Nevin Manimala

Arch Iran Med. 2022 Feb 1;25(2):112-117. doi: 10.34172/aim.2022.18.

ABSTRACT

BACKGROUND: There is limited evidence on the epidemiology and time trend analysis of incidence rates of gynecological cancer in Asia as a whole. We conducted this study to demonstrate breast and gynecological cancers incidence and trends in selected Asian populations.

METHODS: We conducted this ecological study using cancer and population data from cancer incidence in five continents (CI5). We extracted the data of breast, uterine, cervix and ovary cancers in selected Asian populations from 1998 to 2012 from CI5plus. We used Joinpoint regression model (version 4.8.0.1) to evaluate the annual percentage change (APC), which characterizes trends in cancer rates over time, and the average annual percent changes (AAPCs), which describes the average APCs over a period of multiple years. Results were considered statistically significant at P < 0.05.

RESULTS: Between breast and gynecological cancers, breast cancer has the highest incidence rates among women in Asia. The time trend of the incidence rates showed a constant growth in breast, ovary and corpus uteri cancers. This rising trend was obviously sharper for uterine cancer (AAPC 95% CI = 3.4 [3.0, 3.7]) followed by breast [AAPC 95% CI = 2.1 (2.0, 2.2)] and ovarian cancers (AAPC 95% CI = 0.5 [-0.4, 1.3]). The age-adjusted incidence rate (ASR) of cervical cancer displayed a declining trend from 1998 to 2012 (AAPC 95% CI = -1.4 [-2.4, -0.5]).

CONCLUSION: Incidence rates of breast and gynecological cancers have a rising trend in Asian countries. However, breast and gynecological cancers have different patterns of time trend.

PMID:35429948 | DOI:10.34172/aim.2022.18

Environ Int. 2022 Apr 9;163:107235. doi: 10.1016/j.envint.2022.107235. Online ahead of print.

ABSTRACT

BACKGROUND: Prenatal phthalate exposure has been linked to reductions in fetal growth in animal and laboratory studies, but epidemiologic evidence is equivocal.

OBJECTIVE: Examine the association between prenatal phthalate metabolite mixtures and fetal growth and evaluate whether that association is modified by fetal sex or omega-3 intake during pregnancy.

METHODS: Analyses included 604 singleton pregnancies from TIDES, a prospective pregnancy cohort with spot urine samples and questionnaires collected in each trimester. Pregnancy-averaged phthalate exposure estimates were calculated as the geometric means of specific-gravity corrected phthalate metabolites. Fetal growth outcomes included birthweight and length, and ultrasound-derived size and velocity of estimated fetal weight, femur length, abdominal and head circumferences in the second and third trimesters. We used a novel application of quantile g-computation to estimate the joint association between pregnancy-averaged phthalate exposure and fetal growth, and to examine effect modification of that association by infant sex or omega-3 intake during pregnancy.

RESULTS: There were few statistically significant differences in birth size and fetal growth by exposure. A one-quartile increase in the phthalate mixture was modestly associated with reduced birthweight(β [95% confidence interval)]: -54.6 [-128.9, 19.7] grams; p = 0.15) and length (-0.2 [-0.6, 0.2] centimeters; p = 0.40). A one-quartile increase in the phthalate mixture was associated with reduced birth length in males (-0.5 [-1.0, 0.0] centimeters) but not for females (0.1 [-0.2, 0.3] centimeters); interaction p = 0.05. The phthalate metabolite mixture was inversely associated with ultrasound-derived fetal growth among those with adequate omega-3 intake. For example, a one-quartile increase in the phthalate mixture was associated with reduced abdominal circumference in the third trimesters in those with adequate omega-3 intake (-3.3 [-6.8, 0.1] millimeters) but not those with inadequate omega-3 intake (1.8 [-0.8, 4.5] millimeters); interaction p = 0.01.

CONCLUSION: Prenatal phthalate exposure was not significantly associated with fetal growth outcomes, with some exceptions for certain subgroups.

