Category: Nevin Manimala

Front Oncol. 2021 Aug 11;11:699200. doi: 10.3389/fonc.2021.699200. eCollection 2021.

ABSTRACT

AIM: To evaluate the evidence concerning the quality of surgical resection in laparoscopic (LapTME), robotic (RobTME) and transanal (TaTME) total mesorectal excision for mid-/low rectal cancer.

METHODS: A systematic literature search of the PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases was performed. A Bayesian network meta-analysis was utilized to compare surgical resection involved in these 3 surgical techniques by using ADDIS software. Rates of positive circumferential resection margins (CRMs) were the primary endpoint.

RESULTS: A total of 34 articles, 2 randomized clinical trials (RCTs) and 32 non-RCTs, were included in this meta-analysis. Pooled data showed CRM positivity in 114 of 1763 LapTME procedures (6.5%), 54 of 1051 RobTME procedures (5.1%) and 60 of 1276 TaTME procedures (4.7%). There was no statistically significant difference among these 3 surgical approaches in terms of CRM involvement rates and all other surgical resection quality outcomes. The incomplete mesorectal excision rates were 9.6% (69/720) in the LapTME group, 1.9% (11/584) in the RobTME group and 5.6% (45/797) in the TaTME group. Pooled network analysis observed a higher but not statistically significant risk of incomplete mesorectum when comparing both LapTME with RobTME (OR = 1.99; 95% CI = 0.48-11.17) and LapTME with TaTME (OR = 1.90; 95% CI = 0.99-5.25). By comparison, RobTME was most likely to be ranked the best or second best in terms of CRM involvement, complete mesorectal excision, rate of distal resection margin (DRM) involvement and length of DRMs. In addition, RobTME achieved a greater mean tumor distance to the CRM than TaTME. It is worth noting that TaTME was most likely to be ranked the worst in terms of CRM involvement for intersphincteric resection of low rectal cancer.

CONCLUSION: Overall, RobTME was most likely to be ranked the best in terms of the quality of surgical resection for the treatment of mid-/low rectal cancer. TaTME should be performed with caution in the treatment of low rectal cancer.

PMID:34458142 | PMC:PMC8385749 | DOI:10.3389/fonc.2021.699200

Int J Appl Basic Med Res. 2021 Jul-Sep;11(3):182-187. doi: 10.4103/ijabmr.ijabmr_61_21. Epub 2021 Jul 19.

ABSTRACT

BACKGROUND: The correlation of SARS-CoV-2 viral load with disease severity in different population subsets is still elusive. There is a scarcity of literature regarding this aspect in Indian Population.

AIM: To study retrospectively the risk factors and the role of viral load with disease severity among different age groups of North Indian population.

METHODS: Here we quantified the viral load of 239 positive participants and collected data retrospectively from April 2020 to May 2020 and categorised the patients as per disease severity and population subsets.

RESULTS: Asymptomatic patients were found to have higher viral load than the symptomatic patients, though the difference was not found to be statistically significant. The logistic regression analysis showed that contact with laboratory confirmed cases, SARI and ILI were independent risk factors for acquiring COVID-19 infection.

CONCLUSION: SARS-CoV-2 viral load is not significantly associated with disease severity among different population subsets. However, there is a need to carry out more studies with a larger number of patients to validate and confirm the above findings.

PMID:34458122 | PMC:PMC8360218 | DOI:10.4103/ijabmr.ijabmr_61_21

Clin Chem Lab Med. 2021 Aug 27. doi: 10.1515/cclm-2021-0694. Online ahead of print.

ABSTRACT

OBJECTIVES: We hypothesized that the amount of antigen produced in the body during a COVID-19 infection might differ between patients, and that maximum concentrations would predict the degree of both inflammation and outcome for patients.

METHODS: Eighty-four hospitalized and SARS-CoV-2 PCR swab-positive patients, were followed with blood sampling every day until discharge or death. A total of 444 serial EDTA plasma samples were analyzed for a range of biomarkers: SARS-CoV-2 nuclear antigen and RNA concentration, complement activation as well as several inflammatory markers, and KL-6 as a lung marker. The patients were divided into outcome groups depending on need of respiratory support and death/survival.

