Category: Nevin Manimala

Clin Neurol Neurosurg. 2021 Apr 20;205:106644. doi: 10.1016/j.clineuro.2021.106644. Online ahead of print.

ABSTRACT

BACKGROUND: The efficacy of laser interstitial thermal therapy (LITT) in mesial temporal lobe epilepsy (MTLE) has not been clearly established yet.

OBJECTIVE: We conducted a meta-analysis to estimate the efficacy of LITT for TLE (Q1). We also examined the effect of the patient’s age (Q2), the total ablation volume (TAV) (Q3), the strength of the MRI unit (Q4), the type of the utilized stereotactic platform (Q5), and the follow up period (Q6) on the patient’s outcome.

METHODS: Fixed- and random-effects model meta-analysis was conducted to assess the proportion estimate for each parameter individually. Kaplan-Meier survival-analysis was performed on the available individual patient time-to-first seizure data.

RESULTS: Sixteen studies with 575 patients fulfilled our eligibility criteria. The efficacy of LITT was 0.547 (95%CI: 0.506-0.588). Our statistical analysis had robust results after stratification according to the study population (Q2; p = 0.3418), and the type of the utilized stereotactic platform (Q5; p = 0.286), whereas the role of the TAV (Q3; p = 0.058) and strength of the magnetic field (Q4; p = 0.062) in seizure control remained unclear. The median seizure-free period (Q6) was 0.643 (0.569-0.726) and 0.467 (0.385-0.566) for the one- and the two-year follow up.

CONCLUSIONS: LITT seems to offer a viable alternative to resective surgery, with a moderate efficacy and enduring results. Higher ablation volumes may be associated with improved seizure control, although our current study provided no statistically significant data. More high-quality studies are required to highlight the role of LITT in epilepsy surgery, particularly in the pediatric population.

PMID:33962146 | DOI:10.1016/j.clineuro.2021.106644

Clin Imaging. 2021 Mar 31;78:187-193. doi: 10.1016/j.clinimag.2021.03.027. Online ahead of print.

ABSTRACT

OBJECTIVE: A recent study described the relationship between cerebral venous diameter and white matter hyperintensity (WMH) volume. However, the adults were not further grouped; therefore, we aimed to compare across age groups and use susceptibility-weighted imaging (SWI) to explore whether there is also a relationship between a larger cerebral draining venous diameter and age, which could provide evidence of a temporal relationship.

METHODS: We retrospectively analysed data collected from 405 subjects (90 youths, 166 middle-aged participants, and 149 elderly subjects) and respectively used T2-weighted fluid-attenuated inversion recovery (FLAIR) and SWI to assess WMHs and venous diameter.

RESULTS: An increased internal cerebral vein (ICV) diameter was associated with age in different WMH groups (F = 3.453, 10.437, 11.746, and 21.723, respectively, all p < 0.001; multiple comparisons all p < 0.05), whereas the effect of the anterior septal vein (ASV) was opposite (F = 1.046, 1.210, 0.530, and 0.078, respectively, p > 0.05). There was a positive correlation between the ICV diameter and age with increasing WMH severity (R = 0.727, 0.709, 0.754, and 0.830, respectively, all p < 0.001). A statistically significant relationship between the thalamostriate vein (TSV) diameter and age was observed only in the moderate and severe WMH groups (F = 4.070 and 3.427, respectively, all p < 0.05; multiple comparisons all p < 0.05).

CONCLUSIONS: Our study demonstrates that increased TSV and ICV diameters are associated with age with increasing WMH severity, especially the ICV diameter using SWI.

PMID:33962184 | DOI:10.1016/j.clinimag.2021.03.027

Int J Cancer. 2021 May 7. doi: 10.1002/ijc.33674. Online ahead of print.

