Prognosis Prediction in Esophageal Cancer
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820 Jorie Blvd, Oak Brook, IL 60523
Δευτέρα 21 Δεκεμβρίου 2020
Fwd: Prognosis Prediction in Esophageal Cancer
Medicine
| Study Protocol Titles: Erratum No abstract available |
Huanglian Jiedu Decoction for treatment of multiple myeloma: A protocol for a systematic review and meta-analysis Background: Multiple myeloma can lead to lots of clinical problems including pain, fatigue, anemia, infections, renal failure, and so on. Huanglian Jiedu Decoction is a common conservative treatment for this disease in China. Therefore, we conducted a systematic review and meta-analysis to explore the efficacy of Huanglian Jiedu Decoction in the treatment of multiple myeloma. Methods: A systematic literature search for studies will be performed in 8 databases, including PubMed, Web of Science, Embase, the Cochrane library, ClinicalTrials.gov databases, Chinese National Knowledge Infrastructure Database, Wanfang database, and VIP database. The methodological quality of the included studies using the risk bias assessment tool of Cochrane. And the level of evidence for results is assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Statistical analysis is conducted with Revman 5.3. Results: This systematic review and meta-analysis will provide a synthesis of existed evidences for Huanglian Jiedu Decoction on multiple myeloma. Conclusion: The conclusion of this study will provide evidence to assess effectiveness of Huanglian Jiedu Decoction on multiple myeloma, which can further guide clinical decision-making. INPLASY registration number: INPLASY202060094 |
Three metachronous primary lung cancers in a chronic smoker: A case report and review of the literature Rationale: Lung cancer is a leading cause of cancer-related deaths. Smoking is major risk factor for initial and subsequent lung cancer especially in active smokers. Treatment of subsequent lung cancer depends on whether it is synchronous or metachronous. We report a rare case of triple metachronous lung cancer and review of literature of patients with triple metachronous cancers. This will be the second case reported of triple metachronous lung cancer. Patient concerns: A 60-year-old male, active smoker with diabetes mellitus, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease presented with cough and hemoptysis. Initial computed tomography (CT) scan showed right upper lobe spiculated mass. Diagnosis: He underwent transthoracic needle biopsy for right upper lobe mass, showing primary lung adenocarcinoma (ADC)-Stage-IIIA. He continued to smoke and 9-years later had new left upper lobe spiculated nodule, which on surgical resection showed squamous cell carcinoma (SCC)-Stage-IA1. Despite counselling on smoking cessation, he was unable to quit. Six months later, he presented with shortness of breath and CT chest showing right hilar adenopathy in right upper and lower lobes. He underwent transbronchial biopsies of lesion which showed small cell lung carcinoma (SCLC). Interventions: His initial lung ADC-Stage-IIIA, was treated with chemotherapy, weekly thoracic radiation and additional chemotherapy cycles. Nine years later, his left upper lobe mass showing SCC-Stage-IA1 was deemed curative after apical resection and he was kept on surveillance. Six months later, after diagnosis of SCLC in right upper and lower lobe, patient was not a candidate for systemic chemotherapy due to poor performance status and opted for hospice care. Outcomes: His initial lung ADC-Stage-IIIA showed complete radiological response with chemotherapy and radiation. Subsequent SCC-Stage-IA1 was deemed curative after resection. Due to his poor performance status, he was not a candidate for chemotherapy for SCLC and patient opted for hospice care. Lessons: Smoking is a major risk factor for developing lung cancer and with continued smoking, patients are at higher risk for developing subsequent primary lung cancers. We recommend, patients with lung cancer must quit smoking, and those who do not, should remain on long-term surveillance. |
Therapeutic effects of brain-computer interface-controlled functional electrical stimulation training on balance and gait performance for stroke: A pilot randomized controlled trial Background: Brain-computer interface-controlled functional electrical stimulation (BCI-FES) approaches as new feedback training is increasingly being investigated for its usefulness in improving the health of adults or partially impaired upper extremity function in individuals with stroke. Objective: To evaluate the effects of BCI-FES on postural control and gait performance in individuals with chronic hemiparetic stroke. Methods: A total of 25 individuals with chronic hemiparetic stroke (13 individuals received BCI-FES and 12 individuals received functional electrical stimulation [FES]). The BCI-FES group received BCI-FES on the tibialis anterior muscle on the more-affected side for 30 minutes per session, 3 times per week for 5 weeks. The FES group received FES using the same methodology for the same periods. This study used the Mann-Whitney test to compare the two groups before and after training. Results: After training, gait velocity (mean value, 29.0 to 42.0 cm/s) (P = .002) and cadence (mean value, 65.2 to 78.9 steps/min) (P = .020) were significantly improved after BCI-FES training compared to those (mean value, 23.6 to 27.7 cm/s, and mean value, 59.4 to 65.5 steps/min, respectively) after FES approach. In the less-affected side, step length was significantly increased after BCI-FES (mean value, from 28.0 cm to 34.7 cm) more than that on FES approach (mean value, from 23.4 to 25.4 cm) (P = .031). Conclusion: The results of the BCI-FES training shows potential advantages on walking abilities in individuals with chronic hemiparetic stroke. |
Mediating effect of social support on the association between life events and depression: A cross-sectional study of adolescents in Chongqing China Depression is one of the most common mental health problems in adolescents. The link between negative life events and depression has been well established. However, our understanding about the role of social support in the link, which is likely culture-dependent, is quite limited. This study aimed to determine the mediating effect of social support on the association between life events and depression in adolescents in Chongqing China. A total of 1512 adolescents aged 12 to 17 years old in Chongqing of China were selected using a stratified cluster sampling strategy. Depression symptoms, negative life events, and perceived social support of the participants were measured using the Children's Depression Inventory, Adolescent Life Event Scale, and Child and Adolescent Social Support Scale, respectively. Pearson correlation analyses were performed to detect their associations. A multivariate linear regression model was established to determine the association between life events and depression after adjustment for variations in socio-demographic variables. The mediating effect of social support on the association between negative life events and depression was tested using the structural equation model. About 16.8% of the participants were detected with depression. Depression was associated with negative life events and low levels of social support (P < .05). Both frequency and perceived importance of social support showed a mediating effect on the association between life events and depression. Social support has a mediating effect on the association between life events and depression. Strengthening social support may be considered as an effective interventional strategy on depression in adolescents. |
