Category: Nevin Manimala

Am J Clin Oncol. 2021 Jul 1;44(7):340-349. doi: 10.1097/COC.0000000000000816.

ABSTRACT

OBJECTIVE: Ado-trastuzumab emtansine (T-DM1) was recently approved for patients with human epidermal growth factor receptor 2 positive (HER2+) early breast cancer (eBC) with residual invasive disease after neoadjuvant taxane and trastuzumab-based treatment. Cost-effectiveness analysis was conducted to compare T-DM1 versus trastuzumab in the United States.

MATERIALS AND METHODS: A Markov cohort-based model tracked clinical and economic outcomes over a lifetime horizon from a US payer perspective. The model included 6 health states: invasive disease-free, nonmetastatic (locoregional) recurrence, remission, first-line and second-line metastatic BC and death. Model state transitions were based on statistical extrapolation of the head-to-head KATHERINE study and published sources. Dosing and treatment duration reflected prescribing information and trials. Costs (2019 US dollars) associated with pharmaceutical treatment (wholesale acquisition costs), health state specific care, adverse events, and end-of-life care were included. Health state utilities were obtained from KATHERINE and published literature.

RESULTS: T-DM1 dominated trastuzumab, yielding lower lifetime costs (-$40,271), and higher life-years (2.980) and quality-adjusted life-years (2.336). Results were driven by patients receiving T-DM1 spending less time in more costly downstream health states, as these patients are less likely to experience a recurrence overall, despite having a higher likelihood of metastatic disease (distant recurrence) in the subset of patients who experience recurrence. Probabilistic sensitivity analysis indicated robust results, with 96.7% of 5000 stochastic simulations producing dominance for T-DM1. The most influential variables were related to treatment costs, off treatment utilities, and health state costs. Additional scenario analyses tested a range of model inputs and assumptions, and produced consistent results.

CONCLUSION: Relative to trastuzumab, T-DM1 treatment for patients with HER2+ eBC who have residual invasive disease after neoadjuvant taxane and trastuzumab-based treatment is likely to reduce the overall financial burden of cancer, while simultaneously improving patient outcomes.

PMID:34151896 | DOI:10.1097/COC.0000000000000816

J Vestib Res. 2021 Jun 11. doi: 10.3233/VES-190578. Online ahead of print.

ABSTRACT

BACKGROUND: Images that deviate from natural scene statistics in terms of spatial frequency and orientation content can produce visual stress (also known as visual discomfort), especially for migraine sufferers. These images appear to over-activate the visual cortex.

OBJECTIVE: To connect the literature on visual discomfort with a common chronic condition presenting in neuro-otology clinics known as persistent postural perceptual dizziness (PPPD). Sufferers experience dizziness when walking through highly cluttered environments or when watching moving stimuli. This is thought to arise from maladaptive interaction between vestibular and visual signals for balance.

METHODS: We measured visual discomfort to stationary images in patients with PPPD (N = 30) and symptoms of PPPD in a large general population cohort (N = 1858) using the Visual Vertigo Analogue Scale (VVAS) and the Situational Characteristics Questionnaire (SCQ).

RESULTS: We found that patients with PPPD, and individuals in the general population with more PPPD symptoms, report heightened visual discomfort to stationary images that deviate from natural spectra (patient comparison, F (1, 1865) = 29, p < 0.001; general population correlations, VVAS, rs (1387) = 0.46, p < 0.001; SCQ, rs (1387) = 0.39, p < 0.001). These findings were not explained by co-morbid migraine. Indeed, PPPD symptoms showed a significantly stronger relationship with visual discomfort than did migraine (VVAS, zH = 8.81, p < 0.001; SCQ, zH = 6.29, p < 0.001).

CONCLUSIONS: We speculate that atypical visual processing -perhaps due to a visual cortex more prone to over-activation -may predispose individuals to PPPD, possibly helping to explain why some patients with vestibular conditions develop PPPD and some do not.

PMID:34151873 | DOI:10.3233/VES-190578

Front Vet Sci. 2021 Jun 4;8:669117. doi: 10.3389/fvets.2021.669117. eCollection 2021.

