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1
Spigelman, Zachary Simon. "FDG PET/CT May Overestimate Red Bone Marrow Volume." Blood 120, no. 21 (November 16, 2012): 4405. http://dx.doi.org/10.1182/blood.v120.21.4405.4405.
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Abstract Abstract 4405 Sambuceti, et al. (Eur. J. Nuclear Med Mol Imaging, Aug, 2012. 39: 1326–1338) used a computational FDG PET/CT model to estimate the volume of the bone marrow space and specifically “Red” or actively hematopoetic marrow in 102 nonmetastatic melanoma patients. 34.9 percent of all marrow space was estimated to be populated by “Red” Marrow. There was no associated pathologic bone marrow or peripheral blood count correlation of this FDG PET/CT model. In an attempt to define pathologic correlation of the findings of Sambuceti et al., 102 consecutive pathologic samples of femoral hip replacements were evaluated for their “Red” Marrow content and correlated with the patient's peripheral blood counts. The patients reviewed did not have active carcinoma or recent exposure to chemotherapeutic agents. 48/104(47.1%) of the samples obtained contained active “Red” Marrow”upon microscopic evaluation of femoral head and shaft samples stained with Hematoxylin and Eosin. Of these samples “Red' Marrow averaged 5.05 percent of the pathologic sample volume (range 0–40%) as opposed to 20–30 percent of the estimated bone marrow segmental space calculated to be populated by “Red” Marrow heads of long bones as defined by the FDG PET/CT model. In this study patient gender, height, BMI, weight, red marrow cellularity, peripheral white blood cell counts, platelets, hemoglobin, hematocrit, creatinine did not predict the extent of “Red” Marrow volume. Many variables may affect the results of these studies including: spotty metabolic activity of the marrow, clinical inflammatory effects of bone marrow in long bone heads, pathologic sampling errors, low study power, sample preparation and patient selection. Although there was no clear explanation for this overestimation of pathologic-FDG PET signal, the age of the populations were significantly different (55.9 years old in Sambuceti et al and 62.4 years old in this study). Age was found to have a significant correlation with “Red “Marrow volume in the Sambuceti et al study. The FDG PET scan evaluation may overestimate metabolic activity of “Red” Marrow and thus run the risk of obscuring other bone pathology. Therefore, prospective PET/CT-pathologic-clinical correlation studies are warranted in light of the prognostic, therapeutic, and diagnostic importance of “Red“Marrow activity in FDG PET/CT clinical staging of oncologic disease. Disclosures: No relevant conflicts of interest to declare.
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Ilgaz, Selcuk. "An Examination of Fifth Grade Students’ Attitudes Towards Social Studies Course in Terms of Severable Variables." Journal of Education and Learning 7, no. 4 (May 15, 2018): 154. http://dx.doi.org/10.5539/jel.v7n4p154.
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The aim of this research is to investigate the 5th grade students’ attitude towards social studies course regarding several variables. The population of the study consisted of 4435 fifth grade students studying in public schools in Malatya, Yesilyurt. The sample group consisted of 362 students from 10 schools in the same district. The data used in this study were obtained from the social studies attitude scale and was analyzed with SPSS program. As a result of this research, 5th grade students have a positive attitudes towards social studies lesson and this attitudes are different according to 5th students’ teachers’ gender, type of school, fall semester points, but this attitudes is the same considering 5th grade students’ gender, parents’ level of education and taking social studies course.
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Fernández Rodríguez, Carolina. "Gloria Velásquez’s Roosevelt High School series: towards quality multicultural literature through rainbow coalitions." Journal of English Studies 18 (December 23, 2020): 59–81. http://dx.doi.org/10.18172/jes.4406.
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The goal of this paper is to study several YA novels by Chicana writer Gloria Velásquez, the Roosevelt High School series (1994-2018), as an educating tool within the framework of multicultural education. The analysis takes into account Velásquez’s choice of problematic situations (related to racism, sexism, or homophobic harassment, among others) and the solutions her novels propose, which include both individual responses and community-organized measures. Special attention is given to the criticism according to which Velásquez’s Latinx and multi-ethnic characters are steeped in stereotypes, which would cancel the books’ potential capacity to inspire social change. In contrast with this negative vision, this paper proves that Velásquez’s series offers empowering role models for teen Latinxs of various ethnic backgrounds and effectively calls for the neutralization of race, class and gender stereotypes, thus contributing to the implementation of Jesse Jackson’s 1984 proposal that ethnic minorities should form a “rainbow coalition”.
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Colombo, Delia, Giovanni Abbruzzese, Angelo Antonini, Paolo Barone, Gilberto Bellia, Flavia Franconi, Lucia Simoni, et al. "The “Gender Factor” in Wearing-Off among Patients with Parkinson’s Disease: A Post Hoc Analysis of DEEP Study." Scientific World Journal 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/787451.
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Background. The early detection of wearing-off in Parkinson disease (DEEP) observational study demonstrated that women with Parkinson’s disease (PD) carry an increased risk (80.1%) for wearing-off (WO). This post hoc analysis of DEEP study evaluates gender differences on WO and associated phenomena.Methods. Patients on dopaminergic treatment for ≥1 year were included in this multicenter observational cross-sectional study. In a single visit, WO was diagnosed based on neurologist assessment as well as the use of the 19-item wearing-off questionnaire (WOQ-19); WO was defined for scores ≥2. Post hoc analyses were conducted to investigate gender difference for demographic and clinical features with respect to WO.Results. Of 617 patients enrolled, 236 were women and 381 were men. Prevalence of WO was higher among women, according to both neurologists’ judgment (61.9% versus 53.8%,P=0.045) and the WOQ-19 analysis (72.5% versus 64.0%,P=0.034). In patients with WO (WOQ-19), women experienced ≥1 motor symptom in 72.5% versus 64.0% in men and ≥1 nonmotor symptom in 44.5% versus 36.7%, in men.Conclusions. Our results suggest WO as more common among women, for both motor and nonmotor symptoms. Prospective studies are warranted to investigate this potential gender-effect.
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Urrunaga-Pastor, Diego, Fernando M. Runzer-Colmenares, Tania M. Arones, Rosario Meza-Cordero, Silvana Taipe-Guizado, Jack M. Guralnik, and Jose F. Parodi. "Factors associated with poor physical performance in older adults of 11 Peruvian high Andean communities." F1000Research 8 (January 15, 2019): 59. http://dx.doi.org/10.12688/f1000research.17513.1.
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Background: Physical performance in the older adult has been extensively studied. However, only a few studies have evaluated physical performance among older adults of high Andean populations and none have studied the factors associated with it. The objective of this study was to evaluate factors associated with poor physical performance by using the Short Physical Performance Battery (SPPB) in older adults living in 11 Peruvian high Andean communities. Methods: An analytical cross-sectional study was carried out in inhabitants aged 60 or over from 11 high-altitude Andean communities of Peru during 2013-2017. Participants were categorized in two groups according to their SPPB score: poor physical performance (0-6 points) and medium/good physical performance (7-12 points). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor physical performance. Prevalence ratio (PR) with 95% confidence intervals (95 CI%) are presented. Results: A total of 407 older adults were studied. The average age was 73.0 ± 6.9 years (range: 60-94 years) and 181 (44.5%) participants had poor physical performance (0-6 points). In the adjusted Poisson regression analysis, the factors associated with poor physical performance were: female gender (PR=1.29; 95%CI: 1.03-1.61), lack of social support (PR=2.10; 95%CI: 1.17-3.76), number of drugs used (PR=1.09; 95%CI: 1.01-1.17), urinary incontinence (PR=1.45; 95%CI: 1.16-1.82), exhaustion (PR=1.35; 95%CI: 1.03-1.75) and cognitive impairment (PR=1.89; 95%CI: 1.40-2.55). Conclusions: Almost half of the population evaluated had poor physical performance based on the SPPB. Factors that would increase the possibility of suffering from poor physical performance were: female gender, lack of social support, number of drugs used, urinary incontinence, exhaustion and cognitive impairment. Future studies with a larger sample and longitudinal follow-up are needed to design beneficial interventions for the high Andean population.
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Urrunaga-Pastor, Diego, Fernando M. Runzer-Colmenares, Tania M. Arones, Rosario Meza-Cordero, Silvana Taipe-Guizado, Jack M. Guralnik, and Jose F. Parodi. "Factors associated with poor physical performance in older adults of 11 Peruvian high Andean communities." F1000Research 8 (September 10, 2019): 59. http://dx.doi.org/10.12688/f1000research.17513.2.
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Background: Physical performance in the older adult has been extensively studied. However, only a few studies have evaluated physical performance among older adults of high Andean populations and none have studied the factors associated with it. The objective of this study was to evaluate factors associated with poor physical performance by using the Short Physical Performance Battery (SPPB) in older adults living in 11 Peruvian high Andean communities. Methods: An analytical cross-sectional study was carried out in inhabitants aged 60 or over from 11 high-altitude Andean communities of Peru during 2013-2017. Participants were categorized in two groups according to their SPPB score: poor physical performance (0-6 points) and medium/good physical performance (7-12 points). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor physical performance. Prevalence ratio (PR) with 95% confidence intervals (95 CI%) are presented. Results: A total of 407 older adults were studied. The average age was 73.0 ± 6.9 years (range: 60-94 years) and 181 (44.5%) participants had poor physical performance (0-6 points). In the adjusted Poisson regression analysis, the factors associated with poor physical performance were: female gender (PR=1.29; 95%CI: 1.03-1.61), lack of social support (PR=2.10; 95%CI: 1.17-3.76), number of drugs used (PR=1.09; 95%CI: 1.01-1.17), urinary incontinence (PR=1.45; 95%CI: 1.16-1.82), exhaustion (PR=1.35; 95%CI: 1.03-1.75) and cognitive impairment (PR=1.89; 95%CI: 1.40-2.55). Conclusions: Almost half of the population evaluated had poor physical performance based on the SPPB. Factors that would increase the possibility of suffering from poor physical performance were: female gender, lack of social support, number of drugs used, urinary incontinence, exhaustion and cognitive impairment. Future studies with a larger sample and longitudinal follow-up are needed to design beneficial interventions for the high Andean population.
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An, X. P., J. G. Wang, J. X. Hou, H. B. Zhao, L. Bai, G. Li, L. X. Wang, et al. "Polymorphism identification in the goat MSTN gene and association analysis with growth traits." Czech Journal of Animal Science 56, No. 12 (December 22, 2011): 529–35. http://dx.doi.org/10.17221/4415-cjas.
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The myostatin (MSTN) gene was studied as a candidate genetic marker for growth traits. We investigated polymorphisms of the MSTN gene in 664 individuals from four goat populations and applied PCR-SSCP and DNA sequencing analysis to reveal two single nucleotide polymorphisms (DQ167575: g.368A>C (p.Lys49Thr) and g.4911C>T. At g.368A>Clocus, the frequencies of g.368A allele were 0.75–0.81, and the frequencies of g.368C allele were 0.19–0.25. At g.4911C>T locus, the frequencies of g.4911C allele were 0.76–0.82, and frequencies of g.4911T allele were 0.18–0.24. Compared to the female goats with AC genotype, those with AA genotype had superior body weight in Boer goats (15.69 ± 0.28 vs. 14.51 ± 0.31, P < 0.05) and F<sub>1</sub> generation of Boer × Guanzhong dairy goats (19.39 ± 0.34 vs. 18.27 ± 0.33, P < 0.05). In addition, the female goats with AA genotype (45.80 ± 0.33 cm) had greater withers height than those with AC genotype (44.78 ± 0.36 cm) in F<sub>2</sub> generation of Boer × Guanzhong dairy goats (P < 0.05). Hence, the biochemical and physiological functions along with the results obtained in our investigation suggest that the MSTN gene might play an important role in affecting the growth traits in goats.
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Suleimen, Nazym. "Appraising the Attitude towards Information Communication Technology Integration and Usage in Kazakhstani Higher Education Curriculum." Journal of Information Technology Education: Research 18 (2019): 355–78. http://dx.doi.org/10.28945/4403.
