Tag: pubmed

ArXiv [Preprint]. 2025 May 27:arXiv:2505.21080v1.

ABSTRACT

We explored the fractal and multifractal characteristics of breast mammogram micrographs to identify quantitative biomarkers associated with breast cancer progression. In addition to conventional fractal and multifractal analyses, we employed a recently developed fractal-functional distribution method, which transforms fractal measures into Gaussian distributions for more robust statistical interpretation. Given the sparsity of mammogram intensity data, we also analyzed how variations in intensity thresholds, used for binary transformations of the fractal dimension, follow unique trajectories that may serve as novel indicators of disease progression. Our findings demonstrate that fractal, multifractal, and fractal-functional parameters effectively differentiate between benign and cancerous tissue. Furthermore, the threshold-dependent behavior of intensity-based fractal measures presents distinct patterns in cancer cases. To complement these analyses, we applied the Inverse Participation Ratio (IPR) light localization technique to quantify structural disorder at the microscopic level. This multi-parametric approach, integrating spatial complexity and structural disorder metrics, offers a promising framework for enhancing the sensitivity and specificity of breast cancer detection.

PMID:40492247 | PMC:PMC12148087

Ecancermedicalscience. 2025 Mar 13;19:1871. doi: 10.3332/ecancer.2025.1871. eCollection 2025.

ABSTRACT

INTRODUCTION: Sorafenib is a multikinase tyrosine kinase inhibitor whose prolonged use may lead to cognitive impairment due to inhibition of angiogenesis. However, data on its impact on neurocognitive function in desmoid tumours (DTs) is lacking.

METHODS: We conducted a cross-sectional study enrolling 50 participants including 30 with DT on sorafenib (Group 1), 10 treatment-naive patients with DT (Group 2) and 10 healthy controls (Group 3). Questionnaire-based assessment was done using appearance anxiety inventory, Depression anxiety and stress questionnaire-21 (DASS-21), Hindi mental status examination (HMSE) and computer-based Cambridge neuropsychological test automated battery (CANTAB) neuropsychological tests. Statistical analysis was performed using GraphPad Prism software version 10 and individual groups were compared using Kruskal-Wallis test with p value of <0.05 considered significant.

RESULTS: 50 participants had a median age of 29.91 years (25%-75% CI: 27.05-32.77 years), female predominance (n = 26, 52%), median duration of sorafenib 18.1 months (range: 6-60) at a median dose of 241.17 mg (range: 200-400). There was a statistically significant difference in anxiety (p = 0.0127) between Groups 1 (patients on sorafenib) and 3 (healthy controls), while other objective cognitive and neuropsychological parameters were comparable. There was a significant positive correlation between sorafenib duration and anxiety (p = 0.026) by DASS21, and a negative correlation between HMSE and mean five choice reaction time (p = 0.04).

CONCLUSION: This is the first study to examine the neurocognitive effects of sorafenib in patients with DT. We exhibit significantly higher anxiety in patients with DT on sorafenib as compared to healthy controls. There was a significant correlation noted between anxiety and treatment duration. We propose further longitudinal studies to assess the effect of sorafenib in DT.

PMID:40492228 | PMC:PMC12146563 | DOI:10.3332/ecancer.2025.1871

Ecancermedicalscience. 2025 Mar 18;19:1874. doi: 10.3332/ecancer.2025.1874. eCollection 2025.

ABSTRACT

BACKGROUND: Breast cancer (BC) is the second most prevalent cancer among women in sub-Saharan Africa. Despite dedicated efforts to enhance BC care in the region through improving diagnostic and treatment services, little is known about the treatment outcomes of BC patients and the predictors of outcomes in our local settings have not been enumerated. This study aimed to investigate the treatment outcomes and the associated factors among BC patients in Tanzania.

