (p = 0.0012). CCL11 was higher with 3 or more seizures (p = 0.01), seizures longer than 10 min (p = 0.001), and when EEG showed focal slowing (p = 0.02). In saliva, febrile seizures had higher levels of IL-1β (n = 7, p = 0.04) and new onset seizures had higher IL-6 (n = 15, p = 0.02). Plasma and saliva cytokine levels did not show a correlation. The frequency of HHV-6 and EBV detection was similar across groups and not different than controls. We found no correlation between viral load and cytokine levels.

CONCLUSIONS: We showed differential activation of neuroinflammatory pathways in plasma from different seizure etiologies compared to controls, unrelated to viral infection.

PMID:34161903 | DOI:10.1016/j.seizure.2021.05.022

Seizure. 2021 Jun 9;91:159-166. doi: 10.1016/j.seizure.2021.05.025. Online ahead of print.

ABSTRACT

PURPOSE: To retrospectively investigate the prevalence, demography, antiseizure medication (ASM) usage, healthcare resource utilization (HCRU), and mortality of patients with Lennox-Gastaut syndrome (LGS) in primary and secondary care in the UK.

METHODS: Patients with confirmed LGS were anonymously identified from the UK Clinical Practice Research Datalink (CPRD) GOLD database (01/01/1987-31/10/2018) using the LGS Read Code (F250500). Probable LGS was identified using the International Classification of Diseases-10/Read Code for epilepsy (Hospital Episode Statistics [HES]/CPRD) plus rufinamide prescription. Period prevalence was calculated based on patients enrolled in CPRD GOLD and alive in 2017. CPRD data were linked to HES to calculate HCRU, and to the Office for National Statistics mortality registry.

RESULTS: Period prevalence of LGS was 0.578/10,000 (n = 180), with 74 and 106 patients identified with confirmed (0.289/10,000) and probable LGS (0.420/10,000). Mean (max) ASM usage was ~1 (3) per year. In confirmed LGS, valproate (72%), lamotrigine (69%), and clobazam (66%) were the most commonly prescribed ASMs. HCRU (per patient-year) was similar in confirmed and probable LGS and mostly consisted of primary care general practitioner consultations (4-6), outpatient visits (5-10), inpatient admissions (1-4), and A&E visits (1). During the follow-up period, 18 patients died with crude mortality rates of 6.12 (confirmed LGS) and 4.17 (probable LGS) deaths per 1000 person-years.

CONCLUSION: Prevalence of LGS appears low in the UK. The similarly high HCRU and mortality rates in confirmed and probable LGS support the validity and specificity of the probable LGS algorithm and high burden of LGS.

PMID:34161904 | DOI:10.1016/j.seizure.2021.05.025

J Natl Compr Canc Netw. 2021 Jun 22:1-10. doi: 10.6004/jnccn.2020.7683. Online ahead of print.

ABSTRACT

BACKGROUND: Early hospital discharge (EHD) after intensive acute myeloid leukemia (AML) induction chemotherapy has become routine at the University of Washington/Seattle Cancer Care Alliance over the past several years. We assessed the financial implications of EHD over the first 4 years after its broad adoption for patients with AML and other high-grade myeloid neoplasms undergoing AML-like induction chemotherapy.

PATIENTS AND METHODS: We retrospectively compared charges between 189 patients with EHD who received all postinduction inpatient/outpatient care within our care system between August 2014 and July 2018 and 139 medically matched control patients who remained hospitalized for logistical reasons. Charges from the day of initial discharge (patients with EHD) or end of chemotherapy (control patients) until blood count recovery, additional chemotherapy or care transition, hospital discharge (for control patients only), an elapse of 42 days, or death were extracted from financial databases and separated into categories: facility/provider, emergency department, transfusions, laboratory, imaging, pharmacy, and miscellaneous.

