Nevin Manimala

Front Oncol. 2023 Apr 25;13:1105877. doi: 10.3389/fonc.2023.1105877. eCollection 2023.

ABSTRACT

OBJECTIVE: To systematically review the differences between radiofrequency ablation and partial nephrectomy in patients with early-stage renal cell carcinoma, and to provide evidence-based medical evidence for the choice of surgery for patients with early-stage renal cell carcinoma.

METHODS: According to the search strategy recommended by the Cochrane Collaboration, Chinese databases such as CNKI, VIP Chinese Science and Technology Periodicals Database (VIP), and Wanfang Full-text Database were searched with Chinese search terms. And PubMed and MEDLINE as databases for English literature retrieval. Retrieve the relevant literature on renal cell carcinoma surgical methods published before May 2022, and further screen radiofrequency ablation and partial nephrectomy in patients with renal cell carcinoma The relevant literature on the application is analyzed. RevMan5.3 software was used for heterogeneity test and combined statistical analysis, sensitivity analysis, and subgroup analysis. Analysis, and draw forest plot, using Stata software Begger quantitative assessment of publication bias.

RESULTS: A total of 11 articles were involved, including 2958 patients. According to the Jadad scale, 2 articles were of low quality, and the remaining 9 articles were of high quality. Results of this study demonstrates the advantages of radiofrequency ablation in early-stage renal cell carcinoma. The results of this meta-analysis showed that compared with partial nephrectomy, there was significant difference in the 5-year overall survival rate between radiofrequency ablation and partial nephrectomy and there was a statistically significant difference between the two surgical methods in the 5-year relapse free survival rate of early renal cell carcinoma.

CONCLUSION: 1. Compared with partial nephrectomy, the 5-year relapse-free survival rate, the 5-year cancer specific survival rate and the overall 5-year survival rate were higher in the radiofrequency ablation group. 2. Compared with partial nephrectomy, there was no significant difference in the postoperative local tumor recurrence rate of radiofrequency ablation. 3. Compared with partial resection, radiofrequency ablation is more beneficial to patients with renal cell carcinoma.

PMID:37182152 | PMC:PMC10166822 | DOI:10.3389/fonc.2023.1105877

Front Oncol. 2023 Apr 26;13:1072652. doi: 10.3389/fonc.2023.1072652. eCollection 2023.

ABSTRACT

INTRODUCTION: Multi-professional interdisciplinary tumor boards (ITB) are essential institutions to discuss all newly diagnosed, relapsed or complex cancer patients in a team of specialists to find an optimal cancer care plan for each individual patient with regard to national and international clinical practice guidelines, patient´s preference and comorbidities. In a high-volume cancer center, entity-specific ITBs take place at least once a week discussing a large number of patients. To a high level of expertise and dedication, this also requires an enormous amount of time for physicians, cancer specialists and administrative support colleagues, especially for radiologists, pathologists, medical oncologists and radiation oncologists, who must attend all cancer-specific boards according to certification requirements.

METHODS: In this 15-month prospective German single-center analysis, we examined the established structures of 12 different cancer-specific ITBs at the certified Oncology Center and demonstrate tools helping to optimize processes before, during and after the boards for optimal, time-saving procedures.

RESULTS: By changing pathways, introducing revised registration protocols and new digital supports we could show that the workload of preparation by radiologists and pathologists could be reduced significantly by 22.9% (p=<0.0001) and 52.7% (p=<0.0001), respectively. Furthermore, two questions were added to all registration forms about the patient´s need for specialized palliative care support that should lead to more awareness and early integration of specialized help.

DISCUSSION: There are several ways to reduce the workload of all ITB team members while maintaining high quality recommendations and adherence to national and international guidelines.

PMID:37182140 | PMC:PMC10171921 | DOI:10.3389/fonc.2023.1072652

Front Oncol. 2023 Apr 25;13:1131013. doi: 10.3389/fonc.2023.1131013. eCollection 2023.