RESULTS: Circulating SARS-CoV-2 nuclear antigen levels were above the detection limit in blood in 65 out of 84 COVID-19 PCR swab-positive patients on day one of hospitalization, as was viral RNA in plasma in 30 out of 84. In all patients, complete antigen clearance was observed within 24 days. There were definite statistically significant differences between the groups depending on their biomarkers, showing that the concentrations of virus RNA and antigen were correlated to the inflammatory biomarker levels, respiratory treatment and death.

CONCLUSIONS: Viral antigen is cleared in parallel with the virus RNA levels. The levels of antigens and SARS-CoV-2 RNA in the blood correlates with the level of IL-6, inflammation, respiratory failure and death. We propose that the antigens levels together with RNA in blood can be used to predict the severity of disease, outcome, and the clearance of the virus from the body.

PMID:34455731 | DOI:10.1515/cclm-2021-0694

Zhongguo Fei Ai Za Zhi. 2021 Aug 30. doi: 10.3779/j.issn.1009-3419.2021.102.26. Online ahead of print.

ABSTRACT

BACKGROUND: Programmed cell death 1 or programmed cell death-ligand 1 inhibitor (PD-1/PD-L1 inhibitor) and docetaxel, as the standard second-line treatments of advanced non-small cell lung cancer (NSCLC) patients, have limited effects. There are few studies on whether docetaxel combined with PD-1/PD-L1 inhibitor can increase the efficacy and make patients better benefit. The aim of this study is to evaluate the efficacy and safety of docetaxel combined with PD-1/PD-L1 inhibitor for the second-line treatment of stage IV NSCLC patients.

METHODS: Stage IV NSCLC patients (n=118) who received treatment at Shandong Cancer Hospital between October 1, 2018, and December 31, 2020, were retrospectively analyzed. They were divided into observation group (n=69) and control group (n=49) according to different treatment plan. Observation group was given docetaxel plus PD-1/PD-L1 inhibitor, while control group was given PD-1/PD-L1 inhibitor. The clinical curative effect and the incidence of adverse reactions of grade 3 and above were compared between the two groups.

RESULTS: The disease control rate (DCR) was higher in the observation group (89.9%) than that in the control group (73.5%) (P=0.019), and the objective response rate (ORR) showed no significant difference between observation group (24.6%) and control group (16.3%) (P=0.276). Till June 22, 2021, the 1-year PFS rate showed no difference between observation group (16.5%) and control group (7.7%) (P=0.205). During the treatment period, the adverse reactions of the two groups were mostly grade 1 to 2, and could be tolerated. The incidence of bone marrow suppression in observation group was higher than that in the control group (P<0.05), and the remaining adverse reactions were not statistically different from control group. Cox regression analysis showed that performance status (PS) (P=0.020) and age (P=0.049) were independent prognostic factors for the effect of docetaxel combined with PD-1/PD-L1 inhibitor.

CONCLUSIONS: The second-line treatment with docetaxel plus PD-1/PD-L1 inhibitor in patients with stage IV NSCLC can improve the DCR and prolong the PFS, and the adverse reactions are tolerable.

PMID:34455735 | DOI:10.3779/j.issn.1009-3419.2021.102.26

J Thromb Haemost. 2021 Aug 29. doi: 10.1111/jth.15516. Online ahead of print.

ABSTRACT

BACKGROUND: In the Hokusai VTE Cancer study, the risk of major bleeding was 2.9% higher in the edoxaban group compared with the dalteparin group, mainly due to more gastrointestinal bleedings in patients with gastrointestinal cancer. The identification of risk factors for gastrointestinal bleeding may help to guide the use of DOACs in these patients OBJECTIVES: To evaluate risk factors for gastrointestinal bleeding in patients with gastrointestinal cancer receiving edoxaban.

PATIENTS/METHODS: In this nested case-control study in patients with gastrointestinal cancer randomized to edoxaban in the Hokusai VTE Cancer study, cases (patients with clinically relevant gastrointestinal bleeding during treatment) were randomly matched to three controls (patients who had no gastrointestinal bleeding). Data for the 4-week period prior to bleeding were retrospectively collected. Odds ratios (ORs) were calculated in a crude conditional logistic regression model and a multivariable model adjusted for age, sex, and cancer type.