PMID:35429919 | DOI:10.1016/j.envint.2022.107235

Environ Int. 2022 Apr 9;163:107237. doi: 10.1016/j.envint.2022.107237. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to investigate whether urinary metal mixtures are associated with the homeostasis of inflammatory mediators in middle-aged and older adults.

METHODS: A four-visit repeated-measures study was conducted with 98 middle-aged and older adults from five communities in Beijing, China. Only one person was lost to follow-up at the third visit. Ultimately, 391 observations were included in the analysis. The urinary concentrations of 10 metals were measured at each visit using inductively coupled plasma mass spectrometry (ICP-MS) with a limit of detection (LOD) ranging from 0.002 to 0.173 µg/L, and the detection rates were all above 84%. Similarly, 14 serum inflammatory mediators were measured using a Beckman Coulter analyzer and the Bio-Plex MAGPIX system. A linear mixed model (LMM), LMM with least absolute shrinkage and selection operator regularization (LMMLASSO), and Bayesian kernel machine regression (BKMR) were adopted to explore the effects of urinary metal mixtures on inflammatory mediators.

RESULTS: In LMM, a two-fold increase in urinary cesium (Cs) and chromium (Cr) was statistically associated with -35.22% (95% confidence interval [CI]: -53.17, -10.40) changes in interleukin 6 (IL-6) and -11.13% (95 %CI: -20.67, -0.44) in IL-8. Urinary copper (Cu) and selenium (Se) was statistically associated with IL-6 (88.10%, 95%CI: 34.92, 162.24) and tumor necrosis factor-alpha (TNF-α) (22.32%, 95%CI: 3.28, 44.12), respectively. Similar results were observed for the LMMLASSO and BKMR. Furthermore, Cr, Cs, Cu, and Se were significantly associated with other inflammatory regulatory network mediators. For example, urinary Cs was statistically associated with endothelin-1, and Cr was statistically associated with endothelin-1 and intercellular adhesion molecule 1 (ICAM-1). Finally, the interaction effects of Cu with various metals on inflammatory mediators were observed.

CONCLUSION: Our findings suggest that Cr, Cs, Cu, and Se may disrupt the homeostasis of inflammatory mediators, providing insight into the potential pathophysiological mechanisms of metal mixtures and chronic diseases.

PMID:35429917 | DOI:10.1016/j.envint.2022.107237

Eur J Cancer. 2022 Apr 13;168:12-24. doi: 10.1016/j.ejca.2022.03.006. Online ahead of print.

ABSTRACT

BACKGROUND: An earlier analysis of the PEARL phase III study showed that palbociclib plus endocrine therapy (ET) does not improve progression-free survival (PFS) over capecitabine in aromatase inhibitor-resistant, hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer (MBC) patients. Here, we report the final overall survival (OS) analysis.

METHODS: Postmenopausal patients (N = 601) were randomized 1:1 to capecitabine or palbociclib plus ET (exemestane, Cohort 1; fulvestrant, Cohort 2). OS was analysed in Cohort 2, the wild-type ESR1 population and the overall population. Additionally, we analysed subsequent systemic therapies and explored PFS2 (time from randomization to the end of the first subsequent therapy/death).

RESULTS: OS was 31.1 months for palbociclib plus fulvestrant and 32.8 months for capecitabine (adjusted hazard ratio [aHR] 1.10, 95% confidence interval [CI] 0.81-1.50, P = 0.550). In the wild-type ESR1 population, OS was 37.2 months for palbociclib plus ET and 34.8 months for capecitabine (aHR 1.06, 95% CI 0.81-1.37, P = 0.683). In OS analyses, no subgroup showed superiority for palbociclib plus ET over capecitabine. OS in the overall population was 32.6 months for palbociclib plus ET and 30.9 months for capecitabine (P = 0.995). Subsequent systemic therapy was given to 79.8% and 82.9% of patients with palbociclib plus ET and capecitabine, respectively. Median PFS2 was similar between study arms (Cohort 2, P = 0.941; wild-type ESR1 population, P = 0.827). No new safety findings were observed.