ABSTRACT

Extra-axial brain tumors are extra-cerebral tumors and are usually benign. The choice of treatment for extra-axial tumors is often dependent on the growth of the tumor, and imaging plays a significant role in monitoring growth and clinical decision-making. This motivates the investigation of imaging biomarkers for these tumors that may be incorporated into clinical workflows to inform treatment decisions. The databases from Pubmed, Web of Science, Embase, and Medline were searched from 1 January 2000 to 7 March 2022, to systematically identify relevant publications in this area. All studies that used an imaging tool and found an association with a growth-related factor, including molecular markers, grade, survival, growth/progression, recurrence, and treatment outcomes, were included in this review. We included 42 studies, comprising 22 studies (50%) of patients with meningioma; 17 studies (38.6%) of patients with pituitary tumors; three studies (6.8%) of patients with vestibular schwannomas; and two studies (4.5%) of patients with solitary fibrous tumors. The included studies were explicitly and narratively analyzed according to tumor type and imaging tool. The risk of bias and concerns regarding applicability were assessed using QUADAS-2. Most studies (41/44) used statistics-based analysis methods, and a small number of studies (3/44) used machine learning. Our review highlights an opportunity for future work to focus on machine learning-based deep feature identification as biomarkers, combining various feature classes such as size, shape, and intensity. Systematic Review Registration: PROSPERO, CRD42022306922.

PMID:37182138 | PMC:PMC10167010 | DOI:10.3389/fonc.2023.1131013

Cureus. 2023 Apr 10;15(4):e37356. doi: 10.7759/cureus.37356. eCollection 2023 Apr.

ABSTRACT

Objective This study aims to investigate the quality of life (QOL), parental stress, and perception of social support in parents of children with neurodevelopmental disorders (NDD) in Saudi Arabia. Background Studies have shown that parenting a child with NDD impacts the QOL, parental stress, and life satisfaction of parents. Those studies, however, assessed those factors separately as well as focusing on autism spectrum disorder (ASD). This study will use a mixed methods approach to gain a deeper understanding of those three factors as they related to parenting a child with NDD. Method Data about parental stress, QOL, and other related sociodemographic variables were collected from parents of children with NDD (N= 63). Next, semi-structured interviews were conducted with four of those parents to gain a deeper understanding of the parents’ QOL, parental stress, and perception of social support. Results An analysis of variance (ANOVA) test demonstrated that parents who had children with severe symptoms had poorer QOL and higher levels of parental stress compared to parents who had children who had moderate and mild symptoms. In addition, parents who had children with ASD had poorer QOL compared to all of the other disorders. There was no statistically significant difference in QOL and parental stress between mothers and fathers. The thematic analysis highlighted that the most significant challenges they face are financial, familial, and well-being worries. Conclusion In conclusion, this study shows that parents of children with NDD exhibited higher levels of parental stress and lower levels of QOL depending on the diagnosis and intensity of the child’s symptoms. In addition, the interviews highlighted some key challenges that the parents felt affected their QOL and stress levels, as well as their views on family, friends, and community social support. Implications This study can help in developing or improving supportive programs and interventions for parents with children with NDD to enhance their QOL, reduce parental stress, and create a better social support system.

PMID:37182086 | PMC:PMC10171881 | DOI:10.7759/cureus.37356

Cureus. 2023 Apr 10;15(4):e37408. doi: 10.7759/cureus.37408. eCollection 2023 Apr.

