Tag: pubmed

CMAJ Open. 2023 Jun 27;11(3):E569-E578. doi: 10.9778/cmajo.20210291. Print 2023 May-Jun.

ABSTRACT

BACKGROUND: Previous research has shown that cocaine-associated deaths occur more frequently in hot weather, which has not been described for other illicit drugs or combinations of drugs. The study objective was to evaluate the relation between temperature and risk of death related to cocaine, opioids and amphetamines in British Columbia, Canada.

METHODS: We extracted data on all deaths with cocaine, opioid or amphetamine toxicity recorded as an underlying or contributing cause from BC vital statistics for 1998-2017. We used a time-stratified case-crossover design to estimate the effect of temperature on the risk of death associated with acute drug toxicity during the warmer months (May through September). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for each 10°C increase in the 2-day average maximum temperature at the residential location.

RESULTS: We included 4913 deaths in the analyses. A 10°C increase in the 2-day average maximum temperature was associated with an OR of 1.43 (95% CI 1.11-1.86) for deaths with only cocaine toxicity recorded (n = 561), an OR of 1.15 (95% CI 0.99-1.33) for deaths with opioids only (n = 1682) and an OR of 1.11 (95% CI 0.60-2.04) for deaths with amphetamines only (n = 133). There were also elevated effects when toxicity from multiple drugs was recorded. Sensitivity analyses showed differences in the ORs by sex, by climatic region, and when the location of death was used instead of the location of residence.

INTERPRETATION: Increasing temperatures were associated with higher odds of death due to drug toxicity, especially for cocaine alone and combined with other drugs. Targeted interventions are necessary to prevent death associated with toxic drug use during hot weather.

PMID:37369523 | DOI:10.9778/cmajo.20210291

In Vivo. 2023 Jul-Aug;37(4):1703-1713. doi: 10.21873/invivo.13257.

ABSTRACT

BACKGROUND/AIM: Lung percutaneous needle biopsy (PNB) under CT guidance can be performed with a single-needle or with a coaxial (CX) technique. This study evaluated the CX technique in a large cohort of patients who underwent to CT-guided lung PNB in our Institute over a period of 7 years.

PATIENTS AND METHODS: We retrospectively collected and analyzed data relative to 700 CT-guided lung PNBs performed from August 2012 to August 2019 in 700 patients (M:F=436:264; mean age=69 years, range=6-93 years) with normal coagulation and pulmonary function. PNB was considered diagnostic if at least one of the collected tissue specimens allowed for histological diagnosis. Pulmonary hemorrhage (PH) and pneumothorax (PNX) were evaluated as present or absent. Statistical analysis was made by Chi-square test of Pearson, Fisher’s exact test and Wilcoxon test.

RESULTS: The CX technique showed a high diagnostic accuracy (93.0%) and allowed the collection of a great number of appropriate tissue specimens with a single pleural puncture (≥3 specimens in 77.4% of cases). PH was the complication more frequent (55.4%), without significant clinical impact. Global PNXs incidence was high (42.9%), but the introducer allowed to aspirate the PNX with a lower percentage of chest tube placement vs. PNXs not aspirated (6.3% and 13.3%, respectively).

CONCLUSION: This large retrospective study confirmed the high diagnostic accuracy of lung PNB with the CX technique and allowed identification of significant factors to achieve a greater diagnostic power and decrease complication rates.

PMID:37369512 | DOI:10.21873/invivo.13257

In Vivo. 2023 Jul-Aug;37(4):1714-1720. doi: 10.21873/invivo.13258.

ABSTRACT

BACKGROUND/AIM: Synovial calprotectin has been demonstrated as a promising biomarker for periprosthetic joint infections (PJI) in painful total hip (THA) and knee arthroplasties (TKA). However, its diagnostic utility has not been evaluated explicitly in cases with marked loosening or migration of the implant. Concerns have already been raised in cases with metallosis and severe periprosthetic osteolysis because wear-induced inflammation may yield false positive results. The purpose of this study was to evaluate calprotectin for the diagnosis of PJI in cases that preoperatively demonstrate moderate to severe periprosthetic osteolysis or implant migration as signs for implant loosening in THA and TKA.

