Nevin Manimala

Histol Histopathol. 2022 May 5:18464. doi: 10.14670/HH-18-464. Online ahead of print.

ABSTRACT

Invasive micropapillary carcinoma has been reported in the adenocarcinoma of many organs including cervix, and many studies have proved it has more invasive biological behavior. This study, for the first time, reports cervical squamous carcinoma with invasive micropapillary like pattern and phenotype (IMLPP) and further investigates its clinicopathologic features. Cervical squamous carcinoma with IMLPP was selected by histological characteristics and immunohistochemical staining. All patients’ clinical information and pathological parameters were collected. Based on histological characteristics and immunohistochemical staining results, 24 cases, out of 104 cases of cervical squamous carcinoma, were identified as having invasive micropapillary like pattern. The staining of all 24 cases with EMA and MUC-1 showed the feature of “reverse polarity like”. Meanwhile, patient age at diagnosis (P=0.011), maximum invasion depth (P=0.001), maximum diameter (P=0.015), lymphvascular space invasion (P<0.001), pelvic lymph node metastasis (P<0.001), metastasis (P=0.020), death (P=0.025) and FIGO stages (P=0.001) were related to the existence of IMLPP, independently of the proportion of IMLPP to the whole tumor in size. Univariate and multivariate disease-free survival analyses (follow-up time >12 months) showed significant statistical difference between cervical squamous carcinoma with or without IMLPP (P=0.016, P=0.043). Results from our study suggested that IMLPP may be associated with aggressive biological behavior in cervical squamous carcinoma. Therefore, pathologists should pay attention to the existence of it, no matter its proportion with relation to the whole tumor, and bring it to the attention of clinicians.

PMID:35510512 | DOI:10.14670/HH-18-464

Hosp Pediatr. 2022 May 5:e2021006444. doi: 10.1542/hpeds.2021-006444. Online ahead of print.

ABSTRACT

OBJECTIVES: Many medical disciplines incorporate point-of-care ultrasound (POCUS) into their practice. Despite well-defined applications, POCUS has not been widely adopted in pediatrics and is not commonly taught during residency. Our objective was to profile the current state of POCUS education in pediatric residency training from the resident perspective.

METHODS: We surveyed pediatric trainees about their POCUS education, general opinions about POCUS, and perceived barriers to POCUS training in residency. We distributed the survey to a random sample of Ohio pediatric residents, stratified by program size and training level. Descriptive statistics were used to characterize responses.

RESULTS: We sampled 66.4% of the population (371 of 559) of Ohio pediatric residents and achieved a response rate of 59.3%. Only 15% of respondents received POCUS training during residency, with 85% having never performed a POCUS scan. Most (86%) desired POCUS education and 67% believed it should be required during residency. Residents felt that POCUS would be useful for procedural guidance (95%), clinical diagnosis (94%), and patient safety (74%). Most residents (61%) believed POCUS education would benefit their careers, particularly those planning on subspecialization. Barriers to POCUS education included lack of an established curriculum (75%), competing educational priorities (58%), and a shortage of qualified instructors (52%).

CONCLUSIONS: Although Ohio pediatric residents do not receive formal POCUS education in residency, they desire such training and believe it would benefit their future practice. Consensus on scope of practice, development of a standardized curriculum, and increased faculty training in POCUS may help address this educational gap.

PMID:35510494 | DOI:10.1542/hpeds.2021-006444

J Laryngol Otol. 2022 May;136(5):404-409. doi: 10.1017/S0022215121004400. Epub 2022 Jan 7.

ABSTRACT

OBJECTIVE: To examine the effects of mastoid and middle-ear volume on the anatomical and functional success of type 1 tympanoplasty in paediatric patients.

METHODS: This study included 45 paediatric patients who underwent type 1 cartilage tympanoplasty. Patients’ demographic data, pre- and post-operative audiological evaluation results, and post-operative graft status were evaluated. Middle-ear and mastoid cavity volumes were calculated (in cubic centimetres) using temporal bone high-resolution computed tomography. Middle-ear and mastoid cavity volume values were compared between patients with and without post-operative anatomical and functional success.

