Category: Nevin Manimala

Womens Health Issues. 2021 Apr 30:S1049-3867(21)00031-1. doi: 10.1016/j.whi.2021.03.008. Online ahead of print.

ABSTRACT

BACKGROUND: The incidence of thyroid cancer in women is increasing at an alarming rate, with greatest risk in the reproductive years. Establishing relationships of hormonally related reproductive factors with thyroid cancer has been difficult. We aimed to elucidate potential risk factors for thyroid cancer in a large cohort of women.

METHODS: Among 116,228 women in the Nurses’ Health Study II followed from 1989 to 2013, 620 cases of thyroid cancer were identified. We examined reproductive and hormone-related factors, including age at menarche, age at menopause, parity, oral contraceptive use, and postmenopausal hormone therapy use. Pregnancy, reproductive years, and months of breastfeeding were used as surrogate markers for exposure to endogenous reproductive hormones. We used multivariable Cox models to calculate relative risks and 95% confidence intervals for the associations between these factors and risk of thyroid cancer.

RESULTS: Number of reproductive years of 41 years or more was associated with more than double the risk of thyroid cancer compared with 30 years or fewer (relative risk, 2.20; 95% confidence interval, 1.19-4.06). The other variables analyzed (parity number, months of breastfeeding, age at menarche, menopausal status, and postmenopausal hormone therapy) were not associated with the risk of thyroid cancer. Women who entered menopause at age 45 years or older had a higher risk of thyroid cancer compared with women who entered menopause at a younger age. This result did not reach statistical significance; however, there was a linear trend between later age at menopause and increased risk of thyroid cancer (p_trend = .009).

CONCLUSIONS: This study used a unique large, longitudinal dataset to assess thyroid cancer risk factors and potential confounders over an extended time frame. Our key finding suggests increased risk of thyroid cancer may be associated with a variety of indicators of longer reproductive years. The Nurses’ Health Study II has provided new insights into the hormonal risks associated with thyroid cancer.

PMID:33941452 | DOI:10.1016/j.whi.2021.03.008

Prog Urol. 2021 Apr 30:S1166-7087(20)30687-4. doi: 10.1016/j.purol.2020.10.010. Online ahead of print.

ABSTRACT

INTRODUCTION: Greenlight XPS-180W® (AMS, San José, USA) photoselective vaporisation of the prostate (PVP) is considered as an alternative to transurethral resection of the prostate. The objective of this study was to assess the effect of energy density applied on adenoma during PVP treatment for benign prostate hyperplasia (BPH) on postoperative outcomes.

METHODS: A single-centre retrospective study has been conducted in the department of Urology of Colmar Hospital, in patients with symptomatic BPH, treated by PVP, between January 2016 and January 2019. Patients were stratified into two groups according to energy delivered and prostate volume as determined preoperatively: Low density (<4kJ/mL) and high density (>4kJ/mL). Perioperative complications, PSA evolution and functional outcomes (International Prostate Symptom Score, quality of life, maximum urinary flow rate, post-void residual urine volume) were compared with a minimal delay of 6 months. The retreatment rate was similar in the two groups.

RESULTS: A total of 215 patients were included with median follow-up of 25 months. High energy density was associated with less glandular volume. There were no statistically significant differences between the two groups concerning the perioperative complications and the functional outcomes. The postoperative reduction of the PSA level was more significant in the high-energy group (41% vs. 28%, P=0.03).

CONCLUSION: The perioperative complications and functional outcomes of PVP with Greenlight XPS-180W® laser are equivalent depending on the energy density delivered. The greater decrease in postoperative PSA for high-energy density could nevertheless suggest better quality tissue destruction.

LEVEL OF PROOF: 3.

PMID:33941459 | DOI:10.1016/j.purol.2020.10.010

Nutr Metab Cardiovasc Dis. 2021 Feb 24:S0939-4753(21)00086-7. doi: 10.1016/j.numecd.2021.02.017. Online ahead of print.

ABSTRACT

AIMS: Several health benefits are contributed to extra virgin olive oil (EVOO). The polyphenol fraction of EVOO may be responsible for its cardioprotective impacts. This systematic review and meta-analysis aimed to investigate the effect of EVOO intake on glycemic parameters. Electronic literature searched through 1 September 2020 across MEDLINE/PubMed, Web of Science, and SCOPUS databases to find all clinical trials that reported the effect of EVOO intake on glycemic parameters [FBS(fasting blood glucose), insulin, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) and HbA1c (glycated hemoglobin A1c)] vs. control.

