Category: Statistics

Int Cancer Conf J. 2021 Jul 19;10(4):266-273. doi: 10.1007/s13691-021-00502-1. eCollection 2021 Oct.

ABSTRACT

Since colorectal metastases from primary lung cancer are rare, the location of metastatic lesion and prognostic factors have not been well evaluated. Therefore, we carried out a systematic review and meta-analysis to assess the clinicopathological characteristics and prognostic factors of Japanese patients with colorectal metastasis from lung cancer. We searched the Ichushi-Web database from January 1964 to December 2020. We found 59 colorectal metastases in 52 cases for this meta-analysis. Small cell carcinoma was shown to have significantly more metastases to the appendix than non-small cell carcinoma. However, there was no significant correlation between location and histology when classified into right and left colons (P = 0.247). The median overall survival after diagnosis was 6 months. Univariate analysis showed that adenocarcinoma (Hazard Ratio (HR) 0.383, P = 0.024), simultaneous metastasis (HR 0.325, P = 0.046), and chemotherapy group (HR 0.482, P = 0.044) were good prognostic factors. Multivariate analysis confirmed that chemotherapy (HR 0.38, P = 0.02) was an independent good prognostic factor for overall survival. In conclusion, although there was no statistical difference, right colon metastases were more frequent than left colon metastases. Chemotherapy may be effective for colorectal metastases from lung cancer.

PMID:34567936 | PMC:PMC8421478 | DOI:10.1007/s13691-021-00502-1

J Bone Oncol. 2021 Sep 2;30:100388. doi: 10.1016/j.jbo.2021.100388. eCollection 2021 Oct.

ABSTRACT

BACKGROUND: We present the 2-year results of a randomised trial comparing 4- versus 12-weekly bone-targeting agents (BTAs) in patients with bone metastases from breast or castration-resistant prostate cancer (CRPC).

PATIENTS AND METHODS: Patients with bone metastases from breast or CRPC, who were going to start or were already receiving BTAs, were randomised to 4- or 12-weekly BTA treatment for 2 years. The endpoints were: symptomatic skeletal events (SSE) rates, time to SSEs, toxicity and cost-effectiveness.

RESULTS: Of 263 patients (160 breast cancer, 103 CRPC), 133 (50.6%) and 130 (49.4%) were randomised to the 4- and 12-weekly groups, respectively. BTAs included denosumab (56.3%), zoledronate (24.0%) and pamidronate (19.8%). After 2 years, the cumulative incidence rate (95% CI) of SSEs was 32.7% (24.6% to 41.1%) and 28.1% (20.3% to 36.4%) for the 4- and 12-weekly intervention groups respectively. The hazard ratio for time to first SSE was 0.96 (95% CI = 0.63 to 1.47). However, in a post hoc analysis, those patients who had an on-study SSE, there was a small non-statistical increased risk of subsequent SSEs among patients on the 12-weekly dosing arm (HR = 1.14; 95% CI – 0.90-1.44). BTA-related toxicity rates were similar between study arms. A cost-utility analysis showed that 12-weekly BTA is cost-effective from a public payer’s perspective.

CONCLUSION: These results in addition to those previously reported for de-escalating zoledronate, would support that de-escalation of commonly used BTAs is a reasonable and economically valid treatment option. While not statistically significant, the increase in subsequent SSEs in the 12-weekly arm requires further exploration.

PMID:34567960 | PMC:PMC8449269 | DOI:10.1016/j.jbo.2021.100388

Diabetol Int. 2021 Feb 16;12(4):389-398. doi: 10.1007/s13340-021-00494-6. eCollection 2021 Oct.

