Nevin Manimala

Addiction. 2023 Feb 14. doi: 10.1111/add.16167. Online ahead of print.

ABSTRACT

AIMS: To estimate the efficacy of multiple psychosocial interventions for opioid dependent persons receiving methadone maintenance treatment (MMT).

METHODS: Systematic review and network meta-analysis of randomized controlled trials (RCTs) reporting the effect of psychosocial intervention for opioid dependent persons receiving MMT in outpatient clinics. We searched multiple data sources (Medline, Embase, Web of Science, PsycINFO and Cochrane Library) from inception to January 2022, finding 21 RCTs evaluating a total of 2862 persons with opioid dependence receiving MMT. The primary outcome was the opioid positive rate (assessed by urinalysis) and the secondary outcome was treatment discontinuation (the number of patients who terminated the study for any reason). We performed random effects Bayesian meta-analysis. We used relative ranking using surface under the cumulative ranking method and certainty of evidence using grading of recommendations, assessment, development, and evaluations.

RESULTS: Cognitive-behavioral therapy (CBT) [Odds Ratio (OR): 0.66, 95% Credibility Interval (CI): 0.66 to 0.96; low certainty] and educational and behavioral counseling (EBC) (OR: 0.28, 95% CI: 0.12 to 0.25; high certainty) were more effective than treatment as usual (TAU) in efficacy. In terms of treatment discontinuation, at the end of the follow-up period there was no statistical significance among psychosocial interventions. According to the ranking probabilities, EBC might be the best treatment in terms of efficacy and behavioral couple therapy (BCT) might be the best treatment in terms of treatment discontinuation.

CONCLUSIONS: Educational and behavioral counseling and cognitive-behavioral therapy appear to be the most effective psychosocial interventions for opioid dependent persons receiving methadone maintenance treatment.

PMID:36787637 | DOI:10.1111/add.16167

Cir Cir. 2023;91(1):28-33. doi: 10.24875/CIRU.21000624.

ABSTRACT

BACKGROUND: Management of breast cancer is increased by late diagnoses.

OBJECTIVE: To analyse direct costs of breast cancer in early and advanced stage in a third level medical facility at Mexican Social Security Institute.

METHOD: Observational study, direct costs of care in breast cancer in initial and advanced clinical stages are compared. Variables analysed were laboratory and diagnostic imaging studies, drugs, as well as hospitalization costs. The evaluated period included from the first care to the completion of the treatment. Costs were determined according to the table of Unit Costs by Level of Medical Care for the year 2019 of the Mexican Social Security Institute. Student’s t test was used to determinate differences between groups, as well as descriptive statistics.

RESULTS: The advanced stage compared to the initial stage, causes a greater number of laboratory-cabinet studies, surgeries, day/bed and interconsultations. The average cost of breast cancer care per patient is $99,280.36 (US$5,230.78) and $148,023.60 (US$7,789.92) for the initial and advanced stages, respectively (p = 0.024).

CONCLUSIONS: Cost of medical attention in the initial stage is lower than that of the advanced stage.

PMID:36787613 | DOI:10.24875/CIRU.21000624

Cir Cir. 2023;91(1):9-14. doi: 10.24875/CIRU.22000490.

ABSTRACT

OBJECTIVE: The present study aims to investigate the relationship between bile reflux (BR) and diameter of the common bile duct (CBD) in patients after cholecystectomy.

MATERIALS AND METHODS: In our case series analysis, according to the endoscopy results, the patients who underwent cholecystectomy were divided into two groups as those with BR and those non-BR. Age, sex, CBD diameter measured on ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic biopsy results of the patients were statistically analyzed.

RESULTS: In a total of 188 patients included in the study, BR was detected in 93 patients, it was not observed in 95 patients. The CBD diameter of the patients was observed to be 7 mm or less in 70.9% (n = 66) in the BR group, and 23% (n = 22) in the non-BR group. The statistical analysis revealed that while there was a significant difference between the two groups in terms of CBD diameter and intestinal metaplasia, the results were similar in both groups in terms of inflammation, activity, atrophy, and Helicobacter pylori.

CONCLUSION: We believe that CBD diameter may be a predictive factor in the detection of BR after cholecystectomy.

PMID:36787612 | DOI:10.24875/CIRU.22000490

Cir Cir. 2023;91(1):87-93. doi: 10.24875/CIRU.20001361.

ABSTRACT

OBJECTIVE: To evaluate the preoperative tomographic characteristics of the nose and paranasal sinuses of children with chronic dacryocystitis.

METHOD: Prospective, observational, cross-sectional, and descriptive study. CT scans of the paranasal sinuses of patients candidates for endoscopic dacryocystorhinostomy were evaluated for two years. Demographic characteristics, radiological findings, inflammatory processes and anatomical variants were identified using the Lund-Mackay classification. Statistic analysis. Stata 10.0, descriptive analysis, Student’s t: mean difference and χ². Logistic studies to estimate the probability between variables.

