Tag: statistics

Asian Pac J Cancer Prev. 2021 Jul 1;22(7):2025-2031. doi: 10.31557/APJCP.2021.22.7.2025.

ABSTRACT

The administration of high-dose methotrexate (HD-MTX) requires an accurate monitoring of blood MTX levels to determine the regimen of leucovorin rescue and urine alkalinization to prevent toxicity. However, it is technically and logistically challenging to screen patients routinely in limited-resource settings. This study aimed to evaluate blood MTX levels at 24- and 48-hours from start of infusion in relation to clinical toxicity in childhood ALL.

METHODS: A prospective cohort study was conducted on 32 consecutive children with acute lymphoblastic leukemia (ALL) who had received at least one cycle of 1 g/m2 HD-MTX intravenous infusion as a part of consolidation treatment based on the 2013 Indonesian ALL Protocol. In total, 68 cycles were evaluated. Serum MTX concentrations were measured using enzyme immunoassay. MTX toxicity was categorized using common toxicity criteria (CTCAE) 3.0 version. The association between MTX level and clinical toxicity was assessed by non-parametric analysis.

RESULTS: The 24-hours MTX level was median 29.8 ng/mL (0.065 µmol/L) (IQR 8.1-390.6) with a modest decrease in 48-hours MTX serum level in all cycles (median 28.3 ng/mL and 0.062 µmol/L; IQR 0.35-28.7; p <0.05). The two most common toxicities were hepatotoxicity (32.2%) and neutropenia (30.9%). Nephrotoxicity and febrile neutropenia occurred in 8.8% and 5.8% of patients, respectively, with low percentage of mucositis (4.3%) and thrombocytopenia (5.6%) recorded. No statistically significant association was found between MTX levels and clinical toxicity, except for liver toxicity.

CONCLUSION: Serum MTX levels at 24-hours and 48-hours are low, followed by only 4.4% grade III/IV hepatotoxicity and 26,4% grade III/IV neutropenia. There is no significant association between the clinical toxicity and MTX levels at the two points of measurement. An attempt to increase the MTX dose and/or to introduce a loading dose should be considered in subsequent ALL protocol as supported by further pharmacokinetic MTX studies in the Indonesian population.

PMID:34319023 | DOI:10.31557/APJCP.2021.22.7.2025

Asian Pac J Cancer Prev. 2021 Jul 1;22(7):2033-2041. doi: 10.31557/APJCP.2021.22.7.2033.

ABSTRACT

OBJECTIVES: Toxicities of the oral soft and hard tissues due to the radiotherapy of the head and neck cancer can potentially lead to interruptions of cancer treatment and/or dose reduction, resulting in poorer outcomes. The aim of this study was to assess the knowledge of dental practitioners in Saudi Arabia about oral and dental assessment for and complications of radiotherapy of head and neck cancer.

MATERIALS AND METHODS: An online, already validated, self-administered questionnaire was sent via an online link through WhatsApp groups and other Social Media platforms to reach out to the majority of targeted samples (dental practitioners working in Saudi Arabia). Responses were statistically described and analyzed based on the different grouping factors: gender, specialty, working sector, region of work and experience.

RESULTS: There were 370 respondents, 257 (69.5%) of them were males. Most of the respondents were general dental practitioners [144 (38.9%)], The percentages of the correct answers range from as low as 26.2 to as high as 97%. The per cent of correct answers by the respondents in 18 out of 31 questions was above 75%. Females, dental specialists (specifically prosthodontics), working in public sectors and in the central and western regions of Saudi Arabia were associated with higher levels of knowledge.

CONCLUSION: Our results show highly variable knowledge of dental practitioners on oral and dental assessment for, and complications and management of radiotherapy to the head and neck area; that knowledge seems to fluctuate considerably with gender, experience, work sector and specialty.<br />.

PMID:34319024 | DOI:10.31557/APJCP.2021.22.7.2033

Asian Pac J Cancer Prev. 2021 Jul 1;22(7):2043-2047. doi: 10.31557/APJCP.2021.22.7.2043.

ABSTRACT

OBJECTIVE: The role of HMG-CoA reductase (HMGCR) in relation to prognostic and treatment predictive information of HER2 positive breast cancer has been newly explored. In this study, we aimed to determine the expression of HMGCR in HER2 immunohistochemistry (IHC) scores of 2+ and 3+ breast cancer and to correlate with the patients’ outcomes.