Comparison of empirical high-dose and low-dose of meropenem in critically ill patients with sepsis and septic shock: A randomized controlled study protocol Background: Sepsis and septic shock syndrome are the main problems in modern medicine. Current treatment guidelines for the sepsis recommend an appropriate and timely antibiotic treatment. Meropenem has activity against a wide variety of Gramnegative and Gram-positive bacteria. At present, there are few studies on the application of high-does meropenem in the patients with sepsis and septic shock. We therefore carry out the randomized controlled research to compare the low-dose and high-dose meropenem in the critically ill sepsis and septic shock patients, and to assess the safety of the two regimens. Method: This is a prospective, single-center, and randomized research authorized through the local research ethics committee of Zhejiang Chinese Medical University (No.32198276). Sixty-four participants with a diagnosis of sepsis and septic shock are analyzed. Patients who meet the following conditions will be included: (1)patients older than 18 years old,(2)patients diagnosed with the sepsis and septic shock, and(3)patients (or their relatives) who have signed a consent. Patients with the following conditions will be excluded (1)patients with infective endocarditis and central nervous system infection;(2)Within 24 hours after the randomization of patients needing surgery;(3)Within 24 hours after the randomization, patients who received extracorporeal membrane oxygenation (ECMO);(4)Patients with known meropenem allergy. They are assigned to 2 groups, namely, the standard-does group and high-dose group, in the standard-does group, they receive low-dose meropenem (intravenous injection of 1 g meropenem for more than 30 minutes, followed by intravenous injection of 1 g meropenem for more than three hours every 8 hours), and in the high-dose group, patients receive high-does meropenem (intravenous injection of 2 g meropenem for more than 30 minutes, and then intravenous injection of 2 grams of meropenem for more than three hours every 8 hours). The main outcomes are the modified Acute Physiology and Chronic Health Evaluation II (APACHE II) and scores of Sequential Organ Failure Assessment (SOFA). And the secondary outcomes are the 14-day mortality and 28-day mortality, the rate of microbiological cure and clinical cure, ventilator-free days, vasopressor-free days, hospital-free days and the ICU-free days, as well as safety in the two regimen groups. All analysis in our work is carried out via utilizing the software of IBM SPSS Statistics for Windows, version 20. Results: Figure 1 reveal the primary outcomes and the secondary outcomes. Conclusion: This protocol can provide a reliable evidence for the safety and effectiveness of the high-dose meropenem in the critically ill sepsis and septic shock patients. Trial registration number: researchregistry6023 |
Effectiveness and safety of different medicines for Uremia pruritus: A protocol for systematic review and network meta analysis Introduction: A large number of patients will experience pruritus after uremia. Medicine is the preferred treatment for many doctors, but the effectiveness and safety of different medicines for uremia pruritus has not yet been comprehensively compared, based on network meta-analysis. Methods and analysis: According to the retrieval strategy, two team members independently searched the literature in 7 databases, and imported the retrieval results into the EndNote Software AQ8 (V.X9). After deleting repeated articles, they read the abstract and the full text, selected the articles that met the inclusion criteria and extracted valid information. The main results were visual analogue scale (VAS) and the secondary results were verbal rating scale (VRS), Dirk R Kuypers score, and adverse event incidence. The methodological quality evaluation was conducted from 7 aspects, according to The Cochrane Collaborative Tool, Stata Statistical Software (Version 14.0, Stata Corporation, College Station, TX) was used for data analysis. The level of evidence will be assessed by the Grading of Recommendations, Development and Evaluation (GRADE) instrument). Results: The results will rank the efficacy of drugs used to treat uremic pruritus and assess their safety. Conclusion: This study is the first to compare the efficacy and safety of medicines for uremic pruritus based on network analysis and will provide evidence and ideas for the treatment of uremic pruritus. INPLASY registration number: No. INPLASY202090103. |
Different acupuncture therapies combined with rehabilitation in the treatment of scapulohumeral periarthritis: A protocol for systematic review and network meta-analysis Background: Scapulohumeral periarthritis is a disease that seriously affects human daily work and life, and greatly reduces peoples quality of life and affects human health all over the world. Now, many studies have shown that acupuncture and rehabilitation have a significant effect on scapulohumeral periarthritis. In this study, network meta-analysis was used to analyze and compare the clinical efficacy and difference of different acupuncture treatments on scapulohumeral periarthritis. Methods: All patients were diagnosed as scapulohumeral periarthritis by randomized controlled trial. Computer searches will be conducted on CNKI, Wan-Fang databases, VIP, CBM, Pubmed, Cochrane library, Embase, Web of Science. The retrieval period is from the date of database establishment to September 8, 2020. To avoid omissions, we will manually retrieve relevant references and conference papers. Finally, the risk of bias included in the study will be assessed according to the guidelines of the Cochrane Handbook for systematic review of interventions. All data analysis will be performed by Revman 5.3, WinBUGS1.4.3 and Stata14.2. Results: The effectiveness of each intervention was quantified. The main results included cure rate, total effective rate, VAS score and shoulder function score. Conclusion: Objective to provide evidence-based medicine basis for clinicians to choose more effective acupuncture therapy for scapulohumeral periarthritis. INPLASY Registration number: 202090035. |
Clinical features of velamentous umbilical cord insertion and vasa previa: A retrospective analysis based on 501 cases To identify the risk factors associated with velamentous cord insertion (VCI) and investigate the association between adverse pregnancy outcomes and VCI in singleton pregnancies and those with vasa previa. A total of 59,976 single cases admitted from Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014 were included in this study. We retrospectively analyzed the perinatal complications, neonatal complications, and the clinical features, as well as the Color Doppler ultrasonography findings of the velamentous placenta and placenta previa. We reviewed the clinical data of 59,976 women with singleton pregnancies delivered in Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014. Risk factors and the risks of adverse pregnancy outcomes including admission to a neonatal unit, fetal death, preterm delivery, low birth weight of <2500 g, the infant being small for its gestation age, low Apgar scores (<7) at 1 and 5 minute were evaluated separately among women with and without VCI by means of logistic regression analyses. The prevalence of velamentous umbilical cord insertion was 0.84%, and the prevalence of vasa previa was 0.0017%. The independent risk factors for VCI were nulliparity, obesity, fertility problems, placenta previa, and maternal smoking. VCI was associated with a 1.83-, 2.58-, 3.62-, and 1.41-fold increase in the risk of retention in the neonatal unit, preterm delivery (<37 gestation weeks), low birth weight, and small-for-gestational age, compared to pregnancies involving normal cord insertion. Of the women with VCI, 16.1% underwent emergency cesarean section compared to 8.9% (P < .001) of women without VCI. The prevalence of VCI was 0.84% in singletons. The results suggest that VCI is a moderate risk condition resulted in increased risks of prematurity and impairment of fetal growth. |