ABSTRACT

Cancer is a major cause of death in patients with type 2 diabetes mellitus (T2DM) and lung cancer is one of the most prevalent cancers in patients with T2DM. In the present study, we examined the anti-cancer effect of the Sodium-glucose cotransporter 2 (SGLT2) inhibitor, canagliflozin, using a lung cancer model. In lung cancer tissues from non-T2DM human subjects, SGLT2 was detected by immunohistochemistry. SGLT2 mRNA and protein were also detected in A549, H1975 and H520 lung cancer cell lines by RT-PCR and immunohistochemistry, respectively. Canagliflozin at 1-50 µM significantly suppressed the growth of A549 cells in a dose-dependent manner. In BrdU assays, canagliflozin attenuated the proliferation of A549 cells, but did not induce apoptosis. In cell cycle analysis, S phase entry was attenuated by canagliflozin in A549 cells. In in vivo experiments, a xenograft model of athymic mice implanted with A549 lung cancer cells was treated with low and high dose oral canagliflozin. Despite the results of the in vitro experiments, tumor weight was not decreased by canagliflozin. In addition, the serum insulin level, but not body weight or blood glucose level, was decreased by canagliflozin. The number of cells positive for Ki67 was slightly decreased by canagliflozin, but this was not statistically significant. In conclusion, SGLT2 is expressed in human lung cancer tissue and cell lines, and the SGLT2 inhibitor, canagliflozin, attenuated proliferation of A549 lung cancer cells by inhibiting cell cycle progression in vitro but not in vivo.

PMID:34567921 | PMC:PMC8413406 | DOI:10.1007/s13340-021-00494-6

Diabetol Int. 2021 Feb 7;12(4):399-404. doi: 10.1007/s13340-021-00495-5. eCollection 2021 Oct.

ABSTRACT

OBJECTIVE: Multiple drug use (Polypharmacy) is common in Diabetes Mellitus (DM) patients. The purpose of this study was to evaluate the presence of polypharmacy and comorbid conditions in patients with DM.

METHOD: The sociodemographic data, comorbidity diseases, and prescription records of 607 patients diagnosed with type 2 DM were retrospectively analyzed. Polypharmacy was defined as the use of five or more different drugs.

RESULTS: The mean number of drugs used by the DM patients was 6.7 ± 2.5. It was observed that 77.9% of the DM patients had polypharmacy. The mean number of drugs used by the patients in the polypharmacy group was 7.7 ± 1.7. The most common comorbidities in DM patients were diseases of the musculoskeletal system. The use of drugs for musculoskeletal diseases and the number of drugs were statistically higher in female patients than in male patients. In the DM patients, polypharmacy was higher in the females, those older age, those having a longer history of DM disease, and those having a comorbid disease.

CONCLUSION: The total number of drugs used by the DM patients showed the presence of polypharmacy. Advanced age, long disease duration, female gender, and presence of comorbidities were predictive factors for polypharmacy in diabetic patients. Before starting additional medication for DM patients, it is necessary to pay attention to the interaction of the drugs to be used and to plan prescriptions considering the medications used by the patient continuously.

PMID:34567922 | PMC:PMC8413418 | DOI:10.1007/s13340-021-00495-5

Cureus. 2021 Aug 22;13(8):e17369. doi: 10.7759/cureus.17369. eCollection 2021 Aug.

ABSTRACT

Background Various Indian registries have documented a delay of more than five hours for acute coronary syndrome patients from onset of symptoms to reaching thrombolysis-enabled centres. We conducted this study to evaluate the factors responsible for pre-hospital delay in acute coronary syndrome patients. Methods This was a descriptive cross-sectional study conducted in consecutive acute coronary syndrome patients who reported to the tertiary care medical centre in North India. A standardized tool was used to record the demographic data, socioeconomic status and clinical presentation of patients. All factors which led to pre-hospital delay were noted and the appropriate statistical tests were used for analysis. Results A total of 130 patients (males=93, females=37) were included in the study. The median time at which the acute coronary syndrome patients presented to the thrombolysis and percutaneous coronary intervention enabled centre was 490 minutes (range: 20 – 810 minutes) and 710 minutes (range: 45 – 940 minutes) respectively. The various factors responsible for prehospital delay were rural residence (p-value <0.0001), visit to local dispensary (p-value=0.0023), delay in getting transport (p-value=0.03) and misinterpretation of cardiac symptoms (p-value=0.0004). A significant but weak negative correlation was found between per capita income, decision making time and time taken to receive thrombolytic therapy. Out of a total of 83 ST-elevation myocardial infarction patients, only 46 (51.80%) were thrombolysed. Though 69/83 (83.13%) ST-elevation myocardial infarction patients reached thrombolysis enabled centre directly, only nine (10.84%) were thrombolysed at first medical contact; the rest were transferred to the percutaneous coronary intervention-enabled centre without any prior information. Conclusion Our study concludes that besides socioeconomic and demographic variables, lack of public awareness, well established public transport & health insurance system lead to significant pre-hospital delays and increase the time to revascularization. Besides, judgemental error on the part of medical practitioners in the peripheries also significantly delays thrombolysis in ST-elevation myocardial infarction patients.

