Category: Nevin Manimala

Eur Urol. 2021 Apr 23:S0302-2838(21)00230-X. doi: 10.1016/j.eururo.2021.03.024. Online ahead of print.

ABSTRACT

Atezolizumab is an anti-PD-L1 immune checkpoint inhibitor recommended for the treatment of locally advanced or metastatic urothelial carcinoma (mUC) after prior platinum-containing chemotherapy, regardless of PD-L1 status, among other treatment settings. We conducted a long-term follow-up to the exploratory analysis of overall survival (OS) and safety for the IMvigor211 intent-to-treat (ITT) population. Patients with mUC and disease progression during or following platinum-based chemotherapy were randomised 1:1 to receive atezolizumab 1200 mg or chemotherapy (vinflunine 320 mg/m², paclitaxel 175 mg/m², or docetaxel 75 mg/m² according to investigator choice) intravenously every 3 wk. Although the primary analysis did not demonstrate statistically significant longer OS for patients receiving atezolizumab versus chemotherapy, updated OS showed long-term durable remission. With a median of 33 mo of follow-up, the 24-mo OS rate was 23% with atezolizumab and 13% with chemotherapy. Safety findings were consistent with the primary analysis, with no new signals detected. Chemotherapy-treated patients experienced more grade 3/4 treatment-related adverse events (AEs; 43% vs 22%) and more AEs leading to treatment discontinuation (18% vs 9%). Atezolizumab-treated patients experienced more AEs of special interest (35% vs 20%), which tended to be grade 1-2. Our findings support the use of atezolizumab in platinum-treated patients with mUC regardless of PD-L1 status. PATIENT SUMMARY: We report follow-up results from a study of an immunotherapy treatment, atezolizumab, in patients with bladder cancer who had already received platinum-containing chemotherapy. This analysis compared the effectiveness of atezolizumab with chemotherapy over 2.5 years after starting treatment. The results show that patients who received atezolizumab lived longer and had manageable side effects compared with patients who received chemotherapy. This trial is registered at ClinicalTrials.gov as NCT02302807.

PMID:33902955 | DOI:10.1016/j.eururo.2021.03.024

Injury. 2021 Apr 9:S0020-1383(21)00337-5. doi: 10.1016/j.injury.2021.04.028. Online ahead of print.

ABSTRACT

INTRODUCTION: Electrical burn injuries are devastating and cause not only loss of life but also severe disabilities in the form of limb loss. Increase in urbanization, industrialization and overcrowding has led to an increase in electric injuries.

MATERIAL AND METHODS: The study was prospective in nature evaluating electric burns and studied the pattern of limb loss for a duration of 18 months from October 2016 to March 2018. Parameters recorded were demographic data, clinical data regarding the electrical injuries, complications, and outcomes.

RESULTS: Male patients made up 85.3% of cases. Mean TBSA was 24.76 ± 19.18%. Mean age was 27.59 ± 13.73 years. Pediatric patients made up 17%. High voltage burns constituted 68.2 %. Electric contact burn was the most common type making up 49.5% of cases. The most common cause was occupational (38.9%). A fasciotomy was required in 22% of cases with an amputation rate of 38% (209 out of 550). There were 190 major amputations and 106 minor amputations. Overall, the right upper limb amputations were twice as common as the left. The ratio of upper limb: lower limb amputation was 4:1. Fifty patients (23.9%) required revision amputation. The age group 11 to 30 years made up 55.5% of amputations. There was no statistical difference in amputation rates between males (31.31%) and females (41.97%). In patients with TBSA less than 25% amputation rate was 47.77% as compared to patients with more than 25% TBSA, 19.47% (p<0.001). Most amputations occurred due to electric contact burns (74.16%). In the high voltage group, 46.1% underwent amputation vs low voltage group -20.6% (p<0.001). Overall mortality rate was 12.7%. Three hundred patients (55%) had low level of awareness regarding consequences of electric injury. Thirty one percent had medium level of awareness and only 14 % had high level of awareness. There was a significant correlation between education level and awareness in adult patients (p<0.001). Seventy percent of persons with occupational injuries used only footwear and no other protective equipment.