MATERIALS AND METHODS: This was a retrospective cohort study at Muhimbili National Hospital and Ocean Road Cancer Institute in 2022. It involved female patients 18 years and above who were confirmed to have BC by histology. A sample size of 240 was determined to be adequate to detect a survival difference between the stages. Using Research Electronic Data Capture, clinical characteristics were collected from patients’ treatment records and survival status was ascertained both by case notes or phone calls to patients or next of kin. Data were transferred into Statistical Package for the Social Sciences version 27 for subsequent analysis where continuous variables were summarised as proportions. We used chi-square and Fisher’s exact tests to determine the association between various patients’ characteristics and treatment outcomes. Kaplan-Meyer analysis was used to determine survival and a p-value less than 0.05 is considered statistically significant.

RESULTS: In total, 298 BC patients were studied with a mean age of 53.2 ± 13.6 (27-89). Invasive ductal carcinoma, parity and late stage at presentation were predominant features in these patients. A triple negative subtype was identified in 35.2% of the women. Only 27.9% and 33.6% of the patients received neoadjuvant and adjuvant chemotherapy respectively, while 8.1% of the patients were palliated. The overall 5 years survival was 29.7%, while being significantly poor in patients with advanced stages of the disease. Luminal subtypes, parity, menopausal status and age had some influence on BC survival among our patients but not in a significant manner.

CONCLUSION: Mastectomy is predominantly offered to BC patients in Tanzania with no standardisation of use of chemo/radiation both in neo/adjuvant settings. Some important prognostic factors were missing including a lack of standardised work up of patients. With the predominance of advanced stage at presentation, BC carries unacceptable high mortality in Tanzania. Efforts to detect BC early, understand patients’ perception of their disease and standardisation of care are needed to successfully implement treatment guidelines.

PMID:40492227 | PMC:PMC12146571 | DOI:10.3332/ecancer.2025.1874

Ecancermedicalscience. 2025 Mar 20;19:1878. doi: 10.3332/ecancer.2025.1878. eCollection 2025.

ABSTRACT

BACKGROUND: The growing burden of cancer in Africa requires innovative approaches for enhancing the cancer workforce on the continent. Virtual communities of practice (VCoPs) are one such approach that can be utilised for continuous professional development, networking and sharing of cancer knowledge and best practices among different stakeholders.

OBJECTIVES: To describe the experiences of a cancer VCoP, the Africa Cancer Research and Control ECHO, and illustrate short- and long-term outcomes that are relevant to enhancing the cancer workforce in Africa.

METHODS: We collected quantitative and qualitative data about the 2022/2023 Africa Cancer ECHO through (i) statistics from the video conferencing platform (number of participants per session) and (ii) a cross-section survey at the end of the curriculum year in June 2023 (participants’ feedback about the sessions, learning and use of the knowledge and network from the ECHO). We also compared these data with evaluations of the ECHO from previous years, and conducted interviews with core community members to understand long-term outcomes regarding professional networking and collaboration.

RESULTS: The African Cancer ECHO has been running since 2018. Members meet regularly online to discuss different aspects of cancer control through didactical and case presentations. In 2022/2023, twelve 90-minute monthly sessions were held with an average of 33 attendees per session and 200 unique individuals from 14 African countries overall, plus additional representation from outside of Africa.Over the 4 years (2019/2020 to 2022/2023), different cancer control stakeholders participated in the Africa Cancer ECHO, including advocates, patients, clinicians, researchers and cancer planners. For each year, about 30% of the participants were new to the ECHO. The respondents were positive about the ECHO sessions and in agreement with the ECHO’s learning and networking outcomes 70%-90% of the time. The interviews revealed long-term, practical outcomes of the Africa Cancer ECHO, including securing research funding, initiation of a new community of practice to specifically address cancer survivorship in Africa and scientific research collaborations resulting in at least six peer-reviewed publications and several conference abstracts.

CONCLUSION: VCoPs, such as the Africa Cancer ECHO, have the potential to contribute to human resource capacity-building for cancer control in Africa through accessible and convenient peer learning, professional networking and collaboration. However, the identification and use of more robust evaluation tools and methods may provide a more comprehensive assessment of all of their benefits, including short and long-term outcomes.