RESULTS: Combined charges averaged $4,157/day (range, $905-$13,119/day) for patients with EHD versus $9,248/day (range, $4,363-$48,522/day) for control patients (P<.001). The EHD cohort had lower mean facility/provider, transfusion, laboratory, and pharmacy charges but not imaging or miscellaneous charges. During readmissions, there was no statistically significant difference in daily inpatient charges between the EHD and control cohorts. After multivariable adjustment, average charges were $3,837/day lower for patients with EHD (P<.001).

CONCLUSIONS: Together with previous data from our center showing that EHD is safe and associated with reduced healthcare resource utilization, this study further supports this care approach for AML and other high-grade myeloid neoplasms if infrastructure is available to enable close outpatient follow-up.

PMID:34161925 | DOI:10.6004/jnccn.2020.7683

Oral Oncol. 2021 Jun 20;119:105377. doi: 10.1016/j.oraloncology.2021.105377. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the relative prognostic ability of socioeconomic status (SES) compared to overall stage for HPV-negative head and neck squamous cell carcinoma (HNSCC) MATERIALS AND METHODS: Data were obtained from the Carolina Head and Neck Cancer Epidemiology Study (CHANCE). An empirical 4-category SES classification system was created. Cox proportional hazards models, survival gradients, Bayesian information criterion (BIC), and Harrell’s C index were used to estimate the prognostic ability of SES compared to stage on overall survival (OS).

RESULTS: The sample consisted of 1229 patients with HPV-negative HNSCC. Patients with low SES had significantly increased risk of mortality at 5 years compared to patients with high SES (HR 3.11, 95% CI 2.07-4.67; p < 0.001), and the magnitude of effect was similar to overall stage (HR 3.01, 95% CI 2.35-3.86; p < 0.001 for stage IV versus I). Compared to overall stage, the SES classification system had a larger total survival gradient (35.8% vs. 29.1%), similar model fit (BIC statistic of 7412 and 7388, respectively), and similar model discriminatory ability (Harrell’s C index of 0.61 and 0.64, respectively). The association between low SES and OS persisted after adjusting for age, sex, race, alcohol, smoking, overall stage, tumor site, and treatment in a multivariable model (HR 2.96, 95% CI 1.92-4.56; p < 0.001).

CONCLUSION: SES may have a similar prognostic ability to overall stage for patients with HPV-negative HNSCC. Future research is warranted to validate these findings and identify evidence-based interventions for addressing barriers to care for patients with HNSCC.

PMID:34161897 | DOI:10.1016/j.oraloncology.2021.105377

Mult Scler Relat Disord. 2021 Jun 8;53:103071. doi: 10.1016/j.msard.2021.103071. Online ahead of print.

ABSTRACT

BACKGROUND: Cognitive impairment affecting classic and social domains has been consistently reported in patients with Multiple Sclerosis (MS). However, little is known about the cognitive outcomes, particularly on social cognition, in adults with pediatric-onset multiple sclerosis (POMS).

OBJECTIVES: To compare the performance in classic and social cognitive domains between adults with POMS and adult-onset MS (AOMS).

METHODS: A group of 30 patients with POMS (age onset <18 years) was compared with age-matched (AOAMS, n=30) and disease duration-matched (AODMS, n= 30) patients who developed MS after the age of 18 years. Cognitive performance was assessed using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and Theory of Mind (ToM) tests.

RESULTS: Cognitive impairment was more prevalent in POMS patients (40% vs. 16.7%, p=0.045), independently of age or disease duration, affecting more severely information-processing speed and visual memory domains. No statistically significant differences were found in ToM performance between patients with POMS and AOMS. When analyzing ToM performance according to age of disease onset (≤15 years; 15-20 years; ≥20 years), patients with disease onset ≤15 years old had significantly lower scores on ToM tests when compared to the other groups.

CONCLUSION: Patients with POMS were more prone to develop impairment on classic cognitive domains than on ToM ability, when compared with AOMS patients. The interference of POMS with critical neurodevelopmental periods, specific for each cognitive domain, may explain different outcomes at adulthood on social and classic cognition.

PMID:34161899 | DOI:10.1016/j.msard.2021.103071

J Affect Disord. 2021 Jun 11;292:708-713. doi: 10.1016/j.jad.2021.06.009. Online ahead of print.

