Tag: pubmed

J Cancer Educ. 2024 Jul 16. doi: 10.1007/s13187-024-02472-3. Online ahead of print.

ABSTRACT

Breast cancer remains a significant global health challenge, particularly in low- and middle-income countries where disparities in healthcare exacerbate the disease burden. The Breast Cancer Comprehensive Center at the National Cancer Institute, Cairo University, has implemented integrated patient navigation and education programs aimed at enhancing patient outcomes and healthcare quality. This study evaluated the effectiveness of these programs involving 2202 participants over 12 months. The methodology included systematic data collection, material preparation, and the application of tailored educational strategies to facilitate the patient’s journey from diagnosis to treatment. The study utilized three-phased patient navigation assistance to provide comprehensive support. The programs significantly improved patient satisfaction, with over 90% of participants reporting high levels of contentment with the services received. Key improvements included enhanced understanding of breast cancer (including risk factors, symptoms, importance of seeking early care, and treatment options), reduction in patient anxiety, improved treatment adherence, and streamlined diagnostic and treatment processes. Notably, the use of audio-visual educational tools effectively bridged the literacy gap among patients. The integration of patient navigation and education systems at BCCC-NCI has proven to be a highly effective model for improving breast cancer care. This model not only enhances patient understanding and treatment compliance but also facilitates a more efficient healthcare process. The study underscores the potential for replicating this approach in similar healthcare settings globally, suggesting that such integrations can significantly improve cancer care outcomes.

PMID:39012556 | DOI:10.1007/s13187-024-02472-3

Clin Drug Investig. 2024 Jul 16. doi: 10.1007/s40261-024-01382-y. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The estimated prevalence of atopic dermatitis (AD) among adolescents (12-17 years of age) is about 14.8%. AD compromises sleep quality and may be associated with poor scholastic performance, mood disruptions, low self-esteem, and difficulty in building social relationships. Upadacitinib was recently approved by the European Medicines Agency for the treatment of moderate-to-severe AD in patients aged ≥ 12 years who are candidates for systemic treatment. The aim of this real-world study was to determine the effectiveness in disease control and safety of upadacitinib in adolescents aged 12-17 years with moderate-to-severe AD.

METHODS: This is a retrospective study in adolescents with moderate-to-severe AD treated with upadacitinib 15 mg between July 2022 and February 2024 at six Italian dermatological referral centres. The primary endpoint was to analyse the evolution of the response in terms of absolute Eczema Area and Severity Index (EASI) value, as well as the percentage of patients achieving 75% and 90% improvement in EASI (EASI75 and EASI90) from baseline to weeks (W) 4, 16, 24, and 52. Secondary endpoints included the assessment of treatment efficacy in terms of Numerical Rating Scale (NRS) for pruritus (P-NRS) and sleep (S-NRS), Children’s Dermatology Life Quality Index (c-DLQI), and safety.

RESULTS: Thirty-six patients [males: 18 (50%)] were evaluated. A statistically significant improvement of EASI was observed at each timepoint, as stated by a mean percentage reduction from baseline of 72.2% at W4, 82.7% at W16, of 86.4% at W24 (n = 34) and of 92.7% at W52 (n = 18) (p < 0.0001). At W4, 21/36 (58.3%) achieved EASI75 and 12/36 (33.3%) EASI90. At W16, 29/36 (80.5%) achieved EASI75 and 19/36 (52.8%) EASI90. At W24, 32/34 (94.1%) reached EASI75 and 24/34 (70.6%) EASI90. Finally, at W52 all the assessed patients (n = 18) maintained EASI75 and 14/18 (77.7%) reached EASI90. Likewise, a statistically significant reduction of c-DLQI, P-NRS and S-NRS was observed at each timepoint.

CONCLUSION: Our real-world experience seems to confirm the efficacy and safety of upadacitinib for the long-term treatment of moderate-to-severe AD in adolescents.

PMID:39012535 | DOI:10.1007/s40261-024-01382-y

Environ Sci Pollut Res Int. 2024 Jul 16. doi: 10.1007/s11356-024-34242-5. Online ahead of print.

