Tag: nevin manimala

J Coll Physicians Surg Pak. 2023 Jun;33(6):659-665. doi: 10.29271/jcpsp.2023.06.659.

ABSTRACT

OBJECTIVE: To investigate the outcomes of regorafenib treatment in refractory metastatic colorectal cancer (mCRC) patients by primary tumour sidedness, the effects of previously targeted therapies, RAS status and inflammatory markers.

STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Medical Oncology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey, between January 2012 and September 2020.

METHODOLOGY: Clinical data of 102 mCRC patients treated with regorafenib were compared according to the right and left colon subgroups, in terms of factors affecting outcomes of regorafenib treatment. Kaplan-Meier method was used to identify factors associated with the overall survival.

RESULTS: Disease control rate (DCR) with regorafenib were similar in both right and left-sided colon tumours (60% vs. 61%, respectively, p>0.99). The median overall survival (OS) was 6.6 months in patients with right-sided colon cancers and 10.1 months in patients with left-sided colon cancers, but it was not significant (p=0.238). When evaluating by RAS status, there was an increase in favour of the right-sided mCRC in progression-free survival and OS, without statistical significance. In multivariate analysis, the patients with metastatic sites <3 and the number of prior systemic therapies ≤3 line had significantly higher survival.

CONCLUSION: The tumour burden affected the response to regorafenib in subsequent treatments and regorafenib was also effective in heavily treated mCRC patients. There was no difference in PFS and OS in terms of tumour sidedness by regorafenib treatment.

KEY WORDS: Colorectal cancer, Regorafenib, Tumour sidedness.

PMID:37300262 | DOI:10.29271/jcpsp.2023.06.659

J Coll Physicians Surg Pak. 2023 Jun;33(6):653-658. doi: 10.29271/jcpsp.2023.06.653.

ABSTRACT

OBJECTIVE: To identify prognostic inflammatory markers in metastatic renal cell carcinoma (mRCC) patients who received anti-vascular endothelial growth factor receptor (VEGFR) agents.

STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Medical Oncology, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey, between January 2015 and December 2021.

METHODOLOGY: A total of 110 patients with mRCC who received sunitinib or pazopanib for at least 3 months were enrolled. Hemogram, C-reactive protein (CRP) and albumin values of the patients, CRP to albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), prognostic nutrition index (PNI) and systemic inflammatory response indexes (SIRI) were calculated and recorded. Progression-free survival and overall survival analyses of the patients were performed using the Kaplan-Meier method. Cox regression method was used to identify prognostic factors. Variables found to be significant in univariate analysis were enrolled in multivariate analysis.

RESULTS: In the univariate analysis for median overall survival (mOS), whether or not surgery was applied as the primary treatment option, grade, lymphovascular invasion (LVI), International Metastatic RCC Database Consortium (IMDC) score, CAR, NLR, PLR, SII, PNI and SIRI were found to be statistically significant. Systemic inflammation markers (CAR, NLR, PLR, PNI, SII and SIRI) were found to be independent prognostic markers for mOS as a result of Cox multivariate analysis.

CONCLUSION: CAR, NLR, PLR, SII, PNI, and SIRI values measured before anti-VEGFR treatment in patients with mRCC may be of additional prognostic significance. These markers, which are calculated by using parameters that are always measured in routine practice, such as complete blood count (CBC), albumin, and CRP levels, are easy and inexpensive methods that give an idea about the course of the disease.

KEY WORDS: Sunitinib, Pazopanib, Renal cell carcinoma, Prognostic marker, Overall survival, Inflammatory.

PMID:37300261 | DOI:10.29271/jcpsp.2023.06.653

Am Surg. 2023 Jun 9:31348221148350. doi: 10.1177/00031348221148350. Online ahead of print.

ABSTRACT

BACKGROUND: Seminal trials have demonstrated improved survival in pancreatic adenocarcinoma with novel multiagent chemotherapy regimens. To understand the clinical ramifications of this paradigm shift, we reviewed our institutional experience.

METHODS: This retrospective cohort study utilized a prospective database at a single institution to study all patients diagnosed with and treated for pancreatic adenocarcinoma between 2000 and 2020.

RESULTS: 1,572 patients were included of which 36% were diagnosed before (Era 1) and 64% after (Era 2) 2011. Survival improved in Era 2 (Median survival 10 vs 8 months, HR .79; P < .001). The survival advantage for Era 2 was primarily seen in patients with high-risk disease (12 vs10 months, HR .71; P < .001). A similar trend was noted for patients undergoing surgical resection (26 vs 21 months, HR .80; P = .081) and with imminently resectable tumors (19 vs 15 months, HR .88; P = .4); however, this was not statistically significant. There was no survival advantage for patients with stage IV disease (4 vs 4 months). Patients in Era 2 were more likely to undergo surgery (OR 2.78; CI 2.00-3.92, P < .001). This increase was driven primarily by increased surgical resection for those with high-risk disease (42 vs 20%, OR 3.74; P < .001).

