Tag: nevin manimala

Med Teach. 2023 Nov 1:1-6. doi: 10.1080/0142159X.2023.2274286. Online ahead of print.

ABSTRACT

PURPOSE: Competency-based medical education relies on a strong program of assessment, and quality comments play a vital role in ensuring its success. The goal of this study is to determine the effect of the timeliness of assessment completion on the quality of the feedback.

MATERIALS AND METHODS: Using the Quality of Assessment for Learning (QuAL) score 2478 assessments were evaluated. The assessments included those completed between July 2017 and December 2020 for 18 ophthalmology residents. Spearman correlation, Mann-Whitney U and Kruskal-Wallis tests were used to assess variations in QuAL scores based on the timeliness of assessment completion.

RESULTS: The timeliness of assessment completion ranged from 0 to 299 d with the mean time for completion being 3 d. As the delay increased, the QuAL score decreased. Feedback provided 4, 5, and 14 d post-encounter demonstrated statistically significant differences in the QuAL score. Additionally, there was a significant difference in the timeliness of feedback when there is no written comment.

CONCLUSIONS: This study demonstrates that the timeliness of assessment completion might have an effect on the quality of written feedback. Written feedback should be completed within 14 d of the encounter to optimize quantity and quality.

PMID:37910021 | DOI:10.1080/0142159X.2023.2274286

Anticancer Res. 2023 Nov;43(11):5261-5267. doi: 10.21873/anticanres.16728.

ABSTRACT

BACKGROUND/AIM: Peripheral blood inflammatory and nutritional indices are independent prognostic factors for various cancers. However, as society’s longevity and the demand for surgery in the elderly increase, it remains unclear whether these indices are valuable for patients aged ≥80 years. This study aimed to assess the utility of peripheral blood indices as prognostic markers in elderly patients with gastric cancer (GC).

PATIENTS AND METHODS: This study included 103 elderly patients (aged ≥80 years) who underwent radical gastrectomy at our hospital between 2008 and 2020. Preoperative systemic inflammatory and nutritional indices, including the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and prognostic and nutritional index (PNI), were evaluated. Prognostic evaluation was performed using Kaplan-Meier analysis and Cox regression.

RESULTS: There were no statistically significant differences in NLR, PLR, and LMR regarding overall survival (OS) and relapse-free survival (RFS). However, patients with low PNI had a markedly worse prognosis (3-year OS: 63.9% vs. 81.2%, p=0.002; 3-year RFS: 55.3% vs. 77.6%, p=0.002). Multivariate analysis revealed that male sex and low PNI were independent predictors of OS (p=0.007p=0.003, respectively) and RFS, with only PNI showing significance (p=0.023).

CONCLUSION: Preoperative PNI is an independent prognostic factor for survival in elderly patients with GC who undergo radical gastrectomy.

PMID:37910000 | DOI:10.21873/anticanres.16728

Anticancer Res. 2023 Nov;43(11):4823-4832. doi: 10.21873/anticanres.16679.

ABSTRACT

BACKGROUND/AIM: CD103⁺ tissue-resident memory T cells (T_RM) in tumor sites are associated with a favorable prognosis and predict the effectiveness of immune checkpoint inhibitors. The detection of CD103⁺ T_RM infiltration in biopsy samples could be beneficial for patients without surgical indications. However, the usefulness of T_RM detection in biopsy tissue and the difference in T_RM status between biopsy and surgical specimens’ post-neoadjuvant chemotherapy have not been elucidated. In the present study, we aimed to elucidate whether we can detect T_RM in biopsy specimens and the impact of chemotherapy on T_RM infiltration.

MATERIALS AND METHODS: Tissue sections were obtained from 46 patients with esophageal cancer who received neoadjuvant chemotherapy and underwent radical esophagectomy in 2017. Immunohistochemistry was performed using an anti-CD103 antibody for biopsy and surgical specimens. We examined the relationship between CD103 expression, clinicopathological features, and prognosis for each patient.

RESULTS: T_RM infiltration was detected in the biopsy specimens. CD103 expression in biopsy specimens correlated with that in surgical specimens. Although there was no statistical significance in clinicopathological findings between CD103high and CD103low, patients with CD103high biopsy specimens exhibited favorable prognosis. The number of CD103⁺ cells was increased by chemotherapy: though with no survival benefit.