PMID:34567908 | PMC:PMC8455286 | DOI:10.7759/cureus.17369

Diabetol Int. 2021 Jan 25;12(4):356-363. doi: 10.1007/s13340-021-00490-w. eCollection 2021 Oct.

ABSTRACT

INTRODUCTION: Maintaining good glycemic control is the main therapeutic target for diabetes mellitus (DM) patients. Nevertheless, due to complex factors, the majority of patients worldwide persist poorly controlled. Hence the study was conducted to determine the association of anthropometric measurement and other factors with glycemic control among type 2 DM patients.

METHODS: An institutional-based cross-sectional study was conducted among 366 type 2 DM patients from October-1 to November 30/2019. Data were collected by a pre-tested structured questionnaire and data abstraction format. The collected data were edited in Epi-data-4.4.1.0 and exported to SPSS-25 for analysis. The degree of association was assessed using logistic regression analysis and expressed in terms of p value and odds ratio with a 95%CI. p value < 0.05 was considered statistically significant.

RESULTS: Of the total 366 participants, (66.1%) had poor glycemic control. Increased waist circumference (AOR 2.37, 95% CI 1.28-4.40 for overweight and AOR 3.31, 95% CI 1.28-8.58 for obesity), long duration of DM (AOR 2.12, 95% CI 1.14-3.95 for 5-10 years and AOR 5.67, 95% CI 1.76-11.30 for > 10 years), occupation (AOR 3.74, 95% CI 1.94-7.23 for government employee and AOR 4.90, 95% CI 2.19-10.94 for private employee), and family history of DM (AOR 1.93, 95% CI 1.08-3.43), were significantly associated with poor glycemic control.

CONCLUSION: Nearly two-thirds of study participants had poor glycemic control. Increased waist circumference, long duration of DM, occupational status, and family history of DM were independently associated with poor glycemic control. Therefore, type 2 DM patients with these identified factors should be strictly monitored to maintain good glycemic control.

PMID:34567918 | PMC:PMC8413419 | DOI:10.1007/s13340-021-00490-w

Cureus. 2021 Aug 21;13(8):e17343. doi: 10.7759/cureus.17343. eCollection 2021 Aug.

