Nevin Manimala

Abdom Radiol (NY). 2023 May 19. doi: 10.1007/s00261-023-03958-2. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy of low-dose CT (LDCT) with deep learning image reconstruction (DLIR) for the surveillance of pancreatic cystic lesions (PCLs) compared with standard-dose CT (SDCT) with adaptive statistical iterative reconstruction (ASIR-V).

METHODS: The study enrolled 103 patients who underwent pancreatic CT for follow-up of incidentally detected PCLs. The CT protocol included LDCT in the pancreatic phase with 40% ASIR-V, DLIR at medium (DLIR-M) and high levels (DLIR-H), and SDCT in the portal-venous phase with 40% ASIR-V. The overall image quality and conspicuity of PCLs were qualitatively assessed using five-point scales by two radiologists. The size of PCLs, presence of thickened/enhancing walls, enhancing mural nodules, and main pancreatic duct dilatation were reviewed. CT noise and cyst-to-pancreas contrast-to-noise ratio (CNR) were measured. Qualitative and quantitative parameters were analyzed using the chi-squared test, one-way ANOVA, and t-test. Additionally, interobserver agreement was analyzed using the kappa and weighted-kappa statistics.

RESULTS: The volume CT dose-indexes in LDCT and SDCT were 3.0 ± 0.6 mGy and 8.4 ± 2.9 mGy, respectively. LDCT with DLIR-H showed the highest overall image quality, the lowest noise, and the highest CNR. The PCL conspicuity in LDCT with either DLIR-M or DLIR-H was not significantly different from that in SDCT with ASIR-V. Other findings depicting PCLs also revealed no significant differences between LDCT with DLIR and SDCT with ASIR-V. Moreover, the results revealed good or excellent interobserver agreement.

CONCLUSION: LDCT with DLIR has a comparable performance with SDCT for the follow-up of incidentally detected PCLs.

PMID:37204510 | DOI:10.1007/s00261-023-03958-2

Eur Rev Med Pharmacol Sci. 2023 May;27(9):4299-4308. doi: 10.26355/eurrev_202305_32340.

ABSTRACT

OBJECTIVE: This study was planned to evaluate effects of game-based physical activity model on mother-child relationship and parental attitudes during the prolonged COVID-19 pandemic period.

SUBJECTS AND METHODS: This study was designed using a web-based quasi-experimental model with a pre-test/post-test evaluation, with a control group. The mothers who accepted to participate in the study and their children were divided into experimental (group I, n=28) and control groups (group II, n=31). The mothers and children in the experimental group were asked to apply web-based game-based physical activity model for 20 minutes/day for 4 weeks. The online questionnaire included socio-demographic data form, Child Parent Relationship Scale (CPRS), and Parental Attitude Scale (PAS).

RESULTS: There were no significant differences between mean scores of pre-test and post-test subscales of the PAS in group I (p>0.05 for all subscales). It was found that post-test scores of democratic subscales of PAS statistically significant decreased (p=0.047) and the authoritarian attitude subscale scores significantly increased (p=0.033) in group II. The mean pre- and post-activity scores of positive/close relationship and conflictual relationship subscales of CPRS differ between groups (p<0.05 for both subscales). Pre-post test scores of group II were found to be significantly lower compared to group II.

CONCLUSIONS: Our study provides a moderate improvement in parameters evaluated; however, we suggest that longer-term activities may have a more permanent and statistically significant effect.

PMID:37203856 | DOI:10.26355/eurrev_202305_32340

Eur Rev Med Pharmacol Sci. 2023 May;27(9):4280-4291. doi: 10.26355/eurrev_202305_32338.

ABSTRACT

OBJECTIVE: Post-COVID-19 patients complained of pain, fatigue, breathlessness, and reduction in quality of life which required planned intervention. This study aimed to compare the impact of 10 weeks of low vs. moderate-intensity aerobic training on physical fitness, psychological status, and quality of life in post-COVID-19 older subjects.

PATIENTS AND METHODS: 72 patients were randomized into 3 equal groups, moderate-intensity exercise (MIG, n = 24), low-intensity exercise (LIG, n = 24), and control group (CG, n = 24). The exercise was done 40 min/4 times per week for 10 weeks. We measured exercise capacity using the six-minute walking test, 1 min sit-to-stand test, post-COVID-19 functional scale (PCFS), and quality of life using the SF-36 questionnaire and HAMILTON Anxiety and Depression Scale (HADS).

RESULTS: There was no difference between groups regarding the demographic and most clinical characteristics of the subjects. Compared with CG there were statistically significant improvements in studying groups (MIG and LIG) with (p < 0.05) in most outcomes and the improvement was higher in MIG than in LIG in most outcomes.