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Aim/Purpose: The purpose of the study is to examine and understand the attitude of Kazakhstani universities’ instructors towards ICT integration into the curriculum and to find out the relationship between instructors’ attitudes towards ICT and their actual usage of ICT for teaching and learning processes. Background: The Kazakhstani government has taken initiatives and developed state programs to integrate information communication technologies (ICT) into all levels of education. According to previous research studies, instructors’ negative attitude towards ICT integration into curriculum can affect the implementation of ICT-related initiatives in education including higher education. Therefore, this research study examines the attitudes of Kazakhstani higher education instructors towards ICT integration into curriculum. Methodology: The study implemented an explanatory sequential mixed methods design. For quantitative and qualitative data collection paper-based questionnaires and semi-structured interviews were used, respectively. Convenience sampling was conducted, and the sample consisted of 102 instructors working in two universities in Kazakhstan. In quantitative data analysis, descriptive and inferential statistics were used; Spearman’s rho correlation coefficient was used to identify the relationship between variables. Contribution: Understanding instructors’ attitude towards ICT in education and exploring reasons behind attitudes might be beneficial in accomplishing aims and purposes of governmental ICT-related programs in the higher education system. Findings: Quantitative data analysis reveals that instructors generally possess positive to very positive attitude towards using ICT in education. Instructors often use simple basic tools such as multimedia presentation software; however, they very rarely use more advanced tools such as discipline-oriented software. No statistically significant relationship was found between attitude and advanced ICT tools. Qualitative data analysis identifies several barriers to ICT usage: insufficient or lack of provision of ICT tools and software, lack of technical support, and lack of technical knowledge among instructors. Recommendations for Practitioners: As a result of the study, it is firstly recommended to university administrations to create and add positions of information technology (IT) specialists, to each department and on a permanent basis. Secondly, it is recommended to provide faculty members with training courses that focus on ICT in pedagogy. Thirdly, universities could ask for guidance from their existing faculty members who are advanced ICT integrators, that is to say, collegial learning should be encouraged more strongly. Finally, universities are recommended to reward those faculty members who are active and effective in their attempts to integrate ICT into teaching. Future Research: As I was not able to interview those instructors who possessed negative attitude towards ICT in education, I would recommend filling this gap in the future. Interviewing instructors who are reluctant to integrate ICT into teaching can help identify more issues related to using ICT in education which were not discovered in the current research study. Also, the current research study did not investigate instructors’ attitudes in relation to their demographic background. Further research studies can examine how instructors’ age, gender, place of study, place of work, academic degree, or subject area of teaching influence their attitude towards using ICT in education and their actual usage of ICT in teaching practices.
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Cunha, Filipe M., Joana Pereira, Pedro Marques, Helena Moreira, Pedro Rodrigues, Maria João Pinto, Patrícia Lourenço, and Paulo Bettencourt. "Natriuretic Peptide System Activation in Acute Heart Failure Patients with Diabetes." Journal of Diabetes Research 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/1426705.
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Background. Elevated B-type natriuretic peptide (BNP) is a hallmark in heart failure (HF). Diabetic patients with chronic HF seem to have higher BNP than nondiabetics. We studied, in acute HF, if BNP levels are different between diabetics and nondiabetics. Methods. From a prospectively recruited population of acute HF patients, we selected a convenience sample. In pair-matched analysis, each diabetic patient was matched with a nondiabetic of the same age (±1 year), gender, and according to left ventricular systolic dysfunction. Diabetics and nondiabetics were compared. Cox-regression analysis was used to analyse the prognostic impact of diabetes. Results. We studied 328 patients, mean age: 78 years, 44.5% male. Diabetics were more often hypertensive and had ischemic HF; they had higher body mass index, lower haemoglobin, and worse renal function. Diabetics were more often discharged on ACE inhibitors/ARB, antiplatelet therapy, and statins. Neither admission nor discharge BNP values differed between diabetics and pair-matched nondiabetics. One-year mortality was also nondifferent between pairs of diabetics and nondiabetics: 44 (26.8%) and 46 (28.0%), respectively. HR for 1-year mortality in diabetics was 1.00 (95% CI: 0.82–1.24) compared with nondiabetics. Conclusions. HF patients with diabetes have similar neurohumoral activation when compared with nondiabetics. One-year mortality is also nondifferent after matching for age, gender, and systolic function.
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Suchak, Amar A., Geoff Bostick, David Reid, Sandra Blitz, and Nadr Jomha. "The Incidence of Achilles Tendon Ruptures in Edmonton, Canada." Foot & Ankle International 26, no. 11 (November 2005): 932–36. http://dx.doi.org/10.1177/107110070502601106.
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Background: The incidence of Achilles tendon ruptures specific to the North American population has not been previously reported and current epidemiological data are primarily reported from European communities. The purpose of this study was to determine the incidence of Achilles tendon ruptures in the city of Edmonton, Alberta, Canada, and to compare this data to those reported in European studies. Methods: A retrospective chart review from all five acute care hospitals in Edmonton from 1998 to 2002 (inclusive) were reviewed for Achilles tendon ruptures. Data such as gender, age, side, mechanism of injury, and season of injury were obtained. Results: The incidence of Achilles tendon ruptures ranged from an annual average of 5.5 ruptures to 9.9 ruptures per 100,000 inhabitants with an overall mean of 8.3 ruptures per 100,000 people. There was a statistically significant difference in Achilles tendon ruptures over the last two study years for both genders (women, p < 0.02; men, p < 0.03). The mean age for an Achilles tendon rupture was 40.6 years for men and 44.5 years for women. The Achilles tendon ruptures occurred most frequently in the 30 to 39 and 40 to 49 year old age groups in both men and women, respectively ( p < 0.02). Most ruptures occurred in the spring season, but there was no statistical difference in the incidence of Achilles tendon ruptures by season ( p > 0.05). Conclusions: The incidence of Achilles tendon ruptures in this community was comparable to those reported in European communities (range 6 to 37 ruptures per 100,000 people), although a bimodal age distribution of rupture previously reported was not observed in this study.
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Ojala, Satu. "Supplemental Work at Home among Finnish Wage Earners: Involuntary Overtime or Taking the Advantage of Flexibility?" Nordic Journal of Working Life Studies 1, no. 2 (November 18, 2011): 77. http://dx.doi.org/10.19154/njwls.v1i2.2346.
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It is suggested, that the new flexible work practices are enhanced to meet the work-family demandsand therefore benefit especially women. In the article the focus is on informal flexibilitytaking place at home, for which field studies of the role of gender are rare. Against the assumptions,paid work at home is mostly informal, supplementary overtime by nature. In this article, I explorewhy employees undertake work in their private sphere during their free time and whether gendermakes a difference there. I carry out both qualitative and quantitative analyses. The qualitativedata consists of 21 interviews with white-collar employees and the quantitative data from theFinnish Quality of Work Life survey 2008 for which there are almost 4400 respondents. The methodsinclude content analysis, descriptive statistics and logistic regression analysis.According to both the qualitative and quantitative data, job characteristics play the most importantrole for all who work at home; employees with higher education, or supervisory tasks, inparallel with having an autonomous and inspiring job predict both tele- and supplemental work.Importantly, gender plays only a minor role in the puzzles of choosing when and where to work.The social relations at the workplace, including the atmosphere and the support of superiors andthe work community, are only weakly related to work at home. At the same time, supplementalwork is associated with great time pressure and involuntary overtime.
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Takeshita, Akihiro, Hiroko Watanabe, Harumi Fujihara, Chiaki Yamada, Machiko Oshida, Kimiko Yurugi, Yutaka Tomoda, et al. "Erythrocyte Alloimmunization Analyzed by Gender and Transfusion Status." Blood 116, no. 21 (November 19, 2010): 4407. http://dx.doi.org/10.1182/blood.v116.21.4407.4407.
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Abstract Abstract 4407 (Purpose) Prior investigations have looked for trends and patterns in post-transfusion erythrocyte alloantibody formation (e.g., Walker et al., Tormey et al., and Hoeltge et al.). While anti-E has consistently been one of the most frequently observed alloantibodies following transfusion, the relative frequency of other antibodies is variably reported. In fact, some authors have reported no relationship between transfusion and alloantibody prevalence (Coles et al. and Domen et al.). Different outcomes might be attributed to antibody detection methods, cohort size, and cohort composition by race (including differences in the racial composition of donor and patient populations). As yet, the significance of gender has not been explicitly investigated in a large cohort of transfused vs. non-transfused patients. This study reports gender differences in erythrocyte alloantibody formation in a nation where blood donor and patient populations are phenotypically similar and relatively homogeneous. (Methods) In response to an open invitation made in November, 2008, 25 Japanese institutions contributed data on 248,785 patients (male:female=1:1.19). Each institution reported results from the previous 3 years. Patients known to have been transfused were placed in the transfused group, whereas patients known not to have been transfused were placed in the non-transfused group. Patients for whom transfusion history was uncertain were excluded. Erythrocyte alloantibodies against D, C, c, E, e, f, Ce, P1, M, N, S, s, Mia, Lea, Leb, Jka, Jkb, Jk3, Fya, Fyb, K, k, Kpa, Kpb, Jsa, Jsb, Dia, Dib, Lua, Lub, Xga and H were analyzed. A patient investigated multiple times was counted as one case. Multiple antibodies in one patient were separately summarized. Antibody incidence was calculated as the percentage of patients in each group with the corresponding antibody. (Results) Erythrocyte antibodies were detected in 3,554 patients (1.43% of all patients, 1.32% of males and 1.52% of females). Including 655 patients with antibodies reported by four more institutions, a total of 4,219 patients with at least one antibody were analyzed. From these, anti-E was observed in 34.7% and 41.3% of male and female transfused patients vs. 8.0% and 21.9% in those not transfused, respectively. Anti-Dia was observed in 3.5% and 4.8% of male and female transfused patients vs. 2.7% and 2.8% in those not transfused. Jka was observed in 2.6% and 4.7% of male and female transfused patients vs. 0.4% and 0.1% in those not transfused. Anti-E+c was observed in 6.6% and 8.4% of male and female transfused patients vs. 0.4% and 2.3% in those not transfused. Emergence of anti-E, anti-Dia and anti-Jka following transfusion was significantly different between males and females (p<0.05, p<0.05 and p<0.01, respectively). (Conclusion) The frequencies of anti-E, anti-Dia, anti-Jka and others depend not only on transfusion history, but also gender. Discordance with other studies suggests that population genetics may also be relevant. These are especially important results in the emerging era of personalized medicine. Hematologists should continue large-scale investigations of transfusion-related alloimmunization to elucidate contributory factors and to optimize patient care. Disclosures: No relevant conflicts of interest to declare.
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Arendt, Mikkel, Raben Rosenberg, Leslie Foldager, Gurli Perto, and Povl Munk-Jørgensen. "Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases." British Journal of Psychiatry 187, no. 6 (December 2005): 510–15. http://dx.doi.org/10.1192/bjp.187.6.510.
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BackgroundFew studies have examined samples of people with cannabis-induced psychotic symptoms.AimsTo establish whether cannabis-induced psychotic disorders are followed by development of persistent psychotic conditions, and the timing of their onset.MethodData on patients treated for cannabis-induced psychotic symptoms between 1994 and 1999 were extracted from the Danish Psychiatric Central Register. Those previously treated for any psychotic symptoms were excluded. The remaining 535 patients were followed for at least 3 years. In a separate analysis, the sample was compared with people referred for schizophrenia-spectrum disorders for the first time, but who had no history of cannabis-induced psychosis.ResultsSchizophrenia-spectrum disorders were diagnosed in 44.5% of the sample. New psychotic episodes of any type were diagnosed in 77.2%. Male gender and young age were associated with increased risk. Development of schizophrenia-spectrum disorders was often delayed, and 47.1% of patients received a diagnosis more than a year after seeking treatment for a cannabis-induced psychosis. The patients developed schizophrenia at an earlier age than people in the comparison group (males, 24.6 v. 30.7 years, females, 28.9 v. 33.1 years).ConclusionsCannabis-induced psychotic disorders are of great clinical and prognostic importance.
