Tag: nevin manimala

Can Fam Physician. 2021 Aug;67(8):601-607. doi: 10.46747/cfp.6708601.

ABSTRACT

OBJECTIVE: To test the feasibility of reporting diabetes indicators at a regional and community level in order to provide feedback to local leaders on health system performance.

DESIGN: Analysis of administrative data from hospital discharges and physician billings.

SETTING: Sioux Lookout region of Ontario.

PARTICIPANTS: Residents from 30 remote communities served by the Sioux Lookout First Nations Health Authority.

MAIN OUTCOME MEASURES: Incidence and prevalence of diabetes and incidence of diabetes complications, including heart attack, stroke, retinopathy, amputations, end-stage kidney disease, diabetes-related hospitalizations, and death.

RESULTS: Data were available for 18 542 residents from the 30 remote communities. Residents were almost entirely of First Nations descent. The prevalence of diabetes was 12.9%, the annual incidence was 1.0%, and the annual rate of complications was 5.4% in 2015-2016. Prevalence increased slightly over time. We had sufficient data to report prevalence in 25 of 30 communities (average population 738; range 234 to 2626). We reported statistically significant differences in prevalence by community; 8 were above average and 2 were below average. For diabetes complications, data were pooled over 5 years, and while community-level results could be reported, the variance was too high to allow detection of significant differences. Using 2-tailed t tests for difference of proportions, we determined that grouping communities into subregions of approximately 2000 persons would permit the detection of differences of 30% from the average 5-year complication rate.

CONCLUSION: This study demonstrates the possibility of reporting diabetes prevalence by individual First Nations reserve communities. Complication rates can be reported by individual community, but estimates are more useful for comparison if the smallest communities are grouped together. Such studies could be replicated across Canada to promote local use of these data for resource planning and monitoring long-term progress of diabetes programs and services.

PMID:34385208 | DOI:10.46747/cfp.6708601

BMJ Open. 2021 Aug 12;11(8):e044698. doi: 10.1136/bmjopen-2020-044698.

ABSTRACT

BACKGROUND: Drug-resistant tuberculosis (DR-TB) continues to be a major public health threat posing a critical challenge to TB treatment and control worldwide. The present study was conducted among patients with DR-TB of the Saharia tribe residing in Madhya Pradesh state of Central India to document their experiences and needs, and to identify gaps for treatment adherence as this population is known to be poor because of migration and other factors.

METHODS: We conducted 16 in-depth interviews on purposively selected patients with DR-TB among the Saharia tribe using a predesigned open-ended in-depth interview guide, which included questions on domains like general physical health, diagnosis, treatment adherence, side-effects of drugs and experience related to the health facility. Out of these interviews, various subthemes were extracted. The obtained qualitative data were subjected to thematic analysis.

RESULTS: The study helped to understand the experiences and needs of the patients with DR-TB in various stages from diagnosis to treatment. Also, there was the impact of factors like lack of education and awareness, poor living conditions and lack of healthcare facilities on predominance of the disease in the community. Poor access to a healthcare facility, high pill burden and related side-effects, longer duration of treatment, financial burden, misbeliefs and misconceptions were prominent issues posing a challenge to treatment adherence. The narratives pointed out their struggle at every stage be it with diagnosis, treatment initiation or treatment adherence.

CONCLUSION: It is paramount to address the needs and experiences of patients with DR-TB to develop a patient-centric and context-specific approach conducive to the sociocultural set-up of tribal people. This will scale down the attrition rate of tribal patients while adhering to the complete treatment process and reducing the high burden of TB among the Saharia community. In addition, tribal patients should be counselled at regular intervals to increase their confidence in the treatment.

PMID:34385228 | DOI:10.1136/bmjopen-2020-044698

BMJ Open. 2021 Aug 12;11(8):e045313. doi: 10.1136/bmjopen-2020-045313.

ABSTRACT

INTRODUCTION: COVID-19 pandemic has an impact on mortality indicators worldwide. Mitigation and repression actions to reduce the morbidity and mortality associated with the disease are necessary. However, they are criticised in the economic, social and psychological spheres. This social isolation, increased unemployment, routine changes, news of health complications and deaths related to COVID-19 can cause psychological repercussions that will certainly intensify in the coming months, and suicidal behaviour presents itself as a fatal outcome. It is necessary to know factors associated with suicidal behaviour in adults during the pandemic. Although there are studies, there is no systematic review to assess these factors, specifically in adults. The objective is to critically synthesise the scientific evidence on the factors associated with suicidal behaviour in adults in the COVID-19 pandemic.