CONCLUSIONS: 10-week moderate-intensity and low-intensity aerobic training programs are effective with superior effect to moderate-intensity. Moderate-intensity aerobic exercise is more effective and feasible in post-discharge COVID-19 older subjects regarding exercise capacity, quality of life, and psychological status than low-intensity aerobic exercise.

PMID:37203854 | DOI:10.26355/eurrev_202305_32338

Eur Rev Med Pharmacol Sci. 2023 May;27(9):4269-4279. doi: 10.26355/eurrev_202305_32337.

ABSTRACT

OBJECTIVE: Epithelial damage together with endothelitis and microvascular thrombi are responsible for COVID-19 associated acute respiratory distress syndrome (ARDS). Iloprost, improves endothelial damage and reduces thrombotic complications with its vasodilator, anti-platelet, anti-inflammatory, and anti-fibrotic effects. In our study, we aimed to determine the effect of iloprost on oxygenation, hemodynamics, weaning, and mortality in severe COVID-19 ARDS.

PATIENTS AND METHODS: This was a retrospective study conducted in a pandemic hospital in the city of Istanbul, Turkey. Patients, with severe COVID-19 ARDS, who were receiving iloprost for seven days were included in the study. The demographic data, APACHE II, and SOFA (Sequential Organ Failure Assessment score) scores (at admission and discharge), pH, PaO2, PCO2, SatO2, lactate, PaO2/FiO2 (inspiratory fractionated oxygen), respiratory rate-oxygenation (ROX) index (peripheral oxygen saturation/fraction of inhaled oxygen), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressures (MAP), heart rate (HR) values were recorded before starting iloprost (T0), and on days of iloprost administration (2.0 nanograms/kg/minute/6 hours/day) (T1, T2, T3, T4, T5, T6, T7), and the day after last day of iloprost administration (Tfinal). Also, mortality was recorded in a retrospective manner. Two groups were formed according to mortality (Group M) and discharge (Group D).

RESULTS: A total of 22 patients (16 men, 6 women) were evaluated. Age, APACHE II, SOFA scores were higher in Group M. The lactate value at T1-3-4-5-7 was lower than T0 in both groups. PaO2 value between T2-Tfinal was higher than T0. A statistically significant increase was found in PaO2/FiO2 levels in both groups. The PaO2/FiO2value between T5-Tfinal was significantly lower in Group M compared to Group D. ROX index was significantly higher between T4-Tfinal when compared with T0.

CONCLUSIONS: Iloprost improves oxygenation but has no effect on mortality in COVID-19 ARDS.

PMID:37203853 | DOI:10.26355/eurrev_202305_32337

Eur Rev Med Pharmacol Sci. 2023 May;27(9):4175-4184. doi: 10.26355/eurrev_202305_32327.

ABSTRACT

OBJECTIVE: The aim of this study was to report a monoinstitutional multidisciplinary experience about the use of multiparametric imaging to identify the areas with higher risk of relapse in localized prostate cancer, with the purpose of allowing a biologically planned target dose escalation.

PATIENTS AND METHODS: We performed a retrospective evaluation of patients diagnosed with prostate cancer who received treatments at our Interventional Oncology Center with interstitial interventional radiotherapy from 2014 to 2022. Inclusion criteria were histologically confirmed localized prostate cancer; and National Comprehensive Cancer Network (NCCN) risk class unfavorable intermediate or high/very high risk. The diagnostic work-up included multiparametric Magnetic resonance imaging (MRI), multiparametric Transrectal ultrasound (TRUS), Positron Emission Tomography Computed Tomography (PET-CT) with choline or PSMA (or alternatively bone scan). All patients were assessed and received one treatment with interstitial high-dose-rate interventional radiotherapy (brachytherapy) delivering external beam radiotherapy (46 Gy). All procedures were performed using transrectal ultrasound guidance under general anesthesia and the prescribed doses were 10 Gy to the whole prostate, 12 Gy to the peripheral zone and 15 Gy to the areas at risk.

RESULTS: We report the data of 21 patients who were considered for the statistical analysis with a mean age of 62.5 years. The mean PSA nadir was 0.03 ng/ml (range 0-0.09). So far, no biochemical nor radiological recurrences have been recorded in our series. Regarding acute toxicity, the most commonly reported side effects were G1 urinary in 28.5% of patients and G2 urinary in 9.5%; all recorded acute toxicities resolved spontaneously.

CONCLUSIONS: We present a real-life experience of biologically planned local dose escalation by interventional radiotherapy (brachytherapy) boost, followed by external beam radiotherapy in patients with intermediate unfavorable- or high/very high risk. The local control and the biochemical control rates are proved to be excellent and the toxicity profile tolerable.

