Nevin Manimala

West Afr J Med. 2024 Oct 30;41(10):1015-1022.

ABSTRACT

BACKGROUND: Magnesium has been shown to attenuate succinylcholine-induced fasciculation (SIF) and postoperative muscle pain (POMP); however, the optimal dose remains undetermined. This study explores the effects of varying low doses in a Nigerian population.

METHODS: Ninety patients, aged 18 and 65 years, ASA I and II, who had succinylcholine-assisted airway management, under general anaesthesia, (with propofol-midazolam co-induction, isoflurane and pancuronium maintenance), were randomised into three groups. All patients received magnesium pretreatment before induction; group A received 7.5mg/kg, group B received 10 mg/kg, while group C received 20 mg/kg.

RESULTS: Socio-demographic characteristics were comparable in all groups, p-value > 0.05. The overall incidence of SIF was similar between groups A (24, 80.0%) and B (22, 73.3%), and significantly higher than group C (12, 40.0%) (p = 0.001). Incidence of mild SIF were similar between groups A, (13, 43.3%) and B, (16, 53.3%), and statistically lesser than C, (12, 40.0%), p-value 0.001. The overall POMP incidence was similar between group A, (15, 50.0%) and B, (14, 46.7%), and statistically higher than C, (6, 20.0%), p-value 0.021.

CONCLUSION: This study demonstrates that a 20 mg/kg magnesium pretreatment attenuates SIF and POMP more effectively than 7.5 mg/kg and 10 mg/kg doses in patients undergoing succinylcholine-assisted airway management for general anesthesia.

PMID:40009802

JCO Clin Cancer Inform. 2025 Feb;9:e2400156. doi: 10.1200/CCI-24-00156. Epub 2025 Feb 26.

ABSTRACT

PURPOSE: Complex cancers require discussion at multidisciplinary cancer conferences (MCCs) to determine the best management. This study assessed the impact of a tumor board (TB)-specific information technology platform on the quality of information presented, case discussions, and care plans at thoracic MCCs.

METHODS: Between September 2020 and February 2022, using a before-after study design, we prospectively collected data through direct observation of thoracic MCCs at an academic cancer center. In addition, we reviewed medical records to assess the rate of change in care plans, compliance of all care plans with national guidelines, concordance of treatment received with MCC recommendations, and time from MCC presentation to treatment. Observational data were collected using a validated tool, Metric for the Observation of Decision-Making. We used SAS version 9.4 (SAS Institute Inc, Cary, NC) for statistical analyses.

RESULTS: We identified 151 and 166 thoracic cancer cases before and after implementation of the information technology platform, respectively. The overall quality of case presentation and discussion, represented by a mean composite score (summation of individual variables scored on a 1-5 scale, poor to excellent), increased from 56.8 to 82.0 (P < .001). This improvement was also observed across multiple subcomponents of the composite score all with P < .001. There was no statistically significant difference between the two cohorts in rate of change in care plans by the MCC, care plan compliance with national guidelines, and concordance of treatment received with MCC recommendations.

CONCLUSION: Technology improves the quality of information and discussion at TBs. However, this study did not demonstrate an impact on compliance with practice guidelines. Practitioners should explore the available TB technology platforms to optimize the conduct of MCCs in their respective institutions.

PMID:40009786 | DOI:10.1200/CCI-24-00156

West Afr J Med. 2024 Oct 30;41(10):1007-1014.

ABSTRACT

BACKGROUND: Access to affordable and quality care is critical to reducing suffering and mortality from diabetes given the huge economic challenge it poses. Health insurance aims to, among other things, improve the quality of health care services provided to patients.

OBJECTIVES: To assess and compare client satisfaction with quality of care among health-insured and non-insured diabetic patients in Kaduna State.

METHODS: A comparative cross-sectional study was conducted using a two-stage sampling technique and 500 respondents, comprising 250 (50%) insured and 250 (50%) uninsured patients. Data was collected with a pretested, semi-structured, interviewer-administered questionnaire. Data was analysed using IBM SPSS version 25. A p-value < 0.05 was considered statistically significant, and results were presented using tables.