METHODS AND ANALYSES: A systematic review will be carried out, recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, in seven databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), ISI of Knowledge, Excerpta Medica Database (EMBASE), SCOPUS, Latin American and Caribbean Health Sciences Literature (LILACS), Chinese National Knowledge Infrastructure (PsycINFO), Chinese National Knowledge Infrastructure (CNKI) and ScienceDirect. Preliminary search was carried out on 30 July 2020 and will be updated in March 2021. No restrictions on publication date, study location or languages will be considered in this review. The preliminary research strategies were carried out on 30 July 2020 and will be updated in February 2021. To measure the agreement between reviewers at each screening stage, Cohen’s Kappa will be calculated. Primary outcome will be factors related to suicidal behaviour in adults during COVID-19 pandemic. Grouped standardised mean differences and 95% CIs will be calculated. The risk of bias in observational studies will be assessed using the Methodological Index for Non-Randomised Studies (MINORS). Statistical heterogeneity will be assessed with the I2 statistic.

ETHICS AND DISCLOSURE: Ethical approval is not required, as primary data will not be collected. The findings will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER: CRD42020208816.

PMID:34385230 | DOI:10.1136/bmjopen-2020-045313

Int J Gynecol Cancer. 2021 Aug 12:ijgc-2021-002692. doi: 10.1136/ijgc-2021-002692. Online ahead of print.

ABSTRACT

OBJECTIVES: The goal of this study was to determine the impact refusal of surgery has on overall survival in patients with endometrial cancer.

METHODS: From January 2004 to December 2015, the National Cancer Database was queried for patients with pathologically proven endometrial cancer who were recommended surgery and refused. Inverse probability of treatment weighting was used to account for differences in baseline characteristics between patients who underwent surgery and those who refused. Kaplan-Meier analyses and doubly robust estimation with multivariate Cox proportional hazards modeling were used to analyze overall survival.

RESULTS: Of the 300 675 patients identified, 534 patients (0.2%) were recommended surgical treatment but refused: 18% (95/534) were age ≤40 years. The 5-year overall survival for all patients who refused surgery was significantly decreased compared with patients who underwent surgery (29.2% vs 71.9%, P<0.01). This was demonstrated at ages 41-64 years (65.5% vs 91.0%, P<0.01) and ≥65 years (23.4% vs 75.3%, P<0.01). The 5-year overall survival did not meet statistical significance at age ≤40 years (90.1% vs 87.8% P<0.19). However, there were few patients in this cohort. On multivariate analysis, factors associated with refusal of surgery included: Medicaid insurance, Black race, Hispanic Race, Charlson Comorbidity Index scores of 2 or greater, stage II or III, and if patient received external beam radiation therapy alone. Factors associated with undergoing surgery included: age greater than 41, stage IB, and if the patient received brachytherapy.

CONCLUSIONS: Refusal of surgery for endometrial cancer is uncommon and leads to decreased overall survival.

PMID:34385179 | DOI:10.1136/ijgc-2021-002692

Zhonghua Xue Ye Xue Za Zhi. 2021 Jun 14;42(6):466-473. doi: 10.3760/cma.j.issn.0253-2727.2021.06.005.

