Tag: pubmed

Niger J Clin Pract. 2022 Oct;25(10):1647-1653. doi: 10.4103/njcp.njcp_1684_21.

ABSTRACT

BACKGROUND: Most educational institutions in Nigeria were shut down for a long while at the onset of the COVID-19 pandemic as a preventive measure, and this affected dental students’ academic and clinical training.

AIM: To determine the influence of the pandemic on the academic, clinical training, and psychosocial well-being of dental students in Nigeria.

SUBJECTS AND METHODS: This cross-sectional survey was conducted among undergraduate dental students in clinical years in Nigerian dental schools. Participants received the questionnaire through an online platform, it had four sections; socio-demographics, impact on academic training, psychosocial well-being, and an open-ended segment for participants’ suggestions to challenges. A mixed method was utilized to analyze the data. The statistical significance level was P < 0.05.

RESULTS: One hundred two dental students from nine dental schools participated, with a mean age of 25.3 ± 2.4 years. There were 56 (54.9%) males. Most students, 80 (78.4%) reported that their stay-at-home had not been rewarding academically. The majority, 90 (88.2%) were worried about contracting COVID-19 on school resumption. Participants’ psychosocial well-being had significant associations with gender (P = 0.001) and self-directed learning during their stay-at-home (P = 0.001). More female students, 33 (71.7%) were severely worried compared to males 20 (35.7%). Their major suggestions were to commence online teaching and examinations (40.1%) and be provided with adequate personal protective equipment (18.6%).

CONCLUSION: Most undergraduate students in Nigeria were anxious about COVID-19, and females were more affected. This negatively impacted their academic and clinical training. This underscores the importance of adequate psychological support for undergraduate dental students by school authorities.

PMID:36308234 | DOI:10.4103/njcp.njcp_1684_21

Niger J Clin Pract. 2022 Oct;25(10):1635-1640. doi: 10.4103/njcp.njcp_1371_21.

ABSTRACT

BACKGROUND: Congenital diaphragmatic hernia (CDH) is an anomaly with significant morbidity in neonates. It has been traditionally managed by an open approach with a recent trend toward a minimally invasive approach.

AIM: This is a retrospective study of our institutional experience with neonatal thoracoscopic management of CDH, with the impact of few technical nuances.

PATIENTS AND METHODS: The data was collected on neonatal thoracoscopic CDH repair between January 2015 and December 2018, in terms of the demographics, intra-operative parameters, post-operative status, recurrence, and mortality. While analyzing data, we found few technical modifications adopted by the surgeon such as trimming the margin of the defect, use of prosthetic mesh overlay reinforcement for repairs under tension, and to prefer extra-corporeal knotting along with higher placement of trocar, temporary increase in CO₂, maximal use of muscle relaxant, extra-corporeal corner hitch stitch at some point, and continuation for further cases. An internal comparison was made to analyze the technical modifications influencing the outcomes, by dividing them into two groups, those with (group A) and without modifications (group B). The data was analyzed using SPSS software (IBM, Version 23). A P value of <0.05 was considered statistically significant.

RESULTS: Out of 45 newborns 64.4% were males with an average birth weight of 2.6 kg. Baseline variables were comparable between the groups. The operating time significantly reduced after a higher-level camera port was used (P-value: 0.0001). The mean follow-up was 30.8 months. There were totally seven recurrences (6 in group A and 1 in group B), all within 12 months. Seven parents gave the overall post-treatment feedback as “unsatisfied”. The operating time, recurrence rate, and parental satisfaction feedback were significantly less in group B (P-value: 0.001).

CONCLUSION: We recommend trimming the margin of the defect, use of prosthetic mesh overlay reinforcement for repairs under tension, and to prefer extra-corporeal knotting along with higher placement of trocar, temporary increase in CO₂, maximal use of muscle relaxant, extra-corporeal corner hitch stitch to reduce the operating time, and recurrence after thoracoscopic CDH repair.

PMID:36308232 | DOI:10.4103/njcp.njcp_1371_21

Niger J Clin Pract. 2022 Oct;25(10):1624-1628. doi: 10.4103/njcp.njcp_63_21.

ABSTRACT

BACKGROUND: Renal angiomyolipoma is the commonest benign solid kidney neoplasm though rare in clinical practice. The advent of radiological imaging techniques, refinement in surgical approach and techniques and availability of mammalian target of rapamycin have improved the outcome in these cohort of patients.