DATA SYNTHESIS: We pooled standardized mean differences (SMD) and 95% confidence intervals (CIs) from randomized clinical trials (RCTs) using random-effects models. Heterogeneity was assessed by Cochran Q-statistic and quantified (I²). We found 13 related trials comprising a total of 633 subjects. In pooled analysis, EVOO intake had no effect on FBS (SMD: -0.07; 95% CI: -0.20, 0.07; I² = 0.0%), insulin (SMD: -0.32; 95% CI: -0.70, 0.06; I² = 38.0%), and HOMA-IR (SMD: -0.32; 95% CI: -0.75, 0.10; I² = 51.0%). However, a decreasing trend was observed in these effects. Subgroup analysis based on age, health status, dose, and EVOO intake duration also did not significantly change results.

CONCLUSION: Although EVOO seems a promising hypoglycemic effects, we did not find any significant evidence that EVOO consumption impacts glucose homeostasis. Furthermore, well-designed RCTs with longer durations are still needed to evaluate the EVOO’s efficacy on glycemic parameters.

PMID:33941427 | DOI:10.1016/j.numecd.2021.02.017

Chin J Traumatol. 2021 Feb 27:S1008-1275(21)00031-6. doi: 10.1016/j.cjtee.2021.02.008. Online ahead of print.

ABSTRACT

PURPOSE: Triceps tendon avulsion (TTA) is an uncommon injury, and there are no classifications or treatment guidelines available. This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults. The functional outcome of surgical repair has been evaluated too.

METHODS: A retrospective analysis of adult patients with traumatic TTA treated in our institution between 2012 and 2017 was done. We only included complete TTA injuries. Children below 15 years, open injuries, associated fractures, and partial TTA were excluded. The data were obtained from hospital records. The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA. The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score. ANOVA test was used to assess the statistical significance.

RESULTS: There were 15 patients included, including 11 males and 4 females. The mean age was (31.5 ± 9.15) years, and the mean follow-up was (22.4 ± 8.4) months. Fall on outstretched hand was the mode of injury. In 6 patients, diagnosis was missed on the initial visit. TTA were classified as Type 1: palpable soft-tissue defect without bony mass; Type 2: palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray; Type 3: palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface; and Type 4: an olecranon fracture with less than 25% of the articular surface. An algorithm for treatment was recommended, i.e. transosseous suture repair/suture anchor for Type 1, transosseous suture repair for Type 2, and tension band wiring or steel wire sutures for Types 3 and 4. All the patients achieved good to excellent outcome: the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26 ± 2.60 on final follow-up.

CONCLUSION: Our clinicoradiological classification and treatment algorithm for TTAs is simple. Surgical treatment results in excellent functions of the elbow. Since it is a single-center study involving a very small number of cases, a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.

PMID:33941433 | DOI:10.1016/j.cjtee.2021.02.008

Vaccine. 2021 Apr 27:S0264-410X(21)00505-3. doi: 10.1016/j.vaccine.2021.04.046. Online ahead of print.

ABSTRACT

INTRODUCTION: There is widespread concern that disruption to health services during the COVID-19 pandemic has led to declines in immunization coverage among young children, but there is limited information on the magnitude of such impact. High immunization coverage is essential for reducing the risk of vaccine preventable diseases.

METHODS: We used data from two nationwide sources covering the whole of Brazil. Data from the Information System of the National Immunization Program (SIPNI) on the monthly number of vaccine doses administered to young children were analyzed. The second source was a survey in 133 large cities in the 27 states in the country, carried out from August 24-27. Respondents answered a question on whether children under the age of three years had missed any scheduled vaccinations during the pandemic, and available vaccination cards were photographed for later examination.

RESULTS: SIPNI data showed that, relative to January and February 2020, there was a decline of about 20% in vaccines administered to children aged two months or older during March and April, when social distancing was at the highest level in the country. After May, vaccination levels returned to pre-pandemic values. Survey data, based on the interviews and on examination of the vaccine cards, showed that 19.0% (95% CI 17.0;21.1%) and 20.6% (95% CI 19.0;23.1%) of children, respectively, had missed immunizations. Missed doses were most common in the North (Amazon) region and least common in the South and Southeast, and also more common among children from poor than from wealthy families.

