Nevin Manimala

Matern Child Health J. 2022 Sep 17. doi: 10.1007/s10995-022-03492-5. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between housing instability and reproductive healthcare is understudied. We examined the association between housing insecurity and access and utilization of general healthcare, contraceptive healthcare, and abortion care.

METHODS: Using data from a population-representative survey of adult reproductive-age Ohio women (N = 2,529), we assessed housing insecurity (not paying rent/mortgage on time in the past year). We examined associations between housing insecurity and the following outcomes: (1) not being able to access general healthcare in the past year; (2) experiencing delays or difficulties in accessing contraceptive healthcare in the past year; and (3) ever having an abortion. We used unadjusted and adjusted logistic regression models. We selected confounders a priori and included age, socioeconomic status, and healthcare status.

RESULTS: Overall, 10.6% of Ohio women of adult reproductive age experienced housing insecurity. Approximately 27.5% of respondents were not able to access general healthcare and 10.4% experienced delays or difficulties in accessing contraceptive care. Compared to housing-secure respondents, housing-insecure women were less able to access general healthcare (adjusted odds ratio [aOR]:2.16; 95% confidence interval [CI]:1.45-3.23) and more likely to experience delays or difficulties when accessing contraceptive care (aOR:1.74; 95% CI:1.00-3.04). Insecure housing was not statistically associated with ever having an abortion (aOR:1.76; 95% CI:0.93-3.34).

CONCLUSIONS: In this study, recent housing insecurity was associated with poorer access to general and contraceptive healthcare. Studies utilizing multidimensional measures of housing insecurity and other material insecurity measures are needed to further explore the relationship between material insecurity and access to general and contraceptive care.

PMID:36114977 | DOI:10.1007/s10995-022-03492-5

Breast Cancer Res Treat. 2022 Sep 17. doi: 10.1007/s10549-022-06744-8. Online ahead of print.

ABSTRACT

PURPOSE: The impact of elevated body mass index (BMI) on overall survival (OS) in patients receiving modern anthracycline-taxane chemotherapy for early breast cancer (EBC) has not yet been well established. The purpose of our study was to examine overall survival (OS) by BMI category in women with EBC receiving either doxorubicin (A), cyclophosphamide (C) + paclitaxel (P) or fluorouracil (F), epirubicin (E), cyclophosphamide (C) + docetaxel (D).

METHODS: This was a retrospective cohort study in patients ≥ 18 years with resected stage I-III BC diagnosed between 2007 and 2017 in Ontario, identified through linkage of administrative databases. Patients were classified according to baseline BMI into underweight (< 18.5 kg/m²), normal (18.5-24.9 kg/m²), overweight (25-29.9 kg/m²), and obese (≥ 30 kg/m²) World Health Organization (WHO) categories. The primary outcome was OS. Univariable and multivariable analyses were used to examine the association between clinico-pathologic characteristics and OS among BMI categories.

RESULTS: Our cohort included 11,601 women, of whom 3890 (33.5%) were normal weight, 3696 (31.9%) overweight, and 3847 (33.1%) obese. Median OS was 7.9 years. There were no statistically significant differences in OS according to BMI (p = 0.66) in the overall study cohort or among the BMI categories after adjusting for age, nodal status, stage, grade, ER and HER2 status for either AC-P or FEC-D- treated patients (p = 0.45 and p = 0.97, respectively).

CONCLUSIONS: Our large population-based retrospective cohort analysis of EBC patients receiving adjuvant anthracycline-taxane chemotherapy found no significant impact of BMI on OS. Further investigation is warranted to confirm these findings in prospective patient cohorts.

PMID:36114940 | DOI:10.1007/s10549-022-06744-8

Breast Cancer Res Treat. 2022 Sep 17. doi: 10.1007/s10549-022-06689-y. Online ahead of print.

ABSTRACT

PURPOSE: To present an overview of the management of male patients with Ductal Carcinoma In Situ of the breast (male DCIS).