RESULTS: 24 cases and 64 matched controls were included. In the multivariable analysis, advanced cancer, defined as regionally advanced or metastatic cancer (OR 3.6, 95% CI 1.01-12.6) and low hemoglobin levels (OR 4.8, 95% CI 1.5-16.0) were significantly associated with bleeding. There was no significant difference in patients with resected tumors (OR 0.4, 95% CI 0.1-1.4), or in patients on chemotherapy (OR 1.3, 95% CI 0.5-3.5).

CONCLUSION: Advanced cancer and low hemoglobin levels were associated with an increased risk of gastrointestinal bleeding in patients with gastrointestinal cancer receiving edoxaban. We were unable to identify other risk factors, mainly due to limited statistical power.

PMID:34455706 | DOI:10.1111/jth.15516

J Complement Integr Med. 2021 Aug 30. doi: 10.1515/jcim-2021-0181. Online ahead of print.

ABSTRACT

OBJECTIVES: Insomnia and sleep disorders are common and can be severe amongst patients with cancer, especially during chemotherapy. The aim of this study was to evaluate the efficacy of lettuce seed syrup in breast cancer patients who suffer from insomnia or disordered sleep.

METHODS: This pilot study was a double-blinded randomized controlled clinical trial conducted in Shoha–e-Tajrish Hospital (Tehran, Iran) from September 2018 to June 2019. 50 adult patients with breast cancer with insomnia or sleep disorders were enrolled. Participants were randomly allocated to lettuce seed syrup (5 mL twice daily), or placebo syrup at the same dose for four weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality before and after the intervention.

RESULTS: Compared to placebo, the mean of the total PSQI score decreased significantly in participants who received lettuce seed syrup (p=0.014). In addition, there were statistically significant reductions in the mean scores of subject quality sleep (p=0.002), sleep duration (p=0.038), habitual sleep efficacy (p=0.029) and sleep disturbance (p=0.032) in patients who received lettuce seed syrup.

CONCLUSIONS: Lettuce seed syrup may improve self-reported sleep quality in participants with breast cancer. Larger trials are indicated in diverse samples of participants with caner to learn if these finds are generalizable.

PMID:34455726 | DOI:10.1515/jcim-2021-0181

Oral Dis. 2021 Aug 29. doi: 10.1111/odi.14013. Online ahead of print.

ABSTRACT

OBJECTIVE: The objectives of this study were to estimate the prognostic value of the tumour-stroma ratio (TSR) and tumour budding (TB) in oral tongue squamous cell carcinoma (OTSCC) and to establish a reliable model to predict the outcome of OTSCC patients.

METHODS: A total of 103 patients surgically treated at our hospital were enrolled in this study. Chi-square tests, Kaplan-Meier analyses, and Cox proportional hazards regression models were performed for statistical analysis.

RESULTS: Fifty-six patients were categorized as stroma-rich, and forty-seven patients were categorized as stroma-poor. Only pathological grade was associated with the TSR (P=0.017). Kaplan-Meier analysis showed that stroma-rich, high-intensity budding and high risk groups were associated with worse prognosis. The Cox regression model showed that the TSR was an independent risk factor for OTSCC patients prognosis, and the high risk group was also related to poor prognosis (P<0.05). TB was significantly associated with poor prognosis but was not an independent risk factor.

CONCLUSIONS: We found that patients in the stroma-rich group had a worse long-term prognosis. The TSR is an independent risk factor for OTSCC patients outcome. In addition, a risk model that combined the TSR and TB proved to be valuable for predicting OTSCC patients outcome.

PMID:34455659 | DOI:10.1111/odi.14013

Int J Clin Pract. 2021 Aug 29:e14763. doi: 10.1111/ijcp.14763. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to investigate the effect on the occurrence of emergence delirium of propofol and ketofol with intranasal dexmedetomidine and midazolam applied as premedication to paediatric patients during magnetic resonance imaging (MRI).

METHODS: The study included children aged 2-10 years who received sedation for MRI, separated into four groups. Group MP (midazolam-propofol) received intranasal midazolam (0.2mg/kg) for premedication and intravenous (IV) propofol (1mg/kg) as the anaesthetic agent. Group MK (midazolam-ketofol) received intranasal midazolam (0.2mg/kg) for premedication and IV ketofol (1mg/kg) as the anaesthetic agent. Group DP (dexmedetomidine-propofol) received intranasal dexmedetomidine (1mcg/kg) for premedication and IV propofol (1mg/kg) as the anaesthetic agent. Group DK (dexmedetomidine-ketofol) received intranasal dexmedetomidine (1mcg/kg) for premedication and IV ketofol (1mg/kg) as the anaesthetic agent. The Paediatric Anaesthesia Emergence Delirium (PAED) scale was used to evaluate delirium. A PAED score ≥ 10 was accepted as delirium.