RESULTS: 27 men and 11 women (n = 38) were included. Of these, 22 had unilateral and 16 bilateral nasolacrimal duct involvement. Lund-Mackay score range: 2-20. Eleven patients had associated pathology. The most affected were anterior and maxillary ethmoidal sinus (69%), osteomeatal complex (68%), posterior ethmoidal (51%). Patients with severe rhinosinusitis are 12 times more likely to develop dacryocystitis than patients with < 12 points. Men presented greater severity, affectation, and clinical repercussion.

CONCLUSIONS: There is radiological rhinosinusal involvement in dacryocystitis, which must be evaluated and treated preoperatively to avoid postoperative complications or reinfections.

PMID:36787607 | DOI:10.24875/CIRU.20001361

Cir Cir. 2023;91(1):79-86. doi: 10.24875/CIRU.21000470.

ABSTRACT

BACKGROUND: Papillary thyroid cancer is the most common endocrine neoplasia. There are prognostic factors that establish risk of recurrence and mortality; however, patients considered low risk may have a less favorable evolution and hence the importance of finding new markers.

OBJECTIVE: To assess whether the mean platelet volume (MPV) and the platelet-lymphocyte index (PLI) show a relationship with the clinical staging in papillary thyroid cancer.

METHOD: Retrospective, observational and analytical study. Preoperative MPV and PLI were recorded, its relationship with TNM and MACIS systems was sought, as well as locally advanced invasion and tumor focality.

RESULTS: 107 cases treated from November 2017 to February 2020. No statistically significant difference was observed in these two preoperative parameters with advanced and initial stages, risk groups or tumor focality. The statistical analysis used was one-way ANOVA with SPSS 25, a 95% confidence interval and p < 0.05.

CONCLUSIONS: Despite the logical reasoning of tumor pathophysiology, our study did not find a relationship between papillary thyroid carcinoma with MPV and PLI, and should be complemented with more extensive studies.

PMID:36787604 | DOI:10.24875/CIRU.21000470

Cir Cir. 2023;91(1):107-112. doi: 10.24875/CIRU.21000720.

ABSTRACT

PURPOSE: To evaluate the stability and the refractive error of the different intraocular lens (IOL) after cataract surgery.

METHOD: Retrospective, observational and single-center study. Patients diagnosed with cataract and myopia who underwent a phacoemulsification surgery with intraocular lens placement without complications were included. All patients underwent a complete ophthalmological examination, ultrasound biomicroscopy was performed at 2 weeks, 1 and 3 months after surgery. Descriptive statistics were performed using measures of central tendency and comparative analyzes. A value of p < 0.05 was considered significant.

RESULTS: Thirty-one subjects with a diagnosis of axial myopia and senile cataract were included, 20 women (64.5%) and 11 men (35.5%), with a mean age was 62.8 ± 13.14 years. The IOL displacement were not different for the upper, lower, temporal and nasal quadrants; however, we observed a tendency to inclination to the temporal sector (p = 0.054) between the first and third postoperative month. Therefore, the were no significant differences in spherical equivalent between groups postoperatively.

CONCLUSIONS: The inclination of the IOL did not change over time after surgery, the changes were similar with the different three types of IOL.

PMID:36787599 | DOI:10.24875/CIRU.21000720

Clin Lab. 2023 Feb 1;69(2). doi: 10.7754/Clin.Lab.2022.220526.

ABSTRACT

BACKGROUND: There are studies showing associations between hypovitaminosis D and obesity, obesity and depression, and hypovitaminosis D and depression. This study aims to investigate the relationship between vitamin D levels and depression status of patients followed in an obesity center.

METHODS: This retrospective study included 107 obesity patients followed up and treated at an obesity center. Patients were divided into two groups as serum 25(OH)D level < 20 ng/mL (deficient) and ≥ 20 ng/mL (not deficient) and compared in terms of Beck Depression Inventory scores. Patients were also divided into two groups according to BDI scores < 17 and ≥ 17, and serum 25(OH)D levels were evaluated.

RESULTS: Patients at higher risk for depression (BDI score ≥ 17) had statistically significantly higher weight (p = 0.003) and BMI (p < 0.001), but had significantly lower serum 25(OH)D levels (p < 0.001). The BDI scores were found to be moderately positively related with the BMI (r = 0.404, p < 0.001), weakly negatively related with vitamin D levels (r = -0.383, p < 0.001), weakly positively related with weight (r = 0.293, p = 0.002). The BDI score me-dians (12 and 8, respectively) were found to be statistically significantly higher in patients with serum 25(OH)D levels of < 20 ng/mL compared to those with ≥ 20 ng/mL (p < 0.001). The increased BMI and decreased serum 25(OH)D levels have been found to independently increase the risk of depression in multivariate logistic regression analysis. The ROC analysis performed to evaluate the discriminative performance of serum 25(OH)D levels in predicting the risk of depression. The analysis showed that the serum 25(OH)D parameter was likely to reveal patients who were at higher risk for depression. For the cutoff point of 25(OH)D ≤ 19.21 level determined by Youden index, the sensitivity was found as 92.86% and the selectivity as 68.82%.