METHODS: We retrospectively studied all male patients with a diagnosis of pure DCIS from January 1999 to December 2018: 20 patients were identified in our cancer referral center. We collected data regarding clinical presentation, age of onset, radiological features, receptor status of the neoplasm, histological type, and the follow-up of those patients.

RESULTS: The median age was 62 years (range 21-80). All patients underwent surgery, in 15/20 (75%) cases a mastectomy was carried out. Two patients (10%) underwent endocrine treatment and 1/20 (5%) underwent radiotherapy. The receptor status for 15/20 patients was documented: 13/15 patients were ER+/Pr+. In 3 cases the Ki 67% was positive (i.e., > 20%). All cases were negative for Her2. The median follow-up time was 9.0 years (IQR 4.0-13.7). Only one patient had an ipsilateral recurrence with the finding of an infiltrating carcinoma in the same breast after 14 years. The 5-year disease-free survival was 92.9%.

CONCLUSION: Pure DCIS in men is an extremely rare disease: proper diagnosis and management allow an excellent prognosis.

PMID:36114939 | DOI:10.1007/s10549-022-06689-y

Ir J Med Sci. 2022 Sep 17. doi: 10.1007/s11845-022-03152-1. Online ahead of print.

ABSTRACT

BACKGROUND: Kisspeptin has recently emerged as a key regulator of the reproductive axis in women. Kisspeptin, acting centrally via the kisspeptin receptor, stimulates the secretion of the gonadotrophin-releasing hormone (GnRH).

AIMS: To investigate serum kisspeptin levels in infertility patients for its clinical utilisation in management and understanding of the pathophysiology of infertility in a wide array of patients.

METHODS: This prospective case-control study analysis involved 92 primary infertile women with PCOS, diminished ovarian reserve (DOR), unexplained infertility (UEI), and male factor infertility between 20 and 42 years of age. Serum samples were collected between the second and fifth day of the menstrual cycle. The kisspeptin level was determined using a human kisspeptin ELISA kit according to the manufacturer’s procedure.

RESULTS: The median value of serum kisspeptin in the PCOS infertility group was significantly higher than that in the UEI group (p = 0.011). There was a statistically significant (p = 0.015, r = -0.182) negative weak correlation found between serum kisspeptin levels and age. The optimal cutoff value obtained to differentiate the UEI from others (PCOS infertility + DOR + male factor infertility) according to the serum kisspeptin level was 214.3 ng/L with a sensitivity of 55% and specificity of 80.9%.

CONCLUSIONS: Understanding the role of kisspeptin may lead to its use as a biomarker in infertility diagnosis in UEI patients and might guide the use of kisspeptin analogues in selected patients for infertility management.

PMID:36114933 | DOI:10.1007/s11845-022-03152-1

Radiol Med. 2022 Sep 17. doi: 10.1007/s11547-022-01546-w. Online ahead of print.

ABSTRACT

PURPOSE: To assess the role of 2D-shear wave elastography (2D-SWE) in differentiating benign from malignant focal breast lesions (FBLs), providing new vendor-specific cutoff values.

METHODS: 158 FBLs (size: 3.5-50 mm) detected in 151 women (age: 21-87 years) were prospectively evaluated by means 2D-SWE. For each lesion, an expert radiologist assessed US BI-RADS category and calculated the following four 2D-SWE parameters: (1) elasticity maximum (E_max); (2) mean elasticity (E_mean); (3) minimum elasticity (E_min); (4) elasticity ratio (E_ratio). US-guided core-biopsy was considered as standard of reference for all the FBLs classified as BI-RADS 4 or 5. For each 2D-SWE parameter, the optimal cutoff value for a diagnostic test was calculated using the Youden method. Diagnostic performance of the US BI-RADS and 2D-SWE parameters was calculated accordingly.

RESULTS: 83/158 (52.5%) FBLs were benign and 75/158 (47.5%) were malignant. Statistically significant higher stiffness values were observed in malignant FBLs for all 2D-SWE parameters than in benign ones (p < 0.001). 2D-SWE cutoff values were 82.6 kPa, 66.0 kPa and 53.6 kPa, respectively, for E_max, E_mean, E_min and 330.8% for E_ratio. The 2D-SWE parameter showing the best diagnostic accuracy was E_max (85.44%). Considering US BI-RADS 3 (n = 60) and 4a (n = 32) FBLs, E_max and E_mean showed the best diagnostic accuracy (85.87% for both), without a statistically significant decrease in sensitivity (p = 0.7003 and p = 1, respectively).