PATIENTS AND METHODS: Thirty-three patients were included in this prospective study between February of 2019 and November of 2021. The extent of osteolysis was classified according to Engh et al., Paprosky et al., and the modern Knee Society Radiographic Evaluation and Scoring System. Synovial white blood cell count (WBC), percentage of polymorphonuclear neutrophils (PMC), serum C-reactive protein (CRP) and synovial calprotectin using a lateral-flow-assay were tested against the European Bone and Joint Infection Society (EBJIS) definition for PJI. Statistic quality criteria were calculated and compared using a binary classification test.

RESULTS: Ten patients were classified as confirmed infections according to the EBJIS definition (7 THA and 5 TKA). The calprotectin assay yielded a sensitivity of 0.60, a specificity of 0.61, a positive predictive value of 0.40, and a negative predictive value of 0.78. The calprotectin assay resulted in nine false positive and four false negative cases. No correlation between the extent of osteolysis and false classification by means of the calprotectin assay was observed.

CONCLUSION: The diagnostic accuracy of synovial calprotectin is impaired if moderate to severe signs of implant loosening are present. If PJI is unlikely, the calprotectin LFT can be applied as a further exclusion tool as the negative predictive value remains relatively high.

PMID:37369505 | DOI:10.21873/invivo.13258

In Vivo. 2023 Jul-Aug;37(4):1450-1454. doi: 10.21873/invivo.13229.

ABSTRACT

BACKGROUND/AIM: Anastomotic leak (AL) remains one of the most troublesome complications in general surgery. The current review aimed to assess the level of C-reactive protein (CRP) in drainage fluid after entero-enteric, colonic, or colorectal anastomosis as a predictive biomarker for AL.

MATERIALS AND METHODS: Four medical databases (PUBMED-MEDLINE, Google Scholar, UpToDate, and Cochrane Library) were searched in January 2023 for prospective or retrospective studies on the role of acute-phase proteins in drainage fluid as a predictive biomarker of AL. Two independent researchers gathered and processed the data using MedCalc. The data were pooled and Student’s t-test was used to compare the data between the AL and non-AL groups.

RESULTS: Overall, four studies were included in the current review, containing 753 patients in total, for whom various types of enteric and colonic anastomoses were constructed. Overall 79 (10.49%) of patients demonstrated AL and the mean CRP level (±standard deviation) on postoperative day 3 was 167.7±77.13 mg/l. On the contrary, the non-AL group (674/753) had a statistically significantly lower mean CRP level at 83.76±20.32 mg/l. CRP values were not related to mortality. It was not possible to propose a CRP cut-off indicating an increased risk for AL as the data were insufficient.

CONCLUSION: The CRP level in drainage fluid might be a valuable biomarker for predicting the possibility of AL in general surgery. However, further and larger-scale studies are needed to establish a CRP cut-off value and this variable would possibly be different for patients with different pathologies.

PMID:37369500 | DOI:10.21873/invivo.13229

In Vivo. 2023 Jul-Aug;37(4):1455-1476. doi: 10.21873/invivo.13230.

ABSTRACT

BACKGROUND/AIM: COVID-19 has dramatically impacted non-pandemic-related care, including preventive medicine. Our objective was to quantify the alterations in the volume of screening tests for breast and cervical cancer during the COVID-19 era compared to pre-pandemic levels. Secondarily, we discussed the causes responsible for this change, presented suggestions for screening optimization and conducted a targeted search of the relevant literature for worsening of future mortality due to screening setback.

MATERIALS AND METHODS: We systematically searched Pubmed, Google Scholar and Epistemonikos for articles in English or Greek, published from March 11th, 2020, until September 14th, 2022, that illustrated quantitative variations of mammograms or Pap/HPV tests. Preprint articles, editorials and speeches were excluded. Quality of included studies was assessed via the JBI critical appraisal checklist for studies reporting prevalence data. The evidence was narratively synthesized.

RESULTS: A total of 56 articles were included, being either observational studies or reports from cancer registries. Large reductions were universally identified, peaked during the first wave but partially persisted after easing of the restrictions.

CONCLUSION: Our systematic review provides an updated record of the variations in screening volume and approaches screening neglect from a multidimensional perspective answering why it happened and how we could achieve recovery. A strong awareness campaign is proposed, in conjunction with triaging citizens more likely to benefit from screening. Cervical self-sampling is emphasized in the literature. Various studies displayed a potential increase in cancer mortality in the future based on predictive statistical models.

