Nevin Manimala

Gynecol Oncol Rep. 2021 May 13;37:100784. doi: 10.1016/j.gore.2021.100784. eCollection 2021 Aug.

ABSTRACT

Expedited diagnostic processes for all suspected cervical cancer cases remain essential in the effort to improve clinical outcomes of the disease. However, in some developing countries like Zambia, there is paucity of data that assesses factors influencing diagnostic and treatment turnaround time (TAT) and other metrics vital for quality cancer care. We conducted a retrospective hospital-based study at the Cancer Diseases Hospital (CDH) for cervical cancer cases presenting to the facility between January 2014 and December 2018. Descriptive statistics were used to summarize demographic characteristics while a generalized linear model of the negative binomial was used to assess determinants of overall TAT. Our study included 2121 patient case files. The median age was 49 years (IQR: ±17) and most patients (n = 634, 31%) were aged between 41 and 50 years. The International Federation of Gynaecology and Obstetrics (FIGO) Cancer stage II (n = 941, 48%) was the most prevalent while stage IV (n = 103, 5.2%) was the least. The average diagnostic TAT in public laboratories was 1.48 (95%CI: 1.21-1.81) times longer than in private laboratories. Furthermore, referral delay was 55 days (IQR: 24-152) and the overall TAT (oTAT) was 110 days (IQR: 62-204). The age of the patient, HIV status, stage of cancer and histological subtype did not influence oTAT while marital status influenced oTAT. The observed longer oTAT may increase irreversible adverse health outcomes among cervical cancer patients. There is a need to improve cancer care in Zambia through improved health expenditure especially in public health facilities.

PMID:34095422 | PMC:PMC8165546 | DOI:10.1016/j.gore.2021.100784

Pract Lab Med. 2021 Apr 27;25:e00231. doi: 10.1016/j.plabm.2021.e00231. eCollection 2021 May.

ABSTRACT

OBJECTIVES: Whole blood bilirubin measured on blood gas analyzers is accepted by physicians in neonatal hyperbilirubinemia management since it requires a small sample volume. The accuracy of bilirubin measurement on blood gas analyzers is instrument dependent and remains controversial.

DESIGN AND METHODS: Bilirubin in adult and umbilical cord whole blood samples, spiked with an unconjugated bilirubin standard, and non-spiked adult plasma samples was measured on a blood gas analyzer (GEM 4000) and a Core Laboratory Chemistry analyzer (Architect c16000) respectively. We also investigated the linear regression for neonatal and adult hemoglobin measured on the blood gas analyzer and the Core Laboratory hematology analyzer (Alinity h-Series).

RESULTS: Plasma bilirubin measured on the blood gas analyzer and the chemistry analyzer was statistically identical. Adult whole blood bilirubin showed slightly increased proportional bias. When umbilical cord whole blood samples were used, the Deming regression showed GEM bilirubin =1.233(Architect) (95% CI 1.199 ~ 1.266)-44.43 ​μmol/L (95% CI -53.6 ​~ ​-35.2). The regression was significantly different from that in plasma (p ​< ​0.001) or adult whole blood (p ​< ​0.001) samples. 36.1% neonatal samples with bilirubin levels >50 ​μmol/L showed that the bias% was above laboratory standards. In addition, the regression of neonatal hemoglobin measurement between the GEM and the Alinity was significantly different from adult hemoglobin (p ​< ​0.01).

CONCLUSIONS: Neonatal whole blood bilirubin measurement on blood gas analyzers may be affected by neonatal hemoglobin. The method should be validated using neonatal whole blood samples or samples with a similar matrix before the analyzers are implemented into neonatal hyperbilirubinemia management.

PMID:34095416 | PMC:PMC8145737 | DOI:10.1016/j.plabm.2021.e00231

Pract Lab Med. 2021 Apr 17;25:e00221. doi: 10.1016/j.plabm.2021.e00221. eCollection 2021 May.

ABSTRACT

OBJECTIVES: The main aim of this work was to compare the methods of DNA isolation in the moulds of genus Mucorales with special regard to the amount and purity of the DNA acquired. The acquired DNA was then amplified by specific real-time PCR.