The efficacy of Chinese herbal medicine as an adjunctive therapy for colorectal cancer: A protocol for systematic review of randomized controlled trials Background: Colorectal cancer (CRC) is a public health problem and the world's leading cancer killer. It is a disease with high incidence and mortality. Although chemotherapy has achieved some success in the treatment of CRC, drug resistance and tumor metastasis caused by chemotherapy are still the main causes of death in patients with CRC. Notably, many side effects associated with chemotherapy, such as nausea, vomiting, and peripheral neurotoxicity, are major challenges in the treatment of patients with CRC. Chinese herbal medicine (CHM) has been widely used as an adjunctive therapy for CRC, but its efficacy and safety are still uncertain. The aim of this systematic review is to assess the efficacy and safety of CHM for the treatment of CRC. Methods: A comprehensive retrieval will be performed in the following electronic databases: PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, SinoMed, VIP, and Wan Fang Data. The methodologic quality of randomized controlled trials will be assessed using the Cochrane risk assessment tool. Review Manager 5.3 software will be used for data synthesis and analysis. Funnel plot analysis and Egger test will be used to assess publication bias. The Grading of Recommendations Assessment, Development and Evaluation standard will be used to generate summary of finding table. Results: The results of this systematic review will be used to summarize and evaluate the evidence from randomized controlled clinical trials of CHM as adjuvant therapy for CRC. Conclusion: This review will provide a detailed summary of the evidence to assess the efficacy and safety of CHM for CRC. OSF Registration: DOI 10.17605/OSF.IO/X2SKJ |
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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Telephone consultation 11855 int 1193,
Prosthetics and Orthotics
JPO Editor's Comments No abstract available |
Performance of a Sensor to Monitor Socket Fit: Comparison With Practitioner Clinical Assessment Introduction A sensor that detects changes in prosthetic socket fit before they manifest clinically may be helpful towards rehabilitation after limb amputation. Materials and Methods Participants with transtibial amputation walked on a treadmill wearing a motor-driven, cabled-panel adjustable socket. Socket volume was slowly adjusted away from the neutral socket volume (panels flush). The percent socket volume change at which the practitioner, using visual assessment, first noted fit issues was compared with the percent socket volume change at which the sensor first detected a measurable change in fit. Results The median percent socket volume change at which the sensor first detected a measurable socket enlargement (0.50%) was significantly less than both the median percent socket volume change at which the research practitioner first noted a change in fit (1.69%) (P = 0.008) and the median percent socket volume change at which the participant would normally add a sock (2.30%) (P = 0.005). During socket reduction, the practitioner noted a change in fit before the participant would normally remove a sock in only 2 of 10 participants. The median percent socket volume change at which the sensor first detected a measurable socket reduction (−0.44%) was significantly smaller in absolute value than the median percent socket volume change at which the participant would normally remove a sock (−2.76%) (P = 0.005). Conclusions The sensor detected controlled socket fit changes before the research practitioner in this study. A next step will be to determine if the sensor detects unforced socket fit changes, and changes in user free-living environments. |
Parental Perception of Cranial Orthotic Treatment for Infants with Deformational Plagiocephaly Introduction The objective of this study is to increase understanding of the parents' experiences while caring for their infants during cranial orthotic treatment for deformational plagiocephaly. Methods This study is a qualitative descriptive study consisting of interviews focused on parental perceptions of the experience caring for their infant during treatment. Data were analyzed using conventional content analysis. Results Ten parents participated in this qualitative study. Data revealed the pattern of a journey related to caring for an infant undergoing cranial orthotic treatment. Parents described the journey as consisting of the following phases: "making the decision," "acclimating to the cranial orthosis," "developing a routine," "seeing results," and "envisioning the future." Minor nuisances and concerns were present throughout treatment. Discussion With initiation of cranial orthotic treatment, parents expressed some reservations. As treatment advanced, parents discussed their journey more positively as their infant's head shapes improved. The availability of support, someone to answer questions, and patience facilitated a successful journey. Seeing the change in head shapes reinforced continuing with treatment. |
Bracing to Treat Dropped Head Syndrome in Cancer Patients: A Retrospective Review Introduction The objective of this study is to describe the use of postural bracing to treat dropped head syndrome (DHS) in cancer patients. The study design is a retrospective review over a 3-year period of cancer patients who presented to a cancer physiatry outpatient practice for treatment of DHS. Patients were individuals with a history of head and neck cancer, Hodgkin lymphoma, or other cancer with a diagnosis of DHS. Materials and Methods The treatment intervention was postural bracing with either a figure-of-eight orthosis with or without a lumbosacral orthosis or a thoracolumbosacral orthosis. Results Subjective, patient-reported improvements in pain, posture, and neck or back strength in addition to objective improvements in physical examination were made. Out of 41 patients initially evaluated for DHS who followed up in brace clinic, 61% reported a positive response to bracing with 17.1% reporting improvement in neck or back strength, 17.1% reporting improvement in pain, and 39% reporting improvement in posture. Discussion In this study, we present a successful alternative to treat DHS through the use of active bracing. The technique of active bracing in this population theoretically strengthens the weak muscles in head drop and improves head position. Maintenance of these achievements, although not directly studied in this project, must be performed through a regular home exercise and bracing program as patients likely have a tendency to weaken again given prior oncologic treatments. Conclusions Active postural bracing using a combination of a figure-of-eight brace with or without a lumbosacral orthosis or a thoracolumbosacral orthosis in conjunction with physical therapy can help improve the posture, pain, and neck and back strength of cancer patients with DHS. |
Impression Methods for Custom Foot Orthoses—Comparing Semi–Weight-Bearing Foam and Non–Weight-Bearing Plaster Using a Kinematic Measurement of the Medial Longitudinal Arch INTRODUCTION One of the goals for custom foot orthoses (CFOs) is to provide relief for pressure-sensitive areas and provide support to the joints of the foot for an optimal weight-bearing position. The most common CFO impression methods used by practitioners include plaster bandage, foam box, fiberglass, and laser-optical scanning, and are often compared by measuring foot molds created from those methods. The objective of this study is to compare the biomechanical effects of CFOs made from two common casting methods using skeletal kinematics. MATERIALS AND METHODS The medial longitudinal arch (MLA) angle was measured for 13 participants of different foot types: five pes planus, four pes cavus, and four normally arched. Four conditions were compared: barefoot, shod, and CFOs made from both semi-weight-bearing foam and non-weight-bearing plaster casting methods. The MLA angle was measured from three-dimensional bone models using biplane fluoroscopy images during midstance. RESULTS Foam (P = 0.02) and plaster (P = 0.01) cast foot orthoses were significantly different from the barefoot condition, and the shod condition was significantly different from both foam (P = 0.004) and plaster (P = 0.014) cast orthoses. No statistically significant differences were found when comparing the two casting methods: non-weight-bearing plaster and semi-weight-bearing foam (P = 0.170). CONCLUSIONS Clinicians favoring one particular style of casting can feel confident, for the patient set described, that either choice will produce similar biomechanical outcomes with respect to foot kinematics. |