CONCLUSION: Regardless of surgical indication, we were able to determine the T_RM status even in biopsy specimens. CD103 evaluation at biopsy may be more useful and practical than evaluation in surgical specimens, enabling prediction of prognosis and response to immune therapy.

PMID:37909993 | DOI:10.21873/anticanres.16679

Anticancer Res. 2023 Nov;43(11):5083-5088. doi: 10.21873/anticanres.16708.

ABSTRACT

BACKGROUND/AIM: Data on the prevalence of human papilloma virus (HPV) DNA in different subtypes of endometrial carcinomas (EC) are limited.

PATIENTS AND METHODS: We investigated the incidence of HPV16 DNA E6/E7 transcripts in 47 type I (endometrioid-type) tumors and eight type II (non-endometrioid-type) uterine neoplasms applying PCR-based technology. Immunohistochemical staining in HPV16 positive cases was also performed, and seven lymph node metastases were examined for the presence of HPV16 DNA E6/E7.

RESULTS: None of the type I ECs was positive for HPV16 E6 gene transcripts; however, four out of 8 (50%) type II ECs (two out of four papillary-serous and two out of four clear-cell carcinomas) were positive for HPV16 E6 transcripts. The difference in HPV16 E6 transcripts between endometrioid and non-endometrioid neoplasms was statistically significant (p=0.0011). Apart from the cancer subtype, none of the EC clinicopathological features were related to HPV16 E6 positivity. None of 55 ECs contained an HPV16 E7 gene transcripts. All slides from gene-positive samples revealed intense immunostaining reactions. Interestingly, the virus was not detected in any of seven lymph node metastases, including four from HPV16-positive primary tumors.

CONCLUSION: HPV16 E6 gene transcripts may be present in ECs, primarily in the non-endometrioid (type II) uterine cancer subtypes. HPV E6/E7 DNA transcripts were not found in lymph node metastases, even when the primary tumors harboured HPV DNA.

PMID:37909972 | DOI:10.21873/anticanres.16708

Anticancer Res. 2023 Nov;43(11):5041-5050. doi: 10.21873/anticanres.16703.

ABSTRACT

BACKGROUND/AIM: To evaluate the difference in the clinical efficacy and safety of pembrolizumab between patients with metastatic upper tract urothelial carcinoma (UTUC), which includes renal pelvic urothelial carcinoma (UC) and ureteral UC, and those with metastatic lower tract urothelial carcinoma (LTUC).

PATIENTS AND METHODS: A total of 752 patients who received pembrolizumab for the treatment of chemoresistant UC were retrospectively analyzed. We compared progression-free survival (PFS), overall survival (OS) and adverse events (AEs) in patients with renal pelvic UC, ureteral UC, and LTUC.

RESULTS: The median follow-up period was 42.5 [interquartile range (IQR)=35.1-47.4] months. The primary tumor site was in the upper tract in 362 (48.1%) patients [renal pelvis, n=219 (60.5%); ureter, n=143 (39.5%)] and in the lower tract in 390 (51.9%) patients. The estimated glomerular filtration rate before pembrolizumab treatment in the UTUC group was significantly lower than that in the LTUC group (p<0.001). The median PFS in the UTUC and LTUC groups was 3.4 months, respectively (p=0.271). The median OS in the UTUC and LTUC groups was 10.1 months and 11.7 months, respectively (p=0.195). In an analysis of UTUC divided into renal pelvic UC, ureteral UC, and LTUC, patients with renal pelvic UC had a significantly poorer prognosis in comparison to the other two groups (p=0.041). The incidence of any-grade AEs (51.7% vs. 47.9%, p=0.343) and grade ≥3 AEs (12.2% vs. 12.8%, p=0.826) in the two groups was not statistically significantly different.

CONCLUSION: No significant differences were found between the UTUC and LTUC groups with regard to the oncological outcomes and safety of pembrolizumab. Patients with renal pelvic UC had a significantly poorer prognosis than those with other ureteral UCs and LTUCs.

PMID:37909969 | DOI:10.21873/anticanres.16703

Anticancer Res. 2023 Nov;43(11):5089-5097. doi: 10.21873/anticanres.16709.