DESIGN: Five DNA extraction procedures were carried out in a Class 2 Biosafety cabinet in a dedicated room with suitable biosafety precautions and appropriate biowaste disposal methods. A total of 6 Mucorales clinical strains were used.

RESULTS: From the viewpoint of concentration and purity, methods A shown abundant amount of fungal DNA whereas methods E report a pure fungal DNA with R260/280 of 1.7 near the optimal 1.8. The DNA quantity reach statistically difference at ANOVA test with p value 0.0005.

CONCLUSION: Overall, the E method was the most efficient method in the extraction of DNA from fungal cultures compared to the other methods considering time, cost, technical expertise, and instrumentation. Use of this assay will allow researchers to obtain DNA from fungi quickly for use in molecular assays.

PMID:34095411 | PMC:PMC8145739 | DOI:10.1016/j.plabm.2021.e00221

Arthroplast Today. 2021 Apr 22;8:289-294.e2. doi: 10.1016/j.artd.2021.03.017. eCollection 2021 Apr.

ABSTRACT

BACKGROUND: Prolonged length of stay (LOS) after elective total hip (THA) and knee (TKA) arthroplasty is often associated with worse patient outcomes. Social support through room-sharing has been identified as a factor that may reduce LOS in a hospital setting, but has not yet been examined in an orthopedic population. The aim of this study was to evaluate the effect of single- vs shared-room accommodation after elective TKA or THA on hospital LOS.

METHOD: A retrospective study was conducted using data from hospital medical records at our institution. Patients receiving unilateral, elective THA or TKA over a 2-year period were eligible. Patients were allocated to either a single room or four-bed shared room. The primary outcome was LOS; secondary outcomes included complications, discharge destination, and return to operating theater.

RESULTS: One hundred eighty-five patients (70 THA, 115 TKA; mean age 65.74 ± 10.38, 59% female) were included, of whom 82 were allocated to a single room and 103 to a shared room. There was no statistically significant difference in LOS between the 2 groups (5.18 ± 2.21 days [single] vs 4.88 ± 2.12 days [shared]; mean difference -0.29 [95% CI -0.92-0.33], P = .36). Analysis modeling for multiple confounders found no association among room allocation, LOS, and discharge destination. However, more patients in single rooms required discharge to rehabilitation (27% vs 9%) and return to theater (7% vs 1%).

CONCLUSIONS: Room allocation did not correlate with a difference in LOS in patients undergoing elective THA or TKA.

PMID:34095406 | PMC:PMC8167312 | DOI:10.1016/j.artd.2021.03.017

Arthroplast Today. 2021 Feb 26;8:278-282.e1. doi: 10.1016/j.artd.2021.01.008. eCollection 2021 Apr.

ABSTRACT

BACKGROUND: The number of applicants to adult reconstruction fellowships (ARFs) has increased significantly in recent years, making the application process increasingly competitive. With this, applicants are applying to and interviewing at more programs which has inherent cost and time implications. The purpose of this study was to assess these implications as well as investigate applicant attitudes toward proposed changes.

METHODS: This is a cross-sectional survey study of 2019 and 2020 ARF applicants (n = 278) to a single institution. A 10-question survey was distributed to applicants regarding the application and interview process. This survey focused on application and interview volumes, financial and temporal commitments, as well as perceptions regarding potential application process changes. Descriptive statistics and chi-squared analysis were then performed.

RESULTS: Of the 110 (40%) respondents, 87% spent >$3000 and 43% spent >$5000 during the application process. Most respondents applied to ≥26 programs (84%) and both received and attended ≥11 interviews (87% and 74.5%, respectively). Applicants missed significant training time for interviews (99% missed at least 1 week, 62% two weeks, and 15% three weeks). Attending more interviews (P = .001) and multiple visits to the same city (P = .049) were associated with spending >$5000. Most applicants (72%) felt change to the process would be beneficial.

CONCLUSIONS: Applicants to ARF are applying to and interviewing at many programs resulting in significant time away from training and financial investment. Most applicants feel that a change to the system would be beneficial, although no consensus on the best solution was delineated. These data should be considered during the continued evaluation of the match process.

PMID:34095404 | PMC:PMC8167313 | DOI:10.1016/j.artd.2021.01.008

Data Brief. 2021 May 21;37:107161. doi: 10.1016/j.dib.2021.107161. eCollection 2021 Aug.