A Two-Dimensional Mathematical Model to Simulate the Effects of Knee Center Misalignment in Lower-Limb Orthoses Introduction Pistoning is relative sliding motion between an affected limb and its corresponding externally fit assistive device (like an orthosis). Pistoning causes skin problems, pain, and discomfort to the orthosis user. Misalignment of an orthotic joint with respect to the anatomical joint is one of the causes of pistoning motion, and the current knowledge pertaining to the effects of orthotic knee center (OKC) misalignments in lower-limb orthoses is limited. This work quantifies the effects of OKC misalignment in terms of relative motion between the limb and the orthosis and predicts locations of resultant pressure point on the limb. Method A two-dimensional link segment model that simulates relative motion between the limb and orthosis was developed. The OKC was systematically misaligned in the anterior-posterior (A-P), proximal-distal (P-D) directions, and their combination to simulate orthosis/thigh strap sliding and identify pressure points on the thigh. Simulations were performed for stand-to-sit activity and walking with a knee-ankle-foot orthosis. Results It was found that OKC misalignment causes increased A-P and P-D relative motions with an increase in misalignment distance for the stand-to-sit activity. The A-P and P-D relative motions are of greater concern for activities involving increased knee flexion such as sitting, squatting, and kneeling as compared with walking with an orthosis. Although the A-P and P-D relative motions during walking are of small magnitude, they occur with reversals in the direction and are repetitive in nature, which may cause skin problems and discomfort due to recurring pressure points. Conclusions The model provides a means to study the consequences of misalignment and insights for orthosis modification for improved comfort. A software simulation tool based on the presented model can serve as an educational and training tool in prosthetics and orthotics courses for creating awareness about the importance of proper alignment of orthotic knee joints. Study of misalignments of this nature will also guide fabrication and fitting of lower-limb orthoses/exoskeletons. |
Does Propulsive Force Asymmetry during Gait Provide Additional Objective Functional Information to Augment the Traditional Assessment of Prosthetic Fit? Introduction A poorly fitting prosthesis can cause pain and result in a less efficient and a less symmetrical gait pattern for children with amputations; however, fit is generally determined by subjective patient reports of discomfort and/or clinical observation when walking. The purpose of this study was to determine if peak propulsive forces during gait provide clinically relevant objective information to augment the traditional prosthesis fit assessment. Materials and Methods This prospective study compares propulsive force asymmetry with traditional assessments of prosthesis fit. Subjects were between 4 and 21 years of age, with unilateral lower-limb deficiencies, currently wearing the same prosthesis for at least 1 year, and able to walk independently without an assistive device. The absolute asymmetry indexes of peak propulsive forces between the involved and uninvolved limbs were calculated from force data collected from three trials of overground walking at a self-selected velocity. Asymmetry indexes greater than 36.4% were considered clinically meaningful and were associated with poor prosthesis function. A physician and/or a prosthetist, blinded to the results of the gait assessments, then determined the quality of prosthesis fit. Results Thirty-one subjects (20 males, 11 females; mean age, 13.1 years) participated. The traditional prosthetic fit assessment identified 13 prostheses as properly fitting and 18 as poorly fitting. Peak propulsive force asymmetry exceeded the threshold of 36.4% for 15 subjects and categorized as functioning poorly. The proportion of positive agreement of correct fit and correct function was 71% (κ coefficient = 0.42). Conclusions Peak propulsive force asymmetries offer clinically meaningful objective functional data to augment the traditional fit assessment. |
An International, Multicenter Field Trial Comparison Between 3D-Printed and ICRC-Manufactured Transtibial Prosthetic Devices in Low-Income Countries Introduction The gap between the needs of individuals with amputation and access to prosthetists in low-income countries (LICs) is significant. Training new personnel to bridge this gap would exceed the current output of all prosthetic and orthotic programs globally. Strategies are needed to increase the productivity of existing prosthetists in order to serve more patients. Emerging technologies such as 3D scanning, modeling, and printing have been investigated for their ability to decrease the manufacturing time for prosthetic devices; however, few studies have compared the efficacy of 3D-printed devices to traditionally manufactured (e.g., International Committee of the Red Cross [ICRC]) devices. Studies that previously compared these two methods were limited by low population size and restricted timeframes. The purpose of this study was to gather evidence comparing the efficacy of 3D-printed and ICRC transtibial prostheses in large patient populations in LICs over time. Materials and Methods A total of 61participants between the ages of 5 and 25 completed this study's 8-week trial. Participants were recruited from four clinical sites in Uganda, Tanzania, and Cambodia. Ethics approval was obtained from each of the four clinical sites before study initiation. Consent was obtained from each participant before study enrolment. The participants' residual limbs were 3D scanned by local prosthetists using hand-held 3D scanners. Prosthetists digitally rectified the 3D scanned models using Canfit and NiaFit 3D modeling software. The rectified models were fabricated using 3D printers. 3D-printed devices were lined with foam liners and coupled to standard ICRC pylons and feet. Participants used the 3D-printed sockets for 4 weeks, then returned to the clinic to complete a 28-question Likert scale questionnaire, assessing their experiences with their 3D-printed devices. Surveys were based on the Prosthesis Evaluation Questionnaire. Participants were then given a new transtibial prosthetic device manufactured using traditional ICRC methods and instructed to use this device for 4 weeks. They then returned to the clinic to complete the questionnaire as aforementioned. Responses from both surveys were assessed using a two-tailed Student t-test (P < 0.05). Results Data from the Tanzania Training Centre for Orthopaedic Technologists (n = 10) indicated that their users rated ICRC devices significantly higher in categories measuring stability, including ability to walk, walking up steep slopes and stairs, walking on slippery surfaces, overall fit, comfort while standing, and texture of the device. In contrast, participant data from Comprehensive Rehabilitation Services in Uganda (n = 25), Cambodian School of Prosthetics and Orthotics (n = 10), and Comprehensive Community Based Rehabilitation in Tanzania (n = 16) showed no significant differences across all measured outcomes. Conclusions This is the first study to compare and contrast the efficacy of 3D-printed and ICRC transtibial prosthetic devices across geographic locations in LICs with a large study population. Results demonstrate that, in general, 3D-printed devices were rated comparably to ICRC. This result was consistent at three of four clinical trial sites. Further studies will be required to elucidate the rating differences observed at the fourth site. |
Use of Myoelectric Limb Orthoses for Elbow Flexion in Patients with Brachial Plexus Injury: A Case Series Introduction Myoelectric limb orthoses (MLOs) are powered devices that assist with specific motions in patients with neuromuscular deficits or inadequate motor power. MLOs enable patients to self-initiate and control movements using their own muscle signals. While these devices have been used for patients that have sustained neurologic deficits from cerebrovascular accidents, their use in traumatic adult brachial plexus injuries is novel. Materials and Methods This case series presents three patients with traumatic brachial plexus injuries treated with MLOs to improve elbow flexion after inadequate recovery. The MLO was used as both a rehabilitation device and a functional device. Results/Conclusions MLOs demonstrate potential for improving patient clinical outcomes and satisfaction after brachial plexus injuries with incomplete recovery or inadequate function after surgical intervention. |