CONCLUSION: Our study provides new vendor-specific cutoff values for 2D-SWE, suggesting its possible clinical use in the adjunctive assessment of category US-BI-RADS 3 and 4a breast masses.

PMID:36114930 | DOI:10.1007/s11547-022-01546-w

J Math Biol. 2022 Sep 17;85(4):31. doi: 10.1007/s00285-022-01788-2.

ABSTRACT

We introduce a model in the context of ecology that can be used to describe the distribution and abundance of individuals when data from field work is extremely limited (for example, in the case of endangered species). Our procedure is based on an intuitive understanding of the physical properties of phenomena. The idea is that individuals have the tendency to be attracted (or repulsed) to certain properties of the environment. At the same time, they are spread in such a way that if there is no reason for them to be in some specific locations, then they are uniformly distributed throughout the region. Our model draws from quantum mechanics, by using quantum Hamiltonians in the context of classical statistical mechanics. The equilibrium between the spreading and the attractive (or repulsive) forces determines the behavior of the species that we model, and this is expressed in terms of a global control problem of an energy operator which is the sum of a kinetic term (spreading) and a potential (attraction or repulsion). We focus on the full probability measure and a global control of the model (instead of looking at conditional measures that generate a global measure). Furthermore, we propose a numerical solution to this global control problem that overcomes the well-known major difficulty of Gibbs sampling (annealing) which is the fact that a global control is hardly reachable when the number of variables is large (the algorithms get stuck in non-optimal states).

PMID:36114925 | DOI:10.1007/s00285-022-01788-2

J Math Biol. 2022 Sep 17;85(4):33. doi: 10.1007/s00285-022-01808-1.

ABSTRACT

We consider a forager diffusing via a fractional heat equation and we introduce several efficiency functionals whose optimality is discussed in relation to the Lévy exponent of the evolution equation. Several biological scenarios, such as a target close to the forager, a sparse environment, a target located away from the forager and two targets are specifically taken into account. The optimal strategies of each of these configurations are here analyzed explicitly also with the aid of some special functions of classical flavor and the results are confronted with the existing paradigms of the Lévy foraging hypothesis. Interestingly, one discovers bifurcation phenomena in which a sudden switch occurs between an optimal (but somehow unreliable) Lévy foraging pattern of inverse square law type and a less ideal (but somehow more secure) classical Brownian motion strategy. Additionally, optimal foraging strategies can be detected in the vicinity of the Brownian one even in cases in which the Brownian one is pessimizing an efficiency functional.

PMID:36114899 | DOI:10.1007/s00285-022-01808-1

Skeletal Radiol. 2022 Sep 17. doi: 10.1007/s00256-022-04185-4. Online ahead of print.

ABSTRACT

OBJECTIVE: To quantitatively assess the impact of supine and standing positions on the morphological changes in the lumbar intervertebral foramen (LIF) in patients with adult spinal deformity (ASD) using upright CT and conventional supine CT.

MATERIALS AND METHODS: Thirty patients with ASD were prospectively enrolled in this study. All subjects underwent standing whole spine posterior/anterior radiographs, lateral radiographs, and whole spine CT, both in the supine and upright standing positions. Two orthopedic surgeons independently measured nine radiographic parameters in the radiograph and the lumbar foraminal area (FA) and height (FH) in supine and upright CT. Statistical analyses were performed to evaluate the risk of LIF decrease when standing upright compared to the supine position. The chi-squared, t test, Pearson’s coefficients, intra- and inter-rater reliabilities, and ROC curves were calculated. The level of significance was set at p < 0.05.