INTERPRETATION: Our results show that the pandemic was associated with a reduction of about 20% in child vaccinations, but this was reverted in recent months. Children from poor families and from the least developed regions of the country were most affected. There is an urgent need to booster immunization activities in the country to compensate for missed doses, and to reduce geographic and socioeconomic inequalities.

PMID:33941406 | DOI:10.1016/j.vaccine.2021.04.046

Ultrasound Med Biol. 2021 Apr 30:S0301-5629(21)00141-1. doi: 10.1016/j.ultrasmedbio.2021.03.022. Online ahead of print.

ABSTRACT

Common carotid intima-media thickness (CIMT) is a commonly used marker for atherosclerosis and is often computed in carotid ultrasound images. An analysis of different computerized techniques for CIMT measurement and their clinical impacts on the same patient data set is lacking. Here we compared and assessed five computerized CIMT algorithms against three expert analysts’ manual measurements on a data set of 1088 patients from two centers. Inter- and intra-observer variability was assessed, and the computerized CIMT values were compared with those manually obtained. The CIMT measurements were used to assess the correlation with clinical parameters, cardiovascular event prediction through a generalized linear model and the Kaplan-Meier hazard ratio. CIMT measurements obtained with a skilled analyst’s segmentation and the computerized segmentation were comparable in statistical analyses, suggesting they can be used interchangeably for CIMT quantification and clinical outcome investigation. To facilitate future studies, the entire data set used is made publicly available for the community at http://dx.doi.org/10.17632/fpv535fss7.1.

PMID:33941415 | DOI:10.1016/j.ultrasmedbio.2021.03.022

Patient Educ Couns. 2021 Apr 17:S0738-3991(21)00248-2. doi: 10.1016/j.pec.2021.04.010. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine how physicians implement guidelines to deliver insulin dosing education for type 1 diabetes patients in real-world settings.

METHODS: A nationally representative sample of endocrinologists from top tertiary hospitals in China was obtained by a multistage random sampling method (n = 385). Knowledge, perceptions and practices of insulin dosing were assessed by validated questionnaires. Multivariable logistic regression was used to identify independent determinants of clinical practice and knowledge.

RESULTS: Only 20.5% of endocrinologists correctly answered> 75% of the items regarding insulin dosing knowledge. Only 37.7% of endocrinologists reported often teaching insulin-to-carbohydrate ratio and insulin sensitivity factor. Practice behaviours were independently associated with guideline familiarity (OR: 5.92, 95% CI: 3.36-10.41), receiving standardized training (OR: 2.00, 95% CI:1.23-3.25), self-reported lack of time (OR: 0.58, 95% CI:0.34-0.99) and insufficient teaching approaches (OR: 0.57, 95% CI:0.33-0.97) CONCLUSIONS: There was a large gap between guidelines and clinical practice in insulin dosing education. Modifiable factors, including self-reported lack of time, unfamiliarity with guidelines, the shortage of medical training and educational tools hinder insulin dosing education.

PRACTICE IMPLICATIONS: Sufficient medical training and educational tools are important to optimize insulin dosing education. The current care paradigm should also be modified to relieve the burden of physicians.

PMID:33941419 | DOI:10.1016/j.pec.2021.04.010

J Natl Med Assoc. 2021 Apr 30:S0027-9684(21)00052-3. doi: 10.1016/j.jnma.2021.03.005. Online ahead of print.

ABSTRACT

BACKGROUND: Electronic messaging and telemedicine visits increased during the COVID pandemic. African-Americans and older patients have less frequently used electronic messaging with their physicians. This study compares the utilization of virtual health care before and during the COVID pandemic for inflammatory bowel disease (IBD) patients.

METHODS: A chart review of all IBD patients seen at an academic medical center from 2014-2020 was conducted to evaluate the use of telehealth options (e-messaging, e-visits) during a pre-COVID and COVID timeframe. Analysis of telehealth use from March – August 2018 and March – August 2020 was performed. Patient age, gender, race, IBD type, electronic messaging and telehealth visits were obtained. A confidential database was created. Statistical analysis was performed using Fisher Exact test with significance set at p < 0.05. The study was IRB approved.

