Category: Statistics

Cureus. 2021 Mar 2;13(3):e13650. doi: 10.7759/cureus.13650.

ABSTRACT

Introduction Invasive ductal carcinoma (IDC) is the most common histological subtype of breast cancer. Conversely, many special types of breast carcinoma were described with varying prognosis and hormone receptor status. Mucinous carcinoma (MC) is a rare special subtype of breast cancer, and only a few studies have evaluated the clinicopathological and hormone receptor profile of this type of breast cancer. Therefore, in this study, we compared the clinicopathological characteristics of MC with IDC in our population. Methods A retrospective observational study was conducted in the Department of Histopathology, Liaquat National Hospital and Medical College, from January 2013 till December 2020, for eight years. During this period, 38 cases of MC were diagnosed and 1268 cases of IDC were identified. All specimens were grossed according to standard protocols and representative sections were submitted from tumors, resection margins, and lymph nodes. Slides were examined by histopathologists to determine tumor type and grade. Immunohistochemical (IHC) stains were applied to evaluate estrogen receptor (ER), progesterone receptor (PR), Ki67, and human epidermal growth factor receptor 2 (HER2/neu) statuses. Results The mean age of the patients with MC was 56.47±13.90 years, and most of the patients were above 50 years of age. The mean tumor size was 34.89±19.70 mm. Most tumors were grade 1 (68.4%) with a low mean Ki67 index (15.21±14.06%). Axillary metastasis was present in 31.6% of cases and all of them were nodal (N)-stage N1. ER, PR, and HER2/neu positivity were noted in 94.7%, 78.9, and 10.5% cases, respectively. Compared with IDC, a significant association of MC was noted with age, Ki67 index, tumor (T)-stage, N-stage, and tumor grade. MC cases had a higher mean age than IDC cases. Comparative analysis revealed that MC had a lower frequency of axillary metastasis, a lower mean Ki67 index, and a lower tumor grade than IDC. About biomarker status, MC was noted to have a higher frequency of ER and PR expression, and a lower frequency of HER2/neu expression than IDC. Conclusion MC is a rare subtype of breast cancer. However, it is important to recognize this subtype of breast cancer as it is associated with a prognostically better pathological profile, such as lower tumor grade and Ki67 index, lower frequency of axillary metastasis, higher expression of ER and PR, and lower expression of HER2/neu.

PMID:33824803 | PMC:PMC8012174 | DOI:10.7759/cureus.13650

Cureus. 2021 Mar 3;13(3):e13674. doi: 10.7759/cureus.13674.

ABSTRACT

Objective To identify racial disparities in survival outcomes among Stage III & IV patients with squamous cell carcinomas (SCCa) of the oropharynx treated with definitive radiation therapy (RT), with concurrent chemotherapy. Method This is a retrospective analysis of patients with stage III & IV SCCa of oropharynx treated with definitive RT at the State Academic Medical Center. All patients were treated to 70 Gy utilizing intensity-modulated radiation treatment (IMRT), and received concurrent chemotherapy with weekly cisplatin or cetuximab. Chi-square test was used to test the goodness of fit, overall survival (OS), and locoregional control (LRC) comparing races were generated by using Log-rank test & Kaplan-Meier method. The covariables associated with the OS and LRC were determined by the Cox regression model. A p-value of less than 0.05 was considered statistically significant. The SPSS 24.0 software (IBM Corp., Armonk, NY) was used. Results In the total 73 eligible patients, 54.8% were black, and 45.2% white patients. Stage distribution (per American Joint Committee on Cancer-AJCC 8^th Ed) between black patients vs. white patients, Stage III (45.5% vs. 54.5%) and for Stage IV (56.5% vs. 43.5%); p=0.499. Median follow-up for the entire group was 41 months (range: 4-144 months). In the univariate analysis, variables p16 status, body mass index (BMI), alcohol history and tumor subsite were found to be significant. In the multivariate analysis, only BMI has shown to be significant. Three-year LRC for black patients was 37.8% vs.66.8% in white patients (p=0.354) and three-year OS for black patients was 51.8% vs. 80.9% for white patients (p=0.063), respectively. Five-year OS for p16 positive patients was 69.7% vs. 43% for p16 negative patients (p=0.034). Five-year OS for Stage IV black patients was 34% vs. 69.5% for Stage IV white patients (p=0.014). Conclusion Among all the co-variables examined, only BMI has shown affecting the OS outcomes; gender and BMI shown to be affecting the LRC. Racial factor appears to be significant in Stage IV patients.