ABSTRACT

Background The clinical condition of epidemic dropsy is caused by the consumption of edible oils contaminated with Argemone mexicana oil. Two of the most toxic alkaloids found in argemone oil are sanguinarine and dehydrosanguinarine, which cause capillary dilation, proliferation, and increased permeability. Extreme cardiac decompensation leading to congestive heart failure and glaucoma resulting in blindness are the most serious consequences of epidemic dropsy. Materials and methods All patients attending the medicine department of Tezpur Medical College and Hospital with clinical features of epidemic dropsy were included in the study after obtaining informed consent. All patients, after a complete history, underwent a thorough clinical examination, and findings were recorded using a pre-formed proforma. Along with routine blood examination, patients were also evaluated with echocardiography, ECG, and chest X-ray. Cooking oil samples obtained from patients were investigated for the presence of sanguinarine in a standardized laboratory with the help of the district authority. The statistical analysis was done using MS Excel 2017. Results Out of 38 patients, 36 were male (94.7%), and only two were female (5.2%). Male to female ratio was 18:1. This difference in sex ratio may be due to the fact that only severely ill patients attended our tertiary care hospital. In contrast, moderate and mildly ill patients were treated in local hospitals. The mean age of patients was 28.1 years, and the mean length of hospital stay was eight days. Bilateral pitting type of ankle edema was the most common clinical manifestation, and all 38 patients (100%) exhibited edema. A total of 76% of patients had dermatological manifestations. Sixty-two percent of patients had gastrointestinal manifestations. In cardiovascular manifestation, persistent tachycardia was seen in 52% of patients, pansystolic murmur was best heard in the apical area in 42% of patients, and 21 percent had evidence of a raised jugular venous pressure (JVP). Five percent of patients had pleural effusion. Sixteen percent of patients had ophthalmological manifestations. Eight patients (21%) required ICU care. The in-hospital fatality rate was 10.53% (n=4). Of the expired patients, 100% were male. The most common cause of death was cardiogenic shock (75%), followed by septic shock (25%). Conclusion From our study, it was found that most of the patients were male, with an age group of 25-45 years. The most common clinical manifestation was dependent edema, along with signs of heart failure. Other common manifestations were dermatological and gastrointestinal. The severity and outcome were directly related to the delay in seeking medical consultation and diagnosis.

PMID:37182084 | PMC:PMC10172017 | DOI:10.7759/cureus.37408

Cureus. 2023 Apr 11;15(4):e37444. doi: 10.7759/cureus.37444. eCollection 2023 Apr.

ABSTRACT

Background Otorhinolaryngology (ENT) illnesses commonly affect all individuals with a broad range of symptoms, and most causes are preventable. According to the WHO, more than 278 million people have bilateral hearing loss. Locally, a previously published study done in Riyadh showed that most participants (79.4%) had a poor level of knowledge on common ENT-related diseases. The current study aims to investigate and explore the knowledge of and attitudes toward common ENT problems among students in Makkah City, Saudi Arabia. Method This descriptive, cross-sectional study used an Arabic-language electronic questionnaire to assess knowledge of common ENT problems. It was distributed to medical students at Umm Al-Qura University and students attending Makkah City high schools in Saudi Arabia between November 2021 and October 2022. The sample size was calculated to be 385 participants. Results Overall 1080 respondents were enrolled in this survey from Makkah City. Participants with good knowledge of common ENT diseases were over 20 years of age with a p-value <0.001. Furthermore, females also had a significant p-value of <0.004, and those with bachelor’s or university degrees showed a statistically significant p-value of <0.001. Conclusion Female participants with bachelor’s or university degrees and participants aged 20 and older showed superior knowledge. Our findings indicate that students need educational implications and awareness campaigns to increase their knowledge, practice, and perception toward common otorhinolaryngology-related issues.

PMID:37182080 | PMC:PMC10174595 | DOI:10.7759/cureus.37444

Cureus. 2023 Apr 10;15(4):e37366. doi: 10.7759/cureus.37366. eCollection 2023 Apr.