METHODOLOGY: Using a cross-sectional design, invasive breast carcinoma of no special type (NST) and HER2 IHC scores of 2+ and 3+ cases were selected over a 50-month period in Hospital Sultanah Bahiyah (HSB), Alor Setar. IHC staining for HMGCR was performed on paraffin-embedded tissues at the Pathology Laboratory, Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian using the standard staining procedure. The results were correlated with the patient’s demographic and clinicopathological data.

RESULTS: A total of 59 cases of HER2 IHC 2+ and 3+ invasive breast carcinoma were identified. The cases were predominant in young Malay women with tumours smaller than 50mm, higher grade and positive for lymphovascular invasion, axillary lymph nodes involvement and ER/PR expressions. HMGCR was positively expressed in HER2 IHC 2+ and 3+ breast cancer cases, which the staining intensities varied from weak, moderate to strong. Majority of the cases were scored 1+ for HMGCR expression. A low-positive HMGCR was more likely to be associated with less favourable outcomes of patients with HER2 IHC 2+ and 3+. However, the associations were statistically not significant.

CONCLUSION: A study in a larger cohort of tumour samples is needed to further validate HMGCR expression as a potential prognostic biomarker for HER2 positive breast cancer. It is also suggested that all the HER2 IHC 2+ and 3+ cases need to be gene amplified using FISH analysis. <br />.

PMID:34319025 | DOI:10.31557/APJCP.2021.22.7.2043

Nurs Open. 2021 Jul 28. doi: 10.1002/nop2.1010. Online ahead of print.

ABSTRACT

AIM: This study aimed to determine the predictors of hospital stay and mortality in patients with burns.

DESIGN: This is a cross-sectional, retrospective study.

METHODS: This study was performed on 626 medical records in Velayat Subspecialty Burn and Plastic Surgery Center in Rasht, Iran, during 2008-2013.

RESULTS: Men comprised 78.4% of the study population. Overall, 50.2% of the participants lived in rural areas, and 72.5% were married. The majority of burns occurred at home (49.5%), and thermal factor (87.4%) was the major cause of burn injuries. Also, 6.9% of the patients died after burns. The mean length of hospital stay was 12.62 ± 13 days. Age (OR = 1.07), total body surface area (TBSA%) (OR = 1.12) and length of ICU stay (OR = 1.06) were the strongest predictors of mortality. Gender (IRR = 0.85), TBSA% (IRR = 1.01), location of burn (IRR = 1.1), skin graft (IRR = 2.12), length of ICU stay (IRR = 1.04), re-hospitalization (IRR = 1.77) and burn degree (IRR = 1.09) were the predictors of the length of hospital stay.

CONCLUSION: BSA is still an important predictor of mortality and length of hospital stay, as the most important short-term outcomes of burns.

PMID:34319015 | DOI:10.1002/nop2.1010

Asian Pac J Cancer Prev. 2021 Jul 1;22(7):2011-2016. doi: 10.31557/APJCP.2021.22.7.2011.

ABSTRACT

BACKGROUND: Human cytomegalovirus (HCMV) is prevalent viral infection involved in several human cancers including breast cancer. The presence of HCMV genome in breast cancer tissue and footprint of viral last exposure patient’s serum are considered as important factor in the process of breast cancer development.

OBJECTIVES: This study aimed to investigate molecular and serological epidemiology of HCMV in patients with breast cancer in Iran for first time.

METHODS: In our case-control study, 98 samples of breast tissue, including 49 cancerous (case) and 49 adjacent non-cancerous tissue were collected (control). In addition, we collected sera samples from all patients (n=49) and healthy individual (n=49). Seroprevalence of HCMV was assessed by Enzyme-linked immunosorbent assay (ELISA) and detection of HCMV genome was performed using Nested-PCR method.

RESULTS: HCMV genome found in 16.3% (8/49) of cases tissue and 2% (1/49) of controls tissue. In patients group, the levels of anti-CMV IgG and IgM were 93.9% and 2% compared to 69.4% and 4.1% in healthy individuals, respectively. There was a statistically difference between the anti-CMV IgG in patients and healthy control (p= 0.002). We found 75% of (6/8) HCMV genome positive PCR samples were also positive for their anti-CMV IgG in cases which was statistically significant (p= 0.01). Conclusions: Our result showed significant presence of HCMV genome and anti-CMV IgG in patients, supporting the role of HCMV in breast cancer.<br />.

PMID:34319021 | DOI:10.31557/APJCP.2021.22.7.2011

J Adv Nurs. 2021 Jul 28. doi: 10.1111/jan.14985. Online ahead of print.

ABSTRACT

AIM: To test whether infrared non-touch forehead thermometry (FNTT) obtains comparable temperature readings in adults compared with common, non-invasive thermometry methods such as axillary (DAT), oral (DOT) and infrared tympanic (ITT).