PMID:33824825 | PMC:PMC8012264 | DOI:10.7759/cureus.13674

Afr J Lab Med. 2021 Mar 15;10(1):1224. doi: 10.4102/ajlm.v10i1.1224. eCollection 2021.

ABSTRACT

BACKGROUND: Chronic viral hepatitis B (HBV) is characterised by progressive hepatocyte destruction and T-cell depletion. The mechanisms of the CD95-CD95 ligand (CD95L) signalling pathway during this chronic disease and the cirrhotic process remains unclear.

OBJECTIVE: We evaluated the involvement of the CD95-CD95L receptor-ligand system in T-cell depletion and hepatic cytolysis in patients with chronic HBV.

METHODS: This was a cross-sectional study conducted from September to December 2018 at the Yaoundé General Hospital, Cameroon. Four mL of whole blood was collected and analysed. The CD95 and CD95L levels, as well as the CD4+ T-cell and CD8+ T-cell counts, were performed by enzyme-linked immunosorbent assay and flow cytometry.

RESULTS: Of the 130 HBV-positive patients, 36 (27.7%) were cirrhotic and 94 (72.3%) were non-cirrhotic. The cirrhotic patients had significantly elevated CD95 (p < 0.001) and CD95L (p = 0.001) plasma levels, compared with non-cirrhotic patients. The CD4/CD8 ratios were lower in cirrhotic patients, compared to non-cirrhotic patients (p < 0.001). There were statistically significant correlations between CD95 level and CD4⁺ T-cell counts, between CD95 level and CD8⁺ T-cell counts, between CD95 level and the CD4/CD8 ratio, between CD95 level and fibrosis score, and between CD95L level and fibrosis score.

CONCLUSION: CD95 and CD95L could be involved in T-cell depletion and hepatic cytolysis during the pathogenesis of chronic HBV and could potentially be used as biomarkers for immunological and hepatic monitoring in patients with chronic HBV.

PMID:33824856 | PMC:PMC8008047 | DOI:10.4102/ajlm.v10i1.1224

J Addict. 2021 Mar 20;2021:5518946. doi: 10.1155/2021/5518946. eCollection 2021.

ABSTRACT

INTRODUCTION: The impact of alcohol use among adolescents is multidisciplinary and affects the adolescent’s academic performance, precipitates with sexually transmitted infections or psychiatric disorders, and disturbs the social domain of adolescents. Therefore, this study aimed to assess the prevalence and associated factors of alcohol use among adolescents aged 15-19 years at the governmental high schools of Aksum Town, Tigray, Ethiopia, in 2019.

METHODS: A facility-based cross-sectional study was conducted from 1 to 30 January 2019 at Aksum town high school. Alcohol use was assessed by asking the question “have you used at least one of the alcoholic beverages in the last three months for nonmedical purposes?” Study participants were selected using a simple random sampling technique. Data were collected with face-to-face interview and were analyzed using the Statistical Package for the Social Sciences version 22. Bivariate and multivariate logistic regressions were used to see the association between alcohol use and associated factors. Adjusted odds ratio at a p value < 0.05 with a 95% confidence interval was taken to declare the statistical significance of variables.