ABSTRACT

BACKGROUND/AIM: Texture analysis can provide quantitative imaging markers from computed tomography (CT) images. The Node-RADS classification was recently published as a classification system to better characterize lymph nodes in oncological imaging. The present analysis investigated the diagnostic benefit of CT texture analysis and the Node-RADS classification to categorize and stage lymph nodes in patients with perihilar cholangiocarcinoma.

PATIENTS AND METHODS: Overall, 25 patients (n=9 females, 36%) with a mean age of 72.4±8.1 years were included. All patients were surgically resected and the lymph nodes were histopathologically analyzed. CT-texture analysis was performed with the Mazda package. All investigated lymph nodes were scored in accordance with the Node-RADS classification.

RESULTS: Regarding lymph node discrimination (N- versus N+), Node-RADS classification achieved an area under the curve (AUC) of 0.86 resulting in a sensitivity of 78% and a specificity of 86%. Multiple investigated texture features were different between negative and positive lymph nodes. The “S(0,1)SumVarnc” achieved the best AUC of 0.75 resulting in a sensitivity of 0.91 and a specificity of 0.67. Correlation analysis showed various statistically significant associations between CT texture features and Node-RADS score.

CONCLUSION: Several CT texture features and the Node-RADS score derived from preoperative staging CT were associated with the malignancy of the hilar lymph nodes and might aid for preoperative staging. This could change surgical treatment planning in hilar cholangiocarcinoma.

PMID:37909955 | DOI:10.21873/anticanres.16709

Andes Pediatr. 2023 Jun;94(3):392-400. doi: 10.32641/andespediatr.v94i3.4494.

ABSTRACT

Several studies have supported the positive effect of respiratory rehabilitation (RR) in children and adolescents (CRA) with chronic respiratory diseases (CRD); however, qualitative aspects related to the experiences and perceptions about RR have been scarcely studied.

OBJECTIVE: to analyze the qualitative evidence regarding the perceptions and experiences of patients, families and professionals related to the RR of children and adolescents with CKD.

METHODS: Review of qualitative studies in 5 databases. We used MeSH terms and free English-language terms grouped into three dimensions: patients, intervention, and research design. The study subjects had to be patients, their families, teachers or treating health teams. No restrictions were placed on language or year of publication. The search strategy was configured as follows: ((Cystic fibrosis) OR (Asthma) OR (Neuromuscular diseases)) AND ((Respiratory rehabilitation) OR (Exercise)) AND ((Qualitative research) OR (Phenomenology) OR (Grounded theory) OR (Ethnography)). Two independent authors analyzed atingent titles, abstracts and long texts. Finally, a qualitative description of the results was made.

RESULTS: Twenty-one qualitative studies were selected, all on patients, family members, teachers or professionals treating patients with cystic fibrosis (CF), asthma or neuromuscular diseases (NMD). Perception of benefits, parental influence, enjoyment of the protocols, and time required to engage in physical activity were categories identified in all three groups. Aspects such as perceived safety on school grounds and parental stress were specific categories, highlighted in the context of asthma and CF respectively.

CONCLUSION: Several general and specific factors of a qualitative nature influence the experience of children with CRD during RR. Future studies conducted in our cultural context should be conducted to confirm these results.

PMID:37909943 | DOI:10.32641/andespediatr.v94i3.4494

Andes Pediatr. 2023 Jun;94(3):339-349. doi: 10.32641/andespediatr.v94i3.4395.

ABSTRACT

OBJECTIVE: To analyze the frequency of vitamin D (VD) deficiency in adolescents with different degrees of obesity and its association with alterations in the metabolic profile.

PATIENTS AND METHOD: Cross-sectional, descriptive, and analytical study in 250 adolescents with different degrees of obesity, treated at the nutrition polyclinic of the Hospital Dr. Sotero del Río. Data on age, sex, weight, height, Tanner stage, 25-hydroxyvitamin D levels, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, basal insulin, and glycemia were collected. The following were used for statistical analysis: Student’s test, chi-square, multiple linear regression analysis, and Pearson’s correlation coefficient.