RESULTS: Among the 300 LIFs, both the lumbar FA and FH were either increased or decreased by > 5% in approximately 30% of LIFs each. The FA decreased in the lower lumbar spine. The concave side had a significantly higher rate of decreased FA and FH than the convex side (p < 0.05 and < 0.05, respectively). ROC analysis showed that narrowing of the intervertebral disc (cutoff > 0.05°) is a risk factor for decreased FA and FH.

CONCLUSIONS: This study describes the details of the changes in the neuroforamen using a novel upright CT. In patients with ASD, approximately 30% of LIFs either increased or decreased in size by > 5% when standing. The risk factors for LIF decrease are the lower lumbar spine, concave side, and narrow side of the disc wedge.

PMID:36114881 | DOI:10.1007/s00256-022-04185-4

Eur J Orthop Surg Traumatol. 2022 Sep 17. doi: 10.1007/s00590-022-03384-y. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to compare outcomes following surgical treatment of tibial plateau fractures in an elderly (≥ 65y) and non-elderly (< 65) population.

METHODS: Patients with tibial plateau fractures were prospectively followed. Patients were included if they were operatively treated, had an Injury Severity Score of < 16, and had follow-up through 12 months. Clinical, radiographic, and functional outcomes were evaluated at the 3, 6, and 12-month follow-up points.

RESULTS: Mean time to radiographic fracture union was by 4.68 and 5.26 months in young and elderly patients, respectively (p = 0.25). There was no difference in self-reported baseline SMFA (p = 0.617). SMFA scores were better in younger patients at 3 months (p = 0.031), however this did not hold when multivariate modeling controlled for other factors. There was no difference at 6 and 12 months (p = 0.475, 0.392). There was no difference in range of knee motion at 3 months. At 6 and 12 months, young patients had statistically but not clinically better range of knee motion (p = 0.045, 0.007). There were no differences in overall reoperation rates, conversion arthroplasty, post-traumatic osteoarthritis or wound complications.

CONCLUSIONS: Age greater than 65 does not appear to portend poorer outcomes after surgical repair of a tibial plateau fracture. The complication profiles are similar. Elderly and younger patients had similar function at 12 months compared to their baseline. These data suggest that age should not be a disqualifying factor when considering whether a patient with a tibial plateau fracture should be treated operatively.

PMID:36114875 | DOI:10.1007/s00590-022-03384-y

Arch Orthop Trauma Surg. 2022 Sep 17. doi: 10.1007/s00402-022-04621-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Complications associated with the application of the Reamer-irrigator-Aspirator (RIA) system are described in the literature. However, to date a systematic review and meta-analysis to assess prevalence of complications associated with the use of the RIA system have not been conducted.

MATERIALS AND METHODS: The review is registered with PROSPERO (CRD42021269982). MEDLINE, the Web of Science Core Collection, and Embase were searched from the inception to 10 August 2021. The primary objective was to assess complications and blood loss associated with the use of the RIA system.

RESULTS: Forty-seven studies involving 1834 procedures performed with the RIA system were finally included. A total of 105 complications were reported, with a pooled estimated overall prevalence of 1.7% with a 95% confidence interval (CI) of 0.40 to 3.60, with cortex perforation being the largest reported complication with a total of 34 incidences. A significant subgroup difference was observed (p = 0.02). In subgroup 1 (bone graft harvesting), complication prevalence was 1.4% (95% CI 0.2-3.4); in subgroup 2 (clearance intramedullary canal) it was 0.7% (95% CI 0.00-6.30) and in subgroup 3 (reaming with RIA system prior to nail fixation) 11.9% (95% CI 1.80-26.40). No statistically significant difference for tibia and femur as RIA system application site was observed (CI 0.69-4.19). In studies reporting blood loss, a mean volume of 803.29 ml, a mean drop of hemoglobin of 3.74 g/dl and a necessity of blood transfusion in 9.72% of the patients were observed.

CONCLUSIONS: The systematic review and meta-analysis demonstrate a low overall prevalence rate of complications associated with the RIA system. However, especially the risk of cortical perforation and the frequently reported relevant intraoperative blood loss are complications that should be anticipated in perioperative management and ultimately considered when using the RIA system.

PMID:36114869 | DOI:10.1007/s00402-022-04621-z