CONCLUSIONS: Palbociclib plus ET did not show a statistically superior OS compared to capecitabine in MBC patients progressing on aromatase inhibitors.

TRIAL REGISTRATION: NCT02028507 (ClinTrials.gov), 2013-003170-27 (EudraCT).

PMID:35429901 | DOI:10.1016/j.ejca.2022.03.006

Clin Neurol Neurosurg. 2022 Apr 2;217:107238. doi: 10.1016/j.clineuro.2022.107238. Online ahead of print.

ABSTRACT

Brain ischemia affects the integrity of local white matter and regions that are distant to the primary lesion location. In this study, we analyzed the patterns of white matter microstructural damage and the cognitive performance of 22 patients with left hemisphere stroke. Patients were divided in two groups: one with target lesion affecting the left inferior frontal gyrus (left inferior frontal gyrus, LIFG, n = 11) and the other without ischemic lesion in this region (non-left inferior frontal gyrus, NLIFG, n = 11). Each group was compared with 11 matched healthy controls. Tract-Based Spatial Statistics was used to assess differences in diffusion tensor indices between the groups and for the association of white matter structure with cognitive performance. When compared to Controls, the LIFG showed extensive intra- and interhemispheric disconnection, with surrogate markers for tissue loss with demyelination in the corpus callosum, and microstructural changes that are independent of gross tissue loss in the contralateral hemisphere. The NLIFG group presented discrete alterations in white matter from the ipsilateral hemisphere, with surrogate markers for tissue loss with axonal injury. When LIFG is compared to NLIFG, white matter abnormalities with no gross tissue loss were observed in the corpus callosum and in the contralateral hemisphere. In addition LIFG had worse performance on cognitive functions. In conclusion, our results identify different diffusion profiles for LIFG and NLIFG groups, suggesting more extensive and pronounced white matter damage in the commissural and interhemispheric connections in the LIFG group, in addition to more pronounced cognitive impairment.

PMID:35429854 | DOI:10.1016/j.clineuro.2022.107238

Am J Otolaryngol. 2022 Apr 7;43(3):103460. doi: 10.1016/j.amjoto.2022.103460. Online ahead of print.

ABSTRACT

PURPOSE: Micronutrients and their supplementation have been investigated in the development, severity, and treatment of tinnitus. This study aimed to evaluate associations between tinnitus parameters and levels of zinc, manganese, and vitamin B12.

MATERIALS AND METHODS: This retrospective study analyzed National Health and Nutrition Examination Survey 2011-2012 and 2015-2016 participants aged 20-69 who answered whether they had symptoms of tinnitus in the past year. Persons with tinnitus symptoms further reported how regularly they had symptoms and how disruptive symptoms were. Multivariable regressions accounting for age, gender, and race/ethnicity were used to evaluate the influence of low serum/blood levels of zinc, manganese, and vitamin B12 on tinnitus presence, regularity, and disruptiveness.

RESULTS: This study included 9439 participants, with 16.2% of the sample reporting tinnitus symptoms. In multivariable regression models, low blood manganese was associated with tinnitus regularity (proportional OR: 1.47 [95% CI: 1.06, 2.05], p = 0.0213) and tinnitus disruptiveness (proportional OR: 1.78 [95% CI: 1.08, 2.96], p = 0.0250), but not tinnitus presence (p = 0.4813). Low serum zinc and low serum vitamin B12 did not have statistically significant associations with analyzed tinnitus parameters.

CONCLUSIONS: A nationally representative analysis found that low blood manganese was significantly associated with tinnitus regularity and disruptiveness, but found that serum zinc and vitamin B12 had no association with tinnitus parameters. These findings suggest that low micronutrient levels are unlikely to be contributors to tinnitus; however, the results suggest further research on manganese supplementation in patients with tinnitus may be merited.

PMID:35429847 | DOI:10.1016/j.amjoto.2022.103460

Am J Otolaryngol. 2022 Apr 5;43(3):103436. doi: 10.1016/j.amjoto.2022.103436. Online ahead of print.