DISCUSSION/CONCLUSIONS: This single institutional study showed improved survival after the shift to novel chemotherapy regimens. This was driven by improved survival for patients with high-risk disease and may be due to more effective eradication of microscopic metastatic disease with adjuvant chemotherapy and increased resection rates.

PMID:37295019 | DOI:10.1177/00031348221148350

Altern Ther Health Med. 2023 Jun 9:AT8633. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of our study was to investigate the effect of implementing doctor-nurse integrated care combined with health education on joint function recovery, incidence of deep vein thrombosis, coping style, self-efficacy and nursing care satisfaction in patients undergoing hip arthroplasty.

METHODS: This is a clinical prospective randomized study with 83 patients who underwent total hip arthroplasty in the orthopedic department of our hospital between May 2019 and May 2022 selected by a random number table. They were divided into 2 groups: the observation group (n = 42) and the control group (n = 41). Both groups used the integrated care model during the perioperative period. Patients in the observation group were also given health education and the differences in the incidence of lower limb deep vein thrombosis, hip function score, coping style, self-efficacy and nursing satisfaction in the 2 groups were compared.

RESULTS: Preoperatively, there was no statistically significant difference between the Harris Hip Score (HHS) in the observation group and the control group (P > .05); the HHS in the observation group was higher than in the control group at 2 weeks and 1 month after surgery, and the difference was statistically significant (P < .05); there was no statistically significant difference between the confrontation, avoidance and submission scores of the 2 groups the first day after surgery (P > .05); while the confrontation and avoidance scores in the observation group were higher than in the control group at 2 weeks after surgery, with statistical significance. There was no statistically significant difference between role function, emotional control, symptom management and nurse-patient communication scores in the 2 groups the first day after surgery (P > .05); while the emotional control, symptom management and nurse-patient communication scores in the observation group were higher than in the control group at 2 weeks after surgery, and the differences were statistically significant (P < .05). Overall patient satisfaction in the observation group was better than in the control group, and the difference was statistically significant (P < .05). There was no statistically significant difference in the incidence of lower limb deep vein thrombosis in the 2 groups (P > .05).

CONCLUSION: The implementation of an integrated care model combined with health education in patients with hip arthroplasty is beneficial to improving self-efficacy, patient trauma coping style, promoting early hip function recovery and improving nursing care satisfaction.

PMID:37295015

Altern Ther Health Med. 2023 Jun 9:AT8100. Online ahead of print.

ABSTRACT

BACKGROUND: It is estimated that 25% of the patients in Pakistan experience stroke resulting in problems with language. Among many of the conditions, problem with verbal expressive production (Broca’s Aphasia) is one of the main problem faced by people having stoke. Many traditional therapies are incorporated to treat symptoms of Aphasia including fluent and non- fluent Aphasia.

OBJECTIVES: The primary objective of the current study was to determine the effectiveness of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with convention speech therapy, Melodic Intonation therapy (MIT) in enhancing the verbal expressive skills in patients with severe Broca’s Aphasia. Another objective of this study was to compare the efficacy of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with traditional therapy, as well as the quality of life of patients with severe Broca’s Aphasia.

METHODS: A randomized control trial (NCT03699605, clinicaltrials.gov) was conducted from November 2018 – June 2019 in Pakistan railway Hospital (PRH). Patients having a three-month history of severe Broca’s Aphasia, aged between 40-60 years, bilingual (Urdu and English language) and having the ability to use a smart phone were included in the study. Patients with cognitive impairments were excluded. Total of 77 patients were evaluated for eligibility criteria according to the G Power software for sample size. Out of 77, 54 individuals fulfilled the inclusion criteria. The participants were divided into 2 groups (27 each) through sealed envelope method. Patients of both groups were assessed pre and post intervention using the Boston Diagnostic Aphasia Examination (BADE) battery (Primary outcome measure). Experimental group n = 25 received VESMP-U therapy and control group n = 25 (2 drop out in each group) received MIT for 16 weeks i.e. 4 days per week having 64 sessions altogether. Each intervention session lasted up to 30-45 minutes for both groups.