ABSTRACT

In Australia, little is known about the strategies used by farmers to control Fasciola hepatica (F. hepatica) infection in dairy cattle. Triclabendazole-resistant F. hepatica have recently been found on several dairy and beef properties in Australia. It is difficult to draw conclusions about how widespread resistance is in Australian dairy cattle because we have little information about flukicide usage, drug resistance testing, and alternative flukicide usage on-farm. The study objectives were to determine how dairy farmers are currently controlling F. hepatica and to identify knowledge gaps where F. hepatica control strategies need to be communicated to farmers to improve management. The survey was distributed online or by hard copy and 36 dairy farmers completed the survey. There were 34 questions including closed, open-ended, multicheck box, demographic, and text questions. Descriptive statistics were used to quantify each response. The survey results showed high use of clorsulon, limited rotation of flukicides, and limited use of diagnostic tests to inform treatment options and timing. There was poor adherence to best management practice in determining the dose of flukicides administered to cattle, with farmers often relying on estimating body weights or average body weights, suggesting that underdosing of animals is likely to be prevalent. Most respondents in this study did not isolate and quarantine treated and newly returned or purchased animals before joining them with the main herd. The research identified four knowledge gaps where communication needs to be enhanced to improve control of F. hepatica: diagnostic testing to inform flukicide use, rotation of flukicide actives, flukicide administration, and increased testing of replacement animals.

PMID:34150890 | PMC:PMC8213206 | DOI:10.3389/fvets.2021.669117

Front Med (Lausanne). 2021 Jun 2;8:669342. doi: 10.3389/fmed.2021.669342. eCollection 2021.

ABSTRACT

Background: The association between endometriosis and embryological outcomes remains uncertain. The meta-analysis aimed to evaluate the impact of endometriosis on embryo quality. Methods: A systematic review and meta-analysis was conducted to investigate the association between the endometriosis and embryo quality. Searches were performed on the three electronic databases: PubMed, EMBASE, and Web of Science. The detailed characteristics and data of the included studies were extracted. The risk ratio with 95% confidence intervals were calculated using the random and fixed effects model. The main outcome measures were high-quality embryo rate, cleavage rate, and embryo formation rate. Results: A total of 22 studies included were analyzed. Compared with the control group, women with endometriosis had a similar high-quality embryo rate (RR = 1.00; 95% CI, 0.94-1.06), a comparable cleavage rate (RR = 1.00; 95% CI, 0.97-1.02), and a similar embryo formation rate (RR = 1.10; 95% CI, 0.97-1.24). In women with stage III-IV endometriosis, there was no statistically significantly difference in high-quality embryo rate (RR = 1.02; 95% CI, 0.94-1.10), cleavage rate (RR = 1.00; 95% CI, 0.98-1.02), and embryo formation rate (RR = 1.05; 95% CI, 0.97-1.14), compared with those without endometriosis. For women with unilateral endometrioma, pooling of results from the affected ovaries did not show a statistically significantly difference in high-quality embryo rate (RR = 0.99; 95% CI, 0.60-1.63) in comparison to the normal contralateral ovaries. Conclusions: Our results seem to indicate that endometriosis does not compromise embryo quality from the perspective of morphology.

PMID:34150804 | PMC:PMC8206501 | DOI:10.3389/fmed.2021.669342

Front Nutr. 2021 Jun 2;8:608972. doi: 10.3389/fnut.2021.608972. eCollection 2021.

ABSTRACT

Background: Previous studies have suggested that maternal dietary protein was associated with allergic diseases in offspring, but few studies have evaluated the influence of dietary protein patterns. This study aimed to explore the prospective association between maternal dietary protein patterns during pregnancy and the risk of infant eczema. Methods: A total of 713 mother-child pairs from a prospective cohort in Guangzhou, China were recruited. Maternal dietary protein was estimated using a validated face-to-face food frequency questionnaire at 20-28 weeks’ gestation from 2017 to 2018. Dietary protein patterns were calculated based on the sources of protein. The data of infant eczema was assessed at 6 months of age using the symptom questionnaire of eczema. Logistic regression was carried out to examine the associations between maternal dietary protein patterns and infant eczema. Results: The cumulative incidence of infant eczema at 6 months of age was 51.19%. Mothers of infants with eczema consumed more protein from poultry source during pregnancy than mothers of infants without eczema, while no statistical differences were observed in maternal intakes of protein from cereals and tubers, vegetables, fruits, red meat, fish and seafood, eggs, dairy, soybean, and nuts and seeds. Four dietary protein patterns were identified and termed poultry, plant, dairy and eggs, and red meat and fish. The cumulative incidence of eczema was 61.2, 45.8, 48.0, 51.4% for these four patterns, respectively. Compared to the poultry dietary pattern, the plant pattern and the dairy and eggs pattern were associated with a reduced risk of infant eczema, and the adjusted odds ratios (95% confidence interval) were 0.572 (0.330-0.992), 0.478 (0.274-0.837), respectively. No such association was observed for the red meat and fish dietary protein pattern. Conclusion: This is the first study that focused on the association between maternal dietary protein during pregnancy from a whole-diet perspective and infant eczema. Compared with the poultry dietary protein pattern, the maternal plant pattern and the dairy and eggs pattern during pregnancy were associated with a reduced risk of infant eczema.