ABSTRACT

Ewing Sarcoma (ES) is the second most common primary bone tumor in children and adolescents. There are few known epidemiological or genetic risk factors for ES. Numerous reports describe incidence rates and trends within the United States, but international comparisons are sparse. We used the Cancer Incidence in Five Continents (CI5) data to estimate age standardized incidence rates (ASRs; cases per million) and 95% confidence intervals (95% CI), male-to-female incidence rate ratios (IRR; 95% CI), and the average annual percent change in incidence (AAPC; 95% CI) for ES by geographic region for children and adults aged 0-49 years. We also estimated the ASR for each country or country subpopulation among the 10-19-year-old age range; capturing the peak incidence of ES. In total, 15 874 ES cases ages 0-49 were reported in the CI5 series between 1988 and 2012. AAPC estimates varied by age group and geographic region. Most of the statistically significant AAPCs showed an increased incidence over time; the only statistically significant decreases in incidence were observed among 20-29-year-olds and 30-39-year-olds in Southern Asia at -1.93 and – 1.67%. When categorized by predominant ancestry, we observed countries and subpopulations with predominately African, East Asian, and South-east Asian ancestry had the lowest incidence rates, whereas Pacific Islanders and populations with predominantly European and North African/Middle Eastern ancestry had the highest. An excess incidence in males was observed in most regions. Our results highlight substantial variation in ES incidence across geographic populations, reflecting potential ancestral influence on disease risk.

PMID:33961701 | DOI:10.1002/ijc.33674

Intern Med J. 2021 May 7. doi: 10.1111/imj.15340. Online ahead of print.

ABSTRACT

BACKGROUND: Due to the COVID-19 pandemic, telephone clinics have been utilised to reduce the risk of transmission. Evidence supporting its quality and safety is required.

AIMS: Assess the efficacy and safety of telephone clinics in delivering care to established oncology patients and assess patient and health professionals’ preference (telephone vs face-to-face clinics).

METHODS: Retrospective chart audit in the month preceding and month following introduction of telephone clinics at the Gold Coast University hospital and a patient and health professional questionnaire.

RESULTS: In total, 1212 clinical encounters occurred in the month post the introduction of telephone clinics (vs 1208 encounters prior). There were no statistically significant differences in 24-h (18 vs 22, p = 0.531) or 7-day admissions (50 vs 46, p = 0.665) comparing encounters in the month prior to the introduction of telephone clinics vs the month post, but there was a statistically significant difference in 30-day mortality post systemic therapy in favour of the post-telephone clinic period (7 vs 0 patients, p = 0.008). Of the 222 patients who undertook the questionnaire, 42.3% preferred telephone clinics (95% CI 35.97-48.97), 25.2% preferred face-to-face clinics (95% CI 19.92-31.39) and 32.4% did not prefer one method over another. Of the 24 health professionals who undertook the questionnaire, 70.8% felt patients preferred phone clinics.

CONCLUSIONS: Generally, patients and clinicians viewed telephone clinics favourably. Nevertheless, a large portion of patients still prefer face-to-face clinics. Services should be tailored to individual preferences. Although there were no ‘red flags’ in terms of mortality or admission rates, further longitudinal research is required. This article is protected by copyright. All rights reserved.

PMID:33961726 | DOI:10.1111/imj.15340

J Surg Oncol. 2021 May 7. doi: 10.1002/jso.26520. Online ahead of print.

ABSTRACT

BACKGROUND: In the management of peritoneal metastases from colon and rectal cancer, the most favorable results are reported with an aggressive combined treatment on patients who have a small extent of the disease. A test to detect occult peritoneal metastases would greatly facilitate the management of this component of colorectal dissemination.

METHODS: Currently, the standard test by which to confirm the diagnosis of the peritoneal spread of colorectal cancer is peritoneal cytology. To study the utility of this test, we gathered information from patients with biopsy-proven peritoneal metastases. The clinical, histologic, and treatment-related features of these patients at the time of a cytoreductive surgery were statistically correlated with the results of the peritoneal cytology test.

RESULTS: Forty-nine patients with colorectal cancer peritoneal metastases and a peritoneal cytology determination at the time of a cytoreductive surgery were available for analysis. Twenty-eight patients (55.1%) had a positive test. Patients with a high peritoneal cancer index and mucinous histology were most likely to have positive peritoneal cytology.