ABSTRACT

The patterns of the potentially toxic elements (PTEs: Cr, Fe, Ni, Cu, Zn, As, Mo, Pb, Hg) distribution in soils were studied together with the health risk assessment in the area of ore mineralization, past gold activity, and tailing effects of the Sarala gold-ore group located in the Republic of Khakassia, Russia. High PTE concentrations were found in soils with the presence of potential negative impact on human health based on the following: local background investigation, according to statistics; geochemical, environmental, and human health risk calculations; and comparative analysis using international and local reference, such as continental crust, clarke, and permissible concentrations. Sources of PTE soil enrichment and pollution were statistically identified in ascending order of degree: geogenic (local background) < geogenic-technogenic (sites with geological exploration traces – trenches) < technogenic (waste tailings). The main pollutants are Hg and As which showed moderate to significant ecological risk. Negative impact of Cr on soils was found. The pollution degree and toxicity (moderate to significant) of other PTEs increase in the location of ore mineralization zone with exploration trenches and waste tailings. Arsenic poses a carcinogenic risk to adults and children upon contact with polluted soils and non-carcinogenic effect on children in areas affected by tailings and ore mineralization zone. The non-carcinogenic effect of Fe on children was found in soils of all sites. The results provide useful information regarding the studied PTEs and their impact on the environment and human health. Such information can be helpful for the state-level decision-making process when addressing solutions for contaminated areas.

PMID:39012531 | DOI:10.1007/s11356-024-34242-5

Clin Res Cardiol. 2024 Jul 16. doi: 10.1007/s00392-024-02486-3. Online ahead of print.

ABSTRACT

BACKGROUND: Leaflet thrombosis (LT) is a multifaceted and underexplored condition that can manifest following transcatheter aortic valve implantation (TAVI). The objective of this study was to formulate a prediction model based on laboratory assessments and clinical parameters, providing additional guidance and insight into this relatively unexplored aspect of post-TAVI complications.

METHODS: The present study was an observational prospective hypothesis-generating study, including 101 patients who underwent TAVI and a screening for LT (the primary endpoint) by multidetector computed tomography (MDCT). All images were acquired on a third-generation dual-source CT system. Levels of von Willebrand factor (vWF) activity, hemoglobin (Hb), and lactate dehydrogenase (LDH) were measured among other parameters. A predictive score utilizing binary logistic regression, Kaplan-Meier time-to-event analysis, and receiver operating characteristics (ROC) analysis was established.

RESULTS: LT (11 subclinical and 2 clinical) was detected in 13 of 101 patients (13%) after a median time to screening by MDCT of 105 days (IQR, 98-129 days). Elevated levels of vWF activity (> 188%) pre-TAVI, decreased Hb values (< 11.9 g/dL), as well as increased levels of LDH (> 312 U/L) post-TAVI and absence of oral anticoagulation (OAC) were found in patients with subsequent LT formation as compared to patients without LT. The established EFFORT score ranged from – 1 to 3 points, with an increased probability for LT development in patients with ≥ 2 points (85.7% of LT cases) vs < 2 points (14.3% of LT cases; p < 0.001). Achieving an EFFORT score of ≥ 2 points was found to be significantly associated with a 10.8 times higher likelihood of developing an LT (p = 0.001). The EFFORT score has an excellent c-statistic (area under the curve (AUC) = 0.89; 95% CI 0.74-1.00; p = 0.001) and a high negative predictive value (98%).

CONCLUSION: An EFFORT score might be a helpful tool to predict LT development and could be used in risk assessment, if validated in confirmatory studies. Therefore, the score has the potential to guide the stratification of individuals for the planning of subsequent MDCT screenings.

PMID:39012508 | DOI:10.1007/s00392-024-02486-3

Pediatr Surg Int. 2024 Jul 16;40(1):192. doi: 10.1007/s00383-024-05772-3.

ABSTRACT

INTRODUCTION: Trauma is the leading cause of paediatric mortality and morbidity. Stay-home regulations for coronavirus disease 2019 (COVID-19) reportedly changed trauma severity, yet data from Hong Kong were lacking. This study examined Hong Kong’s spectrum of paediatric trauma and addressed knowledge gaps concerning epidemiological changes during COVID-19.

METHODS: Children with traumatic injuries who attended a tertiary trauma centre from January 2010 to March 2022 were included in this retrospective, cross-sectional study. We analysed demographic and clinical data and conducted unadjusted bivariate analyses of injury patterns before and after the pandemic.

RESULTS: In total, 725 children attended the Accident and Emergency Department due to trauma, 585 before and 140 during COVID-19. The male-to-female ratio was 1.84:1. The 90-day trauma-related mortality was 0.7%. The overall Injury Severity Score was 3.52 ± 5.95. The paediatric trauma incidence was similar before and after social-distancing policies (both 5.8 cases monthly). Gender, ISS distribution, intensive care unit stay length, and hospital stay length values were similar (p > 0.05). Trauma call activation (8.4% vs. 5.7%, p = 0.002) and road traffic accidents (10.6% vs. 5.7%, p = 0.009) significantly decreased, yet younger-patient injuries (< 10 years old; 85.7% vs. 71%, p < 0.001), burns (28% vs. 45.7%, p < 0.001), and domestic injuries (65.5% vs. 85.7%, p < 0.001) significantly increased. No significant self-harm, assault, or abuse increases were found.