RESULTS: The mean satisfaction scores of the health-insured and noninsured patients were found to be 106.6 and 109.5 respectively. The noninsured patients were more satisfied with the Health workers’ interpersonal approach (p = 0.022) and communication (p = 0.026), while the health-insured patients were more satisfied with the financial aspect of care (p = 0.040). However, there is no statistically significant difference in the composite satisfaction between the health-insured and non-insured patients. Religion, duration of diabetes and educational status were found to be predictors of client satisfaction.

CONCLUSIONS: The study found that although there was no significant difference in total satisfaction with the quality of care, the noninsured patients were more satisfied with the Health workers’ interpersonal approach and communication. It was recommended that the NHIA through accredited health facilities should improve interpersonal relationships and communication with health-insured diabetic patients.

PMID:40009780

Cogn Emot. 2025 Feb 26:1-12. doi: 10.1080/02699931.2025.2468281. Online ahead of print.

ABSTRACT

The relationships between perceived fatigue and changes in sustained attention performance during early stages of working on cognitively demanding tasks remain poorly understood. In addition, concerns have been raised that self-ratings of fatigue may be biased by socially desirable response tendencies, potentially confounding the relationship between perceived fatigue and attention performance. In this study, we assessed perceived fatigue briefly before tracking changes in concentration performance, processing speed, and error rates among N = 110 tenth graders, while they completed the d2-R test of sustained attention. By statistically controlling for social desirability, we examined relationships between perceived fatigue and the initial levels and slopes of three latent growth-curves capturing changes in the d2-R test’s performance measures. Individuals with higher fatigue exhibited lower concentration performance, a weaker decline in processing speed, and a higher error rate over the course of testing. Post hoc power analyses supported the robustness of our results. Implications for mental fatigue research are discussed.

PMID:40009770 | DOI:10.1080/02699931.2025.2468281

JMIR Aging. 2025 Feb 26;8:e65292. doi: 10.2196/65292.

ABSTRACT

BACKGROUND: Dementia is characterized by impairments in an individual’s cognitive and functional abilities. Digital cognitive assessments have been shown to be effective in detecting mild cognitive impairment and dementia, but whether they can stage the disease remains to be studied.

OBJECTIVE: In this study, we examined (1) the correlation between scores obtained from BrainCheck standard battery of cognitive assessments (BC-Assess), a digital cognitive assessment, and scores obtained from the Dementia Severity Rating Scale (DSRS), and (2) the accuracy of using the BC-Assess score to predict dementia stage delineated by the DSRS score. We also explored whether BC-Assess can be combined with information from the Katz Index of Independence in activities of daily living (ADL) to obtain enhanced accuracy.

METHODS: Retrospective analysis was performed on a BrainCheck dataset containing 1751 patients with dementia with different cognitive and functional assessments completed for cognitive care planning, including the DSRS, the ADL, and the BC-Assess. The patients were staged according to their DSRS total score (DSRS-TS): 982 mild (DSRS-TS 10-18), 656 moderate (DSRS-TS 19-26), and 113 severe (DSRS-TS 37-54) patients. Pearson correlation was used to assess the associations between BC-Assess overall score (BC-OS), ADL total score (ADL-TS), and DSRS-TS. Logistic regression was used to evaluate the possibility of using patients’ BC-OS and ADL-TS to predict their stage.

RESULTS: We found moderate Pearson correlations between DSRS-TS and BC-OS (r=-0.53), between DSRS-TS and ADL-TS (r=-0.55), and a weak correlation between BC-OS and ADL-TS (r=0.37). Both BC-OS and ADL-TS significantly decreased with increasing severity. BC-OS demonstrated to be a good predictor of dementia stages, with an area under the receiver operating characteristic curve (ROC-AUC) of classification using logistic regression ranging from .733 to .917. When BC-Assess was combined with ADL, higher prediction accuracies were achieved, with an ROC-AUC ranging from 0.786 to 0.961.