RESULTS: Anatomical success was achieved in 82.2 per cent of patients (n = 37), and functional success in 68.9 per cent (n = 31). When anatomical success and failure groups were compared, a statistically significant difference was found in mean mastoid volume (p = 0.037), while there was no significant difference in relation to mean middle-ear volume (p = 0.827). The comparison of functional success and failure groups revealed no significant difference in mean mastoid volume (p = 0.492) or middle-ear volume (p = 0.941).

CONCLUSION: The study showed that mastoid pneumatisation volume affects surgical success in paediatric tympanoplasty.

PMID:35510488 | DOI:10.1017/S0022215121004400

J Aging Health. 2022 May 5:8982643221086071. doi: 10.1177/08982643221086071. Online ahead of print.

ABSTRACT

Objectives: To examine post-traumatic stress disorder (PTSD) among Black adults in younger, middle, and older ages. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime and 12-month prevalence of PTSD in Black men and women ages 18-34, 35-49, and 50+. We determined PTSD persistence and severity by age group, then associations of PTSD with socio-economic status, chronic stress, and racial discrimination in middle age. Results: The lifetime prevalence of PTSD was higher in Black women/men ages 18-34 (prevalence=14.0%/6.3%) and 35-49 (12.8%/4.6%) versus 50 and older (8.7%/5.1%). Those ages 35-49 were more likely than younger/older Black adults to have severe interference in work, relationships, and activities domains. In middle age, PTSD was associated with unemployment, lower education, poverty, and stress in Black men, and unemployment, divorce, poverty, stress, and discrimination in Black women. Discussion: Black women experience a disproportionate burden of PTSD in middle age.

PMID:35510479 | DOI:10.1177/08982643221086071

Tidsskr Nor Laegeforen. 2022 Apr 28. doi: 10.4045/tidsskr.21.0848. Online ahead of print.

ABSTRACT

BACKGROUND: Vaccination coverage for COVID-19 varies among immigrant groups in Norway and between different countries. Most likely, childhood/adolescence and consistent contact with the country of birth help form the attitudes to and the desire for vaccination. We therefore compared the vaccination rate among European-born immigrants in Norway and the vaccination coverage in their countries of birth.

MATERIAL AND METHOD: Vaccination coverage, the percentage of the adult population that had received at least one vaccination dose, for 22 European countries with universal access to vaccines by 31 August 2021 was retrieved from the European Centre for Disease Prevention and from the Norwegian emergency preparedness register for COVID-19 for the equivalent immigrant groups in Norway on 30 September 2021. Scatter plots with least-squares regression lines showed the association between the vaccination coverage in the country of birth and the rate in the equivalent immigration group in Norway, in total and by time of residence in Norway (< 6 years and ≥ 6 years).

RESULT: The model estimated an increase in the vaccination rate in immigrant groups in Norway of 0.64 percentage points for each percentage point increase in the vaccination coverage in their European countries of birth, and explained 63 % of the variation in the vaccination rate in the immigrant groups. There was no statistically significant difference in the co-variation with the country of birth when comparing immigrants with short versus long time of residence.

INTERPRETATION: There is a correlation between the vaccination rate for COVID-19 among European-born immigrants in Norway and the coverage in their countries of birth. Attitudes to and desire for vaccination varies between countries and can explain part of the observed differences between immigrant groups in Norway.

PMID:35510450 | DOI:10.4045/tidsskr.21.0848

JAMA. 2022 May 5. doi: 10.1001/jama.2022.4404. Online ahead of print.

ABSTRACT

IMPORTANCE: In nonurban areas with limited access to thrombectomy-capable centers, optimal prehospital transport strategies in patients with suspected large-vessel occlusion stroke are unknown.

OBJECTIVE: To determine whether, in nonurban areas, direct transport to a thrombectomy-capable center is beneficial compared with transport to the closest local stroke center.

DESIGN, SETTING, AND PARTICIPANTS: Multicenter, population-based, cluster-randomized trial including 1401 patients with suspected acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy in Catalonia, Spain, between March 2017 and June 2020. The date of final follow-up was September 2020.

INTERVENTIONS: Transportation to a thrombectomy-capable center (n = 688) or the closest local stroke center (n = 713).

MAIN OUTCOMES AND MEASURES: The primary outcome was disability at 90 days based on the modified Rankin Scale (mRS; scores range from 0 [no symptoms] to 6 [death]) in the target population of patients with ischemic stroke. There were 11 secondary outcomes, including rate of intravenous tissue plasminogen activator administration and thrombectomy in the target population and 90-day mortality in the safety population of all randomized patients.

