Tag: pubmed

Arch Gynecol Obstet. 2022 Oct 17. doi: 10.1007/s00404-022-06817-5. Online ahead of print.

ABSTRACT

PURPOSE: Bacterial vaginosis is a common genital tract disorder. It can lead to preterm birth, but its contribution is equivocal. Bacterial vaginosis is curable and, if diagnosed and appropriately treated, may reduce preterm births. The study desired to confirm the association between bacterial vaginosis and preterm birth.

METHODS: It was a meta-analysis. We included articles published from 2008 to 2022. The authors included studies that measured the association between bacterial vaginosis and preterm birth by relative risk/risk ratio (RR) or odds ratio (OR). We excluded studies with qualitative data. The study utilized five search engines, PubMed, Scopus, Google Scholar, Cochrane, and LILAC. We used the statistical package for social sciences (SPSS) to draw forest and funnel plots separately for RR and OR.

RESULTS: After an extensive search, the study included 20 articles yielding 26 relevant results with a total of 290,397 observations. This meta-analysis proves that bacterial vaginosis is undoubtedly associated with preterm birth. The overall relative risk of preterm delivery is about two-fold as overall OR1.79 (95% Confidence Interval 1.32-2.43). The overall RR of preterm birth is 1.44 (95% Confidence Interval 1.19-1.73).

CONCLUSION: Our study shows a significant association between bacterial vaginosis and preterm birth. The study concludes that investigation for bacterial vaginosis and management should be a part of the routine examination of a pregnant woman. The health system must initiate this strategy soon to reduce the prevalence of preterm births and consequent neonatal mortality.

PMID:36251068 | DOI:10.1007/s00404-022-06817-5

J Egypt Natl Canc Inst. 2022 Oct 17;34(1):43. doi: 10.1186/s43046-022-00139-y.

ABSTRACT

BACKGROUND: EGFR mutation has not been extensively studied in thyroid cancer. This study was conducted to study spectrum of EGFR mutation in thyroid cancer in Kashmiri population for possible therapeutic purpose.

METHODS: It was 2 years prospective cross-sectional study conducted at a tertiary care center in which histologically confirmed, untreated thyroid cancers were included. These specimens were subjected to EGFR mutation analysis by AS-PCR method.

RESULTS: There were a total 60 patients with preponderance of females [44(73%) vs 16(27%)]. Most were in the age group of less than 45 years (75%). Most of these patients were non-smokers [50(83.3%) vs 10 (17.3%)]. Papillary thyroid carcinoma (PTC) was the commonest type 48(80%), rest was follicular type (FTC) 12(20%). Well-differentiated carcinoma (WDC) was common than poorly differentiated (PDC) [41(68.4%) vs 19 (31.6%)]. Lymph node metastasis and vascular invasion were present in 32 (53.4%) and 17 (28.4%) respectively. Thirty-two (53.3%) patients were having 15 bp deletion in exon 19 of EGFR. These deletions were common in PTC than FTC, 29(60.5%) vs 3(25%) which was statistically significant (p = 0.04, CI = 0.2). The total mutational rate of T790M in EGFR tyrosine kinase domain (exon 20) was found to be only 8.4% (5 of 60). Only 4 (8.3%) of these mutations were detected in PTC and rest in FTC (1 of 12). Twenty-six (43.3%) of exon 21 were positive for L858R mutation in EGFR tyrosine kinase domain. Married persons and PDC were significant predictors of L858R mutation in EGFR tyrosine kinase domain in thyroid cancer as this was statistically significant in them with p = 0.04, 0.03 respectively.

CONCLUSION: In our population, PTC is common in females with half of population harboring EGFR mutation and it is statistically significant in poorly differentiated carcinoma and in married individuals. It implies that EGFR may be used in thyroid cancer as a possible therapeutic agent in our set of population.