CONCLUSIONS: Our results suggest that BC-Assess could serve as an effective alternative tool to DSRS for grading dementia severity, particularly in cases where DSRS, or other global assessments, may be challenging to obtain due to logistical and time constraints.

PMID:40009769 | DOI:10.2196/65292

JAMA Netw Open. 2025 Feb 3;8(2):e2454506. doi: 10.1001/jamanetworkopen.2024.54506.

ABSTRACT

IMPORTANCE: Inflammatory breast cancer (IBC) is an aggressive variant for which trimodality treatment (ie, neoadjuvant systemic therapy [NST] followed by modified radical mastectomy without immediate reconstruction and postmastectomy radiotherapy [PMRT]) represents guideline-concordant care (GCC) and is associated with improved overall survival (OS). However, it is unclear whether there are disparities in trimodality treatment receipt among patients with IBC and how such disparities might affect OS.

OBJECTIVE: To assess trends in IBC trimodality treatment receipt in a contemporary cohort.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted using data from the National Cancer Database. Women with nonmetastatic IBC treated from calendar years 2010 to 2018 were included. Data analysis was performed from April 1, 2023, to March 1, 2024.

EXPOSURES: Guideline-concordant care (ie, trimodality treatment administered in the correct sequence with time to NST initiation <60 days post diagnosis).

MAIN OUTCOMES AND MEASURES: The main outcomes were associations between patient-, disease-, treatment-, and facility-level factors and receipt of overall and modality-specific GCC and associations between these factors and adjusted OS.

RESULTS: Of 6945 patients identified (median age, 57 [IQR, 47-66] years; 2.4% Asian or Pacific Islander, 7.8% Hispanic, 17.1% non-Hispanic Black, and 71.5% non-Hispanic White), only 1740 (25.1%) received all forms of GCC: 91.3% (n = 5662) received NST initiation less than 60 days post diagnosis, 63.3% (n = 4395) received PMRT, and 51.3% (n = 3564) underwent guideline-concordant surgery (ie, modified radical mastectomy without immediate reconstruction with >6 lymph nodes removed). Receipt of GCC did not differ significantly by race and ethnicity, insurance status, or location. Asian (odds ratio [OR], 0.48; 95% CI, 0.27-0.84), Black (OR, 0.53; 95% CI, 0.41-0.68), and Hispanic (OR, 0.40; 95% CI, 0.29-0.55) patients were less likely to have NST initiation less than 60 days post diagnosis vs White patients (all P ≤ .001). Recipients of GCC had improved adjusted OS vs nonrecipients (hazard ratio [HR], 0.75; 95% CI, 0.68-0.84; P < .001). Black patients had significantly lower adjusted OS ,compared with White recipients (HR, 1.41; 95% CI, 1.26-1.58; P < .001). When GCC was received for triple-negative IBC, there was no racial and ethnic disparity in OS.

CONCLUSIONS AND RELEVANCE: In this cohort study of women with nonmetastatic IBC, there were no disparities observed in GCC receipt, but only 25.1% of patients with IBC received all forms of GCC for which they were eligible. Among those who received GCC, there was no racial disparity in survival for triple-negative IBC, suggesting opportunities to improve equity through standardization of care.

PMID:40009385 | DOI:10.1001/jamanetworkopen.2024.54506

JAMA Netw Open. 2025 Feb 3;8(2):e2459170. doi: 10.1001/jamanetworkopen.2024.59170.

ABSTRACT

IMPORTANCE: Given the increasing prevalence of dementia and the limited treatment options available, ultrasound neuromodulation could serve as a novel add-on therapy to standard treatments for Alzheimer disease (AD). As ultrasound neuromodulation is still in its early stages, further research is essential to fully explore its potential in treating brain disorders.

OBJECTIVE: To evaluate clinical and functional imaging effects of transcranial pulse stimulation (TPS) in patients with AD.

DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, sham-controlled, crossover clinical trial was conducted at the Medical University of Vienna between January 1, 2017, and July 27, 2022. Sixty patients with clinically diagnosed AD receiving state-of-the-art treatment were randomly allocated to treatment sequence groups verum-sham (first cycle verum, second cycle sham, n = 30) and sham-verum (n = 30). Data analysis was performed from July 28, 2022, to September 5, 2024.

INTERVENTION: Each participant received 6 verum and 6 sham TPS sessions (6000 pulses, 0.20 mJ/mm2, 5 Hz) to frontoparietal brain areas.

MAIN OUTCOMES AND MEASURES: Neuropsychological tests, including the primary outcome Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) corrected total score (CTS), were performed at baseline and 1 week, 1 month, and 3 months following the stimulations in each cycle. Primary and secondary outcomes, including functional magnetic resonance imaging and Beck Depression Inventory-II, were analyzed by intention-to-treat analysis and, for sensitivity, by per protocol analysis.

RESULTS: For the intention-to-treat analysis, 60 patients between ages 51 and 82 years (mean [SD], 70.65 [8.16] years; 30 females; 30 males) were included. The CERAD CTS increased by a mean (SD) of 2.22 (6.87) points in the verum condition from 70.93 (14.27) points at baseline to 73.15 (14.90) 3 months after stimulation, while the mean (SD) score in the sham condition increased by 1.00 (6.82) point vs baseline from 71.68 (13.62] at baseline to 72.68 (14.48) 3 months after stimulation. Primary data analysis of the condition × session interaction was not significant (P = .68; partial η2 [ηp2] = 0.01), but its interaction with age was P = .003; ηp2 = 0.08, followed by post hoc analyses of age subsamples. Although several patients older than 70 years benefited from verum TPS, only the younger subgroup (≤70 years) showed significantly higher CTS increases for verum in all poststimulation sessions (condition × session: P = .005; ηp2 = 0.16). At 3 months after stimulation, for example, a mean (SD) 3.91 (7.86)-point increase was found for verum TPS in the younger patients, but a mean (SD) CTS decrease of 1.83 (5.80) was observed for sham. Memory-associated brain activation was significantly higher after verum TPS in the precuneus, visual, and frontal areas, while resting state functional connectivity was significantly upregulated in the dorsal attention network. In the per protocol sample, a significant reduction of the Beck Depression Inventory-II scores 3 months following verum TPS was found (verum baseline: 7.27 [5.87]; verum 3 months after stimulation: 5.27 [5.27]; sham baseline: 6.70 [5.65]; sham 3 months after stimulation: 6.22 [4.40]; P = .008; ηp2 = 0.23). During both verum and sham conditions, the most common observed adverse symptom was depression; no major neuropathologic change was detected in the patients by detailed neuroradiologic assessments.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of TPS in patients with AD, a 2-week verum treatment improved cognitive scores in the younger subgroup, ameliorated depressive symptoms, and induced upregulation of functional brain activation and connectivity. These findings suggest TPS may be a safe and promising add-on therapy for patients with AD receiving state-of-the-art treatment.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03770182.

PMID:40009384 | DOI:10.1001/jamanetworkopen.2024.59170

JAMA Netw Open. 2025 Feb 3;8(2):e2459548. doi: 10.1001/jamanetworkopen.2024.59548.

ABSTRACT

IMPORTANCE: Neonatal short bowel syndrome with intestinal failure is rare, and observational studies are limited to small cohorts. Health disparities exist in long-term management with little known about the initial hospitalization.

OBJECTIVE: To identify children with neonatal short bowel syndrome with intestinal failure and to determine whether race, ethnicity, and neighborhood opportunity are associated with length of stay during their initial hospitalizations.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of children with neonatal short bowel syndrome and intestinal failure was conducted between 2004 and 2020, with validation and analysis performed from July 2022 to April 2024. Children were identified from the Pediatric Health Information System database, which included administrative data from 50 freestanding US children’s hospitals. Children were included on the basis of a diagnosis code of postsurgical malabsorption and billed charges for a neonatal intensive care unit stay and sustained parenteral nutrition use.