PMID:37369493 | DOI:10.21873/invivo.13230

In Vivo. 2023 Jul-Aug;37(4):1880-1885. doi: 10.21873/invivo.13280.

ABSTRACT

BACKGROUND/AIM: Oral adverse events caused by anticancer drugs are diverse, but few reports have examined pigmentation of the oral mucosa. The aim of this study was to clarify the prevalence of oral mucosal pigmentation caused by anticancer drugs.

PATIENTS AND METHODS: This single-centre retrospective study investigated patients who underwent oral examination in our hospital during cancer chemotherapy for 3 years from April 1, 2019 to March 31, 2021. Inclusion criteria were patients who could be followed-up for ≥3 months after completing chemotherapy with drugs that caused pigmentation. The primary predictive variable was the cancer chemotherapeutic agent used. The primary outcome variable was pigmentation of the oral mucosa. Collected data were statistically analysed using the χ² test or Fisher’s exact test, with the level of significance set at p<0.05.

RESULTS: A total of 388 patients were enrolled in the study. Eleven patients (2.8%) showed oral mucosal pigmentation. Drugs causing pigmentation [deposition rate (number of patients with deposits/users)] were TS-1 (combination of tegafur, gimeracil, and oteracil potassium) [12.2% (5/41)], paclitaxel [4.0% (2/50)], gemcitabine [5.0% (1/20)], cyclophosphamide [2.3% (1/42)], carboplatin [1.6% (1/64)], fluorouracil [2.3% (1/43)], and capecitabine [3.4% (1/29)].

CONCLUSION: Oral pigmentation due to cancer chemotherapy was found in 2.8% of patients. TS-1, carboplatin, cyclophosphamide, capecitabine, fluorouracil, gemcitabine, and paclitaxel caused pigmentation of the oral mucosa. Among these, TS-1 was the most likely to cause pigmentation, affecting 12.2% of users.

PMID:37369479 | DOI:10.21873/invivo.13280

In Vivo. 2023 Jul-Aug;37(4):1603-1608. doi: 10.21873/invivo.13245.

ABSTRACT

BACKGROUND/AIM: MicroRNAs (miRNA) are a class of small non-coding RNAs of 18-25 nucleotides, which regulate gene expression at the post-transcriptional level by disrupting or blocking translation of messenger RNA targets. Non-small cell lung cancer (NSCLC) represents approximately 85% of all lung cancers. Early and accurate diagnosis of the disease affects the probability of success of treatment. The purpose of this study was to investigate the expression levels of serum specific miRNA221 and miRNA222 as a biomarker in NSCLC.

MATERIALS AND METHODS: Thirty-two NSCLC cases and 30 healthy control cases that were diagnosed at Istanbul Yedikule Chest Diseases and Thoracic Surgery Training Hospital were included in this study. miRNAs were detected using miRNA-specific quantitative real-time-PCR. The relative expression of miRNAs was calculated using the 2^-ΔΔCt method.

RESULTS: miR221 and miR222 showed 1.46 and 1.63-fold higher expression in the samples from patients with NSCLC compared to controls, and the difference of expression was statistically significant for miR221 (p=0.000095) but not for miR222 (p=0.084470). In the presence of metastasis in NSCLC patients, miR221 levels were 2.33-fold higher compared to non-metastatic cases (p=0.014), and those of miR221 and miR222 were expressed 1.44 and 1.52-fold higher, respectively, in advanced stage compared to early stage (p=0.000387, p=0.000302).

CONCLUSION: The levels of miR221 and miR222 in the serum of patients could be used as biomarkers for the diagnosis, treatment, and prognosis of NSCLC.

PMID:37369478 | DOI:10.21873/invivo.13245

In Vivo. 2023 Jul-Aug;37(4):1638-1648. doi: 10.21873/invivo.13249.

ABSTRACT

BACKGROUND/AIM: Serine/threonine kinase 11 (STK11), a tumor suppressor, controls 5′ AMP-activated protein kinase (AMPK) signaling in a variety of cellular functions. Mutated STK11 has been identified as a novel driver gene that promotes cancer progression. The purpose of this study was to investigate the alteration of STK11 and its correlation with clinicopathological data in cholangiocarcinoma (CCA).