ABSTRACT

BACKGROUND: In a recent issue in the journal, Humpston, Bebbington, and Marwaha (2021) reported the results of the first large epidemiological study of bipolar disorder in England. The prevalence estimate of bipolar disorder was based on the Mood Disorders Questionnaire (MDQ), a self-administered screening scale for a lifetime history of mania/hypomania. Humpston and colleagues found that the prevalence of bipolar disorder in England was similar to the rates in other parts of the world, and they stated that most individuals with bipolar disorder in England did not receive treatment for the disorder in the past year. A better understanding of the statistics of screening and the performance of the MDQ would indicate that the conclusions drawn from the epidemiological study are not justified.

METHODS: I review the principles and statistics of diagnostic screening and how screening is distinguished from case-finding. I then review the performance of the MDQ in the general population and calculate the positive predictive value of the MDQ in the study by Humpston and colleagues.

RESULTS: The developers of the MDQ reported a sensitivity of 28.1% and specificity of 97.2% in the general population based on a cutoff score of 7. Using this same cutoff, Humpston and colleagues reported the prevalence of “probable” bipolar disorder was 1.7%. Based on these data, the positive predictive value of the MDQ would be only 14.8%.

LIMITATIONS: Humpson et al. did not compare the MDQ to a diagnostic interview in their study; thus, the performance of the MDQ was estimated from another general population study.

CONCLUSIONS: When studying a disorder with a relatively low prevalence, it is near impossible for a screening test to have sufficient positive predictive value to be used to validly compare the individuals who do and do not screen positive. Most of the individuals whom Humpston et al. considered to have “probable” bipolar disorder would not have received the diagnosis had they been directly interviewed. Thus, the results of the Humpston et al. study are not a valid indicator of the correlates of bipolar disorder in the general population of England.

PMID:34161888 | DOI:10.1016/j.jad.2021.06.009

Surg Oncol. 2021 Jun 12;38:101620. doi: 10.1016/j.suronc.2021.101620. Online ahead of print.

ABSTRACT

Exercise prehabilitation prior to major surgery targets a reduction in postoperative complications through improved conditioning and respiratory function. However its effectiveness in cancer surgery is unclear. The objective of this review was to determine if preoperative high-intensity interval training (HIIT) improves preoperative fitness in patients scheduled for oncologic resection, and whether postoperative complications are impacted. METHODS: CINAHL, AMED, PEDro, EMBASE, The Cochrane Library and PubMed/MEDLINE were searched until April 2021 using predefined search strategy and accompanied by manual forward and backwards citation review. Screening of titles, abstracts, full-texts, data extraction, risk of bias assessment and methodologic quality was performed independently by two reviewers. Mean difference (MD) with 95% confidence intervals (CI) was compared and heterogeneity assessed using Chi Squared Test and I² statistic. Six randomised controlled trials (RCTs) were included in the systematic review. Interventions prescribed bouts of high-intensity exercise [80-115% peak work rate (WRp)] interspaced with low-intensity (rest-50% WRp) exercise. The meta-analysis included five RCTs reporting peak oxygen consumption (VO_2peak). Preoperative HIIT did not result in significantly higher VO_2peak in comparison to usual care or moderate intensity exercise (MD 0.83, 95%CI-0.51-2.17) kg/ml/min, p = 0.12). Studies were insufficiently powered with respect to postoperative complications, but there is no evidence of significant impact. No adverse events occurred and high adherence rates were reported. Results of this systematic review and meta-analysis demonstrate there is insufficient evidence to support HIIT as a method of improving preoperative fitness prior to oncologic resection. Further work is needed to determine if specific HIIT parameters can be adapted to improve efficacy over short time-frames.

PMID:34161894 | DOI:10.1016/j.suronc.2021.101620

Public Health. 2021 Jun 20;196:74-81. doi: 10.1016/j.puhe.2021.05.021. Online ahead of print.