PMID:34150822 | PMC:PMC8206490 | DOI:10.3389/fnut.2021.608972

Front Med (Lausanne). 2021 Jun 2;8:578684. doi: 10.3389/fmed.2021.578684. eCollection 2021.

ABSTRACT

Objective: Both rhino-orbital-cerebral mycosis and lethal midline granuloma (LMG) may result in midline destruction. LMG has now been generally considered as a natural killer/T cell lymphoma, nasal type (ENKTL-NT) with an association of EBV. Fungi have been detected from the diseased tissues now and then but are often considered as lymphoma-associated infections. We previously reported an ENKTL-NT case with Mucor irregularis, which played a causal role in the disease and was involved in the overexpression of Ki67 and CD56 in the mouse experiment. The present study describes a chronic Rhizopus arrhizus infection with immunological parameters that are closely similar to LMG. We aim to explore the relationship of another Mucorales fungus, R. arrhizus, and LMG in a patient and in mice. Methods: Case study and mouse infection modules were designed for our observation. A 35-year-old man with midline face ulcers which was clinically suspected as LMG was selected. Biopsy specimens were sent for lymphoma diagnosis and microbiological detection. The isolated fungus was tested in an ICR mouse model for mycological and histological analyses. Results: Five tissue samples yielded Rhizopus arrhizus. In the pathology, characteristic inflammation, necrosis, and granulation with thin-walled hyphae are observed. Immunohistochemistry showed NK/T cell infiltration (CD3+, CD8+, TIA1+, GZMB+, PRF+, individual CD56+) with hyperplasia (Ki67+) and angioinvasion. The patient recovered completely with amphotericin B. In the murine experiment, R. arrhizus caused angioinvasion with NK/T cell infiltration (CD3+, CD56+, TIA1+, GZMB +, PRF+) with proliferation (Ki67+) and was re-isolated from the infected host. Conclusions: We here describe a mid-face destruction patient, which was diagnosed by the top pathologists in China according to the current criteria of NK/T cell lymphoma, with a negative result for EBV and positive result for R. arrhizus. With a then developed mouse experiment, the R. arrhizus in the diseased lesions was responsible for the NK/T cell infiltration (CD3+, CD8+, CD56+, TIA1+, GZMB+, PRF+), proliferation (Ki67+), and angioinvasion, suggesting another fungal etiological agent for LMG, which could be eradicated with amphotericin B. Limitations: The sample size is not sufficient for statistical analysis. However, our findings are suggestive for the role fungus plays in LMG.

PMID:34150783 | PMC:PMC8208083 | DOI:10.3389/fmed.2021.578684

Front Public Health. 2021 Jun 4;9:660813. doi: 10.3389/fpubh.2021.660813. eCollection 2021.

ABSTRACT

Purpose: Because older adults are at elevated risk of COVID-19-related adverse health outcomes, and staying at home is an effective strategy to avoid unnecessary exposures, the current formative study used the Reasoned Action Approach (RAA) to identify the beliefs underlying older adults’ decision to stay home for the next month. Methods: The participants (weighted n = 206, age 65-94) for the current study were selected from a nationally representative online survey of US adults from April 10-20, 2020. We used multiple linear regression to estimate the relative contribution of the four RAA global constructs (instrumental attitude, injunctive norms, descriptive norms, and self-efficacy) in explaining intention to stay home after controlling for demographic covariates. We also conducted a content analysis to identify beliefs about advantages, disadvantages, and facilitators of staying home. Results: After controlling for demographic characteristics, injunctive norms (b = 0.208; SE = 0.059; B = 0.213, p < 0.01) and self-efficacy (b = 0.532; SE = 0.058; B = 0.537, p < 0.001) showed statistically significant independent associations with intention to stay home. The specific beliefs underlying the decision to stay home spanned across health and wellness dimensions and suggested interpersonal, mental health, and leisure/recreational facilitators. Conclusions: These findings suggest three public health intervention targets. First, self-efficacy building interventions could enhance older adults’ perceptions of their ability to stay home to avoid unnecessary exposures. Second, health communication messages to address injunctive norms could emphasize that people important to older adults think they should stay home. Third, for the youngest of the older adults, health communication messages could emphasize the advantages of staying home.