Oxygen Consumption and Speed Performance of a Runner with Amputation Wearing an Elevated Vacuum Running Prosthesis Introduction Persons with lower-limb differences are increasingly seeking out a means to participate in sport and running activities. Suspension of the running-specific prosthesis (RSP) during high-intensity running is crucial for safety and optimal running performance. The vacuum-assisted socket system (VASS) provides enhanced proprioception and residual limb volume stability during walking; however, utilization of the VASS in an individual fit with an RSP has yet to be explored in case or empirical studies. We report outcomes of a recreational running transtibial prosthesis user wearing a novel VASS-RSP. Methods A 33-year-old man with transtibial amputation was provided an RSP with a VASS and performed outcome measures while wearing the VASS-RSP and non–VASS-RSP. He performed a series of straight and counterclockwise (CCW) curve track 40-m runs while speed gates recorded split and total time. The patient also performed a 10-minute treadmill run oxygen consumption was determined, and Socket Comfort Scores (SCS) were recorded. Results No significant differences in track running trials were observed; straight track running speeds were similar VASS (5.37 ± 0.06 m/s) and non–VASS-RSP (5.37 ± 0.16 m/s), [t(1) = 0.320, P = 0.979]. Curve track speeds improved while wearing the VASSRSP (4.72 ± 0.09 m/s) compared with the non–VASS-RSP (4.66 ± 0.03 m/s) [t(2) = 0.846, P = 0.487]. Speeds were significantly faster during straight track running (5.37 ± 0.08 m/s) than during curve track running (4.70 ± 0.07 m/s) when both RSP configurations were combined [t(4) = 15.8, P = 0.001]. Net oxygen consumption reduced while wearing VASS-RSP (24.6 mL/kg per minute) compared with non–VASS-RSP (29.2 mL/kg per minute). Socket comfort during outcome measures improved 33% while wearing the VASS-RSP. Conclusions The patient preferred using the VASS-RSP while performing running exercises, and some outcome measures comparing the two suction suspension systems support the patient values. The novel VASS system should be further tested to determine potential utility for running exercise and sport interventions for persons with amputation. |
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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Telephone consultation 11855 int 1193,
Clinical Rheumatology
The Value of Serum Amyloid A Levels in Familial Mediterranean Fever to Identify Occult Inflammation During Asymptomatic Periods Objective The aim of this observational study was to evaluate whether there was any correlation between the acute phase reactants in children with familial Mediterranean fever (FMF) during attack and attack-free periods. Methods The study was conducted between June 2016 and January 2018. Clinical features and laboratory parameters of children with FMF during attack and attack-free periods were recorded longitudinally. Results The cohort consisted of 168 children with FMF (84 boys, 84 girls). Median values of acute phase reactants during FMF attacks were 433.5 mg/L (34.0–1780.0 mg/L) for serum amyloid A (SAA), 56.7 mg/L (7.6–379.0 mg/L) for C-reactive protein (CRP), and 37.5 mm/h (5–100 mm/h) for erythrocyte sedimentation rate (ESR). Median values for the same tests in attack-free periods were 3.2 mg/L (0.1–25.0 mg/L), 1.7 mg/L (0.1–12.7 mg/L), and 8 mm/h (1–30 mm/h), respectively. Correlation analyses showed that SAA and CRP were highly correlated in FMF attack (r = 0.67, p < 0.01), but no correlation was found between SAA and ESR levels. C-reactive protein was elevated in 13.6%, ESR in 20.8%, and SAA in 28.5% of the patients during attack-free period. Age at onset, sex of the patients, and characteristics of attacks were found to be not associated with elevated SAA in attack-free period. On the other hand, having homozygous exon 10 mutation and having elevated CRP were found to be associated with high SAA in attack-free period. Conclusions C-reactive protein and SAA correlate well with FMF attacks. Therefore, checking for SAA during a FMF attack is not required. However, SAA seems to be the most sensitive method for demonstrating subclinical inflammation in attack-free period. Thus, checking SAA levels might be a valuable tool in selected FMF patients. |
The Spectrum of Pericardial Involvement in Giant Cell Arteritis and Polymyalgia Rheumatica: A Systematic Review of Literature Background Giant cell arteritis (GCA) is a systemic vasculitis that commonly co-occurs with polymyalgia rheumatica (PMR) in elderly patients. Pericardial disease is an unusual manifestation of these inflammatory conditions, which has been reported only in case reports and small observational studies. However, no extensive research has been performed to study the demographics and clinical history of GCA or PMR patients with concomitant pericardial features. As a result, the medical evidence to help guide the physicians when evaluating such individuals is limited. Objective To perform a systematic review of the medical literature in order to summarize the epidemiological and clinicopathological aspects of this unique association. Methods We conducted an extensive search of PubMed, Cochrane Library, Ovid, Google Scholar, and gray literature to identify all the cases of GCA and PMR with pericardial involvement. The demographics, clinical features, and outcomes of the final cohort were reviewed and analyzed. Results The analysis comprised 52 clinical cases (51 identified from 46 articles and 1 from the residents' clinic). These included 44 patients with GCA and 8 with PMR. The mean age at presentation was 69.5 years, with only 46% of patients older than 70 years. The most common abnormality was pericardial effusion (85%), and in 37%, the pericardial event was the initial disease manifestation. Although a significant proportion of the patients were symptomatic (69%), the classic cranial symptoms were present in only 40%. Overall, the outcome was good even in the presence of large-vessel disease, which is usually a poor prognostic factor in classic GCA. On group analysis, patients with PMR were more likely to develop cardiac tamponade (37.5%; odds ratio, 25.8; confidence interval, 2.2–297.5; p = 0.01), whereas those with GCA were more likely to have large-vessel vasculitis (43%; odds ratio, 5.18; confidence interval, 0.58–252.1; p = 0.04). Conclusions This study illustrates that patients with pericardial involvement represent a clinical phenotype of GCA (and possibly PMR), which is quite different from the cranial or large-vessel forms. These patients have a better prognosis likely due to younger age and presence of more overt symptoms resulting in early diagnosis. |
The Relationship Between Autonomic Dysfunction of the Gastrointestinal Tract and Emotional Distress in Patients With Systemic Sclerosis Background/Objectives We hypothesized that emotional distress in systemic sclerosis (SSc) patients with moderate to severe gastrointestinal (GI) dysfunction is associated with dysautonomia. We sought to determine (1) the clinical characteristics associated with emotional distress in SSc, (2) the odds of having dysautonomia in those with emotional distress, and (3) whether GI dysautonomia, as measured by the Survey of Autonomic Symptoms (SAS), correlates with GI dysautonomia on the Composite Autonomic Symptom Score-31 (COMPASS-31). Methods Clinical and demographic features from our prospective cohort study were compared among SSc patients with and without GI-associated emotional distress (University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 well-being subscale >0.5 or ≤0.5) in cross-sectional analysis. Covariates/confounders independently associated with emotional distress were used to construct multivariable logistic regression models. The COMPASS-31 and SAS GI subdomains were compared with Spearman correlation. Results Forty-six patients with SSc were enrolled in the study. In univariate analyses, age (odds ratio [OR], 1.06; p = 0.026), severity of GI dysautonomia (COMPASS-31: OR, 1.41; p = 0.003), anti–centromere (A/B) antibodies (OR, 3.60; p = 0.044), and anti–PM-Scl (75/100) antibodies (OR, 0.15; p = 0.035) were associated with emotional distress. In the adjusted model, those with more severe GI dysautonomia remained more likely to have emotional distress (OR, 1.85; p = 0.026); those with anti–PM-Scl (75/100) antibodies were less likely to have emotional distress (OR, 0.03; p = 0.031). The SAS and COMPASS-31 GI subdomains moderately correlated (ρ = 0.68, p < 0.001). Conclusions In SSc, increased symptom burden related to GI dysautonomia is associated with emotional distress. Multidisciplinary approaches addressing both the physical and emotional needs of the SSc patient may be warranted to optimize patient care. |