EXPOSURES: Race and ethnicity were included as a single variable with categories of Hispanic, non-Hispanic Black, non-Hispanic White, other (Asian and multiracial, combined because of low numbers), and unknown according to hospital report. Child Opportunity Index quintile ranged from very low (lowest quintile) to very high (highest quintile).

MAIN OUTCOMES AND MEASURES: The primary outcome was length of stay measured in number of days from admission to discharge. The χ2 analysis was used to examine unadjusted associations between categorical variables, and Wilcoxon rank-sum test was used for continuous variables.

RESULTS: A total of 2267 children with neonatal short bowel syndrome with intestinal failure were identified (997 female [44%]; 410 Hispanic [18%]; 481 non-Hispanic Black [21%]; 690 non-Hispanic White [30%]; 231 other [10%]; 455 unknown [20%]), with 629 (28%) living in areas with very low Child Opportunity Index. The median (IQR) length of stay for the initial admission was 150 (112-200) days, with a median (IQR) cost of $528 628 ($374 040-$766 446). In multivariable analysis, non-Hispanic Black children remained in the hospital for 16 days longer than their non-Hispanic White counterparts (95% CI, 7-25 days; P < .001). Child Opportunity Index was not significantly associated with length of stay when controlling for race and ethnicity.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, children with neonatal short bowel syndrome with intestinal failure experienced long initial hospital stays, incurring high costs, with non-Hispanic Black children disproportionately affected. Interventions targeting safe and efficient transition to home are needed to address both efficacy and equity for these children.

PMID:40009383 | DOI:10.1001/jamanetworkopen.2024.59548

JAMA Netw Open. 2025 Feb 3;8(2):e2460785. doi: 10.1001/jamanetworkopen.2024.60785.

ABSTRACT

IMPORTANCE: Prostate cancer (PCa) remains a leading cause of cancer-related death among men in the US.

OBJECTIVE: To evaluate the association of healthy lifestyle and dietary behaviors with survival after a nonmetastatic PCa diagnosis in a multiethnic population.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted among men aged 45 to 75 years enrolled between 1993 and 1996 in the Multiethnic Cohort study. Participants with nonmetastatic PCa completed a questionnaire after diagnosis (2003-2008) and were followed up until death or loss to follow-up. Data were analyzed from January 10, 2023, to May 20, 2024.

EXPOSURES: Lifestyle and dietary patterns were assessed after diagnosis using 3 PCa behavior scores and 13 dietary indices (4 prioritized scores: the Healthy Eating Index-2015, Healthful Plant-Based Diet Index, Dietary Inflammatory Index, and Empirical Dietary Index for Hyperinsulinemia).

MAIN OUTCOMES AND MEASURES: Cox proportional hazards models were used to evaluate multivariable-adjusted associations of each PCa behavior score with all-cause, cardiovascular disease (CVD), and PCa-specific mortality.

RESULTS: A total of 2603 men with nonmetastatic PCa (mean [SD] age, 69.6 [7.1] years) were followed up, and 1346 deaths were documented, including 356 (24.6%) from CVD and 197 (14.6%) from PCa. The median (IQR) follow-up was 10.9 (IQR, 6.8-12.7) years from questionnaire return and 14.5 (IQR, 11.8-18.0) years from diagnosis. The 2021 PCa Behavior Score was associated with reduced risks of all-cause (hazard ratio [HR] per point, 0.69; 95% CI, 0.63-0.77) and CVD-related (HR, 0.67; 95% CI, 0.56-0.79) mortality. This score was also associated with a lower risk of PCa-specific mortality among African American men (HR, 0.46; 95% CI, 0.24-0.88) but not in the other racial and ethnic groups. Comparing quintile 5 (highest score) with 1 (lowest score), the Empirical Dietary Index for Hyperinsulinemia was positively associated with all-cause (HR, 1.37; 95% CI, 1.02-1.84) and CVD-related (HR, 1.96; 95% CI, 1.15-3.33) mortality, whereas the Healthful Plant-Based Diet Index was associated with a reduced risk of all-cause (HR, 0.75; 95% CI, 0.58-0.97); findings for CVD-related mortality were not statistically significant (HR, 0.67; 95% CI, 0.44-1.03). No associations were found between lifestyle or dietary patterns and PCa mortality.