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Pörhölä, Maili, Kristen Cvancara, Esta Kaal, Kristina Kunttu, Kaja Tampere, and Maria Beatriz Torres. "Bullying in university between peers and by personnel: cultural variation in prevalence, forms, and gender differences in four countries." Social Psychology of Education 23, no. 1 (October 15, 2019): 143–69. http://dx.doi.org/10.1007/s11218-019-09523-4.
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Abstract This study reports results from cross-cultural comparisons of (a) the frequency of university students’ experiences of bullying victimization and perpetration between students, (b) students’ experiences of bullying victimization by university personnel, and (c) the breakdown of victimization by the forms of bullying students have experienced. Gender breakdowns are offered. Survey data were collected from undergraduates in a total of 47 universities, using large sample sizes, similar measures and assessment methods in four countries: Argentina (N = 969), Estonia (N = 1053), Finland (N = 4403), and the United States (N = 2072). The results confirmed previous findings which suggest that a notable number of students experience bullying during university studies by fellow students and/or staff members, and a smaller number of students admit to bully their fellow students. The results add to previous knowledge by demonstrating remarkable cultural differences in the prevalence and forms of bullying and suggesting that bullying at the university level starts to transform similar to bullying in the workplace. The overall rates of bullying victimization and perpetration between students were the highest in Argentina, followed by the USA, Finland, and finally Estonia. However, victimization by university personnel was reported the most in Estonia, followed by Argentina, the USA, and Finland. Gender breakdowns in bullying experiences varied between countries. Verbal forms of bullying were common experiences. The most often reported form in all countries was unjustified criticism, belittling or humiliation related to academic performance. Students in the USA reported the highest frequencies in most forms of victimization. The results are discussed by reflecting on higher education features and comparing cultural characteristics of the countries. Practical implications are provided.
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Ponomareva, M. N., I. M. Petrov, E. N. Kalyuzhnaya, L. I. Gapon, T. I. Petelina, and E. I. Yaroslavskaya. "Symptomatic Metabolic Treatment of Ophthalmopathies in Patients with COVID-19-Associated Pneumonia." EYE GLAZ 23, no. 3 (October 4, 2021): 19–26. http://dx.doi.org/10.33791/2222-4408-2021-3-19-26.
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Background. The causative agent of the coronavirus infection – SARS-CoV-2 – remains active and causes new cases despite the measures taken around the world. In order to timely detect ophthalmopathies in patients with dyslipidemia who have gone through COVID-19-associated pneumonia, prospective observation during the period of convalescence is advisable, justified and relevant. The assessment of the microcirculation of the bulbar conjunctiva is simple, non-invasive, safe, and allows assessing changes in the entire microcirculatory system of the body. Purpose. To study the features of the somatic status, hemodynamics of the bulbar conjunctiva in patients with dyslipidemia who have gone through COVID[1]19-associated pneumonia, depending on gender, homocysteine and cystatin C indicators during symptomatic therapy. Methods. 55 patients (110 eyes) with a documented diagnosis of COVID-19-associated pneumonia with an increased level of homocysteine and cystatin C were prospectively examined 3 months after discharge from the hospital. After consulting with therapist, cardiologist and functional diagnostics doctor, patients were divided into two groups according to gender. Results. In both groups, the dependence of the severity of lung damage on age was noted: Spearman’s correlation coefficient (r) amounted to r = 0.4; p = 0.017 and r = 0.5; p = 0.045, respectively. A direct correlation on the stage of AH was noted in patients of Group 1 (r = 0.4; p = 0.016), however, in patients of Group 2, this dependence was not found to be significant (r = 0.2; p = 0.367). There were no statistically significant changes in lipid profile in patients of both groups. The severity of endotheliosis during the period of convalescence in the study groups was confirmed by the average values of homocysteine and cystatin C compared to the reference values (1.4/1.6 and 1.62/1.67 times higher, respectively). A month of symptomatic metabolic treatment (Rosuvastatin, 1 mg of folic acid three times a day, 1 pill of Combilipen once a day, 1 drop of Chiloparin[1]Komod solution in both eyes 3 times a day) has shown its effectiveness in the course of changes in bulbar conjunctival microcirculation and disturbed total tear secretion in patients of both groups. Conclusion. In patients who went through COVID-19-associated pneumonia, markers of endotheliosis (homocysteine and cystatin C) remain during the period of convalescence, which indicates the severity of endotheliosis and the need for symptomatic metabolic treatment.
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Formica, Francesco, Francesco Maestri, Florida Gripshi, Alan Gallingani, Silvia Grossi, and Francesco Nicolini. "Long-Term Outcome of Mechanical and Biological Prostheses in Patients with Left-Side Infective Endocarditis: A Systematic Review and Meta-Analysis." Journal of Clinical Medicine 10, no. 19 (September 24, 2021): 4356. http://dx.doi.org/10.3390/jcm10194356.
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Background. Long-term outcomes of patients with infective endocarditis (IE) who received either a mechanical (MP) or biological prosthesis (BP) are conflicting. A meta-analysis of observational studies comparing the long-term outcomes of left-side IE with the use of MP versus BP was performed. Methods. Electronic databases from January 2000 to June 2021 were screened. Studies reporting long-term mortality were analyzed. The primary endpoint was long-term overall mortality. Secondary endpoints were in-hospital/.30-day mortality and freedom from both prosthesis reinfection and reintervention. The pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated for survival according to the random effect model. Results. Thirteen retrospective observational studies reporting on 8645 patients (MP: 4688; BP: 4137) were included for comparison. Twelve studies reported data of long-term survival for a total of 8285 patients (MP: 4517; BP: 3768). The pooled analysis revealed that the use of MP was statistically associated with longer benefits compared to BP (HR 0.74; 95% CI 0.63–0.86; p < 0.0001). The median follow-up time ranged from 1 to 15.3 years. The pooled analysis of five studies reporting data on prosthesis reinfection in 4491 patients (MP: 2433; BP: 2058) did not reveal significant differences (HR 0.60; 95% CI 0.30–1.21; p = 0.15). Five studies reported data on prosthesis reintervention in 4401 patients (MP: 2307; BP: 2094). The meta-analysis revealed a significant difference in favor of MP (HR 0.40; 95% CI 0.29–0.55; p < 0.0001). Meta-regression reported no effect of male gender (p = 0.09) and age (p = 0.77) on long-term survival. Conclusions. In a meta-analysis of retrospective observational studies comparing the long-term outcome of patients who underwent surgery for left-sided IE, the use of MP compared to BP is associated with a significant longer-term survival and with a reduced incidence of late reoperation. The incidence of late reinfection is comparable between the two prostheses.
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Ritvonen, Elina, Eliisa Löyttyniemi, Pia Jaatinen, Tapani Ebeling, Leena Moilanen, Pirjo Nuutila, Ritva Kauppinen-Mäkelin, and Camilla Schalin-Jäntti. "Mortality in acromegaly: a 20-year follow-up study." Endocrine-Related Cancer 23, no. 6 (June 2016): 469–80. http://dx.doi.org/10.1530/erc-16-0106.
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Objective It is unclear whether mortality still is increased in acromegaly and whether there are gender-related differences. We dynamically assessed outcome during long-term follow-up in our nationwide cohort. Patients and methods We studied standardized mortality ratios (SMRs) relative to the general population and causes of death in acromegaly (n=333) compared with age- and gender-matched controls (n=4995). Results During 20 (0–33) years follow-up, 113 (34%) patients (n=333, 52% women) and 1334 (27%) controls (n=4995) died (P=0.004). SMR (1.9, 95% CI: 1.53–2.34, P<0.001) and all-cause mortality (OR 1.6, 95% CI: 1.2–2.2, P<0.001) were increased in acromegaly. Overall distribution of causes of death (P<0.001) differed between patients and controls but not cardiovascular (34% vs 33%) or cancer deaths (27% vs 27%). In acromegaly, but not in controls, causes of deaths shifted from 44% cardiovascular and 28% cancer deaths during the first decade, to 23% cardiovascular and 35% cancer deaths during the next two decades. In acromegaly, cancer deaths were mostly attributed to pancreatic adenocarcinoma (n=5), breast (n=4), lung (n=3) and colon (n=3) carcinoma. In acromegaly, men were younger than women at diagnosis (median 44.5 vs 50 years, P<0.001) and death (67 vs 76 years, P=0.0015). Compared with controls, women (36% vs 25%, P<0.01), but not men (31% vs 28%, P=0.44), had increased mortality. Conclusions In acromegaly, men are younger at diagnosis and death than women. Compared with controls, mortality is increased during 20 years of follow-up, especially in women. Causes of deaths shift from predominantly cardiovascular to cancer deaths.
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Atanassova, Krasimira, Jelka Masin-Spasovska, Goce Spasovski, and Emil Paskalev. "Is there any Gender Difference in the Association between Obesity, Chronic Kidney Disease and Anemia." BANTAO Journal 13, no. 2 (December 1, 2015): 79–83. http://dx.doi.org/10.1515/bj-2015-0017.
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Abstract Introduction. Nowadays, obesity has emerged as one of the most independent risk factors for chronic kidney disease (CKD) in both economically developed and undeveloped countries. The number of patients requiring dialysis as a consequence of obesity-related renal diseases, such as diabetes mellitus and hypertension, is increasing worldwide. Moreover, obesity has been shown to favorize the risk of cardiovascular diseases (CVD) with premature death due to CKD and/or end-stage renal disease (ESRD). The aim of the study was to investigate the association between obesity [e.g. body mass index (BMI)], kidney function [e.g. glomerular filtration rate (GFR)] and renal anemia in CKD patients. Methods. Retrospectively, data from the register of 315 pre-dialysis patients with different stages of CKD not on erythropoiesis stimulation agents (ESAs) during the period between 1 Jan 2013-30 June 2013 were used to assess the association between the degree of CKD impairment with the degree of obesity and anemia. The stage and/or progression of CKD was calculated by GFR, while the degree of obesity by the body mass index (BMI). CKD was defined as a glomerular filtration rate (GFR) <60 mL/min per 1.73 m2. Data analysis was performed by means of the simple Microsoft excel program. Results. Within the study population of 315 CKD patients, 123 were males with mean age of 63.4±1.33 years and 192 females of 57.3±1.2 years. The GFR reduced with the increased BMI in both genders, and majority of patients (n=243) were in CKD stage 3, with a mean GFR of 44.5 ml/min/1.73 m2. The BMI values in female patients with first and second degree of obesity negatively correlated with GFR (r=−0.46, p<0.05). Only female patients with second degree of obesity (BMI of 35-39.9 kg/m2) had a positive correlation between the decreased renal function and reduced Hb levels. Conclusions. Our study provided an unconditional evidence not only for the presence of an association between the degree of obesity (BMI) and the degree of renal function impairment (GFR), but also an association between the higher BMI and the higher degree of kidney anemia seen in women with second degree of obesity. Further larger scale trials and interventional studies are required to see the effect of body weight reduction on renal function and especially anemia.
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Dave, Jayna, Elizabeth Taberes, and Ariun Ishdorj. "A Systematic Review and Meta-Analysis of Fruit and Vegetable Waste From School Lunch." Current Developments in Nutrition 6, Supplement_1 (June 2022): 356. http://dx.doi.org/10.1093/cdn/nzac054.011.