PMID:40492226 | PMC:PMC12146562 | DOI:10.3332/ecancer.2025.1878

Ecancermedicalscience. 2025 Mar 5;19:1864. doi: 10.3332/ecancer.2025.1864. eCollection 2025.

ABSTRACT

PURPOSE: The purpose of this study was to compare the efficacy of oral morphine (MOR) with oral tramadol (TRM) in control of pain as well as physical well-being in patients (pts) with moderate cancer pain (MCP) using the Edmonton Symptom Assessment Scale (ESAS).

METHODS: An Institutional Review Board (IRB) approved randomised phase II trial was performed in opioid-naive pts with MCP as defined by pain score in numerical rating score (NRS) of 4-6. Patients were randomised to receive MOR syrup 5 mg 4 hourly or TRM 50 mg four times a day. Titration of dose was done in both groups for 3 days in case of inadequate pain control as per standard recommendation for MOR or until the maximum recommended daily dose for TRM. MOR was changed to prolonged release form on Day 4. The primary endpoint was the number of early responders, defined as pts with at least 20% reduction in pain intensity on NRS on Day 3. The secondary outcome was the number of patients with highly meaningful pain reduction, defined as a decrease in pain intensity on NRS by ≥5 and improvement in physical well-being with ESAS at Day 7.

RESULTS: Sixty-eight pts consented and were randomised, 34 in each arm. The primary endpoint occurred in 94.1% pts in MOR and 55.9% in TRM (p < 0.001). The number of patients with highly meaningful pain reduction was significantly higher in MOR than in TRM (76.5% versus 32.35%; p < 0.001). Improvement in general physical well-being as assessed by ESAS was better in the MOR group. No difference in adverse effects was noted between the treatment arms.

CONCLUSION: In this study, MOR was superior to TRM in the control of pain with statistically significant differences in the primary and secondary endpoints. Therefore, early use of MOR skipping the World Health Organization sequential analgesic ladder for MCP may be a higher value option in resource-scarce country with limited access to healthcare.

PMID:40492220 | PMC:PMC12146575 | DOI:10.3332/ecancer.2025.1864

Ecancermedicalscience. 2025 Mar 11;19:1868. doi: 10.3332/ecancer.2025.1868. eCollection 2025.

ABSTRACT

Proton pump inhibitors (PPIs) are widely used over-the-counter drugs. The interaction between capecitabine and PPIs is still ambiguous within the literature, with some discrepancies still being present regarding the risks, or benefits, of their concomitant use. This meta-analysis aims to analyse data from the literature regarding both the risk of PPIs on survival in patients treated with capecitabine, as well as their benefits regarding the incidence of hand-foot syndrome (HFS). A total of 17 studies were included after searching PubMed, Medline and Cochrane until October 2022 for the effect of PPIs on the treatment efficacy and pharmacokinetics, and incidence of HFS. Revman Ver. 5.3 was used for all statistical analyses. Our data showed a significant HFS reduction at a relative risk of 0.77 (95% CI: 0.70-085; p < 0.00001) in the PPI-using groups compared to control. Meta-analysis of studies assessing survival, however, showed a reduction in almost all survival aspects, most notably within the recurrence-free survival, with a hazard ratio of 1.75; 95% CI: 1.21-2.53; p = 0.003. Individual data incriminating the use of PPIs with capecitabine is quite limited; however, our robust survival data on around 30,000 patients gave significantly worse survival outcomes, particularly in the (neo)adjuvant setting.

PMID:40492211 | PMC:PMC12146577 | DOI:10.3332/ecancer.2025.1868

MedEdPORTAL. 2025 Jun 9;21:11526. doi: 10.15766/mep_2374-8265.11526. eCollection 2025.

ABSTRACT

INTRODUCTION: Wilderness medicine is a growing field focused on delivering quality medical care in austere environments. Simulation-based education has proven effective in emergency and wilderness medicine, particularly in graduate medical education. We propose that introducing wilderness medicine concepts earlier in medical education as part of a high-fidelity simulation for medical students could both increase interest in wilderness medicine and have widely applicable educational benefits.