ABSTRACT

A survey was conducted with 64 respondents to examine the outcomes of participatory fisheries management in Mweru-Luapula fishery, northern Zambia [1]. The survey was complemented by five focus group discussions (FGDs) and two key informant interviews. The study evaluated the performance of Village Fisheries Management Committees (VFMCs), analysed participation of fishers in management activities and assessed fishers’ compliance to fisheries regulations. Ostrom’s Eight Design Principles and White’s Typology of Interests were employed in the analysis of VFMC Performance and Fishers’ participation respectively [2], [3]. Descriptive statistics and content analysis were employed to analyse the quantitative and qualitative data respectively. Results show inadequate funding to the Department of Fisheries; capture of benefits and VFMC positions by local elites and weak enforcement of fisheries regulations. A nominal form of participation characterizes the co- management system and resource users are not engaged in decision- making. Besides inconsistent patrols by VFMCs and Department of Fisheries, results further show low compliance to the seasonal fish ban and persistent use of illegal fishing practices within the fishery.

PMID:34095395 | PMC:PMC8167142 | DOI:10.1016/j.dib.2021.107161

Glob Pediatr Health. 2021 May 20;8:2333794X211018321. doi: 10.1177/2333794X211018321. eCollection 2021.

ABSTRACT

Background. Prelacteal feeding is defined as administration of any substances other than breast milk to newborn babies during the first 3 days after birth. Despite its negative health outcomes, it is commonly practiced in developing countries. Therefore, this study aimed at assessing the prevalence of pre-lacteal feeding practices and associated factors among mothers of children aged less than 2 years of age in Kersa district, Eastern Ethiopia. Method. A community-based cross-sectional study design was conducted among 465 mothers having children aged less than 2 years in Kersa district. A multistage sampling technique was used to select study participants. Binary logistic regression analysis was fitted to identify factors associated with prelacteal feeding practices. Variables with a P-value <.05 were identified as statistically significant factors. Results. The prevalence of pre-lacteal feeding in Kersa district was 46.4% (95% CI; 42.0%, 51.5%). Initiating breastfeeding after 1 hour of delivery (AOR = 10.80, 95% CI: (5.79, 20.17)), giving birth at home (AOR = 2.77, 95% CI: (1.41, 5.46)), not knowing risks associated with pre-lacteal feeding (AOR = 3.25, 95% CI: (1.72, 6.15)) and perceiving pre-lacteal feeding as beneficial (AOR = 9.56, 95% CI: (4.45, 20.52)) were factors significantly associated with practice pre-lacteal feeding practices. Conclusion. Significant proportions of mothers were practicing pre-lacteal feeding in the study area. Late initiation of breastfeeding, home delivery, not knowing risks of prelacteal feeding, and perceiving pre-lacteal feeding as beneficial were contributing factors for practicing of pre-lacteal feeding. Therefore, promoting institutional delivery and timely initiation of breastfeeding would reduce prelacteal feeding in Kersa district.

PMID:34095353 | PMC:PMC8142237 | DOI:10.1177/2333794X211018321

Open Forum Infect Dis. 2020 Dec 16;8(6):ofaa605. doi: 10.1093/ofid/ofaa605. eCollection 2021 Jun.

ABSTRACT

BACKGROUND: Patients who test positive for Clostridium difficile by polymerase chain reaction (PCR), with a negative toxin enzyme immunoassay (EIA), are commonly colonized and do not require treatment. However, clinicians often treat based on a positive PCR result regardless of the toxin EIA result. We evaluated the clinical impact of a microbiology reporting nudge, changing from a report that included both assay results along with treatment recommendations to one that suggested clinicians consider C difficile colonization or early infection.

METHODS: We conducted a retrospective cohort study of all adult patients admitted to a large multisite community hospital with a positive C difficile PCR result and negative toxin EIA from January 1, 2016 to June 30, 2018. We examined total days of therapy (DOT) and impacts on clinical outcomes.