RESULTS: Within and between group analysis after intervention showed that the VESMP-U group had significantly improved BDAE scores (P = .001; 95% CI) than the MIT group for all variables (articulatory intelligibility, phrase length, grammatical form, prosody/intonation, spontaneous speech, word finding, repetition, and auditory comprehension). The BDAE scores of participants in experimental group having VESMP-U therapy pre- and post-intervention were statistically significant (P = .001; 95% CI), which indicates that participant’s communication skills were enhanced by use of VESMP-U.

CONCLUSION: Android based application VESMP-U has been found to be effective in improving expression and quality of life of patients with severe Broca’s aphasia.

PMID:37295011

Altern Ther Health Med. 2023 Jun 9:AT8254. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigated the impact of combining the Coronary Heart Disease Self-Management Scale (CSMS) with narrative psychological nursing on the rehabilitation of patients with hypertension and coronary heart disease.

METHODS: A total of 300 patients with hypertension and coronary heart disease were enrolled in this study at our hospital from June 2021 to June 2022. Random number tables were used to allocate the patients into two groups, with 150 patients in each group. The control group received conventional care, while the observation group received the CSMS scale combined with narrative psychological nursing.

RESULTS: Rehabilitation efficacy, disease self-management ability, Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) were compared between the two groups. After the intervention, the observation group showed lower systolic blood pressure, diastolic blood pressure, SAS scores, and SDS scores compared to the control group, with statistically significant differences (P < .05). Additionally, the CSMS scores in the observation group were significantly higher than those in the control group.

CONCLUSIONS: The combination of the CSMS scale and narrative psychological nursing is an effective approach for rehabilitating hypertensive patients with coronary artery disease. It leads to decreased blood pressure, improved emotional well-being, and enhanced self-management abilities.

PMID:37295007

Altern Ther Health Med. 2023 Jun 9:AT8196. Online ahead of print.

ABSTRACT

OBJECTIVE: Our aim was to explore the effects of the energy-limiting balance intervention on serum uric acid (SUA) and high sensitivity C-reactive protein (hs-CRP) and analyze the correlation between the two.

METHODS: Retrospectively chosen study patients were 98 obese individuals who received diagnoses and care in Xuanwu Hospital Capital Medical University between January 2021 and September 2022. The patients were divided into the intervention group and the control group via random number table, with 49 patients in each group. The control group received standard food interventions, while the intervention group received minimal energy balance interventions. The clinical outcomes in both groups were compared. We also compared patients’ pre- and post-intervention levels of SUA, hs-CRP, and markers of glucose and lipid metabolism were assessed. Analysis was done on the relationship between markers of glucose and lipid metabolism and SUA and hs-CRP levels.

RESULTS: Patients in the intervention and control groups had respective ineffective rates of 6.12% and 20.41%, effective rates of 51.02% and 57.14%, substantial effective rates of 42.86% and 22.45% and overall effective rates of 93.88% and 79.59%. The intervention group’s overall effective rate was substantially greater than the control group’s rate (P < .05). After the intervention, patients in the intervention group had markedly decreased SUA and hs-CRP levels than patients in the control group (P < .05). Prior to the intervention, there was no clinically meaningful discrepancy between the two groups in terms of fasting blood glucose, insulin, glycated hemoglobin (HbA1c) or 2 hours postprandial blood glucose (P > .05). Following the intervention there was a statistically significant discrepancy between the intervention group and the control group in terms of fasting blood glucose, insulin, HbA1c and 2 hours postprandial blood glucose (P < .05). According to a Pearson correlation study, high-density lipoprotein (HDL) was negatively correlated with the SUA levels and positively correlated with fasting blood sugar, insulin, triglycerides, total cholesterol and low-density lipoprotein (LDL). Before the intervention, there was no clinically meaningful variation in the intervention or control groups in triglycerides, total cholesterol, LDL or HDL (P > .05). Following the intervention, patients in the intervention group had markedly decreased triglycerides, total cholesterol and LDL levels than patients in the control group, while their HDL levels had substantially increased compared with the control group (P < .05). Fasting blood sugar, insulin, triglycerides and LDL all had a positive correlation with their SUA levels (P < .05). The amount hs-CRP was inversely correlated with HDL (P < .05) and positively correlated with fasting blood glucose, insulin, 2h postprandial blood glucose, HbA1c, triglycerides and LDL.

CONCLUSION: An energy-limiting balance intervention can effectively reduce SUA and hs-CRP, regulate the metabolism of glucose and lipid and were closely related.