ABSTRACT

Objective: To explore the relationship between the reconstitution of immune cells in patients with hematological malignancies and the occurrence of chronic graft-versus-host disease (cGVHD) after treatment with unrelated cord blood transplantation (UCBT) and sibling peripheral blood stem cell transplantation (PBSCT) . Methods: A total of 124 patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) in the First Affiliated Hospital of University of Science and Technology of China from March 2018 to August 2019, including 96 patients with UCBT and 28 patients with PBSCT. Peripheral blood immune cells of patients with UCBT and PBSCT were detected at 1, 3, 6, 9, and 12 months after transplantation using flow cytometry, and both UCBT and PBSCT patients were divided into cGVHD and non-cGVHD groups based on whether cGVHD occurred to explore the correlation between the immune cells reconstitution of the two types of transplantation and cGVHD. Results: ①The cumulative incidence of the moderate to severe cGVHD in the UCBT group was significantly lower than that in the PBSCT group[9.38% (95% CI 3.35%-15.02%) vs 28.57% (95% CI 9.72%-43.50%) , P=0.008]; the 2-year cumulative incidence of cGVHD and moderate to severe cGVHD in the UCBT group was lower than that in the PBSCT group[15.60% (95% CI 9.20%-23.60%) vs 32.10% (95% CI 15.80%-49.70%) , P=0.047; 10.40% (95% CI 5.30%-17.50%) vs 28.60% (95% CI 13.30%-46.00%) , P=0.014]. ②The absolute counts of CD4(+)T cells in the UCBT group were higher than those in the PBSCT group at 6, 9, and 12 months after transplantation[59.00 (36.70-89.65) ×10(7)/L vs 31.40 (18.10-44.00) ×10(7)/L, P<0.001; 71.30 (49.60-101.45) ×10(7)/L vs 41.60 (25.82-56.27) ×10(7)/L, P<0.001; 83.00 (50.17-121.55) ×10(7)/L vs 44.85 (31.62-62.10) ×10(7)/L, P<0.001]; the proportions of CD4(+)T cells in the UCBT group were always higher than those in the PBSCT group (P<0.05) . The absolute counts and proportions of B cells in the PBSCT group were higher than those in the UCBT group at the first month after transplantation[0.70 (0.30-1.70) ×10(7)/L vs 0.10 (0-0.30) ×10(7)/L, P<0.001; 0.45% (0.30%-2.20%) vs 0.20% (0.10%-0.40%) , P=0.002]; the absolute counts and proportions of B cells in the UCBT group were higher than those in the PBSCT group at 9 and 12 months after transplantation[53.80 (28.00-103.20) ×10(7)/L vs 23.35 (5.07-35.00) ×10(7)/L, P<0.001; 21.45 (11.80-30.45) % vs 9.00% (3.08%-16.73%) , P<0.001. 66.70 (36.97-98.72) ×10(7)/L vs 20.85 (7.72-39.40) ×10(7)/L, P<0.001; 22.20% (14.93%-29.68%) vs 8.75% (5.80%-18.93%) , P<0.001]. The absolute counts and proportions of regulatory B (Breg) cells in the UCBT group were higher than those in the PBSCT group at 6, 9, and 12 months after transplantation[1.23 (0.38-3.52) ×10(7)/L vs 0.05 (0-0.84) ×10(7)/L, P<0.001; 5.35% (1.90%-12.20%) vs 1.45% (0-7.78%) , P=0.002. 2.25 (1.07-6.71) ×10(7)/L vs 0.12 (0-0.77) ×10(7)/L, P<0.001; 6.25% (2.00%-12.33%) vs 0.80% (0-5.25%) , P<0.001. 3.69 (0.83-8.66) ×10(7)/L vs 0.46 (0-0.93) ×10(7)/L, P<0.001; 6.15% (1.63%-11.75%) vs 1.40% (0.18%-5.85%) , P<0.001].The absolute counts and proportions of CD3(+)T cells, CD8(+)T cells, and Treg cells in the UCBT group were not significantly different from those in the PBSCT group. ③The absolute counts of B cells in the non-cGVHD group of UCBT patients were higher than those in the moderate to severe cGVHD group at 6 and 12 months after transplantation (P=0.038, P=0.043) ; the proportions of B cells in the non-cGVHD group were higher than those in the moderate to severe cGVHD group at 6 months after transplantation (P=0.049) . The absolute counts of Breg cells in the non-cGVHD group of patients with UCBT were higher than those in the moderate to severe cGVHD group at 6, 9, and 12 months after transplantation (P=0.006, P=0.028, P=0.050) ; the proportions of Breg cells in the non-cGVHD group were higher than those in the moderate to severe cGVHD group at 9 months after transplantation (P=0.038) . ④The absolute counts and proportions of B and Breg cells in the non-cGVHD group of patients with PBSCT were not statistically different than those in the moderate to severe cGVHD group. Conclusion: In the process of immune cell reconstitution, the Breg cells in the UCBT group were higher than those in the PBSCT group, and the Breg cells in the non-cGVHD group of the two types of transplantation were always higher than those in the moderate to severe cGVHD group, indicating that Breg cells can reduce the occurrence of cGVHD, revealing the possible reason for the lower incidence of cGVHD in the UCBT group.

PMID:34384152 | DOI:10.3760/cma.j.issn.0253-2727.2021.06.005

Zhonghua Xue Ye Xue Za Zhi. 2021 Jun 14;42(6):480-486. doi: 10.3760/cma.j.issn.0253-2727.2021.06.007.