CONCLUSIONS: The paediatric trauma incidences were similar before and during the pandemic. However, domestic and burn injuries significantly increased, highlighting the importance of injury prevention.

PMID:39012503 | DOI:10.1007/s00383-024-05772-3

Ann Surg Oncol. 2024 Jul 16. doi: 10.1245/s10434-024-15756-1. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with peritoneal carcinomatosis often suffer from loss of skeletal muscle mass and require extensive surgery. Multimodal prehabilitation may improve physical status but its benefits for these specific patients remain unknown. This study aimed to evaluate the effect of prehabilitation on functional walking capacity and skeletal muscle mass, as well as its association with postoperative complications.

PATIENTS AND METHODS: A prospective study of patients with peritoneal carcinomatosis following a home-based trimodal prehabilitation program was carried out. Functional walking capacity was assessed with the 6-min walk test (T6MWT), and by the appendicular skeletal muscle index (ASMI) estimated by bioelectrical impedance analysis. Data were collected at the first medical appointment and on the day before surgery. A 90-day postoperative morbidity was registered according to the Clavien-Dindo classification.

RESULTS: A total of 62 patients were included in the analysis. Women were more prevalent (77.4%) and peritoneal metastasis from ovarian origin accounted for 48.4%. Clavien II-V grades occurred in 30 (57.7%) patients. After prehabilitation, functional walking capacity improved by 42.2 m (39.62-44.72 m) compared with baseline data (p < 0.001), but no improvement was observed in the ASMI (p = 0.301). Patients able to walk at least 360 m after prehabilitation suffered fewer Clavien-Dindo II-V postoperative complications (p = 0.016). A T6MWT of less than 360 m was identified as an independent risk factor in the multivariable analysis (OR 3.99; 1.01-15.79 p = 0.048).

CONCLUSIONS: This home-based trimodal prehabilitation program improved functional walking capacity but not ASMI scores in patients with peritoneal metastasis before surgery. A T6MWT of less than 360 m was found to be a risk factor for postoperative complications.

PMID:39012464 | DOI:10.1245/s10434-024-15756-1

Environ Monit Assess. 2024 Jul 16;196(8):740. doi: 10.1007/s10661-024-12911-9.

ABSTRACT

Land use land cover (LULC) change, global environmental change, and sustainable change are frequently discussed topics in research at the moment. It is important to determine the historical LULC change process for effective environmental planning and the most appropriate use of land resources. This study analysed the spatial autocorrelation of the land use structure in Konya between 1990 and 2018. For this, Global and Local Moran’s I indices based on land use data from 122 neighbourhoods and hot spot analysis (Getis-Ord Gi*) methods were applied to measure the spatial correlation of changes and to determine statistically significant hot and cold spatial clusters. According to the research results, the growth of urban areas has largely destroyed the most productive agricultural lands in the region. This change showed high spatial clustering both on an area and a proportional basis in the northern and southern parts of the city. On the other hand, the growth in the industrial area suppressed the pasture areas the most in the north-eastern region of the city, and this region showed high spatial clustering on both spatial and proportional scales.

PMID:39012437 | DOI:10.1007/s10661-024-12911-9

Sleep Breath. 2024 Jul 16. doi: 10.1007/s11325-024-03105-1. Online ahead of print.

ABSTRACT

PURPOSE: To continuously and dynamically monitor the sleep status of patients in the acute phase of cerebral infarction, and to investigate the characteristics of acute cerebral infarction(ACI)associated with sleep-disordered breathing (SDB), variations in sleep structure, and changes in sleep circadian rhythms.

METHODS: Patients with ACI within 48 h of onset who were admitted to the Department of Neurology at Kailuan General Hospital from November 2020 to December 2022 were selected. Detailed baseline information such as age, gender, smoking history, drinking history, were recorded for the selected participants. From the beginning of their hospitalization, the selected participants were monitored for their sleep status continuously for 5 days using the Intelligent Mattress-based Sleep Monitoring Platform System(IMSMPS). Based on the heart rate data obtained from the monitoring, the interdaily stability (IS) and intradaily variability (IV) of the sleep circadian rhythm were calculated.