METHODS: We developed a novel 1-day case-based simulation curriculum to be performed in a wilderness environment and invited undergraduate medical students to participate. A 25-question survey was administered before and after the simulation to assess subjective change across various topics.

RESULTS: The 10 of 12 students who responded to the survey indicated that the simulation significantly increased their confidence in managing urgent medical cases and increased their interest in the wilderness medicine field. All students agreed that simulation was an effective way to learn this material.

DISCUSSION: Implementing a wilderness medicine simulation in medical curricula appears feasible and provides a comprehensive model that can be easily adapted to other institutions.

PMID:40492203 | PMC:PMC12146433 | DOI:10.15766/mep_2374-8265.11526

J Lipid Atheroscler. 2025 May;14(2):190-199. doi: 10.12997/jla.2025.14.2.190. Epub 2025 Apr 9.

ABSTRACT

OBJECTIVE: The association of lipid parameters with cardiovascular disease (CVD) and the impact of kidney function on this association have not been thoroughly evaluated in patients with type 2 diabetes mellitus (T2DM).

METHODS: Using the Korean National Health Insurance Service Cohort database, we identified 2,343,882 subjects with T2DM in 2015-2016. Baseline lipid levels and kidney function were evaluated and followed up until December 2020. Subjects were classified into three groups according to their estimated glomerular filtration rate (eGFR): ≥60, 30-59, or <30 mL/min/1.73 m². We analyzed the diabetes group with eGFR ≥60 and low-density lipoprotein cholesterol (LDL-C) <70 mg/dL as a reference group.

RESULTS: The risk of CVD began to increase at LDL-C ≥100 mg/dL in the eGFR ≥60 mL/min/m² group. The risk of CVD in the eGFR 30-59 mL/min/m² group was increased by 43%, even in the LDL-C <70 mg/dL, and the risk increased progressively with LDL-C category. Among subjects with eGFR 30-59 mL/min/m², LDL-C 70-99, 100-129, 130-159, and ≥160 mg/dL were significantly associated with the risk of CVD, with hazard ratio (95% confidence interval) of 1.48 (1.43-1.53), 1.54 (1.49-1.60), 1.55 (1.48-1.63), and 1.88 (1.77-2.00), respectively. In the eGFR <30 mL/min/m² group, a 3.3-fold increased risk of CVD was seen, even at LDL-C <70 mg/dL.

CONCLUSION: The cutoff levels of LDL-C that increase CVD risk in patients with T2DM depend on kidney function, which influences the relationship between LDL-C and CVD risk in patients with T2DM.

PMID:40492185 | PMC:PMC12145966 | DOI:10.12997/jla.2025.14.2.190

J Lipid Atheroscler. 2025 May;14(2):145-158. doi: 10.12997/jla.2025.14.2.145. Epub 2025 Feb 11.

ABSTRACT

Statins represent the first-line therapy for cholesterol management. However, for patients prone to statin side effects, unable to tolerate higher doses, or requiring additional low-density lipoprotein cholesterol (LDL-C) reduction, ezetimibe alone or in combination with statins is recommended. This meta-analysis aimed to evaluate the safety and efficacy of combining low- or moderate-intensity statins with ezetimibe compared to high-intensity statin monotherapy, yielding reliable evidence to guide clinical decision-making and personalize treatment strategies. PubMed, Embase, and Scopus were systematically searched from inception until May 2023. All randomized controlled trials (RCTs) comparing a high-intensity statin with a low/moderate-intensity statin with ezetimibe were included. The outcomes of interest comprised changes in concentrations of lipids-LDL-C, high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TGs)-and apolipoprotein (Apo) A1, Apo B, and high-sensitivity C-reactive protein (hs-CRP), along with major adverse cardiovascular events (MACE). All data were analyzed using Review Manager version 5.4. p-values less than 0.05 were considered to indicate statistical significance. Overall, 20 RCTs, with 5,412 participants, were included. A low/moderate-intensity statin combined with ezetimibe yielded a significantly greater reduction in LDL-C levels than high-intensity statin monotherapy (mean difference [MD], -6.59; 95% confidence interval [CI], -10.95, -2.24; p=0.003; I²=84%). No significant differences were observed between combination and high-intensity statin monotherapy regarding TC, TG, or HDL-C levels. However, hs-CRP levels were significantly higher with combination therapy (MD, 0.32; 95% CI, 0.01, 0.64; p=0.04; I²=0%). Combination therapy involving a low/moderate-intensity statin with ezetimibe was significantly associated with lower LDL-C levels than high-intensity statin monotherapy. No significant differences were observed for TC, TGs, HDL-C, alanine transaminase, or MACE. However, creatine phosphokinase levels significantly increased with monotherapy.