RESULTS: Enrollment was halted for futility following a second interim analysis. The 1401 enrolled patients were included in the safety analysis, of whom 1369 (98%) consented to participate and were included in the as-randomized analysis (56% men; median age, 75 [IQR, 65-83] years; median National Institutes of Health Stroke Scale score, 17 [IQR, 11-21]); 949 (69%) comprised the target ischemic stroke population included in the primary analysis. For the primary outcome in the target population, median mRS score was 3 (IQR, 2-5) vs 3 (IQR, 2-5) (adjusted common odds ratio [OR], 1.03; 95% CI, 0.82-1.29). Of 11 reported secondary outcomes, 8 showed no significant difference. Compared with patients first transported to local stroke centers, patients directly transported to thrombectomy-capable centers had significantly lower odds of receiving intravenous tissue plasminogen activator (in the target population, 229/482 [47.5%] vs 282/467 [60.4%]; OR, 0.59; 95% CI, 0.45-0.76) and significantly higher odds of receiving thrombectomy (in the target population, 235/482 [48.8%] vs 184/467 [39.4%]; OR, 1.46; 95% CI, 1.13-1.89). Mortality at 90 days in the safety population was not significantly different between groups (188/688 [27.3%] vs 194/713 [27.2%]; adjusted hazard ratio, 0.97; 95% CI, 0.79-1.18).

CONCLUSIONS AND RELEVANCE: In nonurban areas in Catalonia, Spain, there was no significant difference in 90-day neurological outcomes between transportation to a local stroke center vs a thrombectomy-capable referral center in patients with suspected large-vessel occlusion stroke. These findings require replication in other settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02795962.

PMID:35510397 | DOI:10.1001/jama.2022.4404

J Hum Nutr Diet. 2022 May 5. doi: 10.1111/jhn.13026. Online ahead of print.

ABSTRACT

AIM: Routine malnutrition risk screening of patients is critical for optimal care and part of National Australian Hospital Standards. Identification of malnutrition also ensures reimbursement for hospitals to adequately treat these high-risk patients. However timely, accurate screening, assessment and coding of malnutrition remains suboptimal. This study aimed to investigate manual and digital interventions to overcome barriers to malnutrition identification for improvements in the hospital setting.

METHODS: Retrospective reporting on malnutrition identification processes was done through two stages: 1. manual auditing intervention, and 2. development of a digital solution – the electronic Malnutrition Solution (eMS). Repeated process audits were completed at approximately 6 monthly intervals through both stages between 2016 and 2019 and results analysed. In stage 2, time investment and staff adoption of the digital solution were measured.

RESULTS: Overall, the combined effect of both regular auditing and use of the eMS resulted in statistically significant improvements across all six key measures: patients identified (97% to 100%; p<0.001), screened (68% to 95%; p<0.001), screened within 24 hours (51% to 89%; p<0.001), assessed (72% to 95%; p<0.001), assessed within 24 hours (66% to 93%; p<0.001) and coded (81% to 100%; p=0.017). The eMS demonstrated reduction in screening time by over 60% with user adoption 100%. Data analytics enabled automated, real-time auditing with a 95% reduction in time taken to audit.

CONCLUSIONS: A single digital solution for management of malnutrition and automation of auditing demonstrated significant improvements where manual or combinations of manual and electronic systems continue to fall short. This article is protected by copyright. All rights reserved.

PMID:35510388 | DOI:10.1111/jhn.13026

Pathog Glob Health. 2022 May 4:1-10. doi: 10.1080/20477724.2022.2057722. Online ahead of print.