PMID:37295006

Altern Ther Health Med. 2023 Jun 9:AT8249. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this retrospective cohort study was to evaluate clinical outcomes in high-risk patients with symptomatic intracranial atherosclerotic stenosis (sICAS) resulting from plaque enhancement who underwent balloon dilation or stent implantation. Plaque features were identified based on high-resolution magnetic resonance vessel wall imaging (HRMR-VWI).

METHODS: A total of 37 patients with sICAS (degree of stenosis ≥70%) were enrolled between January 2018 and March 2022 at a single center. All patients underwent HRMR-VWI and received standard drug treatment after hospital admission. The patients were divided into 2 groups based on whether they underwent interventional treatment (n = 18) or non-interventional treatment (n = 19). The grade of enhancement and enhancement rate (ER) of culprit plaque were evaluated using 3D-HRMR-VWI. The risk of symptom recurrence was compared between the 2 groups during follow-up.

RESULTS: There was no statistical difference between the intervention and non-intervention groups in the rate and type of enhancement. Median clinical follow-up time was 17.8 (10.0 to 26.0) months and median follow-up time was 3.6 (3.1 to 6.2) months. In the intervention group, 2 patients had stent restenosis, but no stroke or transient ischemia attacks (TIAs) occurred. In contrast, 1 patient in the non-intervention group had an ischemic stroke and 4 patients had TIAs. The incidence of the primary outcome was lower in the intervention group than in the non-intervention group (0 vs 26.3%; P = .046).

CONCLUSIONS: High-resolution magnetic resonance intracranial vessel wall imaging (HR MR-IVWI) can be used to identify vulnerable plaque features. It is safe and effective in high-risk patients with sICAS with responsible plaque enhancement to undergo intravascular intervention combined with standard drug therapy. Further studies are needed to analyze the link between plaque enhancement and symptom recurrence in the medication group at baseline.

PMID:37295005

Acta Orthop Belg. 2023 Mar;89(1):162-166. doi: 10.52628/89.1.11240.

ABSTRACT

Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function and assisting in clinical decision making. The Western Ontario Rotator Cuff (WORC) index is the PROM for shoulder pathology with the most psychometric properties but is very time consuming. The Single Assessment Numeric Evaluation (SANE) method is a PROM that takes less time to answer and to analyze. The aim of the study is to evaluate the intra- class correlation between these two outcome scores in establishing shoulder function in patients with non-traumatic rotator cuff pathologies. Fifty five subjects of both genders and different ages presenting with non-traumatic shoulder pain for more than 12 weeks had a physical examination and ultrasound as well as MRI arthrogram scan findings that were consistent of a non-traumatic rotator cuff (RC) based pathology. On the same moment a WORC index and a SANE score questionnaire were filled in by the subject. The intra class correlation of both PROMs was statistically analyzed. The WORC index score and the SANE score show a moderate correlation with an Intra Class Coefficient (ICC) of r = 0.60 (95% CI:0.40-0.75). This study demonstrates a moderate correlation between the WORC index score and the SANE score in rating the disability of patients with atraumatic RC disease. The SANE score is applicable in research and clinical practice and is for the patient and the researcher an almost no time consuming PROM.

PMID:37295002 | DOI:10.52628/89.1.11240

Acta Orthop Belg. 2023 Mar;89(1):135-140. doi: 10.52628/89.1.9726.

ABSTRACT

Tibial plateau fractures are usually associated with soft tissue injury. This study aimed to use the extent of joint depression and lateral widening in computed tomography (CT) to predict the soft tissue injury accompanying fractures.The study included 23 patients with type Arbeitsgemeinschaft für Osteosynthesefragen-classified 41B fractures. Demographics, mechanism of injury, age, gender, and injury sites were assessed. Post-traumatic radiography, magnetic resonance imaging (MRI), and CT were obtained. MRI evaluated the meniscal, cruciate, and collateral ligament injuries, and CT measured the extent of joint depression and lateral widening in millimeters using digital imaging software. The relationship between joint depression, lateral widening, and soft tissue injuries was statistically analyzed. Of the 23 patients, 17 (74%) were males and 6 (26%) were females. Lateral meniscus injuries increased and the risk of bucket handle lateral meniscus tears increased as the CT joint depression exceeded 12 mm (p < 0.05). Joint depression of <5.9 mm was associated with medial meniscus injury (p < 0.05). The mean distribution examination of all soft tissue injuries and joint depression revealed no statistically significant difference between the groups (p > 0.05). Increased joint depression in lateral tibial plateau fractures increases the risk of lateral meniscus bucket handle tear, and decreased joint depression increases the risk of medial meniscus injury. Accordingly implementing the treatment plan and patient management will improve the clinical outcomes.

PMID:37294997 | DOI:10.52628/89.1.9726