CONCLUSION: Peritoneal cytology identified patients with mucinous histology and a large extent of disease but was consistently negative in patients who had a small extent of disease compatible with a favorable response to treatment.

PMID:33961696 | DOI:10.1002/jso.26520

PLoS One. 2021 May 7;16(5):e0251382. doi: 10.1371/journal.pone.0251382. eCollection 2021.

ABSTRACT

BACKGROUND: The presence of COVID-19 has led to the disruption of health systems globally, including essential reproductive, maternal, newborn and child health (RMNCH) services. This study aimed to assess the challenges faced by women who used RMNCH services in Nigeria’s epicentre, their satisfaction with care received during the COVID-19 pandemic and the factors associated with their satisfaction.

METHODS: This cross-sectional survey was conducted in Lagos, southwest Nigeria among 1,241 women of reproductive age who had just received RMNCH services at one of twenty-two health facilities across the primary, secondary and tertiary tiers of health care. The respondents were selected via multi-stage sampling and face to face exit interviews were conducted by trained interviewers. Client satisfaction was assessed across four sub-scales: health care delivery, health facility, interpersonal aspects of care and access to services. Bivariate and multivariate analyses were used to assess the relationship between personal characteristics and client satisfaction.

RESULTS: About 43.51% of respondents had at least one challenge in accessing RMNCH services since the COVID-19 outbreak. Close to a third (31.91%) could not access service because they could not leave their houses during the lockdown and 18.13% could not access service because there was no transportation. The mean clients’ satisfaction score among the respondents was 43.25 (SD: 6.28) out of a possible score of 57. Satisfaction scores for the interpersonal aspects of care were statistically significantly lower in the PHCs and general hospitals compared to teaching hospitals. Being over 30 years of age was significantly associated with an increased clients’ satisfaction score (ß = 1.80, 95%CI: 1.10-2.50).

CONCLUSION: The COVID-19 lockdown posed challenges to accessing RMNCH services for a significant proportion of women surveyed. Although overall satisfaction with care was fairly high, there is a need to provide tailored COVID-19 sensitive inter-personal care to clients at all levels of care.

PMID:33961682 | DOI:10.1371/journal.pone.0251382

PLoS One. 2021 May 7;16(5):e0251360. doi: 10.1371/journal.pone.0251360. eCollection 2021.

ABSTRACT

Changes in phenological events have been vastly documented in face of recent global climate change. These studies are concentrated on temperate plants, and the responses of tropical species are still little understood, likely due to the lack of long-term phenological records in the tropics. In this case, the use of herbarium specimens to gather phenological data over long periods and wide geographic areas has emerged as a powerful tool. Here, we used four Melastomataceae species endemic to the Brazilian Atlantic Forest to evaluate phenological patterns and alterations as responses to recent climate changes. Phenological data were gathered from Reflora Virtual Herbarium specimens collected between 1920 and 2018, and analyzed with circular statistics applied to the intervals 1920-1979, 1980-1999, and 2000-2018. The effects of temperature range, average temperature, precipitation, and photoperiod on flowering and fruiting of each species were tested using multiple linear regressions. Through circular statistics, we detected changes, mostly delays, in the flowering of Miconia quinquedentata, Pleroma clavatum and P. trichopodum, and in the fruiting of M. acutiflora, P. clavatum and P. trichopodum. We also found that flowering and fruiting occurrence were related to local climatic conditions from months prior to the collections. We found marked phenological variations over the decades and also that these variations are associated to global climate change, adding up to the large body of evidence from higher latitudes. Our results also support herbarium collections as an important source for long-term tropical phenological studies. The lack of consistent patterns of responses among the four species (e.g. fruiting delayed two months in P. clavatum and advanced one month in M. acutiflora) suggests that climate change has unequal effects across tropical forests. This highlights the urgent need for further research to understand and forecast the ecological implications of these changes in global ecosystems processes.

PMID:33961684 | DOI:10.1371/journal.pone.0251360

PLoS One. 2021 May 7;16(5):e0251260. doi: 10.1371/journal.pone.0251260. eCollection 2021.