Twenty-Year Experience of a Single Referral Center on Pediatric Familial Mediterranean Fever: What Has Changed Over the Last Decade? Background/Objective Familial Mediterranean fever (FMF) is the most common autoinflammatory disease and is characterized by recurrent fever and serositis episodes. We aimed to share our 20-year FMF experience, clarify a phenotype-genotype correlation, and compare the characteristics and outcomes of pediatric FMF patients over the last 2 decades in this study. Methods This medical record review study included 714 pediatric FMF patients (340 females, 374 males), diagnosed by Tel Hashomer diagnostic criteria between January 2009 and January 2019 and followed up in our department. Demographic and disease characteristics, obtained from medical records of the patients, were compared between patients with M694V homozygosity and other genotypes and showed whether they were diagnosed before (n = 137) or after January 2010 (n = 577). χ2, Student t, and Mann-Whitney U tests were used to compare categorical and continuous variables between these groups. Results The most common symptoms were abdominal pain (92%), fever (89.5%), and arthralgia (64.5%). Mean ages at symptom onset and diagnosis were 5.16 ± 3.73 and 7.71 ± 3.87 years, respectively. M694V homozygosity was recorded in 111 patients (15.5%). Fever, arthralgia, arthritis, myalgia, erysipela-like erythema, colchicine resistance, and subclinical inflammation were more frequent, and mean disease severity score was higher in patients with M694V homozygosity. Fever, chest pain, and proteinuria were statistically more frequent in patients diagnosed before January 2010. Although M694V homozygosity rate was similar, patients diagnosed in the last decade had lower mean disease severity score. Conclusions With this study, we speculate that although genotype and delay in diagnosis were similar, patients diagnosed in the last decade have a milder disease severity. |
The Experience With Health Care of Patients With Inflammatory Arthritis: A Cross-sectional Survey Using the Instrument to Evaluate the Experience of Patients With Chronic Diseases Background Patients' experience with health care is becoming a key component for the provision of a patient-centered health care model. The aim of this study was to assess the experience with health care of patients with inflammatory arthritis and patient- and health care–related factors. Methods Patients responded to an anonymous survey provided by their treating clinical teams. The survey comprised the validated 12-item IEXPAC (Instrument to Evaluate the EXperience of PAtients with Chronic diseases) tool and demographic variables and health care–related characteristics that may affect patients' experience. Results A total of 359 of 625 surveys were returned (response rate, 57.4%). Overall, patient responses were positive (>60% gave "always/mostly" answers) for statements assessing the interaction between patients and health care professionals or patient self-management following health care professional guidance. However, positive patient responses for items regarding patient interaction with the health care system via the internet or with other patients were less than 13%. Only 25.6% of patients who had been hospitalized reported receiving a follow-up call or visit following discharge. In the bivariate analysis, experience scores were higher (better experience) in men, those seen by fewer specialists or by the same physician, and in patients treated with a fewer number of drugs or with subcutaneous/intravenous drugs. Multivariate analyses identified regular follow-up by the same physician and treatment with subcutaneous/intravenous drugs as variables associated with a better patient experience. Conclusions This study identifies areas of care for patients with inflammatory arthritis with the potential to improve patients' experience and highlights the importance of patient-physician relationships and comprehensive patient care. |
Patient Perspectives on the Effect of the SARS-CoV-2 Pandemic on Patients With Systemic Sclerosis: An International Patient Survey Background The coronavirus disease (COVID-19) pandemic and its subsequent effects on health care systems have significantly impacted the management of chronic rheumatic diseases, including systemic sclerosis (SSc). Methods In this context, a 25-item anonymized e-survey was posted on the Twitter and Facebook e-groups and pages of various scleroderma organizations and patient communities to assess the problems faced by patients with SSc during the pandemic, with a focus on effects on the disease, drug procurance, continuity of medical care, and prevalent fears among patients. Results Of the 291 participants (median age of 55 [43.5–63] years, 93.8% females), limited systemic sclerosis was the most common diagnosis (42.3%). Many patients experienced problems attributable to the COVID-19 pandemic (119, 40.9%), of which 46 (38.7%) required an increase in medicines, and 12 (10.1%) of these needed hospitalizations for disease-related complications. More than one-third (36.4%) were on glucocorticoids or had underlying cardiovascular risks (39%) that would predispose them to severe COVID-19. A significant proportion (38.1%) faced hurdles in procuring medicines or experienced disruption in physiotherapy sessions (24.7%). One-quarter (24.1%) felt it was difficult to contact their specialist, whereas another 7.2% were unable to do so. Contracting COVID-19 was the most prevalent fear (71.5%), followed by infection in the family (61.9%), and a flare of the disease (45.4%). Most respondents preferred teleconsultations (55.7%) over hospital visits in the pandemic period. Conclusion The results of the patient survey suggest that the COVID-19 pandemic has affected many patients with SSc and may translate to poorer outcomes in this population in the postpandemic period. |
Structural Retinal Assessment Using Optical Coherence Tomography and Fundus Fluorescein Angiography in Systemic Lupus Erythematosus Patients Background Ocular manifestations in systemic lupus erythematosus (SLE) can be the presenting symptom of the disease or a sight-threatening complication. Objectives To detect different structural retinal changes in patients with SLE who had no ophthalmological symptoms and investigate the relationship between different retinal changes and the disease activity assessed by the Systemic Lupus Erythromatosus Disease Activity Index score. Study Design A descriptive pilot study from January 2016 to January 2017. Methods Fifty-two eyes of 26 patients diagnosed to have SLE were examined using visual acuity assessment, fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). Results Fundus fluorescein angiography showed different changes in the form of venular occlusion and optic nerve leakage. There were also degenerative changes in the form of alternating hyperfluorescent and hypofluorescent areas outside the arcades as well as peripapillary areas and capillary dropout. Optical coherence tomography detected signs of degenerative thinning, incomplete posterior vitreous detachment, and epiretinal membrane. A significant correlation was found between SLE activity and the changes detected by FFA (p = 0.017). However, there was no significant correlation between disease activity and changes detected by OCT. Optical coherence tomography changes were significantly correlated with the duration of hydroxychloroquine use of more than 5 years (p = 0.032). There was no correlation between FFA or OCT changes and proteinuria or antiphospholipid antibodies. Conclusions Fundus fluorescein angiography is more sensitive in detecting early subclinical retinal changes in patients with SLE, which correlates with disease activity, whereas OCT is more sensitive in detecting changes resulting from hydroxychloroquine use. |