PMID:34150704 | PMC:PMC8211911 | DOI:10.3389/fpubh.2021.660813

Front Public Health. 2021 Jun 4;9:661058. doi: 10.3389/fpubh.2021.661058. eCollection 2021.

ABSTRACT

Context: The feeding practices during first 2 years of life determine the overall health and survival during childhood and beyond. Child nutrition is responsibility of both parents and so far emphasis has been laid mostly on mothers. Fathers’ involvement toward Infant and Young child feeding (IYCF) has been proved to be of paramount importance and yet it is given limited importance. Objectives: This study aims to study the level of paternal involvement toward IYCF and its associated factors and to assess the knowledge, attitude, and practices toward IYCF in Dakshina Kannada District in South Indian State of Karnataka. Settings and Design: This community-based cross-sectional study was conducted in the coastal District of Dakshina Kannada; Karnataka State in India. Methods: The study included 450 fathers of infant and young children (aged <2 years) in five taluks of Dakshina Kannada district. They were assessed for knowledge, attitude, and practices related to IYCF. Median score for the practice component was considered cut off to classify involvement in IYCF. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. Chi-square-test and Binary Logistic Regression with Hosmer-Lemeshow goodness-of-fit model were used. Unadjusted and adjusted odds ratios were generated. A p-value of <0.05 was considered statistically significant. Results: Mean age of the study population was 34.6 years (SD, 5.4). The practice scores median (IQR) was 34.0 (IQR, 31.0-39.0), and 40.9% of the participants had poor involvement in IYCF. This was significantly higher among fathers from predominantly urban area. Those who had education above graduation and younger fathers had better involvement in IYCF. Conclusions: Less than half of fathers had poor involvement in IYCF, and it was lower among fathers from urban areas, higher age, and lower educational levels.

PMID:34150705 | PMC:PMC8212972 | DOI:10.3389/fpubh.2021.661058

Front Bioeng Biotechnol. 2021 Jun 2;9:694484. doi: 10.3389/fbioe.2021.694484. eCollection 2021.

NO ABSTRACT

PMID:34150740 | PMC:PMC8207135 | DOI:10.3389/fbioe.2021.694484

Front Public Health. 2021 Jun 4;9:651228. doi: 10.3389/fpubh.2021.651228. eCollection 2021.

ABSTRACT

Concerns about weight and body image are common among adolescents since they are particularly vulnerable to body-image dissatisfaction due to the normal physiological, social, and psychological changes they are going through. This study aims to analyse the relationship between food choice motivations and physical activity in body-image perception among adolescents. Twelve to sixteen years old adolescents were recruited from three school districts. The Portuguese version of the Food Choices Questionnaire (FCQ) was used to assess food choice motivators, and the Quantification de l’Activité Physique en Altitude Chez les Enfants was used to assess physical activity and to calculate daily energy expenditure (DEE). Body image perception was measured using Collins’ sequence of seven silhouettes. Body image (dis)satisfaction was estimated by the present body shape minus the desired body shape. ANOVA and Kruskal-Wallis tests were performed to compare groups, and the post-hoc Bonferroni test was used to compare target groups. A multinominal logistic regression was performed to analyse the association between gender, age, hours of sport’s competition, FCQ, and body dissatisfaction. All analyses were performed in IBM SPSS Statistics 26.0. The sample comprised 286 adolescents (51.4% females). Means of FCQ categories varied between 0.33 and 0.97 (range: -2 to 2). Regarding the categories of FCQ, statistically significant differences were found in the category of body satisfaction and weight control among the three groups (p = 0.004). A preventive effect was found of choosing food regarding body satisfaction and weight control, on body-image dissatisfaction.

PMID:34150700 | PMC:PMC8213024 | DOI:10.3389/fpubh.2021.651228