CONCLUSION: Increasing public awareness, safety measures at workplaces are measures that will help reducing electrical burns which reduce limb and life loss.

PMID:33902868 | DOI:10.1016/j.injury.2021.04.028

West Afr J Med. 2021 Apr 23;38(4):347-358.

ABSTRACT

BACKGROUND: COVID-19 was declared a pandemic by the World Health Organization (WHO) on 11th March 2020. Individuals with correct understanding about the risks and severity of the disease are more likely to respond positively and practice recommended preventive measures.

OBJECTIVES: To assess the knowledge, attitudes, and practices towards COVID-19 transmission and preventive measures among residents of Nigeria.

METHODS: The study was cross-sectional and involved 469 participants from 1st July to 31st August 2020. A 36-item questionnaire with Cronbach alpha of 0.753 was adapted and administered through an online survey tool. A snowball sampling approach was employed whereby the questionnaire link was distributed through social media networks including WhatsApp©, Facebook© and Instagram©. Data was analysed using SPSS 23 and a statistical significance level of 0.05 was used. Bivariate and multivariate analysis were employed to determine factors affecting the knowledge, attitude and practices towards COVID-19 transmission and prevention.

RESULTS: The mean age of participants was 39±11.29years. Majority (54%) of the participants heard about COVID-19 through mass and social media. The study found that 71.6% of the participants had good knowledge, just 31.3% had a good attitude while 84.9% of them had good practices towards COVID-19 in Nigeria. The high rates of the knowledge and practices were driven by income, age, education and marital status.

CONCLUSIONS: Majority of the study participants showed correct knowledge and adhered to recommended practices towards COVID- 19. However, there were gaps in the understanding of the underlying realities and beliefs in certain myths about COVID-19. Hence, interventions such as jingles and posters in various languages that would serve to correct the negative perceptions and myths about COVID-19 instituted through mass media and social media are recommended.

PMID:33901392

West Afr J Med. 2021 Apr 23;38(4):359-365.

ABSTRACT

BACKGROUND: School Health Instructions (SHI) entail the instructional aspect of school health programme, which provides a classroom opportunity for inculcating healthy habits into the school- age child.

OBJECTIVE: To assess the status of implementation of school health instruction in primary schools in Gwagwalada Area Council of the Federal Capital Territory, Nigeria.

METHODS: A cross-sectional descriptive study of 146 primary schools in the Gwagwalada Area Council of the Nigerian Federal capital was carried out to assess the implementation of SHI with respect to the contents, methods of delivery and teachers preparation for health teaching using an evaluation checklist for SHI.

RESULTS: Of 146 schools, 115(78.8%) schools attained the minimum acceptable score of 27. Of the 40 public and 106 private schools, 27(67.5%) public and 88(83.0%) private schools attained the acceptable minimum score of 27. There was a statistically significant difference between the mean scores attained cumulatively in the various components of the school health instruction by the public and private schools (t=2.721, p= 0.008). Public schools had significantly more teachers with education-related qualifications than private schools (p<0.001). Teachings on HIV/ AIDS, safety education and community health were undertaken by 95.9%, 93.2% and 95.2% schools respectively. Only 5(3.4%) schools followed the recommendation of giving health instruction at least thrice a week.

CONCLUSION: Implementation of SHI was adequate in the study area, with a better performance among the private schools.

PMID:33901393

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Mar;29(2):306-312. doi: 10.32687/0869-866X-2021-29-2-306-312.

ABSTRACT

The need for changes in the primary health care system in the Russian Federation that is based on the principles of general medical practice is without any question. But, even after more than thirty years, there is no full-fledged reform still.

THE OBJECTIVE: To assess the state of general medical practice in the Russian Federation to identify its strengths and weaknesses, and to determine further ways of its development. The tasks. To analyze the volume and pace of development of general medical practice; to identify its impact on key demographic, medical and social indices; to assess foreign experience in this field; to elaborate proposals on intensifying process of its development in the Russian Federation.