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Abstract Objectives To synthesize findings from studies that assessed fruit and vegetable (F&V) plate waste from school lunches to i) estimate the level of waste, ii) determine whether there is a difference in F&V waste pre- and post- implementation of the new National School Lunch Program's (NSLP) meal standards, and iii) identify factors associated with plate waste. Methods The systematic review followed the Cochrane Collaboration Guidelines, USDA's Nutrition Evidence Library (NEL) Bias Assessment, and USDA NEL Conclusion Statement Evaluation Criteria. Meta-analysis of selection and percentage of waste was performed in STATA-16. Thirty-two studies were included in the systematic review and thirty in meta-analysis. Results The estimated mean percentage of students that selected fruits and vegetables were 61% (95% CI: 50%-72%, n = 14), and 48% (95% CI: 37%-59%, n = 14), respectively. The percentage of students who selected fruits increased significantly after the implementation of the new standards. This increase was consistent across all the studies and ranged from 5% to 24%. Fruit waste was estimated to be 39.5% (95% CI: 33.8%−44.5%) and vegetables waste was 50.5% (95% CI: 42.5%−57.4%). No significant differences were found between pre- and post-implementation for fruit or vegetable waste. Child related factors, such as age, gender, and ethnicity/race, were not statistically significant to explain the aggregate waste across studies. Only few studies on plate waste explored the effect of preferences or attitudes, preparation methods, availability of competitive food, and time devoted to eating on F&V waste. However, no relationships could be established beyond the descriptions provided in the original studies. Conclusions The change in NSLP meal standards has had a positive effect in increasing the number of students selecting fruits. Further research is warranted to improve the overall F&V selection and reduce waste, especially for dark green vegetables, to maximize the nutritional impact of the NSLP. Funding Sources USDA/ARS; The Alliance for Potato Research and Education.
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Edwards, Beatrice J., Xiaotao Zhang, Ming Sun, Juhee Song, Peter Khalil, Meghan Sri Karuturi, Linda Pang, et al. "Overall survival in older patients with cancer." BMJ Supportive & Palliative Care 10, no. 1 (September 22, 2018): 25–35. http://dx.doi.org/10.1136/bmjspcare-2018-001516.
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ObjectivesA growing number of patients with cancer are older adults. We sought to identify the predictors for overall survival (OS) in older adults with solid tumour and haematological malignancies between January 2013 and December 2016.MethodsRetrospective cohort study. A comprehensive geriatric assessment was performed, with a median follow-up of 12.8 months. Analysis: univariate and multivariate Cox proportional hazards regression analysis.ResultsIn this study, among the 455 patients with last follow-up date or date of death, 152 (33.4%) died during the follow-up. The median follow-up is 12.8 months (range 0.2–51.1 months) and the median OS is 20.5 months (range 0.3–44.5 months). Among all older patients with cancer, predictors of OS included male gender, cancer stage, malnutrition, history of smoking, heavy alcohol use, frailty, weight loss, major depression, low body weight and nursing home residence. Traditional performance scores (Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale (KPS)) were predictors of OS. Independent predictors included age >85 years and haematological malignancies. Among solid tumours (n=311) in addition to the above predictors, comorbidity, gait speed and vitamin D deficiency were associated with OS.ConclusionsWe identified specific geriatric factors associated with OS in older patients with cancer, and comparable in predictive ability to traditional performance scores such as KPS and ECOG. Prospective studies will be necessary to confirm our findings.
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Peeters, Marc, George Kafatos, Aliki Taylor, Victor M. Gastanaga, Hua Yu, Kelly Smith Oliner, Gregory A. Maglinte, Jan-Henrik Terwey, and Han H. J. M. Krieken. "Prevalence of RAS mutations among patients with metastatic colorectal cancer by country and region in randomized clinical trials: A pooled analysis." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 520. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.520.
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520 Background: Global mCRC treatment guidelines for EGFR inhibitors require prior confirmation of wild-type RAS status (KRAS exons 2, 3, 4 and NRAS 2, 3, 4). The aim of this study was to estimate the prevalence of RAS mutations among mCRC patients by country, demographic characteristics, and clinical risk factors. A secondary aim was to estimate BRAF and KRASexon 2 mutation prevalence. Methods: Data from 5 published Amgen-sponsored randomized clinical trials (RCTs) were merged in a retrospective pooled analysis. There were 3 phase III, 1 phase II, and 1 phase Ib/II studies. For 4 out of 5 RCTs, RAStesting was conducted in a U.S. laboratory (Transgenomic Inc.) using Sanger sequencing on DNA extracted from tumor samples. For the remaining trial, a combination of next-generation sequencing and Sanger sequencing was used. Results: A total of 3,196 patients from 36 countries were included. The overall unadjusted prevalence of RAS mutations among mCRC subjects was 55.9% (95% CI, 53.9%, 57.9%); KRAS exon 2 mutation prevalence was 42.6% (40.7%, 44.5%). The prevalence by exon is given in the table below. BRAFmutation prevalence was 8.1% (6.7%, 9.6%). There were no statistically significant differences in RAS mutation prevalence by gender, age, or clinical factors such as performance status, tumour site, biopsy origin, or metastasis characteristics. Statistically significant differences in RAS mutation prevalence estimates were observed by country and by region with rates for Central West Europe being significantly lower than Eastern Europe (49.4% [44.4%, 54.3%] and 61.5%; [55.3%; 67.4%] respectively). Statistically significant RASmutation prevalence differences were observed between studies which could be due to varying patient characteristics. Conclusions: By merging data from RCTs, the analysis provides robust estimates of RASmutation prevalence. Studies using observational data are needed to confirm these findings. [Table: see text]
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Rathore, Saif S., Wayne D. Rosamond, Lawton S. Cooper, Lloyd E. Chambless, Herman A. Tyroler, and Albert R. Hinn. "Characterization of Stroke Signs and Symptoms: Findings from the Atherosclerosis Risk in Communities Study." Circulation 103, suppl_1 (March 2001): 1362. http://dx.doi.org/10.1161/circ.103.suppl_1.9998-59.
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P59 Background: Although patterns of stroke occurrence and mortality have been well studied, little epidemiologic data are available regarding the clinical characteristics of stroke events. Methods: We evaluated hospitalized stroke events reported in the Atherosclerosis Risk in Communities Study to describe the clinical characteristics of incident stroke. Incident confirmed stroke cases (n=474) were evaluated for stroke symptoms including headache, vertigo, gait disturbance, and convulsions. Cases were also evaluated for stroke signs including hemianopia, diplopia, speech deficits, paresis, and parasthesia/sensory deficits. Stroke characteristics were also evaluated for univariate associations with race, gender, and stroke subtype. Results: Over an average follow-up of 9.2 years, 407 (86%) ischemic and 67 (14%) hemorrhagic strokes occurred. Stroke symptoms in order of decreasing frequency (95% confidence intervals) were headache (27.4%, 23.4%-31.4%), gait disturbance (10.8%, 7.9%-13.6%), convulsions (4.4%, 2.6%-6.3%), and vertigo (2.1%, 0.8%-3.4%). Speech deficits occurred in 64.1% (59.8%-68.5%), hemianopia in 14.6% (11.4%-17.7%), and diplopia in 5.5% (3.4%-7.5%) of cases. Most cases involved paresis (81.6%, 78.1%-85.1%), predominantly of the arms (75.5%, 71.6%-79.4%). Fewer subjects experienced sensory deficits (44.5%, 40.0%-49.6%), predominantly in the arms (38.6%, 34.2%-43.0%). Blacks were more likely than whites to experience paresis (85.8% vs 77.9%, p=0.03). Men were more likely than women to experience a gait disturbance (14.3% vs 6.7%, p=0.001). As expected, persons with hemorrhagic strokes had a higher proportion of headaches (59.7% vs 22.1%, p=0.001) and convulsions (11.9% vs 3.2%, p=0.001) than those with ischemic events, while speech deficits were more common in ischemic strokes (68.1% vs 40.3%, p=0.001). Conclusions: We present epidemiologic data concerning the clinical characteristics of incident stroke in a population-based cohort. While minor differences by race, gender, and stroke subtype were observed, data from additional follow-up is required to confirm observed variation.
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Rotatori, Melissa Sardenberg, Thais Manfrinato Miola, and Fernanda Ramos de Oliveira Pires. "Perfil nutricional de colaboradores de uma instituição oncológica." out-dez 4, no. 35 (2021): 414–20. http://dx.doi.org/10.37111/braspenj.2020354014.
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Introduction: Overweight and obesity are increasing in the world and are related to the development of chronic diseases that can impair personal and professional quality of life. The aim of this study was to track the nutritional profile and lifestyle of employees of an oncology institution. Methods: Prospective, cohort and observational study with 1,776 employees at the A. C. Camargo Cancer Center, in São Paulo (SP). Data were collected from September 2017 to February 2018, through a questionnaire and deferral of weight, height, waist circumference and body mass index (BMI). Results: Forty-two and a half percent of men and 39.1% of women were in excess according to the BMI. The female gender had a higher prevalence of very high risk classification for waist circumference (45.1%). Night shift workers had a higher prevalence of obesity (34.8%) and a very high risk for cardiovascular disease (47.1%) compared to other shifts. Similar situation was observed in employees who work 11 years or more at the institution, where 27.9% are obese and 44.5% are at very high risk for cardiovascular diseases, compared to those who use less time. Only 35.5% of the sample performed physical activity. Conclusion: A high prevalence of obesity and obesity, and risk for cardiovascular diseases, found in the studied population, shows the need and importance of adopting strategies to promote healthier eating habits and physical activity practices.
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Barros, Aluisio J. D., Cesar G. Victora, Ana M. B. Menezes, Bernardo L. Horta, Fernando Hartwig, Gabriel Victora, Lúcia C. Pellanda, et al. "Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study." Revista de Saúde Pública 54 (August 7, 2020): 75. http://dx.doi.org/10.11606/s1518-8787.2020054002810.
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OBJECTIVE: To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment. METHODS: Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons. RESULTS: In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently. CONCLUSIONS: The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic.
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Siwek, I. W., A. Ślifirczyk, A. Modestowicz- Dobrowolski, M. Bytys, and K. Chomicz. "Right to abortion in the students 'opinion." Progress in Health Sciences 1 (June 11, 2019): 83–89. http://dx.doi.org/10.5604/01.3001.0013.3688.
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<br/><b>Purpose:</b> The study was aimed at getting to know students' opinions on abortion, the circumstances that authorize it, and analysis of factors that may influence the views of the studied group. <br/><b>Materials and methods:</b> The study was conducted among 687 students from various regions of Poland. The respondents answered questions about the abortion law and circumstances entitling them to terminate the pregnancy. <br/><b>Results:</b> The majority of respondents (42.1%) are of the opinion that the current law protects the mother and the child well enough. 58.5% of respondents said that abortion in cases permitted by law is not a sin. Referring to the church's prohibition of abortion, 44.5% of respondents voted for its abolition. Considering the answer to this question in terms of religiosity, it turns out that 31.7% of believers taking part in the study would like this ban to be lifted. <br/><b>Conclusions:</b> Factors such as gender, place of residence, having or willingness to have children influence abortion views. Factors such as the field of study and having a permanent partner do not affect abortion views. Faith has a big impact on abortion views, and believers are more likely than non-believers to forbid abortion or restrict the right to abortion, while much less often advocate unrestricted rights to abortion.
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Dicu, Delia-Roxana, Ana Petra Lazăr, and Luminița Lazăr. "Incidence of Periodontal Disease among Adolescents." Journal of Interdisciplinary Medicine 5, no. 2 (June 1, 2020): 71–75. http://dx.doi.org/10.2478/jim-2020-0013.
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AbstractBackground: Despite the scarcity of studies regarding periodontal disease in young patients (teenagers and young adults), it seems that this disorder is also affecting the young population. Risk factors for periodontal disease include older age, chronic tobacco use, male gender, habits regarding oral hygiene, educational status, ethnicity, and financial status.Aim: This study aimed to evaluate the periodontal health among adolescents in two high schools in Târgu Mureș that had dental practices.Material and Methods: An online questionnaire consisting of 16 questions was distributed among high schoolers of Târgu Mureș. Data about personal characteristics, oral hygiene habits, family history of periodontal disease, risk factors for periodontal disease, and symptoms of periodontal disease observed by the respondents were collected and analyzed.Results: Out of the 501 teenagers who responded to the online questionnaire, 114 (22.8%) were 18 years old and were mostly females (88.2%). Regarding oral hygiene habits, 75.8% prefer a manual toothbrush over an electric toothbrush, 66.7% brush their teeth twice a day, and 54.1% practice a horizontal method of toothbrushing. Mouthwash was the most used oral hygiene aid (58.3%). Family history of periodontal disease was observed in 21.9% of respondents. As favoring factors, nicotine addiction (23.8%), bruxism (24.4%), interposition of various objects between teeth (48.3%), past or present orthodontic treatments (38.7%) were recorded. Symptoms of gingivitis and periodontitis, such as gingival bleeding (81.4%), redness of gingiva (39.3%), increased gingival volume (44.5%), gingival retraction (22.8%), and halitosis (81%), were present in the responding teenagers.Conclusions: In this study, periodontal disease was affecting mostly adolescent females who are practicing inappropriate methods of toothbrushing with inadequate frequency.