ABSTRACT

INTRODUCTION: Work-life conflicts (WLC) may impact health, but few studies prospectively consider the impact of WLC on objective outcomes such as cardiovascular disease. Using data from the Gutenberg Health Study (GHS), we examined if WLC at baseline was associated with an increased five-year incidence of cardiovascular events (myocardial infarct, stroke, atrial fibrillation, peripheral artery disease, coronary artery disease, chronic heart failure, sudden cardiac death). We also considered if WLC was associated with incident hypertension and arterial stiffness and if the effects of WLC on cardiovascular health differ for men and women.

METHODS: A working subsample of the 15,010 GHS cohort participants completed the Copenhagen Psychosocial Questionnaire, which included five “work-privacy conflict” questions at baseline and at the five-year follow-up. Relative risks for incident hypertension due to increased WLC at baseline (WLC scores exceeding 60 out of 100) were estimated with Poisson regression in the subgroup of participants without hypertension at baseline (n = 2426). Categories of WLC at baseline and follow-up were also used to examine the risk of hypertension due to chronic/recurrent WLC. In this subgroup, we also examined the association between WLC as a continuous score ranging from 0 to 100 with change to arterial stiffness after five years using linear regression. Hazard ratios were estimated for incident cardiovascular events in a larger subsample of participants without prevalent cardiovascular disease at baseline (n = 3698) using Cox regression. We used various multivariable regression models to adjust for sex, age, socioeconomic status, occupational, household, and cardiovascular risk factors.

RESULTS: We found no association between WLC and incident hypertension or increased arterial stiffness. The fully-adjusted relative risk for WLC >60 at baseline and hypertension was 0.93 (95% 0.74-1.17). The risk of hypertension due to chronic/recurrent WLC >60 was increased but not statistically significant (RR = 1.13, 95% CI 0.83-1.54). Overall, hazard ratios for incident cardiovascular events were also not increased. However, stratifying the results by sex resulted in a hazard ratio of 1.47 (95% CI 0.54-3.98) for incident cardiovascular disease among women in the fully adjusted model.

CONCLUSIONS: Although our results were not statistically significant, they indicate that WLC is negatively impacting the cardiovascular health of women. While these results need to be confirmed with additional research and a longer follow-up, interventions to prevent WLC will promote health and could be especially beneficial for women.

PMID:33961688 | DOI:10.1371/journal.pone.0251260

PLoS One. 2021 May 7;16(5):e0250644. doi: 10.1371/journal.pone.0250644. eCollection 2021.

ABSTRACT

BACKGROUND: The World Health Organization recently recommended Video Observed Therapy (VOT) as one option for monitoring tuberculosis (TB) treatment adherence. There is evidence that private sector TB treatment has substandard treatment follow-up, which could be improved using VOT. However, acceptability of VOT in the private sector has not yet been evaluated.

METHODS: We conducted a cross-sectional survey employing a theoretical framework for healthcare intervention acceptability to measure private provider perceptions of VOT across seven constructs in three cities of Viet Nam: Ha Noi, Ho Chi Minh City, and Hai Phong. We investigated the differences in private providers’ attitudes and perceptions of VOT using mixed ordinal models to test for significant differences in responses between groups of providers stratified by their willingness to use VOT.

RESULTS: A total of 79 private providers completed the survey. Sixty-two providers (75%) indicated they would use VOT if given the opportunity. Between private providers who would and would not use VOT, there were statistically significant differences (p≤0.001) in the providers’ beliefs that VOT would help identify side effects faster and in their confidence to monitor treatment and provide differentiated care with VOT. There were also significant differences in providers’ beliefs that VOT would save them time and money, address problems faced by their patients, benefit their practice and patients, and be relevant for all their patients.

CONCLUSION: Private providers who completed the survey have positive views towards using VOT and specific subpopulations acknowledge the value of integrating VOT into their practice. Future VOT implementation in the private sector should focus on emphasizing the benefits and relevance of VOT during recruitment and provide programmatic support for implementing differentiated care with the technology.

PMID:33961645 | DOI:10.1371/journal.pone.0250644