ABSTRACT

Background and objective Coronavirus disease 2019 (COVID-19) has become a public health emergency of international concern. Several characteristics of hospitalised cases, including variations in symptoms as well as radiological and laboratory findings, have been described. However, the exact clinical spectrum of hospitalised patients with COVID-19 in Oman is currently unclear. The objective of this paper was to describe the sociodemographic, clinical, laboratory, and radiological characteristics, as well as the treatment and clinical outcomes of the confirmed cases of COVID-19 at Al Nahdha Hospital, Oman. Additionally, factors associated with the severity of the disease were identified. Methodology This was a cross-sectional descriptive study of hospitalised COVID-19 patients. The required data were retrieved from the electronic health information system for the period from 3rd March to 9th May 2020. Information was recorded in a bespoke sheet and exported to SPSS Statistics (IBM, Armonk, NY) for analysis. Results A total of 102 admissions were included in this study. The mean age of the cohort was 49.9 (14.7) years. The majority were males (77.5%), and more than half were expatriates (56.9%). Diabetes and hypertension were found in 39.2% and 36.3% of the study population, respectively. Common symptoms encountered were dry cough (78.3%), fever (76.5%), and shortness of breath (SOB) (69.6%). Radiologically, bilateral infiltrations were present in 73.5% of the patients. Only 19 cases required critical care (18.6%), and those were mostly older [54.1 (13.4) years], males (89.5%), and non-nationals (63.2%). Significant factors associated with requiring critical care were symptoms of SOB (89.5% vs 65.1%, p=0.03), diabetes (68.4% vs 32.5%, OR=1.5, p=0.004), chronic artery disease (15.8% vs 3.6%, OR=1.7, p=0.04), and diagnosis of acute respiratory distress symptoms (63.2% vs 6.0%, p<0.001). Additionally, the mean ferritin levels were significantly higher in cases requiring critical care [2350.4 (423.8) vs 795.7 (554.3), p=0.005]. Depending on disease severity, the treatment included antibacterials, antivirals, heparin, and steroids. The utilisation of steroids was significantly higher in the cases requiring critical care (63.2% vs 26.5%, p=0.001). Among cases that required critical care (n=19), nine died (death rate=47.4%). Conclusions This study has provided fundamental information about the clinical characteristics of confirmed COVID-19 cases in Oman, including factors associated with the disease’s severity. Results from this study can be utilised to update the COVID-19 management guidelines for hospitalised patients.

PMID:34567884 | PMC:PMC8451160 | DOI:10.7759/cureus.17343

Cureus. 2021 Aug 22;13(8):e17364. doi: 10.7759/cureus.17364. eCollection 2021 Aug.

ABSTRACT

Objectives The aim of this study is to determine the appropriateness of histopathologic examination of the placenta at King Abdulaziz University Hospital (KAUH), Jeddah, based on the guidelines of the College of American Pathologists (CAP). Methods It is a retrospective review of obstetric and pathologic records for all deliveries at KAUH, between January 1, 2017, and April 30, 2019. The placentae were assessed for eligibility to undergo pathologic examination. Furthermore, examined and non-examined placentae meeting the CAP criteria were compared based on their actual indications. Results There were 8,929 deliveries, of which 1,444 (16.2%) placentae met the CAP guidelines. A total of 583/1,444 placentae (40.4%; 95% confidence interval [CI] = 37.8-43) were sent for pathologic examination. Of the 7,485 placentae that did not require submission for pathological examination, as determined by the pathologist, 7,456 (99.6%; 95% CI = 99.4-99.7) were not submitted appropriately. The labor and delivery staff were more likely to submit placentae with fetal/neonatal indications rather than those with maternal indications for examination, which was statistically significant (odds ratio = 6.5; 95% CI = 5.08-8.30). Conclusion While most of the examined placentae at KAUH met the CAP guidelines, there was a substantial under-submission of eligible placentae. Further studies are advised to reveal the reasons behind this underestimation so that correctional measures may be adopted, as placenta examination is a valuable tool to understand the risk factors and pathogenesis of deleterious maternal, neonatal, and fetal events.

PMID:34567903 | PMC:PMC8454601 | DOI:10.7759/cureus.17364

Cureus. 2021 Aug 18;13(8):e17292. doi: 10.7759/cureus.17292. eCollection 2021 Aug.