CONCLUSIONS: In our study, the BMIs were higher and serum 25(OH)D levels were lower in obese individuals at risk for depression. Understanding or explaining the relationship between vitamin D deficiency and depression will contribute to revealing the preventive or therapeutic role of vitamin D supplementation for depression.

PMID:36787573 | DOI:10.7754/Clin.Lab.2022.220526

Clin Lab. 2023 Feb 1;69(2). doi: 10.7754/Clin.Lab.2022.220520.

ABSTRACT

BACKGROUND: To investigate the value of prenatal diagnosis in fetal ultrasound abnormalities.

METHODS: Amniotic fluid samples of pregnant women who underwent invasive amniocentesis for ultrasound examination suggestive of fetal ultrasound structural abnormalities and soft markers of abnormalities during pregnancy from January 2016 to June 2021 at the Prenatal Diagnostic Center of Putian College Hospital were collected for amniotic fluid cell culture and G manifest band karyotype analysis.

RESULTS: (1) Most pregnant women with ultrasound abnormalities were delivered at the age of 23 to 32 years. (2) There were 66 cases of abnormal karyotype with an abnormal incidence of 9.64% (66/685), with chromosomal number abnormalities predominating. (3) Fetal ultrasound abnormalities are mainly soft markers of abnormalities. (4) The comparison of ultrasound abnormalities in the low and high maternal-fetal age groups was not statis-tically significant.

CONCLUSIONS: (1) Fetal ultrasound abnormalities are mainly soft markers of abnormalities. (2) The rate of fetal chromosomal abnormalities was the highest among the soft ultrasound indicators with NT thickening. (3) The incidence of fetal ultrasound abnormalities did not increase with increasing age. There was no statistical difference in the incidence of chromosomal abnormalities between the low age group and the high age group. (4) Fetal ultrasound testing provides a scientific and accurate basis for clinical heritage counseling and rebirth counseling, especially for chromosomal aneuploidy number abnormalities.

PMID:36787572 | DOI:10.7754/Clin.Lab.2022.220520

Clin Lab. 2023 Feb 1;69(2). doi: 10.7754/Clin.Lab.2022.220436.

ABSTRACT

BACKGROUND: The impact of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in acute myeloid leukemia (AML) is still controversial. The purpose of this study is to explore the impact of rhG-CSF administration on clinical efficacy and immune cell subsets after initial induction chemotherapy in AML.

METHODS: The clinical efficacy and immune cell subsets were compared in the newly diagnosed patients with AML according to whether rhG-CSF was used after initial induction chemotherapy. Next, rhG-CSF stimulation experi-ments on leukemia cell lines and primary leukemia blasts were performed in vitro.

RESULTS: There was no statistical difference between control group and rhG-CSF therapy group in complete remission rate and relapse free survival. The duration of agranulocytosis was significantly shortened in rhG-CSF therapy group compared with control group. The percentage of circulating monocytic myeloid-derived suppressor cells (M-MDSCs) and regulatory T cells (Tregs) were significantly increased after the administration of rhG-CSF. Furthermore, it was found that rhG-CSF did not promote the proliferation of leukemia cell lines and primary leukemia blasts, but increased the proportion of M-MDSCs and Tregs in vitro.

CONCLUSIONS: Administration of rhG-CSF after initial induction therapy of AML does not affect the clinical remission and relapse rate, but reduces the duration of agranulocytosis and increases the proportion of M-MDSCs and Tregs.

PMID:36787571 | DOI:10.7754/Clin.Lab.2022.220436

Clin Lab. 2023 Feb 1;69(2). doi: 10.7754/Clin.Lab.2022.220507.

ABSTRACT

BACKGROUND: Our aim was to evaluate the cutoff values of RHE and MRV as markers to diagnose IDA in healthy Han ethnic adults of Chengdu.

METHODS: A total of 263 Han adults who needed bone marrow aspiration for diagnosis were enrolled according to the inclusive and exclusive criteria. The cutoff values of RHE and MRV were determined by receiver operating curves.

RESULTS: According to statistical analysis, the cutoff values of RHE and MRV in male and female groups were 26.75 pg, 89.60 fL and 26.65 pg, 88.55 fL respectively. The areas under the curve (AUC) of RHE and MRV were 0.941, 0.939 and 0.925, 0.909 in male and female groups, respectively.

CONCLUSIONS: In our study, we explored the cutoff values of RHE and MRV to diagnose IDA in the Han ethnic population in Chengdu for the first time.

PMID:36787551 | DOI:10.7754/Clin.Lab.2022.220507