MATERIAL AND METHODS: The analytical, sociological (n=1,573) and statistical methods were applied.

THE RESULTS: Since 2007, the number of general practitioners in the Russian Federation and corresponding support of the population increased. During the same time period, population size, natality, mortality, morbidity of tuberculosis, essential hypertension and cataract had positive dynamics. The morbidity of malignant neoplasms, diabetes type II, glaucoma, coronary heart disease and cerebrovascular diseases had negative dynamics. The strong negative relationship of the population’s general practitioners support was established only in case of all-cause mortality and morbidity of lungs tuberculosis. The population was more satisfied with support of general practitioner than district physician.

DISCUSSION: The general practitioner support of the population of the Russian Federation continues to be insufficient and its role in public health management insignificant. The proposals are formulated to improve primary health care and its further development based on the principles of general medical practice on the basis of corresponding best international experiences and national specificity. Hence, in Russia, the national health care requires a set of measures targeted to strengthen the position of general medical practice system throughout ll territories.

PMID:33901373 | DOI:10.32687/0869-866X-2021-29-2-306-312

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Mar;29(2):327-330. doi: 10.32687/0869-866X-2021-29-2-327-330.

ABSTRACT

The chronic kidney disease takes a special place among chronic non-communicable diseases because it is characterized by wide prevalence worldwide. However, its detection rate among Moscow adult population is 1%, though in the European countries this indicator is significantly higher and is made up on average to 6%. At the terminal stage of chronic kidney disease, quality of life of such patients decreases dramatically, that result in working capacity loss and disability. These patients often require expensive methods of programmed hemo- and peritoneal dialysis. The corresponding mortality is much higher as compared with total mortality. Among the frequent causes of hospitalization and mortality of such patients, complications of blood circulation system diseases are registered. The existing problem of low detection of kidney pathology in the population is the main cause of untimely treatment start. The rapid disease progression results in higher indices of premature mortality and increased costs of treatment of patients with this pathology. The timely diagnosis of disorders of carbohydrate and lipid metabolism permits to identify chronic kidney disease at an early stage and to start to carry out adequate treatment and prevention measures. The purpose of the study is to implement the technology of improving efficiency of detection of chronic kidney disease. Methods. The organizational experiment, analytical, mathematical and statistical research methods. Results of the study. The detection rate of chronic kidney disease amounted to 8%. Among the respondents with chronic kidney disease diagnosed, more than 80% had initial stages of disease (I-III). In this case, appropriate therapy and prevention can prolong kidney functioning and reduce velocity of disease progression. At the same time, 16.3% of patients at the late stage of diseases progression (stages IV-V) were identified.The detection rate for all stages of chronic kidney disease increases with age Conclusions. The level of detection of chronic kidney disease in the base territory is comparable with the indices established in the European countries. The need to improve quality of diagnostic and prevention of chronic kidney disease was proven. To improve overall prognosis and prevention of development of terminal renal failure is possible only in case of brigade approach to treatment including active interaction of cardiologist and nephrologist, endocrinologist and nephrologist or of all these three specialists. Scope of the results. The established higher detection rate of chronic kidney disease (8%), as compared to actual one (1%), permits to claim that with systematic improvement of diagnosis, the detection of chronic kidney disease will increase iteratively and population need for nephrologic medical care will significantly increase that will require increasing in resource support and revising of planned and normative indices for this type of medical care.

PMID:33901377 | DOI:10.32687/0869-866X-2021-29-2-327-330

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Mar;29(2):359-368. doi: 10.32687/0869-866X-2021-29-2-359-368.

ABSTRACT

The article analyzes negative changes in the USSR population health in the era of stagnation. These changes are traced on the basis of statistical indices of physical development, morbidity of infectious and mental diseases, mortality and life expectancy. The mentioned data are compared with indices of ecological pollution, drinking water and foodstuff quality. The study results are explained by political decisions on reclamation of unsettled territories, developing of all-Union constructions, (anti)alcohol campaigns.