RESULTS: 58% of the adolescents presented non-severe obesity and 42% severe obesity, the mean age was 12.4 ± 2.1 years, and 54% were male. 91% of the total sample presented VD deficiency, being more frequent among adolescents with severe obesity, reaching 95%. VD levels were significantly lower in winter. HOMA (homeostatic model assessment) values were higher among patients with severe obesity (6.3/4.2). Low HDL-c was more frequent in adolescents with severe obesity (78%/62%). An inverse correlation was found between VD and triglyceride levels (r = -0.20; p = 0.00) and total cholesterol (r = -0.15; p = 0.03).

CONCLUSION: The VD deficiency among obese adolescents is worrying, reaching more than 90% of the study sample. Our results highlight the importance of timely prevention, detection, and treatment of VD deficiency in obese adolescents to prevent bone health deterioration and cardiometabolic risk in adulthood.

PMID:37909937 | DOI:10.32641/andespediatr.v94i3.4395

Acta Oncol. 2023 Nov 1:1-7. doi: 10.1080/0284186X.2023.2275288. Online ahead of print.

ABSTRACT

BACKGROUND/PURPOSE: Gastric dose parameters comparison for deep inspiration breath-hold (DIBH) or free breathing (FB) mode during radiotherapy (RT) for left-sided breast cancer patients (LSBCPs) has not been investigated before. This study aimed to analyze the impact of Active Breath Coordinator (ABC)-DIBH technique on the dose received by the stomach during RT for LSBCPs and to provide organ-specific dosimetric parameters.

MATERIALS AND METHODS: The study included 73 LSBCPs. The dosimetric parameters of the stomach were compared between FB and DIBH mode. The correlation between the stomach volume and dosimetric parameters was analyzed.

RESULTS: Compared to FB mode, statistically significant reductions were observed in gastric dose parameters in ABC-DIBH mode, including Dmax (46.60 vs 17.25, p < 0.001), D1cc (38.42 vs 9.60, p < 0.001), Dmean (4.10 vs 0.80, p < 0.001), V40Gy (0.50 vs 0.00, p < 0.001), V30Gy (6.30 vs 0.00, p < 0.001), V20Gy (20.80 vs 0.00, p < 0.001), V10Gy (51.10 vs 0.77, p < 0.001), and V5Gy (93.20 vs 9.60, p < 0.001). ABC-DIBH increased the distance between the stomach and the breast PTV when compared to FB, from 1.3 cm to 2.8 cm (p < 0.001). Physiologic decrease in stomach volume was not found from FB to ABC-DIBH (415.54 cm³ vs 411.61 cm³, p = 0.260). The stomach volume showed a positive correlation with V40Gy (r² = 0.289; p < 0.05), V30Gy (r² = 0.287; p < 0.05), V20Gy (r² = 0.343; p < 0.05), V10Gy (r² = 0.039; p < 0.001), V5Gy (r² = 0.439; p < 0.001), Dmax (r² = 0.269; p < 0.05) and D1cc (r² = 0.278; p < 0.05) in FB mode. While in ABC-DIBH mode, most stomach dosimetric parameters were not correlated with gastric volume.

CONCLUSIONS: The implementation of ABC-DIBH in LSBCPs radiotherapy resulted in lower irradiation of the stomach. Larger stomach volume was associated with statistically significantly higher dose irradiation in FB mode. To reduce radiotherapy related side effects in FB mode, patients should be fast for at least 2 hours before the CT simulation and treatment.

PMID:37909907 | DOI:10.1080/0284186X.2023.2275288

Chaos. 2023 Nov 1;33(11):113108. doi: 10.1063/5.0171508.

ABSTRACT

Ordinal patterns serve as a robust symbolic transformation technique, enabling the unveiling of latent dynamics within time series data. This methodology involves constructing histograms of patterns, followed by the calculation of both entropy and statistical complexity-an avenue yet to be fully understood in terms of its statistical properties. While asymptotic results can be derived by assuming a multinomial distribution for histogram proportions, the challenge emerges from the non-independence present in the sequence of ordinal patterns. Consequently, the direct application of the multinomial assumption is questionable. This study focuses on the computation of the asymptotic distribution of permutation entropy, considering the inherent patterns’ correlation structure. Furthermore, the research delves into a comparative analysis, pitting this distribution against the entropy derived from a multinomial law. We present simulation algorithms for sampling time series with prescribed histograms of patterns and transition probabilities between them. Through this analysis, we better understand the intricacies of ordinal patterns and their statistical attributes.

PMID:37909906 | DOI:10.1063/5.0171508