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Toro, Mohna M., Sheetal John, and Atiya R. Faruqui. "Pattern of use of analgesics in post-operative pain management in adults undergoing laparotomy surgery: a prospective observational study." International Surgery Journal 5, no. 2 (January 25, 2018): 662. http://dx.doi.org/10.18203/2349-2902.isj20180372.
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Background: Previous studies on post-operative pain document that most patients continue to experience pain after surgery. This study was done to record the drug use for post- operative pain in laparotomy and to determine the patient characteristics that affect their pain score.Methods: A prospective observational study in 250 adult patients undergoing laparotomy surgery from General Surgery and Obstetrics and Gynaecology (OBG) at a tertiary care hospital.Results: Among patients recruited, 161 (64.4%) were females, 134 (53.6 %) from surgery department, mean age 37.29±14.9 years. Caesarean section 85 (73.27%) followed by meshplasty 46 (34.3%) were most common.Parenteral tramadol 100mg (40%) was the most common analgesic post-operative, subsequently shifted to oral. Epidural analgesia used in 31 (12.4%) patients, only from surgery department. First analgesic received within 6 hrs in 55.5 % in surgery and 44.5 % in OBG (Pearson χ2 =2.535, p = 0.111) with mean time to first analgesic 2.85±2.33 hrs. Pain score, using Numerical Rating Scale (NRS) recorded for 200 (80%) patients showed 76 (30.4%) had severe pain on day 1 which decreased to 12 (4.8%) on day 3. Speciality (p=0.01) and nature of surgery (p=0.05) were significantly associated with severity of pain. Gender [OR = 0.55 (95% CI = 0.26, 1.19), p=0.13], nature of surgery [2.32 (1.02, 5.32), p=0.05], speciality [0.35 (0.15, 0.80), p=0.01] and surgical category [0.76 (1.01, 5.32), p=0.05] affected pain score on univariate logistic regression, but were not significant on multivariate analysis.Conclusions: Despite the use of opioids and combination analgesics, one third of patients reported severe pain on the first day after surgery.
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Valenciano-Mendoza, Eduardo, Fernando Fernández-Aranda, Roser Granero, Mónica Gómez-Peña, Laura Moragas, Bernat Mora-Maltas, Anders Håkansson, José M. Menchón, and Susana Jiménez-Murcia. "Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions." International Journal of Environmental Research and Public Health 18, no. 21 (October 21, 2021): 11085. http://dx.doi.org/10.3390/ijerph182111085.
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Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.
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Cardoso, G., J. Graça, C. Klut, S. Xavier, A. Neto, M. Martins, J. Ramos, J. Ribeiro, and C. Vieira. "Frequent users of an acute psychiatric inpatient unit: A 5-year retospective study." European Psychiatry 26, S2 (March 2011): 518. http://dx.doi.org/10.1016/s0924-9338(11)72225-8.
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IntroductionA small subset of patients with above average admissions to psychiatric inpatient units is recognized in clinical practice. These frequent users tend to be younger and to have a diagnosis of schizophrenia or affective disorder. Social conditions and the severity of the illness seem to be associated with this increased number of admissions.Aims/ObjectivesTo study demographic and clinical characteristics of frequent and non-frequent users of a psychiatric inpatient unit.MethodsRetrospective data of all the patients admitted to a psychiatric inpatient unit from January 2004 to December 2008 were reviewed. Frequent-users were defined as patients with 3 or more admissions over that period of time, and non-frequent users as those with less than 3 admissions. The two groups were compared in terms of age, gender, ethnicity, psychiatric diagnosis and compulsory admissionsResultsIn a total of 2018 admissions and 1348 patients, the frequent-user group represented 10.2% (n = 137) of the patients and 28.9%(n = 584) of the admissions. Frequent-users were significantly younger (39.5 vs. 44.5 years, p = .001), more frequently black (22.6 vs. 19.4%, p < .001) and compulsorily admitted (27.7 vs. 14%, p < .001) than non-frequent users. Patients with bipolar disorder (p = .001), schizophrenia (p = .003) belonged significantly more to frequent-users group, while unipolar depressive patients (p = .016) and other diagnosis (p = .011) was more significantly represented in the non-frequent users group. Frequency of admission did not differ with gender.ConclusionsThe results concerning age and psychiatric diagnosis are consistent with previous studies. Compulsory admissions and black ethnicity were significantly higher among frequent- users.
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Shaik, Mohammed, Mohamed Akkad, and Anas Al-Janadi. "The Effect of Iron Deficiency without Anemia on Cardiovascular Fitness: A Nhanes Study." Blood 126, no. 23 (December 3, 2015): 2062. http://dx.doi.org/10.1182/blood.v126.23.2062.2062.
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Abstract Introduction: The prevalence of iron deficiency (ID) without anemia is unknown. Iron is a vital constituent of hemoglobin, myoglobin, and some mitochondrial enzymes and its deficiency may result in reduced aerobic capacity. A few clinical studies have shown improvement in exercise performance after replacement of iron in subjects (subs) with ID and no anemia. As maximum oxygen consumption (Vo2 max) is the gold standard laboratory measure of cardiorespiratory fitness, in this study we investigated the prevalence of ID without anemia in general population and the effect of iron deficiency on Vo2 max in non-anemic subjects. Methods Data is obtained from continuous National Health and Nutrition Examination Survey (NHANES) 1999-2003, a nationally representative health survey combined with examination of non-institutionalized healthy subs. The data regarding demographics, age, race and smoking status, complete blood count, ferritin and estimated Vo2 max was obtained from questionnaires, laboratory and examination datasets respectively. The subs with normal hemoglobin were divided in to two groups based on ferritin level: Group A (GpA); ferritin ≤20 ng/mL, Group B (GpB); ferritin >20 ng/mL. Based on Vo2 max level subs were divided into: 'below average' (Vo2 max ≤ 30 ml/kg/min), and 'average' (Vo2 max >30 ml/kg/min). The prevalence of ID without anemia was obtained using chi-square test. The correlation of Vo2 max and ferritin was obtained using linear regression. Odds ratio (OR) of ID with low Vo2 max was obtained using logistic regression after adjusting to age, race, gender and smoking. NHANES is a complex multistage probability sampling, and sampling weights were used in this analysis. P-value <0.05 was considered statistically significant. Analyses were performed using SAS 9.3 (SAS Institute, Cary NC). Results: Of 8628 subs with normal hemoglobin, 1074 subs had ID with weighted prevalence of 10.7% (95%CI 11.3-10). The prevalence of ID in males and in females was 0.86% (95%CI 1.15-0.57) and 9.8%(10.46-9.14), respectively. In individuals who had Vo2 max examination (n=2592), 408 subs had ID. The median age, hematocrit, platelet count and Vo2 max in GpA were 25, 39.2, 281, and 36.5 vs. GpB 29, 44.5, 262, and 40.8, respectively (table1). There was a weak correlation between Vo2 max and ferritin level with r-square=0.006. After adjusting for covariates, OR of below average Vo2 max in GpA was 0.93 (95%CI 0.64-1.34). Conclusion: Weighted prevalence of iron deficiency in general adult population was 10.7% (95%CI 11.0-14.3). There was no significant difference between functional aerobic capacity indicating cardiovascular fitness between ID and non-ID subjects. Further studies are needed to validate our findings Table 1. Comparision of GpA and GpB Variables GpA (ferritin ≤ 20) (n=408) GpB ( ferritin > 20) (n=2184) Median age 25 29 Median Hematocit 39.2 44.5 Median RDW 12.5 12.2 Median Platelets 281 262 Median WBC 6.9 6.9 Median Neutrophils 4.1 4.0 Vo2 max 36.5 40.8 Disclosures No relevant conflicts of interest to declare.
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Akhmetov, Kanat, Yerkezhan Zhadykova, Askar Sadykov, Yerzhan Adilbekov, Altynshash Jaxybayeva, Serik Akshulakov, and Nurbek Igissinov. "Assessment of mortality from traumatic subdural hemorrhage in Kazakhstan." Journal "Medicine" 11-12, no. 221-222 (January 30, 2021): 27–34. http://dx.doi.org/10.31082/1728-452x-2020-221-222-11-12-27-34.
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Traumatic brain injury (TBI) is one of the most severe and common forms of damage to the central nervous system. At the same time, traumatic subdural hemorrhage refers to severe TBI leading to severe disability and death. Aim of the research. To study the epidemiological features of mortality from traumatic subdural hemorrhage in Kazakhstan. Material and Methods. The study was retrospective, 2009-2018, the material was data on cases of death from traumatic subdural hemorrhage in the country, descriptive and analytical methods of epidemiology were used. Results and discussion. It is established that the average age of those who died from traumatic subdural hemorrhage in men (44.5±0.78 years) was younger than in women patients (47.6±1.17 years). The crude and standardized mortality rates for men (1.33±0.070/0000 and 1.39±0.070/0000, respectively) were higher than for women (0.45±0.040/0000 and 0.42±0.040/0000, respectively). Age indicators had a unimodal increase with a peak of mortality in the group of 70 years and older in both men (2.8±0.38) and women (1.05±0.14). Trends in age-related indicators in men and women tended to increase, with the most pronounced growth rates of the equalized indicators being at the age of 70 years and older in men (Tgr=+7.1%), and in women (Tgr=+9.2%). Conclusions. The analysis of mortality from traumatic subdural hemorrhage indicates a gender difference and an increase in mortality in all the studied population groups. The obtained data are recommended to be used for monitoring and evaluation of diagnostic and therapeutic measures in this pathology. Keywords: traumatic subdural hemorrhage, mortality, Kazakhstan
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Aftab, Marium, Alsaleem Mohammed Abadi, Shamsun Nahar, Razia Aftab Ahmed, Syed Esam Mahmood, Manik Madaan, and Ausaf Ahmad. "COVID-19 Pandemic Affects the Medical Students’ Learning Process and Assaults Their Psychological Wellbeing." International Journal of Environmental Research and Public Health 18, no. 11 (May 28, 2021): 5792. http://dx.doi.org/10.3390/ijerph18115792.
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Background: With the emergence of the COVID-19 pandemic, people are living within a milieu of stress, anxiety, and fear. Medical students are susceptible to these emotional injuries, but their psychological wellbeing and learning may further be assaulted by future uncertainties and altered teaching and training programs. Our objective was to find the extent of the psychological impact of the pandemic and the learning difficulties they are experiencing; Methodology: This cross-sectional study included 418 undergraduate and postgraduate medical students from all over the world. A questionnaire was uploaded in Google survey form. It included background characteristics, questions for psychiatric impact like PHQ-9, GAD-7, ZF-OCS, and questions for learning difficulties perceived in comparison to the pre-pandemic time. Results: Among participants, 34.9% of students were male and 65.1% female. Around 46.4% belonged to the WHO, Eastern Mediterranean region, 26.8% from South East Asia region, 17.5% from the region of America, 5.5% from the European region,2.2%from the Western Pacific region, and 1.7% from the African region. Symptoms due to psychiatric illness were noticed in 393 (93.1%); depression in 386 (92.3%), anxiety in 158 (37.8%), obsessive compulsion disorder in 225 (53.8%), and post-traumatic stress syndrome in 129 (39.9%). Female gender, geographical region, and history of previous psychiatric illness were significantly related to almost all the psychiatric illnesses. Regarding learning difficulty, 96% of students faced problems: trouble with memorizing in 54.0%, concentration problems in 67.0%, about 55.5% of students made more mistakes, while 44.5% noted an increase in reaction time for solving questions. In addition, 90% experienced greater difficulty in overall learning during the pandemic in comparison to the pre-pandemic time. Conclusion: Assault on psychological wellbeing, struggling to memorize, inattention and difficulty in concentration on studies, along with perceived overall trouble with learning, have emerged as collateral damage from the COVID-19 pandemic with respect to medical students.