AIM: To report our experience with the surgical management of renal angiomyolipoma in the sub-Saharan Africa.

PATIENTS AND METHODS: This was a retrospective review of the records in the operating theatre book of urology division of patients who underwent radical nephrectomy over a 7-year-period (January 2013 to December 2019). The histologically confirmed renal angiomyolipoma information were retrieved from the records in the Department of Pathology. The clinical data were obtained from the patients’ case files by identifying the patient with their registration number and not their names. The clinical features, investigations done, treatment offered, and the outcome of management were recorded in an SPSS version 20. The data was analyzed using statistics of central tendency and percentage.

RESULTS: Only 3 females with symptomatic renal angiomyolipoma were managed. This represented 4.9% of 61 patients with solid renal masses managed in the study period. The mean age was 51.2 (ranged 40-70) years. The mean tumor size was 18.9 cm. All the patients underwent radical nephrectomy. The pre- and postoperative urea and creatinine remained normal. The median follow-up period was 21 (16.5-30) months and were asymptomatic.

CONCLUSION: The incidence of renal angiomyolipoma among solid renal masses is 4.9% in our environment. Open radical nephrectomy is still the preferred method of treatment with satisfactory outcome.

PMID:36308230 | DOI:10.4103/njcp.njcp_63_21

Indian J Pathol Microbiol. 2022 Oct-Dec;65(4):873-878. doi: 10.4103/ijpm.ijpm_1475_20.

ABSTRACT

BACKGROUND: For the management of connective tissue disorders (CTDs), antinuclear antibody (ANA) testing is essential, both from diagnostic and prognostic points of view. Usually, patterns obtained by ANA-IIF testing correlates to specific autoantibodies as obtained from the test for ENA (by LIA/ELISA, etc.). But to apply these data from western studies, we may need validation in the local population like our subjects in sub-Himalayan (Garhwal region) area where CTDs are common. Also, suppose ANA-IFA pattern’s correlation is reliably known in our population, it can minimize the cost of managing CTDs by limiting ENA testing, which is 10 times costlier than ANA-IIF. Hence, this study was undertaken to know the specific autoantibody targets (ENA by LIA) against ANA-IIF patterns in our local population.

MATERIALS AND METHODS: In this retrospective cross-sectional work, serum samples of CTDs were tested for ANA by IIF (Euroimmune AG) and ENA by LIA (Euroline ANA-3G) continuously for 36 months. The manufacturer’s kit insert was followed, and results were analyzed applying appropriate statistical methods.

RESULTS: Major ANA-IIF patterns were found to be associated with specific autoantibodies, for example, Nuclear homogenous with dsDNA, nucleosomes, histones; speckled pattern with nRNP/Sm, Sm, SSA/Ro-52, SSB; nucleolar pattern with Scl-70, Pm-Scl 100 and centromere pattern with CENP-B. Anticytoplasmic (ACA) are found to be linked with some ANA negative (by IIF) samples, emphasizing the need for careful observation for ACA especially where ANA is not found.

CONCLUSIONS: In most subjects, specific ENA targets correlated well with ANA-IIF patterns, implying effective cost minimization in CTD management. Similar future prospective studies (with clinical data) can provide a database and reference for our population.

PMID:36308197 | DOI:10.4103/ijpm.ijpm_1475_20

Indian J Pathol Microbiol. 2022 Oct-Dec;65(4):856-859. doi: 10.4103/ijpm.ijpm_223_21.

ABSTRACT

OBJECTIVES: CD47 is a membrane protein that belongs to the immunoglobulin superfamily and regulates macrophage phagocytosis negatively. As CD47 expression at the cancer cell membrane would inhibit the phagocytic activity of immune cells, it is connected to an unfavorable prognosis in leukemia and malignancies of various solid organs. Materials and.

METHODS: In this study, retrospectively evaluated 72 patients who had been diagnosed with endometrial carcinoma at Pathology Department and had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO) and/or lymphadenectomy. CD47 expression was evaluated in tumorous and nontumor areas in all patients considering cytoplasmic and membranous brown staining in cells. The proportion of expression was evaluated as well as the intensity and an “h score” was obtained. This score was compared with known prognostic parameters.

RESULTS: CD47 expressions showed a statistically significant correlation with tumor grade (P < 0.05); however, no significant relationship was observed with myometrial invasion depth and lymph vascular invasion status (P = 0.923 and P = 0.754, respectively).