RESULTS: 392 patients were in the pre-COVID cohort. There were 204 White, 99 African-American, 11 Asian, and 78 racially un-identified patients. 160 (40.8%) initiated E-communication with their physicians. There was a significant difference in the use of e-messaging based upon age (51.1% < 50 vs 39.7% ≥ 50; p = 0.0396) and race (62.3% White vs 28.2% African-American; p < 0.00001).There were no significant differences in the use of e-messaging based upon patient gender (p = 0.6840) or IBD type (p = 0.6374). There were 295 patients in the COVID cohort. There were 155 White, 83 African American patients, 24 Hispanic patients, 10 Asian patients, and 22 racially un-identified patients. 109 (36.9%) utilized a telehealth option (53 via e-messaging; 56 via telemedicine visit). There was no significant difference in the use of a telehealth option based upon age (36.8% < 50 vs 37.25% ≥ 50 years; p = 1.00), race (42.6% White vs 35.9% African-American; p = 0.2693) or IBD type (p = 0.331). Males used telehealth more than females (46.1% vs 29.7%, respectively; p = 0.0051).

DISCUSSION: The COVID pandemic emergency increased e-visits and e-messaging for care delivery. Expanded telemedicine options for IBD patients eliminated previously identified racial and age disparities in virtual medical care. African Americans utilized electronic communication as frequently as Whites during the pandemic. Post-pandemic policy consideration for continued telemedicine options may expand patient-physician engagement and eliminate disparities in health care.

PMID:33941370 | DOI:10.1016/j.jnma.2021.03.005

Placenta. 2021 Apr 18:S0143-4004(21)00128-4. doi: 10.1016/j.placenta.2021.04.010. Online ahead of print.

ABSTRACT

INTRODUCTION: Trophoblast inclusions (TIs) are associated with aneuploidy and pregnancy loss and have thus been considered to be a marker of genetic abnormality. However, to date, no study has specifically explored whether TIs are a manifestation of fetal genetics or, rather, the result of the intrauterine environment. The goal of this study was to compare the frequency of TIs in the placentas of monozygotic (MZ) and dizygotic (DZ) twin pairs in order to determine whether the formation of TIs is genetically driven or not.

METHODS: We performed a retrospective case series of placentas from 48 twin pairs. The placentas were grouped based on zygosity: MZ, DZ, or unknown (UZ). The average number of total TIs per slide was calculated for each twin individual and the mean absolute difference in the total TIs per slide between the twin pairs was calculated for each zygosity group and compared.

RESULTS: The mean difference in the total TIs per slide for DZ twins was significantly greater than the mean difference in the total TIs per slide for MZ twins (p = 0.003). The mean difference in the total TIs per slide for the UZ group was also significantly greater than the mean difference in total TIs per slide between MZ twin pairs (p = 0.028).

DISCUSSION: Our finding that MZ twins were significantly more concordant than DZ twins for the average number of TIs per slide supports the conclusion that TIs are intrinsic to the genetics of the fetus, not the uterine environment.

PMID:33941390 | DOI:10.1016/j.placenta.2021.04.010

Eur Urol. 2021 May 1:S0302-2838(21)00253-0. doi: 10.1016/j.eururo.2021.04.013. Online ahead of print.

ABSTRACT

Although prostate cancer is known to have a strong genetic basis and is influenced by both common and rare variants, the ability to investigate the combined effect of such genetic risk factors has been limited to date. We conducted an investigation of 81 094 men from the UK Biobank, including 3568 prostate cancer cases, to examine the combined effect of rare pathogenic/likely pathogenic/deleterious (P/LP/D) germline variants and common prostate cancer risk variants, measured using a polygenic risk score (PRS), on prostate cancer risk. The absolute risk of prostate cancer for HOXB13, BRCA2, ATM, and CHEK2 P/LP/D carriers ranged from 9% to 56%, and the absolute risk in noncarriers ranged from 2% to 31%, by age 85 yr, for men in the lowest and highest PRS decile, respectively. The high-penetrant HOXB13 G84E prostate cancer risk variant was most common in cases in the lowest PRS quintile (4.4%) and least common in cases in the highest PRS quintile (0.5%; p = 0.005), whereas there was no statistically significant difference in frequencies by PRS in controls. While rare and common variants strongly and distinctly influence prostate cancer onset, consideration of rare and common variants in conjunction will lead to more precise estimates of a man’s lifetime risk of prostate cancer. PATIENT SUMMARY: We found that the risk of prostate cancer conveyed by rare variants could vary depending on an individual’s genetic profile of common risk variants. This implies that in order to comprehensively assess genetic risk of prostate cancer, it is important to consider both rare and common variants.

PMID:33941403 | DOI:10.1016/j.eururo.2021.04.013