ABSTRACT

Background Baska Mask (BM) is a third-generation supraglottic airway device with a self-inflating cuff. This study aimed to evaluate the efficacy of the BM compared to ProSeal laryngeal mask airway (PLMA) regarding insertion time, ease of insertion, and oropharyngeal seal pressure in patients undergoing elective surgeries under general anesthesia for less than two hours. Methods This prospective, randomized, double-blind comparative study was done on 64 patients randomly divided into two groups, with 32 patients in the PLMA group (Group A) and 32 in the BM group (Group B). Individuals with a body mass index (BMI) of more than 30, a history of nausea/vomiting, or pharyngeal pathology were excluded from the trial. After induction with propofol 3-4 mg/kg, fentanyl 1-2 mcg/kg, and the neuromuscular blockade was achieved with atracurium 0.5 mg/kg, patients were inserted with either BM (n= 32) or PLMA (n= 32). The primary outcome measure was the time taken for insertion and ease of insertion. Secondary outcome measures included the number of attempts, oropharyngeal seal pressure (OSP), and laryngopharyngeal morbidity (trauma to lips, blood staining, and sore throat) immediately and 24 hours postoperatively. Results Demographic data were comparable and statistically insignificant. Regarding time and ease of insertion, the BM could be inserted in a lesser time of 24±1.136 seconds compared to PLMA which took 28.59±1.682 seconds, with a high success rate in the first attempt which was statistically significant. The BM provided a higher OSP (31.34 +1.638 cmH2O) when compared to PLMA (24.81±1.469 cmH2O) and was statistically significant. Complications associated with insertion trauma to the lip, blood staining, and sore throat were more in PLMA (15.6%, 15.6 %, 9.4%, respectively) compared to the BM (6.3%, 3.1%, 3.1%, respectively), and statistically insignificant. Conclusion BM had higher first-attempt successful insertion with better OSP compared to PLMA in patients under controlled ventilation.

PMID:37182077 | PMC:PMC10170866 | DOI:10.7759/cureus.37366

Cureus. 2023 Apr 10;15(4):e37382. doi: 10.7759/cureus.37382. eCollection 2023 Apr.

ABSTRACT

BACKGROUND: Inguinal hernia repair is one of the most common general surgical procedures. It has been performed under local, regional, or general anesthesia. We hypothesized that using regional plus general anesthesia rather than general anesthesia alone would improve outcomes in neonates and pediatric patients undergoing hernia repair.

METHODS: This is a retrospective cohort study, including all pediatric patients who underwent inguinal hernia repair from 2015-2021. We divided patients into two groups. The first group was labeled “general anesthesia” (GA), while the second group was labeled “combined general and regional anesthesia” (GA+RA). We compared both groups in terms of demographic data, intraoperative outcome variables, and postoperative outcome variables.

RESULTS: 212 children fulfilled the study criteria, with 57 in the GA group and 155 in the GA+RA group. Demographic and preoperative data were comparable between both groups except for age, which was 60.3±49.4 months in the GA group versus 26.7±33.13 months in the GA+RA group (p<.0001). Outcome variables demonstrated statistically significant improvement in postoperative pain occurrence, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation in the GA+RA group in comparison to the GA group with P values of 0.031, 0.02, 0.005, and 0.02, respectively.

CONCLUSION: Using regional and general anesthesia techniques rather than general anesthesia alone is associated with a decrease in postoperative pain, length of hospital stay, incidence of bradycardia, and need for mechanical ventilation. Further studies are still warranted to validate our conclusions.

PMID:37182070 | PMC:PMC10171397 | DOI:10.7759/cureus.37382

Cureus. 2023 Apr 9;15(4):e37346. doi: 10.7759/cureus.37346. eCollection 2023 Apr.