DESIGN: A prospective, repeated-measures comparative diagnostic test study design was used for this study.

METHODS: Data were collected from a convenience sample of 169 nursing students over 3 months (March 2019 to May 2019). Participants had their temperature measured once with each of the four thermometers. Agreement between thermometers was assessed using repeated-measures analysis of variance with Bonferroni post hoc testing.

RESULTS/FINDINGS: One hundred and sixty-one participants were included in the final analysis. A repeated-measures ANOVA showed statistically significant differences between the four thermometer temperature readings. Post hoc pairwise comparisons with Bonferroni adjustment revealed infrared non-touch forehead thermometry demonstrated statistically significant higher mean temperatures compared with digital oral thermometry MD = 0.466℃ (95% CI, 0.357-0.576, p < .001) and digital axillary thermometry MD = 0.897℃ (95% CI, 0.752-1.043, p < .001), but not with infrared tympanic MD = 0.069℃ (95% CI, -0.025-0.162, p = .307).

CONCLUSIONS: This study found that infrared non-touch forehead thermometry consistently produced higher temperature readings in adults compared with other common forms of peripheral thermometry. Caution should be taken when using forehead non-touch thermometer readings interchangeably with digital oral and digital axillary readings unless corrections for bias are made. More research is needed into whether infrared non-touch forehead thermometry and infrared tympanic could be used interchangeably.

IMPACT STATEMENT: This study aimed to address whether non-touch forehead could be used interchangeably with other common forms of non-invasive thermometry. Our result revealed inconsistencies in temperature readings between the different thermometers. Consequently, healthcare professionals should exercise caution when monitoring temperature trends where readings have been taken by different types of peripheral thermometers. This study could impact healthcare clinicians responsible for the monitoring and recording of peripheral temperatures.

PMID:34318950 | DOI:10.1111/jan.14985

J Appl Clin Med Phys. 2021 Jul 28. doi: 10.1002/acm2.13345. Online ahead of print.

ABSTRACT

PURPOSE: The integration of auto-segmentation and automated treatment planning methods on a fast-rotating O-ring linac may improve the time efficiency of online adaptive radiotherapy workflows. This study investigates whether automated treatment planning of prostate SBRT with focal boosting on the O-ring linac could generate plans that are of similar quality as those obtained through manual planning on clinical C-arm linacs.

METHODS: For 20 men with prostate cancer, reference treatment plans were generated on a TrueBeam STx C-arm linac with HD120 MLC and a TrueBeam C-arm linac with Millennium 120 MLC using 6 MV flattened dual arc VMAT. Manual planning on the Halcyon fast-rotating O-ring linac was performed using 6 MV FFF dual arc VMAT (HA2-DL10) and triple arc VMAT (HA3-DL10) to investigate the performance of the dual-layer MLC system. Automated planning was performed for triple arc VMAT on the Halcyon linac (ET3-DL10) using the automated planning algorithms of Ethos Treatment Planning. The prescribed dose was 35 Gy to the prostate and 30 Gy to the seminal vesicles in five fractions. The iso-toxic focal boost to the intraprostatic tumor nodule(s) was aimed to receive up to 50 Gy. Plan deliverability was verified using portal image dosimetry measurements.

RESULTS: Compared to the C-arm linacs, ET3-DL10 shows increased seminal vesicles PTV coverage (D_99% ) and reduced high-dose spillage to the bladder (V_37Gy ) and urethra (D_0.035cc ) but this came at the cost of increased high-dose spillage to the rectum (V_38Gy ) and a higher intermediate dose spillage (D2cm). No statistically significant differences were found when benchmarking HA2-DL10 and HA3-DL10 with the C-arm linacs. All plans passed the patient-specific QA tolerance limit.

CONCLUSIONS: Automated planning of prostate SBRT with focal boosting on the fast-rotating O-ring linac is feasible and achieves similar plan quality as those obtained on clinical C-arm linacs using manual planning.

PMID:34318996 | DOI:10.1002/acm2.13345

Agri. 2021 Jul;33(3):168-175. doi: 10.14744/agri.2021.65807.

ABSTRACT

OBJECTIVE: The circadian rhythm is the most important of the main rhythms that affect our daily lives and has a significant role in the efficiency of a lot of drugs used in anesthesia. The aim of this study is to prove whether circadian rythm has an effect on spinal anesthesia and, if any, its effect on postoperative analgesic request by retrospectively studying the patients operated under spinal anesthesia.