ABSTRACT

OBJECTIVES: Breast cancer survivors have reported worse health-related quality of life (HRQoL) outcomes on some subscales when compared with members of the general population. However, the increased attention to breast cancer survivorship should have improved the HRQoL of these survivors. Our aim was to examine whether physical and mental component scores (PCS-12 and MCS-12) using the Short Form (SF-12) questionnaire were different for racial/ethnic minorities, specifically for Black and Hispanic women relative to White women. Furthermore, we stratified the data by age group to evaluate these racial/ethnic differences in HRQoL of breast cancer survivors.

STUDY DESIGN: Cross-sectional study.

METHODS: Pooled cross-sectional analyses using data from the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the racial/ethnic differences in PCS-12 and MCS-12 scores of breast cancer survivors. Furthermore, stratified analyses by age group were conducted to evaluate racial/ethnic differences in HRQoL by the age of breast cancer survivors.

RESULTS: After adjusting for confounders, there was no association between race/ethnicity and PCS-12 scores. However, Hispanic breast cancer survivors had statistically significantly lower MCS-12 scores (by 1.9 points [95% confidence interval {CI}: -3.53 to -0.37]) when compared with White breast cancer survivors. For PCS-12, after stratifying by age, the adjusted analyses showed no significant differences in PCS-12 scores when White female breast cancer survivors were compared with the other racial/ethnic categories. On the other hand, Black female survivors aged <50 years had 4.3 points (95% CI: 0.46-8.13) higher MCS-12 scores when compared with their White counterparts, while Hispanic breast cancer survivors aged <50 years had 3.1 points (95% CI: -0.40-6.69) higher MCS-12 scores relative to White women. Furthermore, among female breast cancer survivors aged ≥50 years, Hispanic women had 3.2 points (95% CI: -4.98 to -1.40) lower MCS-12 scores than White women.

CONCLUSION: Our study generated findings showing the racial/ethnic differences in HRQoL of breast cancer survivors and presented results stratified by age group. These findings provide the much-needed rationale for targeted and racial/ethnic-specific HRQoL improvement strategies among breast cancer survivors.

PMID:34161858 | DOI:10.1016/j.puhe.2021.05.021

Water Res. 2021 Jun 4;201:117329. doi: 10.1016/j.watres.2021.117329. Online ahead of print.

ABSTRACT

Sea level rise has increased the frequency of tidal flooding even without accompanying precipitation in many coastal areas worldwide. As the tide rises, inundates the landscape, and then recedes, it can transport organic and inorganic matter between terrestrial systems and adjacent aquatic environments. However, the chemical and biological effects of tidal flooding on urban estuarine systems remain poorly constrained. Here, we provide the first extensive quantification of floodwater nutrient concentrations during a tidal flooding event and estimate the nitrogen (N) loading to the Lafayette River, an urban tidal sub-tributary of the lower Chesapeake Bay (USA). To enable the scale of synoptic sampling necessary to accomplish this, we trained citizen-scientist volunteers to collect 190 flood water samples during a perigean spring tide to measure total dissolved N (TDN), dissolved inorganic N (DIN) and phosphate concentrations, and Enterococcus abundance from the retreating ebb tide while using a phone application to measure the extent of tidal inundation. Almost 95% of Enterococcus results had concentrations that exceeded the standard established for recreational waters (104 MPN 100 mL^-1). Floodwater dissolved nutrient concentrations were higher than concentrations measured in natural estuarine waters, suggesting floodwater as a source of dissolved nutrients to the estuary. However, only DIN concentrations were statistically higher in floodwater samples than in the estuary. Using a hydrodynamic model to calculate the volume of water inundating the landscape, and the differences between the median DIN concentrations in floodwaters and the estuary, we estimate that 1,145 kg of DIN entered the Lafayette River during this single, blue sky, tidal flooding event. This amount exceeds the annual N load allocation for overland flow established by federal regulations for this segment of the Chesapeake Bay by 30%. Because tidal flooding is projected to increase in the future as sea levels continue to rise, it is crucial we quantify nutrient loading from tidal flooding in order to set realistic water quality restoration targets for tidally influenced water bodies.

PMID:34161874 | DOI:10.1016/j.watres.2021.117329