PMID:36245068 | DOI:10.1186/s43046-022-00139-y

World J Urol. 2022 Oct 16. doi: 10.1007/s00345-022-04185-y. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to externally validate the Rotterdam Prostate Cancer Risk Calculator (RPCRC)-3/4 and RPCRC-MRI within a Dutch clinical cohort.

METHODS: Men subjected to prostate biopsies, between 2018 and 2021, due to a clinical suspicion of prostate cancer (PCa) were retrospectively included. The performance of the RPCRC-3/4 and RPCRC-MRI was analyzed in terms of discrimination, calibration and net benefit. In addition, the need for recalibration and adjustment of risk thresholds for referral was investigated. Clinically significant (cs) PCa was defined as Gleason score ≥ 3 + 4.

RESULTS: A total of 1575 men were included in the analysis. PCa was diagnosed in 63.2% (996/1575) of men and csPCa in 41.7% (656/1575) of men. Use of the RPCRC-3/4 could have prevented 37.3% (587/1575) of all MRIs within this cohort, thereby missing 18.3% (120/656) of csPCa diagnoses. After recalibration and adjustment of risk thresholds to 20% for PCa and 10% for csPCa, use of the recalibrated RPCRC-3/4 could have prevented 15.1% (238/1575) of all MRIs, resulting in 5.3% (35/656) of csPCa diagnoses being missed. The performance of the RPCRC-MRI was good; use of this risk calculator could have prevented 10.7% (169/1575) of all biopsies, resulting in 1.2% (8/656) of csPCa diagnoses being missed.

CONCLUSION: The RPCRC-3/4 underestimates the probability of having csPCa within this Dutch clinical cohort, resulting in significant numbers of csPCa diagnoses being missed. For optimal performance of a risk calculator in a specific cohort, evaluation of its performance within the population under study is essential.

PMID:36245015 | DOI:10.1007/s00345-022-04185-y

Arch Dermatol Res. 2022 Oct 17. doi: 10.1007/s00403-022-02402-7. Online ahead of print.

ABSTRACT

Various therapeutic options are available for verruca. While physical destruction may be associated with scarring, immunotherapy may be effective in treating warts through stimulating body immune response. The objective of the study was to compare the efficacy, safety, and outcome of Candida antigen vs diphencyprone (DPCP) in the treatment of warts. Fifty patients were randomly assigned to receive either intralesional Candida antigen every 3 weeks or weekly DPCP application. Both treatments were applied only to the mother wart. Lesions’ clearance and associated side effects were observed up to 4 weeks after treatment. Two blinded physicians evaluated photos of warts before and 4 weeks after the end of treatment. Both modalities granted wart clearance and/or improvement with no statistically significant difference; however, Candida antigen was significantly better in clearing adjacent untreated warts (p = 0.046). Fewer side effects were observed among the Candida antigen group. The response was duration associated in the Candida groups only. Intralesional Candida antigen injection and DPCP treatments for warts yielded improvement with superiority of Candida injection in eradicating distant lesions and fewer side effects. A shorter wart duration may be associated with a better therapeutic response with Candida antigen.

PMID:36245011 | DOI:10.1007/s00403-022-02402-7

Arch Physiother. 2022 Oct 17;12(1):23. doi: 10.1186/s40945-022-00149-y.

ABSTRACT

BACKGROUND: The need for an efficient and feasible strategy to deal with neck pain has a high priority for many countries. Validated assessment tools like the Neck Disability Index (NDI) to evaluate the functional status of a neck pain patient are urgently needed to treat and to follow-up patients purposefully. A German version (NDI-G) was shown to be valid and reliable, but has so far not been tested for responsiveness. The aim of this study was to evaluate the NDI-G`s responsiveness.

METHODS: This was a prospective cohort study with a seven-week follow-up. Fifty chronic neck pain patients filled out NDI-G twice. Additionally, the Patients’ Global Impression of Change score (PGIC) was assessed at follow-up. Wilcoxon and Spearman tests were used to assess direction and strength of the association between the change in NDI-G and PGIC. The receiver operating characteristics method and the area under the curve (AUC) were calculated to assess sensitivity and specificity of the NDI-G change over time.