ABSTRACT

Objective To analyze the effect of clinical, biochemical factors, and Mannose Binding Lectin 2 (MBL2) gene variations on medical management in filarial chyluria (FC) patients. Material and methods We conducted a study between March 2013 and April 2016. MBL2polymorphisms were genotyped in confirmed 101 medically-treated cases of FC. Demographic, clinical, and biochemical variables were compared between remission and failure groups. Genotyping of MBL2 codon 54 and promoter -221 were undertaken by polymerase chain reaction. Genotype frequencies were compared with clinical and biochemical variables and medical treatment outcomes (remission/failure). The association between genotypes and treatment response was estimated by OR and 95% CI and generated by the chi-square test. Results The mean age was 36.9±10.28-years and the male-female ratio was 3:1.2. Sixty-six patients had remission (Group-A) while 35 had recurrence (Group-B) at a mean follow-up of 21 months. The success rate for medical therapy was 65.35%. There was no statistical difference observed in the demographic profile of the two groups. On multivariate analysis, patients in Group-B had a higher grade of chyluria (p=0.005), had experienced greater number of disease attacks in the past (p=0.022), and had higher urinary triglyceride levels (TG) (p<0.001) as compared to Group-A patients. A significant association of MBL2 codon 54 genotypes was observed with the recurrent presentation of chyluria (p=0.044), grade of chyluria (p=0.028), and urinary TGs (p=0.001). However, genotype distribution at -221 did not show association with clinical and biochemical parameters of FC patients. The distribution of genotypes at codon 54 differed significantly between remission and failure/recurrence group; the variant genotype BB was significantly higher in the recurrence or failure group (OR:6.00; 95%CI, 1.00-35.91; p=0.050). However, frequencies of variant genotype YX and recessive group YX+XX of MBL2 -221 promoter was higher in remission group (OR:2.97;95%CI, 1.23-7.13; p=0.018 and OR:2.76; 95%CI, 1.80-6.50; p=0.020), respectively, showing that genetic variant may be associated with response to medical therapy. Conclusion Higher grade of chyluria, a higher number of disease attacks in the past, and higher urinary TGs levels were clinical predictors of poor response to medical treatment. Our results showed that the variants of MBL2 genes have an impact on treatment outcomes in FC patients. These observations may be limited by sample size.

PMID:34567855 | PMC:PMC8454256 | DOI:10.7759/cureus.17292

Int J Surg Oncol. 2021 Sep 15;2021:9947540. doi: 10.1155/2021/9947540. eCollection 2021.

ABSTRACT

BACKGROUND: Despite the undeniable benefit of tamoxifen therapy for ER-positive breast cancer patients, approximately one-third of those patients either do not respond to tamoxifen or develop resistance. Thus, it is a crucial step to identify novel, reliable, and easily detectable biomarkers indicating resistance to this drug.

OBJECTIVE: The aim of this work is to explore SOX2 and AGR2 biomarker expression in the tumor tissue of ER-positive breast cancer patients in combination with the evaluation of serum AGR2 level of these patients in order to validate these biomarkers as early predictors of tamoxifen resistance.

METHODS: This study was conducted on 224 ER-positive breast cancer patients. All patients were primarily subjected to serum AGR2 levelling by ELISA and their breast cancer tissue immunostained for SOX2 and AGR2. After 5 years of follow-up, the patients were divided into 3 groups: group 1 was tamoxifen sensitive and groups 2 and 3 were tamoxifen resistant. Time to failure of tamoxifen treatment was considered the time from the beginning of tamoxifen therapy to the time of discovery of breast cancer recurrence or metastases (in months).

RESULTS: SOX2 and AGR2 biomarkers expression and serum AGR2 level were significantly higher in groups 2 and 3 in comparison to group 1, while the relationship between Her2 neu expression and Ki67 index in the 3 different groups was statistically nonsignificant. Lower SOX2 and AGR2 expression and low AGR2 serum levels in the studied patients of groups 2 and 3 were significantly associated with longer time-to-failure of tamoxifen treatment. According to the ROC curve, the combined use of studied markers validity was with a sensitivity of 100%, specificity of 96%, PPV 96%, and NPV 100% (p < 0.001; AUC: 0.984).

CONCLUSIONS: Integrated use of SOX2 and AGR2 biomarkers with serum AGR2 assay holds a promising hope for their future use as predictive markers for early detection of tamoxifen resistance in ER-positive breast cancer patients.

PMID:34567804 | PMC:PMC8460385 | DOI:10.1155/2021/9947540