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Mishra, Sandeep, and Prashant Mishra. "Association between oral health knowledge attitude and practices of government primary school teachers." IP Journal of Surgery and Allied Sciences 4, no. 3 (October 15, 2022): 112–21. http://dx.doi.org/10.18231/j.jsas.2022.022.
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Oral health is an integral part of general health and imparting oral health education at younger age can prevent common oral diseases in later age. The school-going age is the most influential period of a child’s life and it is this period during which the children develop skills, beliefs and attitudes which they practice throughout their lives. Teachers play a vital role in shaping the behavior and overall comprehensive development of school children.10 Therefore, engagement of teachers in health promotion programmes can hypothetically lead to improvement of health in children. A Web Based Questionnaire Study was conducted among Teachers in Government Primary Schools in Indore district. A total of 1404 teachers from 615 government primary school out of which 1200 teachers were willing to participate in the study were included. Permission and informed consent was obtained prior to study. The data on oral health knowledge, attitude, practice and their oral health related quality of life of teachers will be collected through online questionnaire using pretested proforma. Questions included in the questionnaire were taken from previously published studies. Majority of the participants in the present study were in the age group of 40-50 years with a total of 555(46.3%). Among gender males (56.5%) are more than females (43.5%). For the qualification variable most of them are post graduate in qualification (38.9%). Greater proportion of the school teachers were teaching Hindi subject (46.8%), had 10-20 years’ experience in teaching (44.5%). Among the region most of them are from rural region with 71.3% Majority of the participants reported positive attitude towards exclusion of unhealthy foods from school premises (98.1%), inclusion of oral health topics in the school curriculum (98.8%), teachers being an oral health educator (83.8%) and role model for the children (98.8%) and the importance of oral health for overall health (95.3%). The present study was conducted with the aim to evaluate the oral health knowledge, attitude and practices of Government Primary School Teachers and to determine the association among these factors with oral health related quality of life.
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Huluka, Dawit Kebede, Desalew Mekonnen, Sintayehu Abebe, Amha Meshesha, Dufera Mekonnen, Negussie Deyessa, James R. Klinger, et al. "Prevalence and risk factors of pulmonary hypertension among adult patients with HIV infection in Ethiopia." Pulmonary Circulation 10, no. 4 (October 2020): 204589402097151. http://dx.doi.org/10.1177/2045894020971518.
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Globally, non-communicable diseases are increasing in people living with HIV. Pulmonary hypertension is a rare non-communicable disease in people living with HIV with a reported prevalence of <1%. However, data on pulmonary hypertension in people living with HIV from Africa are scarce and are non-existent from Ethiopia. This study aimed to examine the prevalence and severity of echocardiographic pulmonary hypertension and risk factors associated with pulmonary hypertension in people living with HIV in Ethiopia. A total of 315 consecutive adult people living with HIV followed at the Tikur Anbessa Specialized Hospital HIV Referral Clinic were enrolled from June 2018 to February 2019. Those with established pulmonary hypertension of known causes were excluded. A structured questionnaire was used to collect data on demographics, respiratory symptoms, physical findings, physician-diagnosed lung disease, and possible risk factors. Pulmonary hypertension was defined by a tricuspid regurgitant velocity of ≥2.9 m/sec on transthoracic echocardiography. A tricuspid regurgitant velocity ≥3.5, which translates into a pulmonary arterial pressure/right ventricular systolic pressure of ≥50 mmHg, was considered moderate-to-severe pulmonary hypertension. The mean age of the participants was 44.5 ± 9.8 years and 229 (72.7%) were females. Pulmonary hypertension was diagnosed in 44 (14.0%) of participants, of whom 9 (20.5%) had moderate-to-severe disease. In those with pulmonary hypertension, 17 (38.6%) were symptomatic: exertional dyspnea, cough, and leg swelling were seen in 12 (27.3%), 9 (20.5%), and 4 (9.1%), respectively. There was no significant difference in those with pulmonary hypertension compared to those without the disease by gender, cigarette smoking, previous history of pulmonary tuberculosis treatment, physician-diagnosed chronic obstructive pulmonary disease or bronchial asthma, duration of anti-retroviral therapy therapy or anti-retroviral regimen type. Pulmonary hypertension looks to be a frequent complication in people living with HIV in Ethiopia and is often associated with significant cardiopulmonary symptoms. Further studies using right heart catheterization are needed to better determine the etiology and prevalence of pulmonary hypertension in people living with HIV in Ethiopia compared to other countries.
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Mohd Shukri, Nurul Husna, Jonathan Wells, Simon Eaton, Firdaus Mukhtar, Ana Petelin, Zala Jenko-Pražnikar, and Mary Fewtrell. "Randomized controlled trial investigating the effects of a breastfeeding relaxation intervention on maternal psychological state, breast milk outcomes, and infant behavior and growth." American Journal of Clinical Nutrition 110, no. 1 (June 4, 2019): 121–30. http://dx.doi.org/10.1093/ajcn/nqz033.
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ABSTRACT Background Biological signaling and communication between mothers and infants during breastfeeding may shape infant behavior and feeding. This signaling is complex and little explored in humans, although it is potentially relevant for initiatives to improve breastfeeding rates. Objectives The aim of this study was to investigate physiological and psychological aspects of mother–infant signaling during breastfeeding experimentally, testing the effects of a relaxation intervention on maternal psychological state, breast milk intake, milk cortisol levels, and infant behavior and growth. Methods Primiparous breastfeeding mothers and full-term infants were randomly assigned to receive relaxation therapy [intervention relaxation group; n = 33 (RG)] or to the control group [n = 31 (CG); no relaxation therapy] at 2 wk postpartum. Both groups received standard breastfeeding support. Home visits were conducted at 2 (HV1), 6 (HV2), 12 (HV3) and 14 (HV4) wk to measure maternal stress and anxiety, breast milk intake and milk cortisol, and infant behavior and growth. Results RG mothers had lower stress scores postintervention than the CG (HV3 ∆ = −3.13; 95% CI: −5.9, −0.3) and lower hindmilk cortisol at HV1 (∆ = −44.5%; 95% CI: −76.1%, −12.9%) but not at HV2. RG infants had longer sleep duration (∆ = 82 min/d; 95% CI: 16, 149 min/d) at HV2 and higher gains in weight and body mass index standardized deviation score than the CG infants (∆ = 0.76; 95% CI: 0.3, 1.22; and ∆ = 0.59; 95% CI: 0.09, 1.1, respectively). RG infants had a mean milk intake at HV3 that was 227 g/d higher than that of the CG infants (P = 0.031) after controlling for gender and milk intake at HV1. Conclusions The trial shows the effectiveness of a simple relaxation intervention for improving maternal and infant outcomes and identifies some potential signaling mechanisms for investigation in future and larger studies, especially in settings where mothers are more stressed, such as those with preterm or low birth weight infants. This trial was registered at clinicaltrials.gov as NCT01971216.
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Enzinger, Andrea Catherine, Jen Wind, Elizabeth Frank, Nadine Jackson McCleary, Christine Cronin, Hanna Kelly Sanoff, Katherine Van Loon, et al. "Understanding the non-curative potential of palliative chemotherapy: Do patients hear what they want to hear?" Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 6575. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.6575.
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6575 Background: Misconceptions about the curative potential of PC are common, and may arise from gaps in informed consent. Another contributing factor could be patients’ desire, or lack of desire, for information about prognosis and PC outcomes. Methods: We surveyed 137 patients with advanced colorectal (N = 102) or pancreatic cancer (N = 35) within 2 weeks of consultation about 1st or 2ndline PC, as part of randomized trial of a PC education intervention at 6 US sites. Patients rated how much information they wanted about PC risks/benefits, including impact on prognosis. Responses ranged from no information to as much as possible on a 5-point Likert scale. They reported decision-making preferences; whether a doctor discussed curability, and how likely they thought PC was to cure their cancer. Chi square and Wilcoxon tests examined whether information and decision-making preferences, or curability discussions were associated with expectations of cure. Multivariable logistic regressions evaluated whether associations were modified by age, race, gender, marital status, or cancer type. Results: Only 44.5% of patients accurately reported that their cancer was not at all likely to be cured by PC. Most patients wanted a lot, or as much information as possible about PC risks/benefits, including likelihood of cure (81.7%), cancer control (84.7%), and impact on length of life (80.3%). Most patients preferred shared (70.8%) versus active or passive decision-making. Neither decision-making nor prognostic information preferences were associated with expectations of cure. Patients (13.9%) who did not recall curability discussions were less likely to have accurate expectations (21% v 48%; OR, 0.29; 95% CI, 0.07-.97). Patient characteristics did not significantly confound this association. Conclusions: Most patients value shared decision-making and want maximal information about PC risks/benefits, including impact on prognosis. Despite wanting prognostic information and reporting curability discussions, many patients report inaccurate expectations about cure from PC. Future studies should examine whether these assertions reflect misunderstandings, differences in belief, or expressions of hope.
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Sarfraz, Farrukh, Muhammad Zahid Latif, Fahad Sarfraz, Sadia Ikram, Nasir Iqbal, and Jawairia Saleem. "Burnout Syndrome among Students of a Private Medical College at Lahore." Pakistan Journal of Medical and Health Sciences 15, no. 9 (September 30, 2021): 2896–99. http://dx.doi.org/10.53350/pjmhs211592896.
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Background: Background: Medical education is a dynamic and lifelong process directly linked with human life. The profession is supposed to minimize the human sufferings, prevent diseases and promote the healthy practices at individual and community level. Burnout in undergraduate medical education can influence the academics and overall well-being of the learners in a negative way, which will ultimately affect the process of learning. Objective: The current study was conducted to assess the magnitude of Burnout syndrome among the students of a private medical college. Study Design: Descriptive, cross sectional study design. Place & Duration: The study was conducted during the period of six months from September 2019 to March 2020 at Azra Naheed Medical College Lahore. Methodology: Non probability convenient sampling technique was used and all the students of 3rd and 4th year MBBS were invited for the study. Burnout was evaluated by using the Maslach Burnout Inventory-Student Survey (MBI-SS). Approval of institutional ethical review committee and informed consent from the participants were obtained. The collected data was organized, entered in the version 21 of SPSS and analyzed by the use of statistical tools. Results: Out of total 200 participants, 43.5% were females and 56.5 % were males, 55.5% were from 3rd year and 44.5% were from 4th year of MBBS class. The prevalence of high Burnout was found to be 45(22.5%). Gender and residence-based prevalence was studied and calculated P value of (0.87) and (0.41), showed no association. However, a statistically significant association of burnout, (P value 0.003) was found between the 3rd and 4th year MBBS classes. Conclusion: The study concludes that a substantial number of undergraduate medical students suffers from the Burnout syndrome which may influence the health, well-being and academic progress of students in a negative way. Preventive measures including counselling, early diagnosis and clinical management should be opted by the medical institutes. Key Words: Burnout, Medical Education, Emotional Exhaustion, Depersonalization
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Ansheles, A. A., I. V. Sergienko, E. I. Denisenko-Kankiya, and V. B. Sergienko. "Myocardial perfusion single-photon emission computer tomography and coronary angiography results in patients with different pretest probability of ischemic heart disease." Terapevticheskii arkhiv 92, no. 4 (May 19, 2020): 30–36. http://dx.doi.org/10.26442/00403660.2020.04.000549.
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Aim. To study the relationship between pretest probability (PTP) of ischemic heart disease (IHD), calculated according to the recommendations of the European Society of Cardiology (ESC) of 2013 and 2019, with the perfusion of the left ventricle of the myocardium according to the single-photon emission tomography (SPECT) and the results of the invasive coronary angiography (CAG).