ABSTRACT

BACKGROUND: Based on a 2018 American Academy of Otolaryngology – Head and Neck Surgery survey, an average of 37 tablets of opioid medication, or about a week’s worth of medication, were prescribed after adult tonsillectomy. Nearly 15% of patients will still be taking opioids one year after an initial weeklong prescription, according to data from the Centers for Disease Control and Prevention. Non-steroidal anti-inflammatory medications have traditionally been avoided in adult tonsillectomy patients due to concern for increased bleeding risk from platelet dysfunction, despite little evidence supporting this claim. This study sought to demonstrate that ibuprofen prescriptions after tonsillectomy could be a safe and effective way to reduce postoperative opioid use.

METHODS: This study was a retrospective chart review of patients undergoing tonsillectomy with one surgeon over three years. Half of the patients received a prescription for postoperative opioid medications and were counseled against taking ibuprofen. The other half of patients were prescribed ibuprofen following surgery and only provided with opioid analgesia as a rescue medication. The New Mexico Prescription Monitoring System was used to verify opioid prescriptions. Descriptive statistics and logistic regression were used to analyze the data.

RESULTS: Ninety-nine patients were included in analysis, with 53 in the first group that did not receive ibuprofen and 46 in the second group that did receive ibuprofen. There was no difference in the bleeding rate between the two groups. Significantly fewer patients in the ibuprofen group filled postoperative opioid prescriptions when compared to the group that did not receive ibuprofen (40% vs. 96.2%, p < 0.0001, OR = 0.02).

CONCLUSION: Ibuprofen is a safe and effective analgesic following adult tonsillectomy and significantly reduces the proportion of patients who must fill a postoperative opioid prescription.

PMID:35429845 | DOI:10.1016/j.amjoto.2022.103436

Am J Otolaryngol. 2022 Apr 5;43(3):103427. doi: 10.1016/j.amjoto.2022.103427. Online ahead of print.

ABSTRACT

PURPOSE: To describe the changes in workforce gender distribution over time and characterize geographically where women are finding job opportunities within the field of otolaryngology.

MATERIALS AND METHODS: The Centers for Medicare and Medicaid Services (CMS) publishes a Physician Compare National Downloadable File, which lists all active providers registered within CMS, as well as specialty, medical school graduation, and current practice location. The file of March 2021 was filtered for all providers that listed “otolaryngology” as their primary specialty. Providers were sorted based on medical school graduation year. Physicians were organized into five-year and ten-year quantiles, based on career experience. For each quantile, the gender distribution was recorded. For each decade of experience, the geographic distribution of gender was recorded at a state-by-state level. Descriptive statistics were conducted to characterize the number of female otolaryngologists per state. The geographic distribution of male versus female physicians was superimposed onto state boundary files as published by the U.S. Census Bureau using R Studio (2020) [13].

RESULTS: The Physician Compare National Database listed 1719 women (19.0%) and 7292 men (81.0%) otolaryngologists actively registered to practice in the United States. By career periods, the following proportions of otolaryngologists were women: 1-5 years, 317/971 (32.6%); 6-10 years, 417/1291 (32.3%); 11-15 years, 299/1159 (25.8%); 16-20 years, 207/1108 (18.7%); 21-25 years, 190/1156 (16.4%); 26-30 years, 138/1141 (12.1%); 31-35 years, 86/968 (8.9%); 36+ years, 60/1212 (5.0%). The linear regression of the male-female distribution data suggests that the proportion of men and women in practice in otolaryngology will equalize nationally in the 2030s. By geographic distribution, the mean and median number of female otolaryngologists per state was 34.3 (19.0%) and 21 (17.2%), respectively. The number of female otolaryngologists by state ranged from 2 (Idaho) to 258 (California). States with the lowest percentage of female otolaryngologists included Idaho (2/51, 3.9%), Oklahoma (5/86, 5.8%), and Utah (6/99, 6.1%). There has been a national increase in the percentage of women practicing in otolaryngology over the last several decades.