ABSTRACT

The objectives of this study were to explore global epidemiological characteristics of leprosy, and to provide reference for the construction of prevention strategies for leprosy. Computer retrieval of the study on the epidemiology of leprosy from 2010 to 2020 in Web of Science, PubMed, and SCOPUS databases were summarized. The included studies were assessed for the quality of the AHRQ; the proportions of the study indices were meta-analyzed with Stata 16.0. A random effects model was adopted to merge categories, including sex, type, grade 2 deformity (G2D) and age group for meta-analysis. The subgroup analysis used region as a stratification factor to analyze whether there were differences in the indicators. The meta-analysis included 30 studies totaling 11,353 cases. The global pooled proportion of male to female subjects with leprosy was 63% (95% CI 59%, 66%) to 37% (95% CI 34%, 41%), respectively. The pooled multibacillary proportion and paucibacillary proportion were 69% (95% CI 62%, 76%) and 31% (95% CI 24%, 38%), respectively. The pooled grade 2 deformity (G2D) proportion was 22% (95% CI 15%, 30%). Among age groups, the pooled children proportion was 11% (95% CI 8%, 13%), and the pooled adult proportion was 89% (95% CI 87%, 92%). The subgroup analysis indicated that epidemiological indicators varied from country to country. This study suggested that disparities existed between sex, type, grade 2 deformity (G2D) and age group characteristics of leprosy from country to country.

PMID:35510339 | DOI:10.1080/20477724.2022.2057722

Rev Esp Enferm Dig. 2022 May 5. doi: 10.17235/reed.2022.8814/2022. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of this systematic review and meta-analysis was to evaluate the outcomes of fecal microbiota transplantation (FMT) therapy for recurrent Clostridium difficile infection (C) among inflammatory bowel disease (IBD) patients.

METHODS: Electronic databases were searched for studies that reported efficacy and/or safety of FMT therapy for recurrent CDI among IBD. We used the meta-prop command of the meta package in R to assess the efficacy and safety. Subgroup analyses were performed for exploration of heterogeneity regarding all outcomes.

RESULTS: 11 trials were included in our study. Pooled analysis showed that the initial cure rate of recurrent CDI among IBD patients was 80% (95% CI 0.76, 0.84), and the overall cure rate after two or more FMT procedures was 90% (95% CI 0.84, 0.94). The recurrence rate post FMT therapy was 25% (95% CI: 0.20, 0.32). Sub-analyses suggested that the initial cure rate of CDI in ulcerative colitis (UC) patients was higher than that in Crohn’s disease (CD) patients (85% vs. 79%), with no statistically significant differences (P >0.05). No serious adverse events were noted in any of the patients post-FMT.

CONCLUSIONS: FMT is an effective and safe treatment for recurrent CDI in patients with IBD. FMT should be considered early in cases of recurrent or refractory CDI. Multiple FMT procedures can improve the cure rate of CDI.

PMID:35510325 | DOI:10.17235/reed.2022.8814/2022

Physiol Rep. 2022 May;10(9):e15267. doi: 10.14814/phy2.15267.

ABSTRACT

Oral contraceptives (OC) are associated with increased risk of hypertension and elevated blood pressure (BP). Whether non-oral hormonal contraceptives have similar associations is unknown. We sought to investigate the effect of non-oral hormonal contraceptive (NOHC) use on the risk of hypertension and changes in BP, compared to non-hormonal contraceptive and OC use. We searched bibliographic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) until August 2020. Studies reporting risk of hypertension or changes in systolic and diastolic BP with NOHC use compared with either non-hormonal contraceptive or OC use. Abstract screening, full-text review, data extraction, and quality assessment were completed in duplicate. For studies reporting dichotomous outcomes, we reported results as relative risk with 95% confidence intervals (CI). A random-effects model was used to estimate pooled weighted mean difference and 95% CI of change in BP. Twenty-five studies were included. A lower incidence of hypertension was observed with injectable contraceptive use compared to non-hormonal contraceptive and OC use, although it was unclear if this was statistically significant. Compared to non-hormonal contraceptive use, injectable contraceptive use was associated with increased BP (SBP: 3.24 mmHg, 95%CI 2.49 to 3.98 mmHg; DBP: 3.15 mmHg, 95%CI 0.09 to 6.20 mmHg), the hormonal intra-uterine device use was associated with reduced BP (SBP: -4.50 mmHg, 95%CI -8.44 to -0.57 mmHg; DBP: -7.48 mmHg, 95% -14.90 to -0.05 mmHg), and the vaginal ring was associated with reduced diastolic BP (-3.90 mmHg, 95%CI -6.67 to -1.13 mmHg). Compared to OC use, the injectable contraceptive use was associated with increased diastolic BP (2.38 mmHg, 95%CI 0.39 to 4.38 mmHg). NOHC use is associated with changes in BP which differ by type and route of administration. Given the strong association between incremental increases in BP and cardiovascular risk, prospective studies are required.

PMID:35510324 | DOI:10.14814/phy2.15267