PMID:33901383 | DOI:10.32687/0869-866X-2021-29-2-359-368

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Mar;29(2):238-244. doi: 10.32687/0869-866X-2021-29-2-238-244.

ABSTRACT

The growth of population older than working age with specific age characteristics and problems inevitably results in increasing number of their visits to physicians both in out-patient and in-patient organizations. The purpose of the study is to evaluate indices of hospital medical care of patients older than working age based on the beds profile in the Russian Federation during 2012-2019. The comprehensive study was organized to investigate dynamics of the main indices of inpatient medical care of people older than working age residing at specialized hospital beds (hospitalization rate, hospital mortality, average length of stay in bed). The forms of the Federal statistical observation form № 47 and 30 for the Russian Federation in 2012-2019 were used. The statistical and analytical research methods were applied. During these 8 years, the hospitalization rate of patients older than working age increased up to 4.5% (from 27.36 to 28.6 per 100 of population of corresponding age), the hospital mortality rate – from 3.42% to 3.95%The average length of bed stay of patients decreased from 13.4 to 10.85 days that may be associated with intensification of treatment and diagnostic process. The rates of hospitalization of patients older than working age as compared with adults of able-bodied age were higher by 1.5-8.9 times for certain types of specialized medical care (ophthalmology, palliative care, nursing, cardiology, cardiac surgery, radiology, neurology, vascular surgery, oncology).

PMID:33901361 | DOI:10.32687/0869-866X-2021-29-2-238-244

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Mar;29(2):260-264. doi: 10.32687/0869-866X-2021-29-2-260-264.

ABSTRACT

The article considers the results of sociological study that was carried out to determine vector of dynamics of indices regulating duration of life of the Russian population, including the expected one. The method of secondary analysis of statistical and sociological information data was applied. Results. Against the background of decreasing of birth rate, “aging of population”, migration inflows and transformation of value systems the reduction of population size in The Russian Federation (natural loss) dominates, though life expectancy itself is slightly increasing. The high value of indicator of «death external causes» is established. The trend of steady decreasing of infant mortality in Russia over the past 27 years is marked. The groups of factors affecting life expectancy of the Russian population is identified. The main characteristics are revealed that are fundamentally important to ensure higher life expectancy of Russians. One of the demographic behavior models in modern Russia is described. The approaches to solve demographic problems in the Russian Federation, proposed by state bodies on the basis of policy documents (Concept of demographic development of the Russian Federation for the period up to 2025, etc.) are considered. The importance of health-preserving projects (such as “Moscow longevity”, etc.), is determined.

PMID:33901365 | DOI:10.32687/0869-866X-2021-29-2-260-264

Plant J. 2021 Apr 26. doi: 10.1111/tpj.15291. Online ahead of print.

ABSTRACT

Coastal regions contribute an estimated 20% of annual gross primary production in the oceans, despite occupying only 0.03% of their surface area. Diatoms frequently dominate coastal sediments, where they experience large variations in light regime resulting from the interplay of diurnal and tidal cycles. Here, we report on an extensive diurnal transcript profiling experiment of the motile benthic diatom Seminavis robusta. Nearly 90% (23,328) of expressed protein-coding genes and 66.9% (1124) of expressed long intergenic non-coding RNAs (lincRNAs) showed significant expression oscillations and are predominantly phasing at night with a periodicity of 24h. Phylostratigraphic analysis found that rhythmic genes are enriched in deeply conserved genes, while diatom-specific genes are predominantly associated with midnight expression. Integration of genetic and physiological cell cycle markers with silica depletion data revealed potential new silica cell wall associated gene families specific to diatoms. Additionally, we observed 1752 genes with a remarkable semidiurnal (12-h) periodicity, while the expansion of putative circadian transcription factors may reflect adaptations to cope with highly unpredictable external conditions. Taken together, our results provide new insights into the adaptations of diatoms to the benthic environment and serve as a valuable resource for diurnal regulation in photosynthetic eukaryotes.

PMID:33901335 | DOI:10.1111/tpj.15291