Material and methods. The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019.
Results. Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (15%) in 13 patients (5.9%), as intermediate (1585%) in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (15%) in 117 patients (53.2%), including 514% in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization.
Conclusion. PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.
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Kadotani, H., K. Ito, A. Matsuda, K. Nishikawa, Y. Sumi, and M. Matsuo. "0453 Longitudinal Relationship Between Insomnia and Work Productivity in Japanese City Government Employees." Sleep 43, Supplement_1 (April 2020): A174. http://dx.doi.org/10.1093/sleep/zsaa056.450.
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Abstract Introduction “Presenteeism” refers to the decrease in productivity in employees who are present but not functioning at full capacity due to illness or other medical conditions. It is reported that the cost of presenteeism to businesses is 10 times higher than absenteeism (away from work due to illness or disability). Relative presenteeism is a ratio of actual performance to the performance of most workers at the same job. We analyzed effects of insomnia and depression two years before on presenteeism in a Japanese working population. Methods Questionnaire survey was conducted as a part of a cohort study named “Night in Japan Home Sleep Monitoring Study (NinJaSleep Study)” in 2016 and 2018. Participants were the city government employees in a rural city in Shiga prefecture, Japan. Presenteeism, insomnia and depression were analyzed by WHO-HPQ (Health and Work Performance Questionnaire), ISI (insomnia severity index) and PHQ-9 (Patient Depression Questionnaire), respectively. Pearson correlation coefficient analyses were performed to determine the strength of the association between two variables. Logistic regression was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of poor relative presenteeism (the lowest tertile of the relative presenteeism scores) after 2-year follow up. Results 1143 subjects (participation rate: 61.7%, 36.7% male, 44.5±11.4 years, BMI: 22.3±3.30) participated in both 2016 and 2018. Participants with poor productivity (poor relative presenteeism) in 2018 was significantly associated with ISI in 2016 (OR: 1.050, 95%CI: 1.010-1.090, p=0.013) but not with PHQ-9 in 2016 (OR: 1.008, 95%CI: 0.972-1.045, p=0.664) after adjusting for age, gender and BMI. Positive correlation was found between the total score of ISI and item 3 of PHQ-9 which asks insomnia or hypersomnia symptom (r=0.6122, P<0.0001). Conclusion Insomnia may be an independent risk factor for poor presenteeism. ISI may be useful to predict poor productivity in the future. Support Supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. / MSD K.K. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. / MSD K.K.”
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Christiansen, Jens Juel, Sanne Fisker, Claus Højbjerg Gravholt, Paul Bennett, Birgit Svenstrup, Marianne Andersen, Ulla Feldt-Rasmussen, Jens Sandahl Christiansen, and Jens Otto Lunde Jørgensen. "Discontinuation of estrogen replacement therapy in GH-treated hypopituitary women alters androgen status and IGF-I." European Journal of Endocrinology 152, no. 5 (May 2005): 719–26. http://dx.doi.org/10.1530/eje.1.01898.
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Objective and design: Compared with their male counterparts, healthy females secrete more growth hormone (GH) and those with GH-deficiency have lower insulin-like growth factor I (IGF-I) levels and are less responsive to GH substitution. To test whether this gender difference is related to sex hormones we measured androgen status and IGF-I related parameters in 38 hypopituitary women (mean (range) age 41.5 (20–58) years) during continued GH substitution as compared with a control group of 38 healthy women matched for age and menopausal status. Twenty six patients were studied twice: with estrogen replacement and after 28 days of estrogen discontinuation in a randomised design. Results: The patients were androgen deficient compared with controls (median, range), dehydroepiandrosterone sulphate (DHEAS): 185 (99–7800) nmol/l vs 4400 (820–13 000) nmol/l, P = < 0.001; androstenedione: 0.5 (0.1–7.1) nmol/l vs 4.3 (1.6–8.8) nmol/l, P = < 0.001; dihydrotestosterone (DHT): 0.13 (0.09–0.54) nmol/l vs 0.55 (0.09–0.89) nmol/l, P = < 0.001; testosterone: 0.28 (0.09–1.56) nmol/l vs 1.1 (0.71–2.24) nmol/l, (P = < 0.001); free testosterone: 0.004 (0.001–0.030) nmol/l vs 0.016 (0.001–0.030) nmol/l, P = < 0.001. The circulating levels of IGF-I, IGF-II, IGF-binding protein 1 (IGFBP-1), and IGFBP-3 did not differ between patients and controls. The subgroup of patients receiving hydrocortisone (HC) replacement (n = 24) had significantly lower levels of androgens (suppressed by 80–100%) as well as IGF-I and IGFBP-3 as compared with the patients not receiving HC. IGF-I was correlated to free testosterone in patients (r = 0.57, P = 0.0005) as well as controls (r = 0.43, P = 0.008), and free testosterone was a significant positive predictor of IGF-I. Estrogen discontinuation induced an increase in IGF-I (167 ± 15 vs 206 ± 14 μg/l, P = 0.005 and IGFBP-3 (3887 ± 139 vs 4309 ± 138 μg/l, P = 0.0005). Estrogen discontinuation was associated with a significant increase in median (range) free testosterone (0.004 (0–0.02) vs 0.0065 (0–0.03) nmol/l, P = 0.001) and a significant decrease in median (range) sex-hormone binding globulin (SHBG; 93 (11–278) vs 55.5 (20–142) nmol/l, P = 0.001). ΔIGF-I correlated with ΔSHBG (r = −0.45 P = 0.033) and ΔIGFBP-3 (r = 0.67 P = < 0.001). In a regression model ΔE2, Δtestosterone, ΔSHBG and ΔIGFBP-3 explained 93% of the variation in ΔIGF-I. Conclusions: Androgen levels are low in hypopituitary women and free testosterone correlates with IGF-I. Discontinuation of estrogen replacement in these patients induces elevations in IGF-I as well as free testosterone, and ΔIGF-I correlated positively with Δfree testosterone. These effects may contribute to the gender differences observed in the GH–IGF axis in healthy adults as well as in the responsiveness of hypopituitary patients to GH substitution.
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Khalique, Najam, Zeeshan Ahmad, Kamlesh Chandra, Md Yasir Zubair, and Md Anas. "Clinico-epidemiological study of safe and unsafe chronic suppurative otitis media." Indian Journal of Community Health 34, no. 1 (March 31, 2022): 106–10. http://dx.doi.org/10.47203/ijch.2022.v34i01.020.
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Introduction: Chronic Suppurative Otitis Media (CSOM) remains one of the most commonest chronic infectious diseases worldwide particularly in children and adolescents. India has been classified as the high prevalence country with national prevalence of 4%. Knowledge of differential regional prevalence of risk factors is required for adequate health education of masses and for customised preventive and control measures in respective areas. Aims: To study the clinical and socio-demographic profile of patients with CSOM. Methods: The study was carried out in the department of Otorhinolaryngology, Jawaharlal Nehru Medical College, AMU, Aligarh from November, 2017 to December, 2019. Patients with CSOM attending the otorhinolaryngology OPD and those admitted in IPD were included in the study. Results: A total 200 cases of chronic suppurative otitis media including both safe (mucosal) and unsafe (squamous) type were studied. The mean age of participants was 22.8 ± 15.18 years. Of the total participants, 111 (55.5%, 95% CI 48.6 to 62.2) were males, 89 (44.5%, 95% CI 37.8 to 51.4) were females and the majority (60.5%, 95% CI 53.6 to 67) of them were from rural background. Around one-fourth of the patients were illiterate (23%, 95% CI 17.7 to 29.3) and the patients mostly belonged to lower side (lower middle, upper lower and lower) of the spectrum of Kuppuswamy socioeconomic classification. The distribution of age-group, gender and laterality (side of involvement) was similar (P>0.05) in both safe and unsafe type. Overall, 151(75.5%, 95% CI 69.9 to 80.9) patients were found to have conductive hearing loss, 30 (15%, 95% CI 10.7 to 20.6) with mixed and 19 (9.5%, 95% CI 6.2 to 14.4) did not have any hearing loss at presentation. The distribution of patients with regards to hearing loss was found to be similar in both safe and unsafe groups (P = 0.311). Conclusion: CSOM particularly afflicts younger age populations from rural background with poor socioeconomic status. Appropriate timely interventions in the form of health promotion, education about the risk factors and improvement in the living conditions will result in decrease in incidence and prevalence of the disease. Moreover, knowledge of symptoms and signs of the disease is likely to result in early seeking of healthcare and hence better treatment outcomes and prevention of complications.
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Sama, Shashank, Christopher Duane Nevala-Plagemann, Jarrod Smith, Lisa M. Pappas, Benjamin Haaland, and Ignacio Garrido-Laguna. "Real-world outcomes with front-line doublet versus triplet chemotherapy in advanced gastroesophageal adenocarcinoma." Journal of Clinical Oncology 41, no. 4_suppl (February 1, 2023): 313. http://dx.doi.org/10.1200/jco.2023.41.4_suppl.313.
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313 Background: Current guidelines recommend an upfront cytotoxic doublet with or without targeted therapy or immunotherapy for the management of patients with advanced gastroesophageal adenocarcinoma (aGEA).While evidence for the superiority of combination chemotherapy over single agent chemotherapy has been well established, the comparison of two drug versus three drug regimens has been less definitive. This study analyzed a large real-world database to compare clinical outcomes between doublet and triplet approaches in the frontline setting. Methods: The nationwide de-identified Flatiron Health electronic health record (EHR)-derived database was reviewed for patients with aGEA treated with a first line (1L) cytotoxic doublet or triplet irrespective of combination targeted therapy between 2011 and 2022. Patients who received non-standard chemotherapy combinations or did not have a visit or medication order within 90 days of advanced stage diagnosis were excluded. Kaplan Meier and Cox proportional hazards models were used to compare overall survival outcomes between groups. Overall survival was considered as time from the 1L therapy to death with censoring for loss to follow up. Results: 5375 patients with aGEA who met inclusion criteria, 4415 (82%) received doublet chemotherapy and 960 (17%) received triplet in the 1L. Median OS (mOS) for those receiving a doublet was 11 months (95%CI 10-11) similar to those receiving a triplet (11 months, 95% CI 10-12). A Cox proportional hazards model controlling for potential confounding variables of gender, race, smoking status, disease site, as well as HER2 and PDL1 status did not show a significant difference in outcomes between the two groups (HR 0.9, 95%CI 0.8-1). A subgroup analysis comparing FLOT with FOLFOX/CapeOx demonstrated an improved mOS with FLOT (13 mo vs 10 mo; 95%CI 11-15 vs 9-10). This benefit was sustained in a multivariable analysis which demonstrated an increased risk of death with FOLFOX/CapeOX compared to FLOT (HR 1.2, 95% CI 1-1.4). Conclusions: Consistent with prior studies, this real-world study did not identify a significant difference in survival outcomes with 1L triplet compared to doublet chemotherapy in aGEA. When limiting analysis to modern chemotherapy regimens however this data does suggest that a survival benefit may exist with the use of FLOT when compared to FOFOX/CapeOX. This finding would need to be further evaluated in prospective trials incorporating immunotherapy and targeted therapy prior to widespread recommendation.
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Wei, Yu, Xuebin Ji, Jingxia Wang, Enqin Yang, Zhengcheng Wang, Yuqi Sang, Zuomu Bi, et al. "Conventional Oral Prednisone Versus High-Dose Dexamethasone for Management of Adult Immune Thrombocytopenia: A Prospective Randomized Multicenter Clinical Trial." Blood 124, no. 21 (December 6, 2014): 1455. http://dx.doi.org/10.1182/blood.v124.21.1455.1455.