CONCLUSIONS AND RELEVANCE: In this multiethnic cohort of patients with nonmetastatic PCa, healthier lifestyles were associated with improved overall survival but not with PCa-specific survival. Given the predominance of non-PCa-specific deaths, these findings support the need for health behavior counseling to treat comorbidities in men with PCa.

PMID:40009382 | DOI:10.1001/jamanetworkopen.2024.60785

JAMA Netw Open. 2025 Feb 3;8(2):e2461639. doi: 10.1001/jamanetworkopen.2024.61639.

ABSTRACT

IMPORTANCE: Subgroup definitions for possible deescalation of neoadjuvant cancer treatment are urgently needed in clinical practice.

OBJECTIVE: To investigate the effect of BRCA1 and/or BRCA2 tumor pathogenic variants (tPVs) by comparing 2 deescalated neoadjuvant regimens (nab-paclitaxel plus either carboplatin or gemcitabine) on pathologic complete response (pCR), invasive disease-free survival (IDFS), and overall survival (OS) of patients with early-stage triple-negative breast cancer (TNBC).

DESIGN, SETTING, AND PARTICIPANTS: This was a preplanned secondary analysis of a phase 2 prospective randomized clinical trial (ADAPT-TN) conducted by the West German Study Group (WSG) at 45 sites in Germany between June 2013 and February 2015. The trial enrolled patients with noninflammatory early-stage TNBC (clinical tumor size ≥1 cm; estrogen receptor and progesterone receptor expression <1%; and ERBB2 negative). DNA samples from pretreatment biopsies were obtained. Genetic analysis was performed between January 2018 and March 2020. Final data analyses took place in September 2023.

EXPOSURE: Patients were randomized to 12 weeks of treatment with nab-paclitaxel plus either carboplatin or gemcitabine; omission of otherwise mandatory anthracycline-containing chemotherapy was allowed in the case of pCR. tPVs in 20 cancer-associated genes, including BRCA1 and BRCA2, were analyzed using a customized gene panel.

MAIN OUTCOMES AND MEASURES: The prevalence of BRCA1 and/or BRCA2 tPVs and their effect on pCR rate, IDFS, and OS were evaluated using logistic and Cox proportional hazards regression.

RESULTS: Of the 307 patients with DNA samples from pretreatment biopsies available, tumor next-generation sequencing analyses were successful for 266 patients. The 266 patients included in this analysis were female, with a median age of 51 years (range, 26-76 years). A total of 162 patients (60.9%) had a clinical tumor size of 2 cm or greater, and 70 (26.3%) had clinical node-positive disease. BRCA1 and/or BRCA2 tPVs were detected in 42 patients (15.8%). The highest pCR rate among patients with BRCA1 and/or BRCA2 tPVs was seen in the nab-paclitaxel plus carboplatin group (9 of 14 patients [64.3%]) compared with the nab-paclitaxel plus gemcitabine group (10 of 28 [35.7%]) (odds ratio, 3.24 [95% CI, 0.85-12.36]; P = .08); the highest numeric 5-year IDFS and OS rates (84.4% and 92.9%, respectively) were seen in the nab-paclitaxel plus carboplatin group.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of the WSG-ADAPT-TN randomized clinical trial on tPVs, deescalated nab-paclitaxel plus carboplatin was superior to nab-paclitaxel plus gemcitabine, particularly in patients with BRCA1 and/or BRCA2 tPVs. These findings suggest that BRCA1 and/or BRCA2 tPV status could be a candidate marker for a deescalation strategy in early-stage TNBC; however, prospective validation of survival outcomes in larger cohorts with differentiation between germline and somatic pathogenic variants is necessary.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01815242.

PMID:40009381 | DOI:10.1001/jamanetworkopen.2024.61639