RESULTS: The Wilcoxon test showed statistically significant differences for NDI-G at baseline and follow-up in the total sample, the “clinically improved” and “clinically not improved” subgroups as indicated in the PGIC. Spearman test resulted in a moderate correlation between the NDI-G and the PGIC (r_S = -0.53, p = 0.01) at follow-up. AUC showed an acceptable discrimination [AUC = 0.78 (95% confidence interval 0.64 – 0.91)] of the NDI-G, with a cutoff score of 1.5, between clinically improved and clinically not improved patients, based on the PGIC.

CONCLUSIONS: The NDI-G is responsive to change in chronic neck pain. Together with the results of a previous study on its validity and reliability, the NDI-G can be recommended for research and clinical settings in patients with neck pain in German speaking countries.

TRIAL REGISTRATION: NCT02676141. February 8, 2016.

PMID:36244985 | DOI:10.1186/s40945-022-00149-y

BMC Med. 2022 Oct 17;20(1):366. doi: 10.1186/s12916-022-02550-7.

ABSTRACT

BACKGROUND: Extraintestinal symptoms are common in inflammatory bowel diseases (IBD) and include depression and fatigue. These are highly prevalent especially in active disease, potentially due to inflammation-mediated changes in the microbiota-gut-brain axis. The aim of this study was to investigate the associations between structural and functional microbiota characteristics and severity of fatigue and depressive symptoms in patients with active IBD.

METHODS: We included clinical data of 62 prospectively enrolled patients with IBD in an active disease state. Patients supplied stool samples and completed the questionnaires regarding depression and fatigue symptoms. Based on taxonomic and functional metagenomic profiles of faecal gut microbiota, we used Bayesian statistics to investigate the associative networks and triangle motifs between bacterial genera, functional modules and symptom severity of self-reported fatigue and depression.

RESULTS: Associations with moderate to strong evidence were found for 3 genera (Odoribacter, Anaerotruncus and Alistipes) and 3 functional modules (pectin, glycosaminoglycan and central carbohydrate metabolism) with regard to depression and for 4 genera (Intestinimonas, Anaerotruncus, Eubacterium and Clostridiales g.i.s) and 2 functional modules implicating amino acid and central carbohydrate metabolism with regard to fatigue.

CONCLUSIONS: This study provides the first evidence of association triplets between microbiota composition, function and extraintestinal symptoms in active IBD. Depression and fatigue were associated with lower abundances of short-chain fatty acid producers and distinct pathways implicating glycan, carbohydrate and amino acid metabolism. Our results suggest that microbiota-directed therapeutic approaches may reduce fatigue and depression in IBD and should be investigated in future research.

PMID:36244970 | DOI:10.1186/s12916-022-02550-7

Eur Urol Focus. 2022 Oct 13:S2405-4569(22)00222-X. doi: 10.1016/j.euf.2022.09.014. Online ahead of print.

ABSTRACT

BACKGROUND: Hydronephrosis and renal impairment may persist even after relieving an obstruction, particularly in cases of chronic obstruction. Obstruction can cause fibrotic changes of the ureter, potentially contributing to long-term kidney damage.

OBJECTIVE: To characterise pathophysiological changes of obstructed ureters with focus on inflammatory responses triggering fibrosis and potential impairment of ureteral function.

DESIGN, SETTING, AND PARTICIPANTS: Eighty-eight mice were randomly assigned to unilateral ureteral obstruction (UUO) for 2 d, UUO for 7 d, and UUO for 7 d followed by 8 d of recovery, or a control group (no prior surgical intervention).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Peristaltic rate was determined over 2 min by direct visualisation with a microscope, while hydronephrosis was assessed by ultrasound. Obstructed and contralateral ureters were harvested, and underwent histopathological evaluation. We quantified 44 cytokines/chemokines, and five matrix metalloproteases using Luminex technology. Cell composition was characterised via immunofluorescence. Statistical significance was assessed using Welch analysis of variance, Kruskal-Wallis test, and Dunnett’s T3 multiple comparison test.