RESULT: About 633 adolescents aged 15-19 years were addressed with a response rate of 99.7%. Prevalence of alcohol use was found to be 39.7% [95% CI (35.7, 43.6)]. Being male [AOR = 1.80; 95% CI (1.24, 2.60)], fathers’ educational status 1-8 grades [AOR = 2.98; 95% CI (1.60, 5.53)], fathers’ occupation farming [AOR = 4.24; 95% CI (2.038.85)], experienced parental neglect [AOR = 1.75; 95% CI (1.20, 2.55)], strong social support [AOR = 1.79; 95% CI (1.11, 2.87)], and family size of greater than five [AOR = 2.03; 95%CI (1.39, 2.97)] were factors identified to be significantly associated with alcohol use among adolescents aged 15-19 years.

CONCLUSION: In the current study, the prevalence of alcohol use is found to be high when compared to other populations. A strong association has been found between alcohol use and lower paternal educational status and farming as an occupation of parents. There should be a regular awareness creation program for parents with lower education about the devastating effects of alcohol on adolescents.

PMID:33824774 | PMC:PMC8007373 | DOI:10.1155/2021/5518946

Int J Biochem Mol Biol. 2021 Feb 15;12(1):35-48. eCollection 2021.

ABSTRACT

High Myopia (HM) is a common complex-trait eye disorder. There is essential evidence that genetic factors play a significant role in the development of nonsyndromic high myopia. Identification of susceptibility genes of high myopia will shed light on the pathophysiological mechanism underlying their genesis. This was a case control study examining the prospect of association of DLGAP1, EMILIN2 & MYOM1 genes on MYP2 locus in purely ethnic (Kashmiri) population representing a homogeneous cohort. Genomic DNA was extracted using phenol chloroform and salting out method. Extracted DNA was genotyped for polymorphic variations in MYOM1, EMILIN2 and DLGAP1 genes involving Sanger di-deoxy method. Allele frequencies were tested for Hardy-Weinberg disequilibrium in 224 cases and compared with 220 emmetropic controls. In DLGAP1, documented single nucleotide polymorphism (SNP); Pro517Pro was observed. A previously reported Asn451Asn SNP was observed in EMILIN2. MYOM1 showed five polymorphic variations; two in coding region (Gly333Gly & Gly341Ala) and three intronic (c.1022+23, G>A; c.3418+44 G>T & c.3418+65; C>G). All of the elucidated SNPs were having statistical significant role in increasing or decreasing the risk of disease. Although not statistically significant, a novel Glu507Lys SNP was observed in DLGAP1 (P>0.05). In silico predictions showed MYOM1 Gly341Ala to be benign & tolerated substitution while as DLGAP1 Glu507Lys to be possibly damaging substitution. The studied SNPs followed Over-Dominant, Recessive and Co-Dominant mode of inheritance with specific haplotypes associated with the disease. Our study reveals the involvement of MYP2 locus candidate gene polymorphism in the pathogenesis of HM.

PMID:33824778 | PMC:PMC8012819

Int J Burns Trauma. 2021 Feb 15;11(1):34-40. eCollection 2021.

ABSTRACT

INTRODUCTION: Ankle sprain is one of the most common musculoskeletal injuries that occur most commonly in the active and working population. Ottawa and Burns Laws are tools for physicians to determine the need for a radiograph of an ankle injury. The purpose of this study was to evaluate the accuracy of the Ottawa and Bernese criteria in patients with torsion of the foot and the economical savings resulting from the application of these two criteria.

METHODS: This prospective study was designed to evaluate the two rules burns of Bernese and Ottawa and their economic savings were designed in two phases. They were referred to Poursina Medical Center, Rasht, Iran from September 2019 to the achieved sample size. Data were analyzed by SPSS software version 24 (Statistical Package for Social Science (SPSS) 21, Chicago, IL, USA).

RESULTS: A total of 800 patients were included in this study to determine the accuracy of bronze and Ottawa criteria in ankle torsion and the economic cost of using them. Of the 800 patients studied, 430 (53.7%) were male and 370 (46.3%) were female, with a mean age of 35.77±16.42 years. The diagnostic accuracy of the Ottawa criteria is 90% and the diagnostic accuracy of the Bernese criteria is 90.75%. The sensitivity of the Ottawa evaluation method was 97.6% and the specificity was 88%. The sensitivity of Bernese evaluation method was 91% and specificity was 90.7%.