MATERIALS AND METHODS: Gene mutation and expression analyses were performed using cBioportal and Gene Expression Profiling Interactive Analysis version 2 (GEPIA2). qRT-PCR was performed to measure STK11 mRNA levels and immunohistochemistry was performed to investigate STK11 protein expression in CCA tissues.

RESULTS: The results from publicly available cancer datasets showed that 2.7% of CCA cases had STK11 mutations. Most of STK11 gene mutations are of the truncating type and result in low STK11 mRNA and protein expression. We detected a correlation between STK11 mutation status and the tendency for shorter patient survival. The results of qRT-PCR revealed that STK11 mRNA levels were statistically significantly lower in CCA patients with mutated STK11 compared to those with wild-type STK11 (p-value=0.013). Immunohistochemical staining showed high STK11 expression in 43.8% and low expression in 56.2% of CCA tissues examined. Low STK11 protein expression resulted in poor prognosis compared with high STK11 expression, especially in CCA papillary carcinoma. Univariate and multivariate analysis revealed that high STK11 expression was associated with a decreased hazard ratio of patient survival rates (HR=0.696, p-value=0.06 and HR=0.666, p-value=0.04, respectively).

CONCLUSION: Alteration of STK11 mutational or mRNA/protein status might be used as a potential predictive biomarker for the prognosis of the clinical outcomes in CCA patients.

PMID:37369462 | DOI:10.21873/invivo.13249

J Dr Nurs Pract. 2023 Jun 27:JDNP-2022-0026.R1. doi: 10.1891/JDNP-2022-0026. Online ahead of print.

ABSTRACT

Background: The most modifiable risk factor contributing to antibiotic resistance is the inappropriate prescription of antibiotics. Urinary tract infections (UTIs) are a common outpatient infection in the United States, with increasing antimicrobial resistance to uropathogens. As empiric UTI treatment is often appropriate, telemedicine offers an opportunity to enhance practice by adopting current clinical practice guidelines. Objective: The project aims to improve appropriate first-line antibiotic choice and decrease urinalysis and urine culture orders in the telehealth management of uncomplicated UTIs. Methods: Chart reviews of women aged 18-65 years diagnosed with an uncomplicated UTI and/or symptoms during a telehealth primary care visit were conducted for a period of 30 days prior to and following a provider educational intervention. Results: Improvement (37.5%-62.1%, p = .133), though not significant, of appropriate first-line antibiotics prescribing postintervention was achieved. There was a minimal (3%) improvement in the appropriate urine labs ordered. Conclusion: Following the intervention, there was not a statistically significant practice change, albeit somewhat of an improvement in the ordering of first-line antibiotics. Adopting evidence-based practice in telehealth could provide an opportunity to improve antibiotic stewardship. Providers are potentially better engaged through the presence of champions, in-person education sessions, and the availability of streamlined algorithms.

PMID:37369453 | DOI:10.1891/JDNP-2022-0026

J Dr Nurs Pract. 2023 Jun 27:JDNP-2021-0042.R1. doi: 10.1891/JDNP-2021-0042. Online ahead of print.

ABSTRACT

Background: Measurement-based care (MBC) is a method for demonstrating performance outcomes but is rarely used in behavioral health settings despite it being an evidence-based practice. As psychiatry moves to value-based care and payment for performance, the adoption of MBC will be essential. Objective: The purpose of the study was to test proactive reporting of patient self-reported measurement tool results to providers on treatment outcomes to promote the adoption of MBC. Methods: The study entailed a mixed methods design with a pre-/post-test quantitative measurement of scores on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 and a semistructured qualitative interview with providers following data collection. Results: Results showed, during the intervention period, statistically significant decreases in anxiety scores for all patients. Depression symptom decreases trended toward significance for female patients. After initial disregard for scores, all providers found a benefit to continued use of MBC. Conclusions: Identification and removal of barriers can assist in the adoption of evidence-based practices in healthcare. Implications for Nursing: Successful change can be accomplished with minor adjustments to an already-established workflow and a team approach to the process.

PMID:37369450 | DOI:10.1891/JDNP-2021-0042