PMID:40492183 | PMC:PMC12145961 | DOI:10.12997/jla.2025.14.2.145

Sex Med. 2025 Jun 9;13(3):qfaf043. doi: 10.1093/sexmed/qfaf043. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Lesbian, gay, bisexual, transgender, and other gender and sexual minority (LGBT+) individuals often face healthcare disparities, and physicians’ knowledge, attitudes, and clinical preparedness significantly impact access to competent care.

AIM: This study evaluated Turkish physicians’ perspectives, knowledge, and clinical approaches to LGBT+ sexual health, highlighting educational and clinical gaps.

METHODS: A nationwide cross-sectional survey was conducted among physicians from 10 specialties involved in LGBT+ sexual health. The survey, administered anonymously via Google Forms between June 4, 2024, and February 1, 2025, included sociodemographic questions and items assessing attitudes, clinical experience, and guideline familiarity. Statistical analyses included descriptive statistics, chi-square, Fisher’s exact tests, and binary logistic regression to identify predictors of physician attitudes and perceived competence.

OUTCOMES: The primary outcome was to assess physicians’ perspectives, competency, and willingness to provide LGBT+ healthcare, including gender-affirming procedures.

RESULTS: Among 745 participants, 58.8% considered LGBT+ identities normal, while 22.9% classified them as psychiatric disorders. Perceiving LGBT+ identities as normal was significantly associated with being female (OR = 3.12, 95% CI: 1.96-4.96, P < .001), prior experience treating LGBT+ patients (OR = 2.22, 95% CI: 1.60-3.07, P < .001), and physician specialty. This view was most common among psychiatrists (P = .012) and child and adolescent psychiatrists (P = .015). Physicians’ views were primarily shaped by education (43.2%) and socio-cultural environment (40.9%). Although 63.9% had treated LGBT+ patients, only 28.2% felt competent, and 11.5% were aware of relevant guidelines. Only 18% of surgical specialists supported gender-affirming procedures. The most commonly cited reason for reluctance was lack of surgical experience (44.8%), along with concerns related to religious beliefs, absence of a surgical team, and potential surgical complications. Ethical dilemmas were evident, as 58.3% believed LGBT+ patients face discrimination in healthcare, and 21.9% supported a physician’s right to refuse care based on personal beliefs.

CLINICAL IMPLICATIONS: Enhancing physicians’ education and competency in LGBT+ healthcare through structured training and standardized guidelines is crucial to improving equitable healthcare delivery.

STRENGTHS AND LIMITATIONS: This study provides novel insights into physicians’ attitudes and practices regarding LGBT+ healthcare in Turkey. However, self-reported data may introduce response bias, and findings may not be fully generalizable to other regions.

CONCLUSION: Significant educational and clinical gaps persist in LGBT+ healthcare. Addressing these through structured training programs, standardized protocols, and multidisciplinary collaboration is essential to ensuring competent, inclusive, and ethical medical care.

PMID:40492177 | PMC:PMC12147215 | DOI:10.1093/sexmed/qfaf043