RESULTS: One hundred ninety-nine episodes occurred preintervention and 165 episodes occurred postintervention. The mean DOTs per episode decreased from 13.6 to 7.9 days (difference -5.8 days; 95% confidence interval, -3.9 to -7.6) postintervention, with statistical process control charts suggesting special cause variation. Patients receiving no treatment increased from 6.5% to 23.6% postintervention (P < .0001). No significant changes in subsequent toxin positive disease (9.0% vs 6.7%), colectomy (0% vs 0.6%), mortality (7.5% vs 12.1%), or length of stay (18.5 vs 16 days) were observed.

CONCLUSIONS: Microbiology reporting nudges raising the possibility of C difficile colonization were associated with altered prescribing, reinforcing a postanalytic strategy for invoking change. Decreases in antimicrobial prescribing occurred without increasing subsequent disease or other adverse outcomes, suggesting a safe strategy for decreasing unnecessary treatment of C difficile colonization.

PMID:34095335 | PMC:PMC8176399 | DOI:10.1093/ofid/ofaa605

Biomed Res Int. 2021 May 22;2021:9919080. doi: 10.1155/2021/9919080. eCollection 2021.

ABSTRACT

Advanced single-cell profiling technologies promote exploration of cell heterogeneity, and clustering of single-cell RNA (scRNA-seq) data enables discovery of coexpression genes and network relationships between genes. In particular, single-cell profiling of circulating tumor cells (CTCs) can provide unique insights into tumor heterogeneity (including in triple-negative breast cancer (TNBC)), while scRNA-seq leads to better understanding of subclonal architecture and biological function. Despite numerous reports suggesting a direct correlation between circulating tumor cells (CTCs) and poor clinical outcomes, few studies have provided a thorough heterogeneity characterization of CTCs. In addition, TNBC is a disease with not only intertumor but also intratumor heterogeneity and represents various biological distinct subgroups that may have relationships with immune functions that are not clearly established yet. In this article, we introduce a new scheme for detecting genotypic characterization of single-cell heterogeneities and apply it to CTC and TNBC single-cell RNA-seq data. First, we use an existing mixture exponential family graph model to partition the cell-cell network; then, with the Markov random field model, we obtain more flexible network rewiring. Finally, we find the cell heterogeneity and network relationships according to different high coexpression gene modules in different cell subsets. Our results demonstrate that this scheme provides a reasonable and effective way to model different cell clusters and different biological enrichment gene clusters. Thus, using different internal coexpression genes of different cell clusters, we can infer the differences in tumor composition and diversity.

PMID:34095314 | PMC:PMC8164540 | DOI:10.1155/2021/9919080

Biomed Res Int. 2021 May 21;2021:6793860. doi: 10.1155/2021/6793860. eCollection 2021.

ABSTRACT

OBJECTIVE: Interleukin- (IL-) 34 is a new type of cytokine with neuroprotective effects discovered in recent years. However, the relationship between IL-34 and vascular dementia (VaD) has not yet been elucidated. The purpose of this study is to determine whether IL-34 is involved in cognitive impairment of VaD.

METHODS: From January 2017 to December 2020, 84 VaD patients and 60 healthy controls who attended Qingpu Branch of Zhongshan Hospital were prospectively included in the study. Once included in the study, demographic features of all research subjects are collected. They include age, gender, education, white blood cells (WBC), neutrophil, lymphocyte, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), triglycerides (TG), and total cholesterol (TC). Meanwhile, the Montreal Cognitive Assessment (MoCA) scale was used to assess the cognitive function of participants. The serum IL-34 level was determined by enzyme-linked immunosorbent assay (ELISA).

RESULTS: There was no significant difference between the demographic features of VaD patients and healthy controls (p > 0.05). However, the serum IL-34 levels of VaD patients and healthy controls are 27.6 ± 3.9 pg/ml and 41.8 ± 6.0 pg/ml, respectively, and there is a significant statistical difference between them (p < 0.001). The results of bivariate correlation analysis showed that serum IL-34 levels were significantly positively correlated with MoCA scores (r = 0.371, p = 0.023). Further regression analysis showed that IL-34 was still correlated with MoCA after adjusting for demographic features (β = 0.276, p = 0038).

CONCLUSIONS: Serum IL-34 levels in VaD patients were significantly reduced, which may be an independent predictor of cognitive impairment in VaD patients.

PMID:34095310 | PMC:PMC8163526 | DOI:10.1155/2021/6793860