RESULTS AND LIMITATIONS: Obstruction resulted in hydronephrosis and significantly impaired peristalsis. Marked fibrosis was observed in lamina propria, muscle layer, and adventitia. Connective tissue in obstructed ureters showed hyperaemia and leucocyte infiltration. Unsupervised hierarchical clustering demonstrated different cytokine/chemokine patterns between groups. Ureters obstructed for 7 d followed by recovery were notably different from other groups. Inflammatory cytokines, chemoattractants, and matrix metalloproteases increased significantly in obstructed ureters. Contralateral unobstructed ureters showed significantly increased levels of chemokines and matrix metalloproteases. Immunofluorescence confirmed activation of T cells, Th1 and Th2 cells, and M1 macrophages in obstructed and contralateral ureters, and a shift to M2 macrophages following prolonged obstruction.

CONCLUSIONS: Ureteral obstruction triggers severe inflammation and fibrosis, which may irreversibly impair ureteral functionality. Function of the unobstructed contralateral ureter may be regulated by a systemic immune response as a result of the obstruction.

PATIENT SUMMARY: Here, we studied in more detail the way the ureter responds to being blocked. We conclude that a strong immune response is activated by the blockage, leading to changes in the structure of the ureter possibly impacting function, which may not be reversible. This immune response also spreads to the opposite ureter, possibly allowing it to change its function to compensate for the reduced functionality of the blocked ureter.

PMID:36244955 | DOI:10.1016/j.euf.2022.09.014

Aust Crit Care. 2022 Oct 13:S1036-7314(22)00121-7. doi: 10.1016/j.aucc.2022.08.011. Online ahead of print.

ABSTRACT

BACKGROUND: Caregiver workload in the ICU setting is difficult to numerically quantify. Ambient Intelligence utilises computer vision-guided neural networks to continuously monitor multiple datapoints in video feeds, has become increasingly efficient at automatically tracking various aspects of human movement.

OBJECTIVES: To assess the feasibility of using Ambient Intelligence to track and quantify allpatient and caregiver activity within a bedspace over the course of an ICU admission and also to establish patient specific factors, and environmental factors such as time ofday, that might contribute to an increased workload in ICU workers.

METHODS: 5000 images were manually annotated and then used to train You Only LookOnce (YOLOv4), an open-source computer vision algorithm. Comparison of patientmotion and caregiver activity was then performed between these patients.

RESULTS: The algorithm was deployed on 14 patients comprising 1762800 framesof new, untrained data. There was a strong correlation between the number ofcaregivers in the room and the standardized movement of the patient (p < 0.0001) withmore caregivers associated with more movement. There was a significant difference incaregiver activity throughout the day (p < 0.05), HDU vs. ICU status (p < 0.05), delirious vs. non delirious patients (p < 0.05), and intubated vs. not intubated patients(p < 0.05). Caregiver activity was lowest between 0400 and 0800 (average .71 ± .026caregivers per hour) with statistically significant differences in activity compared to 0800-2400 (p < 0.05). Caregiver activity was highest between 1200 and 1600 (1.02 ± .031 caregivers per hour) with a statistically significant difference in activity comparedto activity from 1600 to 0800 (p < 0.05). The three most dominant predictors of workeractivity were patient motion (Standardized Dominance 78.6%), Mechanical Ventilation(Standardized Dominance 7.9%) and Delirium (Standardized Dominance 6.2%).

CONCLUSION: Ambient Intelligence could potentially be used to derive a single standardized metricthat could be applied to patients to illustrate their overall workload. This could be usedto predict workflow demands for better staff deployment, monitoring of caregiver workload, and potentially as a tool to predict burnout.