ABSTRACT

Objective: To analyze the genetic landscape of multiple fusion genes in patients with de novo acute myeloid leukemia (AML) and investigate the characteristics of immunophenotypes and mutations. Methods: The results of multiple fusion genes from 4192 patients with de novo AML were retrospectively analyzed from 2016 to 2020. In addition, the immunophenotypical data and the mutational results from high-through put method were statistically investigated and correlated as well. Results: ①Among the 52 targets, 29 different types of fusion genes were detected in 1948 patients (46.47%) with AML, which demonstrated an “exponential distribution” . ② As the age increased, the number of patients with fusion gene increased first and then decreased gradually. The total incidence rate of fusion genes and MLL rearrangment in children were significantly higher than those in adults (69.18% vs 44.76%, 15.35% vs 8.36%) . ③The mutations involving FLT3 and RAS signaling pathway contributed most in patients with MLL rearrangment. ④No specific immunophenotypic characteristics were found in AML patients with MLL or NUP98 rearrangements. Conclusion: Nearly half of AML patients were accompanied by specific fusion gene expression, the proportions of different fusion genes in pediatric and adults patients were different by multiple PCR. The gene mutations and immunophenotype of these AML patients have certain rules.

PMID:34384154 | DOI:10.3760/cma.j.issn.0253-2727.2021.06.007

Clin Chem Lab Med. 2021 Aug 11. doi: 10.1515/cclm-2021-0747. Online ahead of print.

ABSTRACT

OBJECTIVES: Low-density lipoprotein cholesterol (LDL-C) estimation is critical for risk classification, prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). Predictive equations and direct LDL-C are used. We investigated the comparability between the Martin/Hopkins, Sampson, Friedewald and eight other predictive equations on two analysers, to determine whether the equation or analyser influences predicted LDL-C result.

METHODS: In two unpaired datasets, 9,995 lipid profiles were analysed by the Abbott Architect and 4,782 by the Roche Cobas analysers. Non-parametric statistics and Bland Altman plots were used to compare LDL-C.

RESULTS: On the Abbott analyser; the Martin/Hopkins, Sampson and Friedewald LDL-C were comparable (median bias ≤1.8%) over a range of 1-4.9 mmol/L. On the Roche platform, Martin/Hopkins LDL-C was comparable to Friedewald (median bias 0.3%) but not to Sampson LDL-C (median bias 25%). In patients with LDL-C <1.8 mmol/L and triglycerides (TG) ≤1.7 mmol/L, predicted LDL-C using Abbott reagents was similar between Martin/Hopkins, Sampson and Friedewald equations but not comparable using Roche reagents. Abbott reagents classified 10-20% of patients in the 1.0-1.8 mmol/L range (Martin/Hopkins 13.4%; Sampson 14.5%; Friedewald 16%; direct LDL-C 13.2%). Roche reagents classified 11-30% in the 1.0-1.8 mmol/L range (Martin/Hopkins 23%; Sampson 11%; Friedewald 25%; direct LDL-C 17%).

CONCLUSIONS: Performance of predictive equations is influenced by the choice of analyser for total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and TG. Replacement of the Friedewald equation with Martin/Hopkins estimation to improve quality of LDL-C results can be safely implemented across analysers, whereas caution is advised regarding the Sampson equation.

PMID:34384146 | DOI:10.1515/cclm-2021-0747

Zhonghua Xue Ye Xue Za Zhi. 2021 Jun 14;42(6):459-465. doi: 10.3760/cma.j.issn.0253-2727.2021.06.004.

ABSTRACT

Objective: To investigate the expression of SET-NUP214 fusion gene in hematological malignancies and to analyze its related clinical biological characteristics. Methods: The clinical data of 24 patients with SET-NUP214 fusion gene-positive hematological malignancies were retrospectively analyzed, and the Kaplan-Meier method was used for survival analysis. Results: Among the 24 patients with SET-NUP214 fusion gene, 15 cases of acute lymphoblastic leukemia (ALL) (13 cases of T-ALL and 2 cases of B-ALL) , 7 cases of acute myeloid leukemia (AML) , and 2 cases of T/myeloid mixed acute leukemia have been identified. The immunophenotype of 13 cases of T-ALL was mainly characterized by CD3(+)CD2(-), 73.3% of ALL was characterized by myeloid marker expression, and 85.7% of AML was characterized by CD7 expression. Complete remission (CR) was achieved in 22 patients (91.7%) after induction chemotherapy. All 24 patients received allogeneic hematopoietic stem cell transplantation (HSCT) . With a median follow-up of 24 months, the 3-year relapse free survival (RFS) of AML and ALL was 85.7% and 33.3%, respectively (P=0.128) . Comparing 13 cases of SET-NUP214-positive and 62 cases of SET-NUP214-negative T-ALL, the CR rates of induction chemotherapy were 92.3% and 93.5% (P=0.445) , and the 4-week CR rates of induction chemotherapy were 69.2% and 72.6%, respectively (P=0.187) ; the differences were not statistically significant. After HSCT, the 3-year RFS of SET-NUP214(+)T-ALL and SET-NUP214(-)T-ALL was 38.5% and 66.4%, respectively (P=0.028) , and the difference was statistically significant. Conclusion: The SET-NUP214 fusion gene is mainly detected in T cell-derived hematological malignancies, and the prognosis of SET-NUP214 positive T-ALL is relatively poor.