CONCLUSIONS: As with other tumors, anti-CD47 antibody may be an alternative treatment option in patients with high-grade endometrial carcinoma.

PMID:36308193 | DOI:10.4103/ijpm.ijpm_223_21

Indian J Pathol Microbiol. 2022 Oct-Dec;65(4):851-855. doi: 10.4103/ijpm.ijpm_109_21.

ABSTRACT

BACKGROUND: Tumor budding (TB) is a morphological finding believed to play an important role in determining the prognosis in many cancers.

AIM: Our aim is to evaluate the prognostic importance of TB in endometrial carcinomas.

SETTINGS AND DESIGN: Two-hundred-eleven endometrial cancers were obtained from 2008 to 2015 that were comprised of those having undergone surgical staging with a hysterectomy and at least 5 years followed up.

MATERIAL AND METHODS: All hematoxylin and eosin stained slides were reevaluated for the status of TB.

STATISTICAL ANALYSIS: Nonparametric tests, the Kaplan-Meier method, the Log-rank test, and Cox proportional hazard regression were used.

RESULTS AND CONCLUSION: TB was found to correlated with larger diameter (P = 0.000), nonendometrioid (P = 0.038), mixed cell types (P = 0.005), higher grade (P = 0.000), deeper invasion of the myometrium (P = 0.000), cervical stromal invasion (P = 0.000), advanced pT (P = 0.011), lymph node involvement (P = 0.000), lymphovascular invasion (P = 0.000), and advanced stage (P = 0.000). The presence of TB worsens the 5-year overall survival (OS) (P = 0.0001). In cases such as grade 1, pT1, or stage 1 endometrial carcinomas, the presence of TB decreases the OS rate (P = 0.00017, P = 0.0016, P < 0.0001). Our result suggested that the presence of TB adversely affects the prognosis. It was concluded that TB could be a valuable prognostic parameter.

PMID:36308192 | DOI:10.4103/ijpm.ijpm_109_21

Indian J Pathol Microbiol. 2022 Oct-Dec;65(4):839-843. doi: 10.4103/ijpm.ijpm_1472_20.

ABSTRACT

INTRODUCTION: High-grade urothelial carcinoma has a different molecular pathway than superficial low grade urothelial carcinoma, and is characterized by genomic instability. The high tumor mutation burden leads to neoantigen formation, evoking an immune response. The immune response has been keenly studied in last two decades and programmed death ligand-1 (PDL-1) has emerged as acceptable immunohistochemical marker for assessment of response to therapy, prognostication and patient selection for immunotherapy. The targeting of PD-1 and PDL-1 by checkpoint inhibitors (CPIs) is an attractive strategy to unblock the inhibitor and induce cytotoxic cell death. However, the presence of complementary and companion diagnostic testing with multiple PDL-1 assays and platforms for various CPIs make a diagnostic quagmire. Thus, it is the need of hour to harmonize these assays. In this undertaken study we evaluated the concordance in PD-L1 expression between the two PD-L1 clones: SP263 and SP142, in treatment naïve muscle invasive bladder cancer (MIBC).

METHODS: We evaluated Ventana PD-L1 “SP263 and SP142” qualitative immunohistochemical assay using rabbit monoclonal anti-PD-L1 clones in evaluation of PDL-1 immunoexpression on Ventana autostainer platform. The study includes 30 muscle invasive urothelial carcinomas, with 10 of 30 having nodal metastasis.

RESULTS: SP263 assay was statistically more sensitive than SP142 for tumor cell (TC) scoring (P = 0.0009), whereas SP142 was more sensitive for immune cell (IC) scoring (P = 0.0067). There was no statistical significant discordance for TC or IC scoring between primary tumor and metastatic lymph node.

CONCLUSION: PD-L1 testing status can be done on both primary tumor and metastatic site, however in metachronous metastatic setting, testing on recent metastatic site should be preferred. The harmonization of immunoexpression between 2 PD-L1 clones could not be achieved.

PMID:36308190 | DOI:10.4103/ijpm.ijpm_1472_20

Indian J Pathol Microbiol. 2022 Oct-Dec;65(4):828-831. doi: 10.4103/ijpm.ijpm_93_21.

ABSTRACT

CONTEXT: Though mast cells infiltrate solid tumors, the exact role of mast cells in tumor biology is controversial. Mast cell density (MCD) may vary depending on its location in the tumor and tumor vascularity. MCD may influence the tumor aggressiveness.