PMID:37203844 | DOI:10.26355/eurrev_202305_32327

Eur Rev Med Pharmacol Sci. 2023 May;27(9):4135-4144. doi: 10.26355/eurrev_202305_32322.

ABSTRACT

OBJECTIVE: The study aimed to analyze the efficacy of aparatinib and carrilizumab combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary hepatocellular carcinoma (HCC).

PATIENTS AND METHODS: A total of 150 patients with primary HCC admitted to our hospital from March 1, 2019, to March 1, 2022 was chosen and randomized as the control and treatment group. The control group went through TACE treatment, and the treatment group experienced apatinib + karilizumab + TACE treatment. The near and long-term efficacy of the two groups were compared. The total survival time (OS), time to progression (TTP), and hospital costs were compared between the two groups. Fasting venous blood was collected before and one month after treatment in the two groups, and liver and kidney functions were tested using automatic biochemical analyzer. The levels of CD3+, CD4+ and CD8+ were detected by flow cytometry, and CD4+/CD8+ was calculated. The levels of cysteinyl aspartate specific protease-8 (Caspase-8), vascular endothelial growth factor (VEGF) and alpha fetoprotein (AFP) were detected by enzyme-linked immunosorbent assay (ELISA). The patients’ conditions were closely observed and the adverse reaction rates of diarrhea, hand foot syndrome, bone marrow suppression, proteinuria, fever and pain were compared between the two groups.

RESULTS: The disease control rate (DCR) of short-term treatment in the treatment group was 97.33%, which was much higher than 88.00% in the control group. The survival ratios of the treatment group in September and December were 65.33% and 42.67% respectively, which were also much higher than 48.00% and 20.00% in the control group (p < 0.05). The TTP and OS of patients in the treatment group were significantly longer than those in the control group (p < 0.05), and the hospital expenses were significantly higher than those in the control group (p < 0.05). The levels of liver function indicators such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) were largely decreased in both groups after treatment, and more significant difference was detected in the treatment group (p < 0.05). Renal function between the two groups had no significant difference after treatment (p > 0.05). After treatment, the levels AFP and VEGF were strongly decreased and the level of Caspase-8 was markedly increased in both groups, and the treatment group had lower levels of AFP and VEGF and higher level of Caspase-8 than the control group (p < 0.05). The CD3+ and CD4+/CD8+ levels in two groups were dramatically elevated after treatment, and the treatment group had much higher CD3+ and CD4+/CD8+ levels than the control group (p < 0.05). There was no statistically significant difference in the rates of adverse reactions such as diarrhea, hand-foot syndrome, bone marrow suppression, proteinuria, fever, and pain between the two groups (p > 0.05).

CONCLUSIONS: The combination of apatinib and carrilizumab with TACE had better near- and long-term efficacy in the treatment of primary HCC by effectively inhibiting tumor vascular regeneration, inducing tumor cell apoptosis, and improving patients’ liver function and immune function with higher safety, which could be widely used in clinical practice.

PMID:37203839 | DOI:10.26355/eurrev_202305_32322

Eur Rev Med Pharmacol Sci. 2023 May;27(9):4103-4107. doi: 10.26355/eurrev_202305_32318.

ABSTRACT

OBJECTIVE: We aim to investigate the treatment efficacy of combinational applications of oral probiotic with intravenous infusion of antibiotics in pediatric bronchopneumonia infection.

PATIENTS AND METHODS: A total of 76 pediatric patients with bronchopneumonia infection were included in the study. We divided the patients into observation group (n=38) and control group (n=38). The patients in control group received intravenous infusion of antibiotics and symptomatic treatments. In the observation group, in addition to the treatments of the control group, the patients also received oral probiotic. We compared the effective times of treatment, including the durations of wet rale in lung auscultation, cough, fever, and the total time of hospitalization. Additionally, we also recorded the occurrence of adverse reaction, including rash and gastrointestinal reaction. Meanwhile, laboratory tests for systemic inflammation were recorded at different time points.

RESULTS: The durations of rale in lung auscultation (p=0.006), cough (p=0.019), fever (p=0.012), and the total time of hospitalization (p=0.046) in observation group were significantly shorter than those in the control group. The incidence rate of diarrhea was 10.5% (4/38) in the observation group, and 34.2% (13/38) in the control group, with a significantly statistical difference (p=0.013). In the laboratory tests, we found that blood lymphocyte (p=0.034) and high-sensitive C reactive protein (p=0.004) were significantly higher in the control group than that in the observation group at 7th day after the treatments.

CONCLUSIONS: The combinational applications of probiotic and antibiotics in pediatric bronchopneumonia infection were safe and effective and can lower the diarrhea rate.