CONCLUSION: Because of the higher sensitivity of the Ottawa criterion than the Bernese criteria, it is preferred to determine the probability of fracture for emergency unit personnel. Using these two methods can reduce the time, energy and cost of treatment for the patient during the treatment period.

PMID:33824783 | PMC:PMC8012874

S Afr J Psychiatr. 2021 Mar 3;27:1587. doi: 10.4102/sajpsychiatry.v27i0.1587. eCollection 2021.

ABSTRACT

BACKGROUND: Schizophrenia is a debilitating mental health condition affecting the lives of many South Africans. The origins of the heterogeneity in the presentation of the illness remain uncertain.

AIM: This cross-sectional study performed a retrospective data analysis to determine the usefulness of digit ratio as an endophenotype in a South African schizophrenia population.

SETTING: A large genetic study in a South African schizophrenia population recruited patients from services in the Western and Eastern Cape.

METHODS: Complete clinical histories were captured for participants, including sets of images of the face and extremities. Software was utilised to measure the lengths of participants’ digits from said images and digit ratios (2D:4D) were calculated. Descriptive analyses were performed on the ratios and statistical differences in digit ratio means were calculated between groups characterised by sex, age of onset and the presence vs absence of positive symptoms. Linear modelling was utilised to assess for correlates between 2D:4D and positive and negative symptom severity using scores obtained from the Positive and Negative Syndrome Scale (PANSS) and Scale for the Assessment of Negative Symptoms (SANS).

RESULTS: 2D:4D in male participants did not significantly differ from female participants as in healthy populations. 2D:4D did not significantly correlate with the severity of positive or negative symptoms and 2D:4D means between groups did not significantly relate to age of onset.

CONCLUSION: 2D:4D appears to be a possible endophenotype in schizophrenia in this population. 2D:4D, however, may not be as readily identifiable as certain minor physical anomalies and neurological soft signs significantly associated with schizophrenia in this population.

PMID:33824756 | PMC:PMC8008037 | DOI:10.4102/sajpsychiatry.v27i0.1587

J Ophthalmol. 2020 Nov 18;2020:5217645. doi: 10.1155/2020/5217645. eCollection 2020.

ABSTRACT

AIM: To investigate the changes in the retinal nerve fiber layer (RNFL) following pars plana vitrectomy (PPV) with surgically induced posterior vitreous detachment (PVD) and idiopathic epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling.

METHODS: Patients with unilateral ERM with vitreomacular traction were included in this prospective, randomized, and controlled clinical trial. The control group (Group 1) was formed with the nonoperated fellow eyes of the patients, and the study group (Group 2) was formed with the eyes that underwent PPV including idiopathic ERM and ILM peeling. In the preoperative and postoperative periods (1^st, 2^nd, 3^rd, 6^th, and 12^th months), complete ophthalmological examination of the eyes was performed and RNFL measurements were examined in 4 different quadrants (superior, temporal, inferior, and nasal) with the help of spectral domain optical coherence tomography (OCT).

RESULTS: There was no statistically significant change in Group 1 during the follow-up period in all quadrants (p > 0.05). The mean RNFL thickness in Group 2 was statistically significantly higher than in Group 1 in superior, inferior, and temporal quadrants (p < 0.01), preoperatively. The mean RNFL in Group 2 was higher in the 1^st, 2^nd, 3^rd, and 6^th months and lower in the 12^th month in superior, inferior, and temporal quadrants (p < 0.01) when compared to the preoperative period. The mean RNFL thickness in the nasal quadrant in Group 2 was higher in the 1^st, 2^nd, and 3^rd (p < 0.01) months, same in the 6^th month (p > 0.05), and lower in the 12^th (p < 0.01) month when compared to the preoperative period.