RESULTS: Statistical analysis was made of 140 paediatric patients. Delirium developed in 1.42% of all the patients, and in 5.7% of Group MP. The mean Aldrete and PAED scores were lower and the length of stay in the recovery room was shorter in Group DP than in the other groups. The need for additional anaesthetic was highest in Group DP at 94.3% and lowest in Group DK at 14.3%. The groups administered ketofol were observed to have a lower requirement for additional anaesthetic.

CONCLUSION: Delirium was seen at a very low rate only in the Group MP and it is difficult to say the best combination in terms of delirium frequency. However, intranasal dexmedetomidine and IV ketofol seem to be better and safer than the other groups in terms of the need for additional doses and the number of side effects. The addition of ketamine to propofol reduces the need for additional doses with a synergistic effect.

PMID:34455665 | DOI:10.1111/ijcp.14763

Int J Clin Pract. 2021 Aug 29:e14760. doi: 10.1111/ijcp.14760. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to determine the predictive risk factors for development of severe bronchiolitis in patients with acute bronchiolitis with no previous chronic disease.

METHODS: Four hundred forty children aged 1-24 months hospitalized with acute bronchiolitis, were examined between February 2018 and February 2019 in this prospective study.

RESULTS: Eighty-five cases were regarded as severe bronchiolitis and 355 as mild-moderate bronchiolitis. Statistically significant differences were observed between the severe and mild-moderate bronchiolitis groups in terms of weight-for-age z-scores, history of bronchiolitis, hemoglobin levels, and time elapsed between onset of symptoms and admission. Weight-for-age z-scores, the mean time interval between onset of symptoms and admission, and mean hemoglobin values were lower in the severe bronchiolitis group while the mean number of bronchiolitis attacks was higher than in the mild-moderate bronchiolitis group. Logistic regression analysis determined that a low weight-for-age z-score increased the risk of severe bronchiolitis development 0.56-fold (CI: 0.409 – 0.760), a short duration between the onset of symptoms and admission increased the risk 0.62-fold (CI: 0.519 – 0.735), a frequent history of bronchiolitis increased the risk 1.81-fold (CI: 1.135 – 2.968) and low hemoglobin levels increased the risk 0.72-fold (CI: 0.537 – 0.969).

CONCLUSION: Low weight-for-age z-scores, a short duration between the onset of symptoms and admission, a high number of previous attacks, and low hemoglobin levels were identified as independent parameters of severe bronchiolitis development.

PMID:34455690 | DOI:10.1111/ijcp.14760

J Card Surg. 2021 Aug 29. doi: 10.1111/jocs.15952. Online ahead of print.

ABSTRACT

INTRODUCTION: To assess the efficacy of C-reactive protein (CRP) and procalcitonin (PCT) at identifying infection in children after congenital heart surgery (CHS) with cardiopulmonary bypass (CPB).

MATERIALS AND METHODS: Systematic review of the literature was conducted to identify studies with data regarding CRP and/or PCT after CHS with CPB. The primary variables identified to be characterized were CRP and PCT at different timepoints. The main inclusion criteria were children who underwent CHS with CPB. Subset analyses for those with and without documented infection were conducted in similar fashion. A p value of less than .05 was considered statistically significant.

RESULTS: A total of 21 studies were included for CRP with 1655 patients and a total of 9 studies were included for PCT with 882 patients. CRP peaked on postoperative Day 2. A significant difference was noted in those with infection only on postoperative Day 4 with a level of 53.60 mg/L in those with documented infection versus 29.68 mg/L in those without. PCT peaked on postoperative Day 2. A significant difference was noted in those with infection on postoperative Days 1, 2, and 3 with a level of 12.9 ng/ml in those with documented infection versus 5.6 ng/ml in those without.

CONCLUSIONS: Both CRP and PCT increase after CHS with CPB and peak on postoperative day 2. PCT has a greater statistically significant difference in those with documented infection when compared to CRP and a PCT of greater than 5.6 ng/ml should raise suspicion for infection.

PMID:34455653 | DOI:10.1111/jocs.15952