PMID:37203836 | DOI:10.26355/eurrev_202305_32318

Eur Rev Med Pharmacol Sci. 2023 May;27(9):4060-4064. doi: 10.26355/eurrev_202305_32312.

ABSTRACT

OBJECTIVE: While clinical trials provide invaluable evidence, real-world data can offer further insight on the efficacy and safety of biologic drugs. This report aims to analyze the long-term efficacy and safety of ixekizumab in real-world clinical practice in our facility.

PATIENTS AND METHODS: Patients with a diagnosis of psoriasis and who started treatment with ixekizumab were included in this retrospective study and followed for 156 weeks. The severity of cutaneous manifestations was evaluated using the PASI score at several time points and clinical efficacy was evaluated using PASI 75, -90 and -100 responses.

RESULTS: Not only PASI 75, but also PASI 90 and 100 responses showed a favorable outcome after treatment with ixekizumab. Responses at week 12 were sustained through the following three years in the majority of patients. No statistically significant difference was found between bio-naive and bio-switch patients and weight and disease duration had no impact on the efficacy of the drug. Ixekizumab had a favorable safety profile, as we observed no major adverse events. Two cases of eczema were observed and led to drug discontinuation.

CONCLUSIONS: This study confirms the efficacy and safety of ixekizumab in real-world clinical practice.

PMID:37203830 | DOI:10.26355/eurrev_202305_32312

Eur Rev Med Pharmacol Sci. 2023 May;27(9):3967-3978. doi: 10.26355/eurrev_202305_32303.

ABSTRACT

OBJECTIVE: The study aim is to determine the drug-induced incidence of basophobia, falls, its’ related variables and the consequences among older adults.

PATIENTS AND METHODS: A descriptive, cross-sectional study was adopted with 210 older adult samples. The tool consisted of 6 sections: a standardized, semi-structured questionnaire and physical examination. Descriptive and inferential statistics were used to analyze the data.

RESULTS: Among the study participants, 49% had falls or near falls and 51% had basophobia in the past 6 months. As per final simultaneous regression analysis model of the study, the covariates to activity avoidance were age (ß=-0.129, CI=-0.087 to -0.019), having >5 chronic diseases (ß=-0.086, CI=-1.41 to -1.182), depressive symptoms (ß=-0.09, CI=-0.089 to -0.189), vision impairment (ß=-0.075, CI=-1.28 to -1.56), basophobia (ß=-0.26, CI=-0.059 to -0.415), taking regular antihypertensives (ß=-0.096, CI= -1.21 to -1.56), oral hypoglycemics and insulin (ß=-0.17, CI=-0.442 to -0.971) and sedatives and tranquilizers (ß=-0.37, CI=-1.32 to -1.73). Use of antihypertensives (p<0.001), oral hypoglycemics and insulin (p<0.01), sedatives and tranquilizers (p<0.001) were strongly associated with fall related to activity avoidance.

CONCLUSIONS: The result of this current study suggests that the falls, basophobia and its related activity avoidance among elderly may set in a “vicious cycle” of falls, basophobia, and the numerous negative outcomes such as functional impairment, a decrease in quality of life, and hospitalization. Preventive strategies such as tittering dosage, home- and community -based exercises, cognitive behavioral therapy, yoga, meditation and sleep hygiene may be the choice to break this vicious cycle.

PMID:37203821 | DOI:10.26355/eurrev_202305_32303

Eur Rev Med Pharmacol Sci. 2023 May;27(9):3914-3921. doi: 10.26355/eurrev_202305_32297.

ABSTRACT

OBJECTIVE: The aim of the study was to evaluate the prevalence of pelvic organ prolapse (POP) and correlate the various factors including, but not limited to, educational status, socio-economic condition, body mass index (BMI), menstrual history, with the status and severity of POP.

PATIENTS AND METHODS: A retrospective cross-sectional study was conducted between August 2021 and September 2022 and suspected patients of POP were considered from the outpatient Department of Gynecology and Obstetrics. The study has mainly used 3 indicators of socio-economic status, namely, occupation, education, and income. These factors were correlated and statistically analyzed with that of POP.

RESULTS: The study findings revealed that there are more symptomatic patients who are illiterate as compared to asymptomatic POP and with increasing education status, there is a decrease in symptomatic POP patients (p<0.05). Also, there is a significant proportion of symptomatic POP patients in the lower class and lower middle class as compared to asymptomatic patients in each class, respectively (p<0.05). It also found that micturition difficulty and vaginal bulging are significantly correlated with the stages of POP (p<0.05).

CONCLUSIONS: Educational status and socio-economic condition are significant indicators of the presence of symptoms or severity of POP. The study further concluded that menopausal females have more symptomatic POP as compared to pre-menopausal females.

PMID:37203815 | DOI:10.26355/eurrev_202305_32297