RESULTS: 1,367 patients with ACI were selected. Monitoring results over 5 days indicated 147 cases (10.75%) without SDB, and 1,220 cases (89.25%) with SDB. Among the group with SDB, there were 248 cases (18.14%) with continuous mild SDB, 395 cases (28.90%) with moderate SDB, 295 cases (21.58%) with severe SDB, and 282 cases (20.63%) that fluctuated between different severity levels. Within this fluctuating group, 152 cases (53.90%) fluctuated between two severity levels, 120 cases (42.55%) between three levels, and 10 cases (3.55%) among all four levels. There were statistically significant differences (P < 0.05) in the sleep latency, sleep efficiency, non-rapid eye movement stages 1-2, rapid eye movement, proportion of non-rapid eye movement, proportion of rapid eye movement, wake after sleep onset, time out of bed, number of awakenings, respiratory variability index, and heart rate variability index among patients with ACI monitored from day 1 to 5. However, other monitored sleep structure parameters did not show statistically significant differences (P > 0.05). The coefficient of variation for all sleep monitoring parameters ranged between 14.54 and 36.57%. The IV in the SDB group was higher than in the group without SDB (P < 0.05), and the IS was lower than in the group without SDB (P < 0.05).

CONCLUSION: Patients in the acute phase of cerebral infarction have a high probability of accompanying SDB. The sleep structure of these patients shows significant variability based on the onset time of the stroke, and some patients experience fluctuations among different severity levels of SDB. ACI accompanied by SDB can further reduce the IS of a patient’s sleep circadian rhythm and increase its IV.

PMID:39012435 | DOI:10.1007/s11325-024-03105-1

Inflamm Bowel Dis. 2024 Jul 16:izae128. doi: 10.1093/ibd/izae128. Online ahead of print.

ABSTRACT

BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for medically refractory inflammatory bowel disease (IBD). In this systematic review and meta-analysis, we assess outcomes and safety of endoscopic balloon dilatation (EBD) for IPAA strictures.

METHODS: A systematic search of numerous databases was performed through June 2023 to identify studies reporting on the outcomes of EBD in pouch-related strictures. Outcomes included technical success, clinical success at index dilation and in pouch retention, recurrence of symptoms post-EBD, and adverse events of EBD. Meta-analysis was performed using a random-effects model, and results were expressed in terms of pooled rates along with relevant 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran Q statistical test with I2 statistics.

RESULTS: Seven studies with 504 patients were included. The pooled rate of technical success and clinical success of index dilatation was 98.9% (95% CI, 94.8-99.8%; I20%) and 30.2% (95% CI, 7.1-71%; I20%), respectively. The pooled rate of clinical success in pouch retention without the need for additional surgery was 81.4% (95% CI, 69.6-89.3%; I272%). The pooled failure rate of EBD was 18.6% (95% CI, 10.7-30.4%, I272%). The pooled rate of recurrence of symptoms after index dilatation was 58.9% (95% CI, 33.3-80.5%; I213%). The pooled rate of serious adverse events was 1.8% (95% CI, 1-3.5%, I20%). No deaths related to EBD were reported.

CONCLUSIONS: Endoscopic balloon dilatation is safe and highly effective for management of IPAA strictures. Additional studies are needed to compare its efficacy with surgical interventions.

PMID:39011760 | DOI:10.1093/ibd/izae128

Int J Paediatr Dent. 2024 Jul 16. doi: 10.1111/ipd.13238. Online ahead of print.

ABSTRACT

BACKGROUND: Pain and anxiety can be considerable obstacles while treating paediatric dental patients. Moderate sedation is needed to treat uncooperative patients.

AIM: This study aimed to compare the effectiveness of buccal administration of dexmedetomidine-ketamine combination versus dexmedetomidine.

DESIGN: Fifty-six uncooperative children were randomly assigned into two groups: Group I received buccal dexmedetomidine (2 μg/kg) and ketamine (2 mg/kg) (DEX-KET), whereas Group II received buccal dexmedetomidine (4 μg/kg) (DEX). The effects of drugs were evaluated based on changes in vital signs, onset and duration of sedation, sedation level, analgesia, ease of treatment and procedural adverse effects.

RESULTS: There were no significant differences in vital signs or sedation onset between the two groups. DEX-KET group showed shorter recovery time than DEX group (p < .0001). There were no statistically significant differences between both groups regarding sedation level at optimum sedation and during operative procedure (p = .064, p = .069 respectively). The ease of treatment was significantly better in DEX-KET group than in DEX group (p = .048). Procedural side effects and analgesic effects of the sedative drugs were comparable between both groups.

CONCLUSION: The combination of dexmedetomidine and ketamine delivered buccally provided a better method of delivering care to uncooperative children with more rapid recovery than dexmedetomidine.

PMID:39011758 | DOI:10.1111/ipd.13238