METHODS: We conducted the study on patients operated on inguinal hernia and anorectal surgery under spinal anesthesia in general surgery room. The patients were divided into two groups according to the time when they were taken into surgery: between 06.00-12.00 (Group 1) and 12.00- 18.00 (Group 2). Time to first analgesic request, time to start walking, time to first urination, intraoperative and postoperative side effects, intraoperative hemodynamic data, and patient satisfaction were detected and recorded.

RESULTS: The time to first analgesic request in Group 1 was longer than in Group 2, and this difference was statistically significant. The mean heart rate of the groups was found significantly lower in Group 2 than in Group 1 during measurements at the 25. and 30. minute when compared with their changes over time. There were no statistically significant differences between the groups in terms of side effects and the most common side effect was detected to be nausea – vomiting.

CONCLUSIONS: We found out that the time to first analgesic request after spinal anesthesia was significantly longer in Group 1 than in Group 2.

PMID:34318918 | DOI:10.14744/agri.2021.65807

Aust Occup Ther J. 2021 Jul 28. doi: 10.1111/1440-1630.12759. Online ahead of print.

ABSTRACT

INTRODUCTION: The manual wheelchair skills training programme is used to structure teaching manual wheelchair use for people following injury or disability. This pilot study aimed to explore the outcomes of introducing a group wheelchair skills training programme on skill performance, confidence and frequency of wheelchair use for people with lower limb amputation in a rehabilitation setting from the perspective of participants and group facilitators.

METHOD: This pilot study used a two-phase mixed methods nested design. Eleven people with lower limb amputations received a minimum of two 45-min wheelchair skills sessions, using the Wheelchair Skills Training Program, delivered in a mix of group and one-to-one sessions. In phase one, wheelchair skill performance, confidence and frequency were measured using the Wheelchair Skills Test Questionnaire-Version 5.0, goal achievement was measured through the Functional Independence Measure and Goal Attainment Scale. These measures were repeated in phase two. Nested within phase two was qualitative data collection. Interviews were conducted with eight participants and a focus group held with three programme facilitators, to gather their perceptions of the training process. Descriptive statistics were used to analyse and report quantitative data and thematic analysis was used to combine qualitative data from the two participant groups.

RESULTS: Post intervention, the mean Wheelchair Skills Test Questionnaire score increased in performance (42.3 ± 13.4), confidence (33.9 ± 20.7) and frequency (33.9 ± 27.3). Goal Attainment was achieved or exceeded by 91% of all participants. Four themes were developed from qualitative data including, “motivators driving learning,” “delivery methods, structure and profile of the Wheelchair Skills Training Program,” “managing risk and safety” and “confidence in wheelchair use.”

CONCLUSIONS: The pilot study found that The Wheelchair Skills Training Program can improve wheelchair performance, confidence and frequency to support enhanced safety, independence and quality of life for people with lower limb amputations.

PMID:34318937 | DOI:10.1111/1440-1630.12759

Agri. 2021 Jul;33(3):155-167. doi: 10.14744/agri.2021.79836.

ABSTRACT

Objective – To evaluate if a current smoking status and a higher nicotine dependence were associated with chronic low back pain and/or radicular neuropathic pain. Materials and methods- A cross-sectional study was conducted on the first eligible consecutive 120 patients. Demographic data, pain intensity, worst pain location, most distal pain radiation, the DN4 questionnaire, STarT back tool, and the Fagerström Test were collected during the initial examination. An age- and gender-matched control group (n=50), free from chronic low back pain was recruited. Results- In the chronic pain group, there was a significant difference between smokers and lifetime non-smokers in the average pain intensity (p=0.037), total DN4 score (p=0.002), STarT Back tool (p=0.006), worst pain location (p=0.023) and the most distal pain radiation (p=0.049). The mean total DN4 score increased with a corresponding increase in the number of cigarettes smoked daily (p=0.002). Current smokers had an OR of 3.071 (p=0.013) (95% CI 1.268-7.438) for developing chronic low back pain and lumbar related leg pain and an OR of 6.484 (p<0.001) (95% CI 2.323-18.099) for developing chronic radicular neuropathic leg pain. For every one-unit increase in the Fagerström test score, the likelihood for chronic low back pain and lumbar related leg pain increased by 40.71% (p=0.008) (95% CI 1.095-1.809) and for chronic radicular neuropathic leg pain increased by 71.3% (p<0.001) (95% CI 1.292-2.272). Conclusion- A current smoking status and a higher nicotine dependence were both independently associated with an increased risk for chronic low back pain and/or chronic radicular neuropathic pain.

PMID:34318914 | DOI:10.14744/agri.2021.79836