| Helicobacter pylori and Upper Endoscopy in Systemic Sclerosis: A Cross-sectional Study in the Real World Background/Aims A role for Helicobacter pylori in triggering systemic sclerosis (SSc) has been proposed, but data are conflicting. In previous studies, infection has been generally searched for by using serology. We designed this study to assess H. pylori prevalence in SSc patients with histology of gastric mucosa, considered the criterion standard for infection diagnosis. Methods This cross-sectional study enrolled 30 SSc patients who complained of upper gastrointestinal symptoms. All underwent upper endoscopy with gastric biopsies. Endoscopic alterations were recorded, and gastric mucosa biopsies were used for both histological examination and searching for H. pylori. The role for proton-pump inhibitor (PPI) therapy was considered. Fisher exact test was used for statistical analysis. Results Data of 28 SSc patients were available, 14 with ongoing PPI therapy. Helicobacter pylori infection at histology was detected in 14.3% patients, and it equally occurred in patients with or without PPI therapy. Erosive esophagitis/Barrett esophagus was detected in 26.6% of cases. Among patients with PPI therapy, 30% received half dose only. The prevalence of intestinal metaplasia was low (14.3%). Endoscopic esophageal alterations were significantly more frequent in those patients showing anti-Scl70 antibody positivity. Conclusions This study showed that prevalence of H. pylori is very low in SSc patients, so that it seems not having a role in triggering SSc. Management of gastroesophageal diseases in SSc patients needs to be improved, and looking to the autoimmune profile may be of help. Thus, collaboration between rheumatologist and gastroenterologist is highly recommended. |
Xray Findings No abstract available |
Retroperitoneal Fibrosis With a Damaged Kidney in IgG4-Related Disease No abstract available |
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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Telephone consultation 11855 int 1193,
Porto Biomedical Journal
| Can students make a difference in science during a pandemic? No abstract available |
| Metabolic syndrome: what we know and what we need to know No abstract available |
| The Sustainable Development Goals and the Community of Portuguese Speaking Countries (CPLP) in the post-COVID-19 era The universalization and full realization of the objectives and goals of the United Nations 2030 Agenda for Sustainable Development can be called into question by the significant drop in international funding available to support developing countries. This situation may be worsened by the effects caused by the COVID-19 pandemic and the consequent increase in nonregular cooperation programs, based on humanitarian and emergency actions. The promotion of horizontalization strategies for the Sustainable Development Goals (SDGs), considering interventions with a transversal nature, in a 360° view, which encourages the promotion of strategic alliances, multisectoral and multidimensional partnerships as well as shared financing mechanisms, appears as a credible hypothesis to assure the commitment with sustainable development. The article addresses some perceptions of multilateral organizations, namely within the scope of the United Nations System and Bretton Woods institutions, and how the strategic development cooperation instruments created by Community of Portuguese Speaking Countries may contribute to boosting post-COVID-19 cooperation scenarios aligned with the accomplishment of the SDGs in this community. |
Socioeconomic, behavioural and sexual-health factors associated with nutritional status of female commercial sex workers in Dhaka city, Bangladesh: a cross-sectional study Objectives: To investigate the prevalence of nutitional status of female commercial sex workers (FCSWs) in Dhaka city and to determine which socio-economic, behavioural and sexual health practices associated with chronic energy deficiency (CED) and overweight/obesity. Methods: Cross-sectional study conducted among 635 FCSWs (308 hotel-based/HBSWs and 327 floating-based/FBSWs). Research tools were pretested questionnaire and anthropometric measurement (height–weight). Multistage sampling technique was employed to collect the data according to probability proportional to size from 7 hotels and 3 spots. Socio-demographic, sexual-health and behavioural data were collected by direct interview of the FCSWs from working places and were processed by statistical software package. Multinomial logistic regression model was used to determine the factors influencing BMI kg/m2 of FCSWs. Results: Mean age of the FCSWs was 21.1 years with a range of 14 to 55 years. Vast majority of FCSWs were illiterate (65.8%), widowed/separated/abandoned (44.6%) followed by 43.5% married. Prevalence of CED (<18.5 kg/m2) and overweight/obesity (≥25) was 22.8% and 16.3%, respectively. CED rate was almost doubled among FBSWs than HBSWs (P < .001). From the fitted MNLR model, variables like being HBSWs [odds ratio (OR) = .518], no mass media exposure (OR = 2.29) are found to be significant (P < .05) in the model of normal BMI verses CED. Similarly, being HBSWs (OR = 2.2), <26 years age (OR = .418), one-time coital frequency with normal clients (OR = .412), 1 to 7 days monthly absent (OR = .381), no alcohol consumption (OR = .149), drug habit (cannabis) (OR = .441), monthly income ≤7000 BDT (OR = .487) are found to be significant in the model of normal BMI verses overweight/obesity. Conclusion: FCSWs face double burden of malnutrition. Older age, higher income, being hotel-based FCSW, frequency of coitus, monthly abstinence from sex work, regular alcohol consumption and taking no drug are influential factors for overweight/obesity while being floating FCSW and having no mass media items (TV/Radio) are important determinants of CED. |
Experience of a Portuguese radiation therapy department in the treatment of synchronous and metachronous head, neck, and oesophageal cancers Background: Multiple primary cancers in patients with head and neck squamous cell carcinoma (HNSCC) and oesophageal squamous cell carcinoma (ESCC) share common features. Their treatment approach can be a challenge. This retrospective study aims to estimate the cumulative incidence and to describe the outcome of patients with multiple primary cancers, treated in a Tertiary Centre in Portugal. Methods: The study includes patients with HNSCC, ESCC, and multiple tumours (synchronous or metachronous), treated with curative intent in a Centre, between 2004 and 2019. The analysis is focused on the clinical baseline characteristics, the treatment approach, and the outcomes. Patients with distant metastasis at tumour diagnosis were excluded. Results: Of a total of 820 cases, 31 had multiple tumours. In 15.8 years, the cumulative incidence of multiple tumours was 6.45%. Twenty-seven patients were treated with curative intent (n = 7 synchronous, n = 20 metachronous). The most frequent HNSCC cancers in synchronous tumours were oropharynx and hypopharynx tumours (n = 4); oral cavity was the most frequent HNSCC cancer (n = 12) in metachronous tumours. The primary treatment included surgery, adjuvant or definitive radiation therapy or chemoradiation. With a median follow-up time of 73 months, the median overall survival was 51.8 months for synchronous and 102 months for metachronous tumours. Conclusions: Multiple tumours of HNSCC and ESCC are uncommon. In the small group of Portuguese patients analysed, there is a potential pattern of occurrence and treatment outcome. Due to the limited number of patients this study has included, the authors have considered that additional prospective studies with large samples are needed. |