PMID:36244918 | DOI:10.1016/j.aucc.2022.08.011

Brachytherapy. 2022 Oct 13:S1538-4721(22)00166-0. doi: 10.1016/j.brachy.2022.09.005. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates the feasibility and potential impacts of utilizing a Groupe Européen de Curiethérapie-European Society for Therapeutic Radiation and Oncology (GEC ESTRO) recommended surgical margin-based planning margin in permanent breast seed implant (PBSI) brachytherapy.

METHODS AND MATERIALS: Seventy-nine patients were included in this retrospective study. Three margin selections were used for PTV construction: (1) 1.25 or 1.5 cm isotropic margin (PTV_PBSI), (2) 2 cm minus surgical margin in each direction as recommended by GEC ESTRO (PTV_aniso), and (3) 2 cm minus minimum surgical margin isotropically (PTV_iso). PTV volume and dose coverage using clinical PBSI plans were compared across three groups. New PBSI plans were constructed on PTV_aniso for 20 patients and planning parameters were compared to original plans constructed on PTV_PBSI.

RESULTS: Twenty patients had surgical margins in six directions reported, with a median value of 8 mm anteriorly, and 10 mm in all other directions. PTV_aniso (36.3 ± 15.0 cc) was overall smaller than PTV_PBSI (55.6 ± 14.3 cc), p value < 0.05. PBSI clinical plans showed satisfactory coverage on PTV_aniso, with a median (range) V100 of 97.9% (85.8%-100.0%). Comparing to original treatment plans, new plans constructed on PTV_aniso reduced the number of implant seeds and skin dose.

CONCLUSIONS: Clinical PBSI plans provide satisfactory coverage of GEC ESTRO recommended PTVs. In this patient cohort, GEC ESTRO planning margin resulted in smaller target volumes, and therefore, new plans constructed on PTV_aniso required fewer implanted seeds and lower skin doses were achieved. However, given PBSI delivery uncertainties, further investigations are required to determine if the GEC ESTRO planning margin will be sufficiently robust.

PMID:36244908 | DOI:10.1016/j.brachy.2022.09.005

J Craniomaxillofac Surg. 2022 Oct 4:S1010-5182(22)00145-7. doi: 10.1016/j.jcms.2022.09.008. Online ahead of print.

ABSTRACT

This study aimed to assess various auditory canal injuries in patients with direct or indirect temporomandibular joint (TMJ) trauma, and, in collaboration with an otolaryngologist, evaluate the need for intervention. A prospective study was conducted at the institution. Patients who had sustained trauma to the TMJ were assessed for auditory canal injury through clinical and CT scan examination. All the patients were cross-consulted by an otolaryngologist for diagnosis and eventual management of any auditory canal injury. A close 3-month follow-up was carried out for all patients. Out of 32 cases (64 sides) of TMJ trauma, the following auditory canal injuries were documented: five cases (six sides) with tympanic plate fracture; five cases (five sides) with soft-tissue injury to the EAC; two cases (two sides) with tympanic membrane (TM) perforation; and one case (one side) with external auditory canal (EAC) hematoma (all p < 0.001). Corroborative results for the diagnosis of auditory canal injuries between the oral and maxillofacial surgeon (OMFS) and ENT surgeon were found to be statistically significant (p < 0.001). One case of tympanic membrane perforation required tympanoplasty and the rest were treated by conservative management. No complications were seen after 3 months of follow-up. To conclude, maxillofacial surgeons should perform a thorough bilateral ear examination to rule out any auditory canal injury in all the cases presenting with direct or indirect trauma to the TMJ. Timely management of such injuries should be undertaken by an otolaryngologist before TMJ trauma management to avoid any complications.

PMID:36244893 | DOI:10.1016/j.jcms.2022.09.008