CONCLUSION: Idiopathic ERM may cause an increase in RNFL thickness in superior, inferior, and temporal quadrants with possible tractional effect. PPV with PVD induction and ERM and ILM peeling may cause these RNFL changes.

PMID:33824761 | PMC:PMC8006755 | DOI:10.1155/2020/5217645

Thromb Haemost. 2021 Apr 6. doi: 10.1055/a-1475-2263. Online ahead of print.

ABSTRACT

BACKGROUND: The 2019 European Society of Cardiology (ESC) guidelines recommend evaluation for right ventricular dysfunction in all normotensive patients with acute pulmonary embolism (PE). We compared the predictive performance of the 2019 and 2014 ESC risk stratification algorithms and the Pulmonary Embolism Severity Index (PESI).

METHODS: We performed a post-hoc analysis of normotensive patients aged ≥65 years with acute PE from a prospective cohort. The primary outcome was overall mortality; secondary outcomes were PE-related mortality and adverse outcomes (PE-related death, cardiopulmonary resuscitation, intubation, catecholamine use, recurrent venous thromboembolism) at 30 days. We assessed outcomes in intermediate-high, intermediate-low, and low risk groups according to the 2019 and 2014 ESC algorithms and the PESI. Discriminative power was compared using the area under the receiver operating curve (AUC).

RESULTS: Among 419 patients, 14 (3.3%) died (7 from PE) and 16 (3.8%) had adverse outcomes within 30 days. The 2019 ESC algorithm classified more patients as intermediate-high risk (45%) than the 2014 ESC algorithm (24%) or PESI (37%), and only 19% as low risk (32% with 2014 ESC or PESI). Discriminatory power for overall mortality was lower with the 2019 ESC algorithm (AUC 63.6%), compared to the 2014 ESC algorithm (AUC 71.5%) or PESI (AUC 75.2%), although the difference did not reach statistical significance (p=0.063). Discrimination for PE-related mortality and adverse outcomes was similar.

CONCLUSIONS: While categorizing more patients in higher-risk groups, the 2019 ESC algorithm for PE did not improve prediction of short-term outcomes compared to the 2014 ESC algorithm or the PESI.

PMID:33823559 | DOI:10.1055/a-1475-2263

Gerontology. 2021 Apr 6:1-11. doi: 10.1159/000514449. Online ahead of print.

ABSTRACT

BACKGROUND: The evidence supporting the use of antiresorptive and anabolic agents for fracture prevention in elderly patients is still inconclusive. Whether it is too late to alter the course of the disease in this age-group has remained uncertain.

OBJECTIVES: The objective of this study was to determine the efficacy and safety of antiresorptive and anabolic agents in elderly patients.

METHODS: PubMed, Web of Science, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) and post hoc analyses of RCTs reporting efficacy outcomes or adverse events of antiresorptive and anabolic agents in elderly patients. Statistical heterogeneity was assessed with the Cochran Q χ2 test and I2 statistic. All results were expressed as relative risk (RR) with 95% confidence intervals (CIs).

RESULTS: The meta-analysis included 1 RCT and 11 post hoc analyses of data from 10 double-blind placebo-controlled RCTs. Antiresorptive therapy significantly reduced the pooled incidence of vertebral fractures (RR = 0.43; 95% CI = 0.35-0.53; and p < 0.001). It was also associated with lower risk of nonvertebral and hip fractures (RR = 0.84; 95% CI = 0.74-0.96; and p = 0.009 and RR = 0.75; 95% CI = 0.58-0.97; and p = 0.028, respectively). For any adverse events, no difference was observed between antiresorptive agents and placebo groups (RR = 1.01; 95% CI = 1.00-1.02; and p = 0.23).

CONCLUSIONS: Both antiresorptive and anabolic agents represented potentially important osteoporosis treatments, showing significant effects on reducing vertebral, nonvertebral, or hip fracture risk, and were well-tolerated by elderly patients. Even in the elderly, maybe it is not too late to alter the course of the disease.

PMID:33823511 | DOI:10.1159/000514449