ABSTRACT

Focal segmental glomerulosclerosis (FSGS) is a common renal disorder, characterized by progressive segmental sclerosis of renal glomeruli and clinical symptoms corresponding to proteinuria. Classically, it is not considered to be an antibody-mediated disease, however, IgM and C3 deposition may be seen in a subset of cases of FSGS. The impact of this immune deposition on histopathological features in renal core biopsies, on the urinary biochemical parameters, and the clinical outcomes, has not been previously investigated in our population. The aim of this study is to analyze the aforementioned parameters in patients with primary FSGS having antibody deposition as compared to those who do not have any antibody deposition. Some 155 patients diagnosed with FSGS were retrospectively enrolled in our study. The renal biopsies were reviewed for histopathological features and immunofluorescence (IF) findings of IgM and C3 glomerular deposition. These histological features were then compared with the biochemical parameters as well as the clinical outcomes of patients. The patients were assigned to Groups 1 and 2 based on the IF findings. The IgM and/or C3 glomerular deposition had a low incidence in patients with primary FSGS in our study (28.3%). Patients having IgM and C3 co-deposition had a significantly longer time duration since the onset of their clinical symptoms; active disease duration (42 months vs 22 months, p=0.049). The mean pre-treatment serum creatinine of patients with IgM and C3 co-deposition was 6.00 mg/dL as compared to 3.29 mg/dL in patients with no immune deposition (p=0.037). The immune deposition was associated with higher rates of segmental and global glomerulosclerosis, but this finding along with other evaluated histological parameters did not show statistical significance. The number of patients having IgM and/or C3 deposition and with active steroid use/renal dialysis was similar to patients having no IgM and/or C3 deposition. The IgM and/or C3 deposition in FSGS has a low incidence within and is not associated with any significant differences in histological parameters on renal core biopsies of patients from the Pakistani population. IgM and/or C3 deposition is also associated with a significantly longer duration of active disease and these patients may present with higher pre-treatment serum creatinine. Other biochemical parameters and clinical outcomes appear comparable between the groups based on the available clinical data.

PMID:37182061 | PMC:PMC10169510 | DOI:10.7759/cureus.37346

Cureus. 2023 Apr 11;15(4):e37448. doi: 10.7759/cureus.37448. eCollection 2023 Apr.

ABSTRACT

BACKGROUND: Refractive error is the most common cause of decreased visual acuity. Refractive measurement in adults consists of cycloplegic (objective) and manifest (subjective) refraction. Although the effectiveness of autorefraction is a crucial factor, there needs to be more information on its accuracy and precision on each autorefractor compared with subjective measurement in Thai patients.

OBJECTIVE: To compare the accuracy and precision of the two autorefractors’ findings in Rajavithi Hospital, OptoChek Plus, and TOMEY Auto Refractometer RC-5000, with each other and with those of the subjective method.

MATERIALS & METHODS: An observational study was conducted at the Ophthalmology clinic in Rajavithi Hospital from March 1, 2021, to March 31, 2022. All subjects were tested using the two autorefractors (OptoChek Plus and TOMEY Auto Refractometer RC-5000) and subjective refraction. One eye per subject was included in the study.

RESULTS: Forty-eight patients (48 eyes) were enrolled in the study. The difference between spherical powers obtained by OptoChek and subjective refraction was not significantly different; however, there was a significant difference between those calculated by Tomey and the subjective method (p=0.77, p=0.04 respectively). The variations between cylindrical powers arrived at by the two autorefraction techniques and those calculated by the subjective method were significantly different (OptoChek and Tomey p-=0.01, p-value<0.001, respectively). In addition, 95% of the limit of agreement (95% of LOA) was low in the cylindrical measurement of each autorefractor compared with subjective refraction. (84.61%, 86.36%, respectively). No statistically significant difference between the spherical equivalent calculated by the two autorefractors and that of subjective refraction was observed in the present study (OptoChek: p-value=0.26 and Tomey: p-value=0.77).

CONCLUSIONS: There was a clinically significant difference between the cylindrical power calculated by the two autorefractors and those obtained from subjective refraction. Patients with high astigmatism should be monitored closely when measured by autorefractors, as there can be a slightly lower agreement between objective and subjective refraction.

PMID:37182059 | PMC:PMC10174683 | DOI:10.7759/cureus.37448