CONCLUSIONS: There is a significantly higher proportion of female otolaryngologists within earlier practice years, which suggests that progress has been made toward closing the gender gap within this field. The geographic distribution of female otolaryngologists is highly variable and should be studied further to assess what factors contribute to more females choosing to practice in these regions to continue to build regional support networks for women within the field.

PMID:35429843 | DOI:10.1016/j.amjoto.2022.103427

Mult Scler Relat Disord. 2022 Apr 10;62:103798. doi: 10.1016/j.msard.2022.103798. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the influence of immunoglobulins (Ig) level on the rate of infections in people with multiple sclerosis (pwMS) treated with ocrelizumab.

METHODS: We enrolled 109 consecutive pwMS treated with ocrelizumab with a mean follow-up of 2.69±0.56 (1.36-4.27) years. We have retrospectively searched our electronic database and the following information was collected: age, sex, MS characteristics, number of ocrelizumab cycles, infections, duration of the infection, hospitalization due to infection, treatment of the infection, and COVID-19 characteristics. Ig levels were measured within 14 days before each ocrelizumab infusion.

RESULTS: Number of pwMS with values of IgM and IgG below lower level of normal at baseline was 3 (2.8%) and 2 (2.8%), respectively; and before 6^th cycle of ocrelizumab 5 (13.5%) and 5 (13.5%), respectively. Levels of IgM were steadily decreasing over time, while levels of IgG started to show statistically significant drop only after 5^th cycle of ocrelizumab. 58.7% pwMS experienced infection during treatment, with a median number of infections per pwMS being 1, range 0-4. Female sex increased the risk of any infection (HR 2.561, 95%CI 1.382-4.774, p=0.003). Higher age and smaller drop in IgM before 3^rd ocrelizumab cycle increased the risk for infection requiring hospitalization (HR 1.086, 95%CI 1.018-1.159, p=0.013 and HR 9.216, 95%CI 1.124-75.558, p=0.039, respectively). Longer disease duration increased the risk for COVID-19 (HR 1.075, 95%CI 1.002-1.154, p=0.045).

CONCLUSION: The present findings broaden limited real-world data on infection and COVID-19 risk in pwMS treated with ocrelizumab.

PMID:35429819 | DOI:10.1016/j.msard.2022.103798

J Infect Public Health. 2022 Mar 25;15(5):526-532. doi: 10.1016/j.jiph.2022.03.013. Online ahead of print.

ABSTRACT

BACKGROUND: Many survivors of COVID-19 have developed symptoms and diseases similar to those observed after severe acute respiratory syndrome (SARS). Therefore, this study aimed to characterize the symptoms that appear after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been eradicated and to determine their relationship with COVID-19 severity.

METHODS: This multicenter, retrospective cross-sectional study was conducted in all eligible confirmed cases of SARS-CoV-2 infection from Saudi Arabia. Study participants were randomly selected using computerized random sampling from a population of 314,821 patients. Descriptive statistics were used to describe baseline demographic data and clinical characteristics. Categorical variables were presented as counts and percentages, while continuous variables were presented as means and standard deviations.

RESULTS: Approximately 70% of patients were found to have five or fewer symptoms simultaneously. Late symptoms (in the ongoing symptomatic COVID-19) occurred in 225 (22·5%) patients with the most common late symptoms being loss of smell, loss of taste, fatigue, shortness of breath, and cough (52·4%, 31·1%, 11·5%, 10·2%, and 8·9% of patients with late symptoms, respectively). We also found that the presence of acute symptoms of COVID-19 and admission to the hospital were significant independent predictors of the post-COVID-19 condition.

CONCLUSION: Saudi patients with COVID-19 develop a wide range of symptoms, similar to those observed and reported in other countries. The loss of smell, the loss of taste, shortness of breath, and fatigue were the main persistent symptoms. Regular follow-up of COVID-19 survivors is highly recommended to minimize the burden of the post-acute COVID-19 condition and improve the quality of life of patients.

PMID:35429791 | DOI:10.1016/j.jiph.2022.03.013