PMID:34384151 | DOI:10.3760/cma.j.issn.0253-2727.2021.06.004

Eur J Dent. 2021 Aug 12. doi: 10.1055/s-0041-1731831. Online ahead of print.

ABSTRACT

OBJECTIVES: Polymethyl methacrylate as the most common material used in denture bases has some problems. The aim of this study was to introduce a new nanocomposite of PMMA to improve flexural strength and antifungal properties.

MATERIALS AND METHODS: In this experimental study, AgSiO₂ nanoparticles were prepared, and their characteristics were confirmed by scanning electron microscope and energy dispersive spectroscopy techniques. Then the nanoparticles in the weight ratio of 0.1, 0.3, 0.5, and 0.7% were incorporated to heat-cured PMMA and the control group included no nanoparticles.To measure the flexural strength before and after thermocycling three-point bending test was used. Eight samples per group with dimensions of 65 × 10 × 2.5 mm were used. Antifungal activity against Candida albicans (PTCC 5027) was investigated through colony count method. Statistical analysis was done by SPSS at significance level of p-value ≤0.05.

RESULTS: The mean flexural strength in groups 0.1, 0.3, and 0.7% was significantly higher than the control. After thermocycling flexural strength of the control group was significantly lower than 0.3 and 0.5% groups. As the concentration of nanoparticles increased the antifungal activity improved (p < 0.05).

CONCLUSION: Addition of nanoparticles AgSiO₂ improved flexural strength and antifungal characteristics of PMMA.

PMID:34384125 | DOI:10.1055/s-0041-1731831

ORL J Otorhinolaryngol Relat Spec. 2021 Aug 12:1-6. doi: 10.1159/000517561. Online ahead of print.

ABSTRACT

INTRODUCTION: Unilateral vocal fold paralysis (UVFP) was a relative common glottic insufficiency disease; however, a completely satisfactory treatment of UVFP was elusive. This study was aimed to evaluate the surgical efficacy of modified arytenoid adduction with fenestration of the thyroid cartilage in the management of patients with UVFP, including voice and aspiration outcomes, and to summarize the postoperative complications.

METHODS: A retrospective analysis was performed on a total of 21 patients who underwent modified arytenoid adduction operation with fenestration of the thyroid cartilage for UVFP from July 2012 to June 2017. The scores of Grade, Roughness, Breathiness, Asthenia, Strain scale (GRBAS), voice self-satisfaction, dynamic laryngoscopy and the voice acoustic data (fundamental frequency [F0], fundamental frequency perturbation [jitter], loudness, amplitude perturbation [shimmer], and maximal phonatory time [MPT], etc.) were statistically analyzed preoperatively and 3-6 months postoperatively. The occurrence of postoperative complications was also summarized.

RESULTS: The voice subjective perception of 21 patients was significantly improved after operation. The rate of voice self-satisfaction was 90.5%. The mean values of voice acoustics parameters were significantly improved. The MPT was significantly longer (p < 0.001), and the ratings of postoperative aspiration were significantly decreased compared with the preoperation. Among the 21 patients, 15 cases had sense of laryngeal obstruction, 8 cases had of 1-2° laryngemphraxis (recovered after 10-15 days). There were 2 cases of laryngeal stridor, 1 case of incision infection, 1 case of pharyngeal fistula, and 1 case of falsetto (corrected by voice training). No patient had laryngeal hematoma, neck hematoma, or laryngospasm.

CONCLUSION: The modified arytenoid adduction operation with fenestration of the thyroid cartilage can significantly improve the vocal function of patients with UVFP and effectively reduce the aspiration, with fewer postoperative complications, less trauma, and more convenient advantages.

PMID:34384083 | DOI:10.1159/000517561