AIMS: This study evaluates MCD and tumor vascularity in different histopathological grades of adenocarcinoma prostate.

SETTINGS AND DESIGN: Descriptive study with purposive sampling.

METHODS AND MATERIAL: The subjects of study were 42 adenocarcinoma patients. 20 cases were of intermediate grade (Gleason score 2-7) and 22 were of high-grade (Gleason score 8-10). Histological diagnosis was made by examining sections stained with hematoxylin and eosin. Additional sections from the same block were stained for mast cells using Giemsa stains as per standard protocol. Mast cell count was done in minimum six random high-power microscopy fields in four different regions- intratumoral, peritumoral, stromal and perivascular regions.

STATISTICAL ANALYSIS USED: SSPS software version 13.0. Descriptive statistics, Student’s t test and ANOVA test.

RESULTS: In high-grade adenocarcinoma, mast cell counts were higher in perilesional, stromal and perivascular regions, whereas it was lower in intralesional areas as compared to the intermediate grade. However, statistical significance was observed only for the perivascular region. There was significantly higher number of blood vessels in high-grade adenocarcinoma as compared to intermediate grade adenocarcinoma.

CONCLUSIONS: In this study, perilesional mast cells and vascularity increased with increased severity of adenocarcinoma. These findings suggest a possible influence of mast cells on the tumor microenvironment such as vessel density and aggressiveness of tumor. However, further studies are required to substantiate results of this study.

PMID:36308188 | DOI:10.4103/ijpm.ijpm_93_21

Diabetes Technol Ther. 2022 Oct 28. doi: 10.1089/dia.2022.0331. Online ahead of print.

ABSTRACT

To assess the compliance of “integrated” continuous glucose monitoring (CGM) systems with U.S. Food and Drug Administration (FDA) requirements, the calculation of confidence intervals on agreement rates, i.e., the percentage of CGM measurements lying within a certain deviation of a comparator method, is stipulated. However, despite the existence of numerous approaches that could yield different results, a specific procedure for calculating confidence intervals is not described anywhere. This report therefore proposes a suitable statistical procedure to allow transparency and comparability between CGM systems. Three existing methods were applied to six datasets from different CGM performance studies. The results indicate that a bootstrap-based method that accounts for the clustered structure of CGM data is reliable and robust. We thus recommend its use for the estimation of confidence intervals of agreement rates. A software implementation of the proposed method is freely available (https://github.com/IfDTUlm/CGM_Performance_Assessment).

PMID:36306521 | DOI:10.1089/dia.2022.0331

AIDS Patient Care STDS. 2022 Oct 27. doi: 10.1089/apc.2022.0072. Online ahead of print.

ABSTRACT

Pre-exposure prophylaxis (PrEP) is a lifesaving medical intervention that protects against human immunodeficiency virus (HIV), but to date, PrEP uptake has been limited. PrEP utilization and adherence among youth, including stigmatized and highly vulnerable young sexual and gender minorities, have been exceptionally low across all regions, leading to preventable HIV transmission. Considering the scientific value of measuring and understanding predictors or associations of PrEP adherence, our study team validated two scales: a PrEP Difficulties Scale and a PrEP Confidence Scale tested within the Adolescent Trials Network P3 study (2019-2021). Data from sexual and gender minorities who were prescribed PrEP across nine domestic sites were evaluated (N = 235). Descriptive statistics, exploratory factor analysis, and correlation coefficients are reported herein. Results for the PrEP Difficulties Scale yielded a four-factor solution (Disclosure, Health Effects, Logistics, and Cost), and results for the PrEP Confidence Scale produced a three-factor solution (Scheduling, Distraction, and Planning). Factor loadings and Cronbach’s alphas suggested good internal consistency for both scales. PrEP Confidence Scale subscales were correlated with PrEP adherence, and subscales of both scales were associated with dimensions of social support and PrEP-related stigma. Given the persistence of preventable HIV infections among key populations, multi-level barriers and facilitators to medication adherence, and expansion of PrEP modalities, the PrEP Difficulties Scale and PrEP Confidence Scale have the potential to enhance intervention, exploratory, and mechanistic HIV prevention research. ClinicalTrials.gov Identifier: NCT03320512.

PMID:36306520 | DOI:10.1089/apc.2022.0072