Diagnostic importance of mean platelet volume, platelet distribution width and platelet large cell ratio as screening tool in immune thrombocytopenia Objective: To determine diagnostic importance of mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (PLCR) in diagnosing cases of immune thrombocytopenia. Methodology: The study was done in Khyber Teaching hospital from January 2017 to May 2018. Cases with low platelet count of all the ages and both the genders were included in the study by non probability purposive sampling technique and were subjected to bone marrow aspiration to rule out other causes of thrombocytopenia and thus confirm the diagnosis of immune thrombocytopenia. The platelet indices were noted and their sensitivity, specificity and accuracy were determined for immune thrombocytopenia. Mean and standard deviation were used for quantitative data. Percentage and frequency were used to measure qualitative data. Data was analysed by SPSS. Results: 84 cases with thrombocytopenia of mean age 23.4 ± 12.1 years (range 7–81 years) were included in the study. There were 38 (45.2%) males and 46 (54.8%) females. There were 40 cases of immune thrombocytopenia. The sensitivity and specificity for PDW (59.1% and 43.1%, respectively), MPV (59.1% and 52.9%, respectively), and PLCR (50% and 52.9%, respectively) were found low to be used as screening tool for immune thrombocytopenia. Conclusion: The MPV, PDW and PLCR has low sensitivity and specificity and therefore should not be used as reliable screening tool in giving preliminary diagnosis of the immune thrombocytopenia. |
Eosinopenia as predictor of infection in patients admitted to an internal medicine ward: a cross-sectional study Background: The identification of infection in an internal medicine ward is crucial but not always straightforward. Eosinopenia has been proposed as a marker of infection, but specific cutoffs for prediction are not established yet. We aim to assess whether there is difference in eosinophil count between infected and noninfected patients and, if so, the best cutoffs to differentiate them. Methods: Cross-sectional, observational study with analysis of all patients admitted to an Internal Medicine Department during 2 consecutive months. Clinical, laboratory and imaging data were analyzed. Infection at hospital admission was defined in the presence of either a microbiological isolation or suggestive clinical, laboratory, and/or imaging findings. Use of antibiotics in the 8 days before hospital admission, presence of immunosuppression, hematologic neoplasms, parasite, or fungal infections were exclusion criteria. In case of multiple hospital admissions, only the first admission was considered. Sensitivity and specificity values for eosinophils, leukocytes, neutrophils, and C-reactive protein were determined by receiver operating characteristic curve. Statistical analysis was performed with IBM SPSS Statistics® v25 and MedCalc Statistical Software® v19.2.3. Results: A total of 323 hospitalization episodes were evaluated, each corresponding to a different patient. One hundred fifteen patients were excluded. A total of 208 patients were included, 62.0% (n = 129) of them infected at admission. Ten patients had multiple infections. Infected patients had fewer eosinophils than uninfected patients (15.8 ± 42 vs 71.1 ± 159 cell/mm3; P < .001). An eosinophil count at admission ≤69 cell/mm3 had a sensitivity of 89.1% and specificity of 54.4% (area under the curve 0.752; 95% confidence interval 0.682–0.822) for the presence of infection. Eosinophil count of >77 cells/mm3 had a negative likelihood ratio of 0.16. Conclusions: Eosinophil count was significantly lower in infected than in uninfected patients. The cutoff 69 cells/mm3 was the most accurate in predicting infection. Eosinophil count >77 cells/mm3 was a good predictor of absence of infection. |
Identification of afzelin potential targets in inhibiting triple-negative breast cancer cell migration using reverse docking Background: Triple-negative breast cancer (TNBC) tends to be aggressive and metastatic, characteristics attributable to its cellular migration capabilities. Afzelin is a chemical compound with anti-metastatic potentials. This study aimed to predict proteins involved in TNBC cell migration which could be inhibited by afzelin. Methods: The protein database was constructed from the Kyoto Encyclopedia of Genes and Genomes pathways collection which related to cell motility, then screened for druggability using SuperTarget and Therapeutic Target Database. The involvement of druggable proteins in the TNBC metastasis process was investigated through existing publications in The National Center for Biotechnology Information PubMed database. Inhibitory potential of afzelin toward target proteins was compared to the proteins' known-inhibitor, using the reverse docking method. Results: Ten proteins identified as potential targets of afzelin, with the top 3 being ERK2, KRas, and FAK, respectively. Afzelin's 3-O-rhamnoside group played a dominant role in forming hydrogen bonds with the target proteins. Further analysis with STRING suggested that afzelin might be able to inhibit chemotaxis and haptotaxis of TNBC cells. Conclusions: Afzelin was predicted to inhibit TNBC cell motility, by targeting ERK2, KRas, and FAK activation. |
Effects of a nursing care program focused on basic self-care in older acute medical in-patients: a randomized controlled trial Background: Acute illness and hospitalization are often associated with decreased independence in basic activities of daily living. The aim of this study was to test the hypothesis that a nursing care program focused on basic self-care (N_BSC) improves functional outcomes in older patients admitted to an acute medical unit. Methods: This was a 2-group randomized controlled trial with repeated measures: 182 older patients admitted to an acute medical unit were randomly allocated to the usual care group (n = 91) and intervention group (n = 91). The intervention consisted of nursing care centered on basic self-care that includes promotion of daily walking and all daytime meals seated, out of bed. The main outcome was changes in the number of independent basic activities of daily living (BADL) from 2 weeks before admission (baseline) to discharge. Results: There was significant effect of the N_BSC on the outcomes. Changes from baseline to discharge in the number of independent BADL differ significantly between the intervention and usual care group. Intervention group patients were discharged with a superior functional status than usual care group. On discharge they were able to perform independently 2.93 BADL, whereas usual care patients performed independently 1.90 BADL (P < .001). Conclusions: N_BSC for hospitalized older adults was feasible and program participants were discharged with better functional status than a clinically similar comparison group. N_BSC could be readily adapted for use in other hospitals and warrants further evaluation as a potential new tool for improving outcomes for hospitalized older patients. |
Stigma toward people with mental disorders in adolescents: comparison between Portugal and Moldova Background: Mental disorders are one of the most significant public health challenges. Stigma toward people with mental disorders decreases help-seeking behaviors, and may be a cause of depression and anxiety. Research on the level of stigma and comparison between different countries in adolescence is scarce. We aim to study stigma toward people with mental disorders in adolescents, and to evaluate differences between Portugal and Moldova. Methods: In a cross-sectional analysis, we evaluated 657 high school students from Portugal and 612 from Moldova. Data were collected by a self-reported questionnaire that, beyond stigma, evaluated individual and family characteristics. Stigma was evaluated using the Attribution Questionnaire for Children (AQ-8-C) and the Depression Stigma Scale (DSS). Data were summarized using means and standard deviations, and comparison was performed using Student t test and analysis of variance. Results: The mean (standard deviation) level of mental disorder stigma measured by the AQ-8-C was 32.10 (8.77) in Moldova and 24.32 (9.20) in Portugal, P < .001. Adolescents from Moldova presented higher values for all items except for "Fear," with higher mean value in Portugal and for "Help" with no significant differences between countries. Regarding the Depression Stigma Scale, adolescents from Moldova presented higher values, both for personal stigma [19.84 (4.78) vs 15.09 (5.08), P < .001] and for perceived stigma [26.43 (4.30) vs 22.62 (5.15), P < .001]. Stigma levels did not differ according to having or not someone with a mental disorder in the class or family. Conclusion: The level of stigma toward people with mental disorders is higher in Moldova than in Portugal. |
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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Telephone consultation 11855 int 1193,
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