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Abstract Introduction Oral prednisone (PDN) is conventional standard initial management for adult immune thrombocytopenia (ITP). In recent years single arm studies propose that high-dose dexamethasone (HD-DXM) improves response rate and remission duration and reduces adverse effects, though a randomized trial demonstrated no superiority of HD-DXM. It still lacks evidence-based conclusion on which one is better in efficacy and safety. We conducted a prospective randomized multicenter clinical trial to compare the efficacy and safety of HD-DXM and PDN as first-line strategy for adult newly diagnosed ITP. Methods We enrolled adult newly diagnosed ITP patients aging between 18 and 80 years, peripheral PLT count <30x109/L or with bleeding symptoms. Diagnosis of ITP and definition of newly diagnosed ITP followed international working group report and ASH evidence-based guideline. A 1:1 randomization was assigned between HD-DXM and PDN arm. In HD-DXM arm, dexamethasone was administered orally at 40mg/d for 4 consecutive days. If PLT count remained or dropped below 30x109/L by day 10, another four-day course of HD-DXM was given. Patients received prednisone orally at 1.0mg/kg/d for no more than 28 days in PDN arm, and then tapered rapidly to minimized maintenance dosage of <15mg/d in responders or stop in non-responders. Early response was evaluated according to criteria mentioned above. We defined sustained response as PLT count maintaining above 30x109/L for 6 months or more. Responders underwent follow-up for at least 6 months or until relapse. Adverse effects were recorded for analysis of safety. Informed consent was obtained from all enrolled patients in accordance with the Declaration of Helsinki. This study was approved by Ethics Committee of each participating site and registered at http://clinicaltrials.gov/ as NCT01356511. Results From Jan 2011 to May 2014, 182 newly diagnosed adult patients were enrolled from 9 sites over Shandong Province, China, with 92 randomized to HD-DXM arm (62 females and 30 males; age median 43, range 18~73 years) and 90 to PDN arm (68 females and 22 males; age median 44.5, range 18~76 years). Baseline PLT count were 8.93±8.19 (HD-DXM arm) and 10.60±8.67 (PDN arm) x109/L, respectively. Overall response rate in HD-DXM arm was 84.8% (78/92) with 52.2% (48/92) CR, while in PDN arm 74.4% (67/90) and 28.9% (26/90). HD-DXM arm showed similar overall response (P=0.099) but higher CR rate (P=0.002). HD-DXM arm also demonstrated shorter time to response (3.21±1.35 vs. 5.97±4.28 days, P=0.001). 149 patients were available for evaluation of sustained response, 76 in HD-DXM arm and 73 in PDN arm, with follow-up of a median of 10(1-40) and 12(1-39) months, respectively. There was no statistically significant difference between the two arms in sustained response rate (39.5% vs. 49.3%, P=0.251). Generally both treatments were well tolerated. Adverse effects were recorded (HD-DXM/PDN), including hyperglycemia (3/5), hypertension (3/3), peptic ulcer (1/3), gaining weight (0/4), and infection trend (0/2). Conclusion One or two courses of HD-DXM demonstrated higher CR rate and shorter time to response than PDN. HD-DXM could be a better first-line choice for adult ITP. Table 1. Characteristics of patients in HD-DXM and PDN arm Parameter HD-DXM PDN No. of patients 92 90 Age, median (range) 43 (18 - 73) 44.5 (18 - 76) Gender, female/male 62/30 68/22 Baseline platelet count, x109/L 8.93±8.19 10.60±8.67 Disclosures No relevant conflicts of interest to declare.
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Li, Chi Kong, Yiping Zhu, JingYan Tang, Xiuli Ju, Runming Jin, Ningling Wang, Yumei Chen, et al. "Septicemia after Chemotherapy for Acute Lymphoblastic Leukemia: A Multicenter Study Chinese Children Cancer Group (CCCG)-ALL-2015." Blood 134, Supplement_1 (November 13, 2019): 5080. http://dx.doi.org/10.1182/blood-2019-123451.
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Introduction: Septicemia is one of the common complications after chemotherapy for acute lymphoblastic leukemia (ALL) and is also an important cause of treatment related mortality and treatment failure. A multicenter study CCCG-ALL-2015 was conducted in China and factors associated with septicemia and mortality were studied. Methods: Patients participated in CCCG-ALL-2015 study from January 2015 to December 2017 were included in this study. Patients with documented septicemia were identified from the Database of Central Data Center. Additional data were then collected from participation centers, including associated co-morbidity, blood counts before septicemia and infection preventive measures. Results: A total of 4080 patients were recruited from 18 centers. There were 527 patients with septicemia identified (12.9%). The Intermediate risk (IR)/ High risk (HR) group(n=1930) had significantly higher incidence of septicemia as compared with Low risk (LR) group (n=2150), 17.15% vs 9.12% (p<0.001). Among the IR/HR group, children with Philadelphia (Ph) positive ALL (n=166) had similar incidence of septicemia as compared with Ph negative group (n=1764), 20.5% vs 16.8% (p =0.14). Induction phase was the period with most septicemia episodes occurred, 66.3% in LR and 56.1% in IR/HR groups. There was another peak of septicemia in IR/HR group during the re-induction phase (18%) and early maintenance phase at week 35-54 (9.3%). Gram positive bacteria accounted for 54.2%, Gram negative bacteria 44.5% and fungus 1.4% of positive cultures. The top 10 isolates were Coagulase negative staphylococcus (20.1%), staphylococcal epidermidis (14.6%), E. Coli (11.5%, 29/68 were ESBL), klebsiella pneumonia (8%, 7/47 were ESBL), pseudomonas aeruginosa (7%, 2/41 were ESBL), staphylococcus aureus (5.6%, 8/33 were MRSA), streptococcal mitis (3.2%), streptococcal pneumonia (3%), salmonella (2%) and Enterobacter cloacae (1.7%). Multi-drug resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.2%. Multiple logistic regression identified female gender, comorbid complications and fungal infection as risk factors associated with mortality. Gram negative septicemia was also associated with higher mortality, 4.9% vs 1.9% (P<0.05%). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%. Centers allowed additional beds opened in the ward due to full occupancy had higher incidence of septicemia, 16.3% (342/2101) vs 11% (218/1979), p <0.001. Centers with the practice of using modular High Efficiency Particulate Air (HEPA) filter units in the wards for patients with severe neutropenia had lower incidence of septicemia, 8.3% (118/1430) vs 16.7% (442/2650), p<0.001. Prophylactic use of G-CSF at time of neutropenia (neutrophils < 0.5x109/L) was also associated with lower incidence of septicemia, 10.1% (165/1626) vs 16.1% (442/2650). Similarly prophylactic intravenous immunoglobulin and antibiotics was also associated with lower incidence of septicemia, 8.9% (78/877) vs 15% (481/3203) and 7.8% (70/970) vs 18.7% (490/3110) respectively. Conclusion: Overall the incidence and pattern of septicemia in this multicenter study in China was similar to reports of western countries. The septicemia related mortality rate was low. However there was marked variation in the incidence of septicemia among the centers, further studies are required to validate factors such as infection preventive measures which might influence the septicemia incidence. Disclosures No relevant conflicts of interest to declare.
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Gavriilaki, Eleni, Ioanna Sakellari, Thomas Chatziconstantinou, Despina Mallouri, Ioannis Batsis, Eleni Katsifa, Stergios Papadimitriou, et al. "Risk Factors and Outcomes of Klebsiella Pneumoniae Infection before and after Allogeneic Hematopoietic Cell Transplantation." Blood 134, Supplement_1 (November 13, 2019): 4502. http://dx.doi.org/10.1182/blood-2019-125320.
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Introduction: Carbapenemase-producing (KPC) Klebsiella pneumoniae (Kp) infections have emerged as a major healthcare concern worldwide. Although infections are recognized as a major contributor of morbidity and mortality before and after allogeneic hematopoietic cell transplantation (HCT), the burden of Kp infections has not been extensively evaluated. Therefore, we aimed to determine risk factors and outcomes of these infections in HCT recipients. Methods: We retrospectively studied consecutive patients with Kp colonization and/or infection before and/or after HCT performed in 2008-2018. Patients were transplanted according to standard operating procedures of our JACIE-accredited center. Colonization was defined as the isolation of the microorganism from any non-sterile body site in the absence of clinical signs or symptoms of disease. Patients with colonization or infection pre-transplant received secondary prophylaxis pre and during transplant. Nurses, visitors and staff were carefully trained on infection control measures such as contact precautions and intensified hygienic measures in patients with pre-transplant isolation. Statistical analysis included the following factors: age, gender, disease phase at transplant (early, intermediate or advanced), donor, pre-transplant and post-transplant Kp infections and colonizations, KPC-Kp, severe acute and extensive chronic GVHD, relapse, treatment-related mortality (TRM) and overall survival (OS). Results: We studied 52 patients with a median age of 42 (range 17-42). Colonizations were detected in 9 patients pre-transplant (17%) and 29 post-transplant (56%); whereas infections in 23 pre- and 28 post-transplant (44% and 54%, respectively). KPC-Kp was isolated in 12 patients (29%). With a median follow-up of 23.5 months (range 1-99), cumulative incidence (CI) of severe acute GVHD was 44.5% and severe chronic GVHD 56.7%. Two-year CI of TRM was 14.3% and was independently predicted by the isolation of KPC-Kp (p=0.040, Figure 1A) and chronic GVHD (p<0.001). Among pre-transplant and transplant factors, acute GVHD was associated only with pre-transplant Kp infections (p=0.049). Pre-transplant infections were also associated with post-transplant infections (p=0.010), despite secondary prophylaxis. Overall survival was associated with disease phase at transplant (p=0.017), post-transplant infections (p=0.034) and acute GVHD (p=0.013). In the multivariate model, only post-transplant Kp infections independently predicted OS (beta=9.042, p=0.008, Figure 1B). Conclusions: Our study highlights the significant impact of Kp infections on TRM and OS of HCT recipients. In our population of patients with Kp colonization and/or infection, the burden of GVHD was high. Acute GVHD was linked with pre-transplant Kp infections, suggesting that disruption of intestinal microbiota may be an underlying predisposing condition. Secondary prophylaxis did not improve rates of post-transplant infections, but allowed the performance of HCT with an acceptable TRM rate. Our data suggest that additional interventions need to be further investigated to address the major problem of Kp infections in HCT. Figure 1 Disclosures No relevant conflicts of interest to declare.
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Buisson, A., M. Fumery, M. Serrero, L. Orsat, S. Nancey, P. Rivière, R. Altwegg, et al. "P355 Acceptability of treatment regimen in inflammatory bowel disease: Results from a prospective nationwide study (ACCEPT2)." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S337—S338. http://dx.doi.org/10.1093/ecco-jcc/jjz203.484.
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Abstract Background The multiplication of therapeutic options with close efficacy and safety, leads to consider acceptability of treatment regimen as a key point for therapeutic decision in inflammatory bowel disease (IBD). We aimed to compare acceptability of IBD treatment regimen and to identify its associated factors. Methods From a nationwide prospective study conducted in 24 public or private centres, IBD patients were consecutively included for 6 weeks. A dedicated questionnaire was developed, tested and validated for the study. It was administered to each included patient and his/her related physician. Acceptability was graded with an acceptability numerical scale (ANS) from 0 (absolutely not acceptable) to 10 (totally acceptable). Results Overall, 1850 patients were included (65.9% with Crohn’s disease (CD), mean age = 41.0 ± 14.7, 22.2% experiencing IBD flare at inclusion). The medications at inclusion were none in 9.0%, oral (PO) monotherapy in 17.3%, subcutaneous (SC) injections in 29.2% and intra-venous (IV) infusions in 44.5% of the patients. The ANS were 8.68 ± 2.52 for PO, 7.67 ± 2.94 for SC and 6.79 ± 3.31 for IV (p < 0.001 for each comparison). The patients reported PO, SC and IV as their first choice in 65.8%, 21.4% and 12.8%, respectively. The reasons for reduced acceptability were the need to come to the hospital (63.0%) for IV infusion, none for SC injections and the fear to forget to take pills (30.5%), the number of daily dose (28.4%) and daily medication as a reminder of disease every day (24.8%) for PO therapy. In multivariable analyses, the following factors were associated with a better acceptability of IV infusion (current IBD flare: p = 0.003 and current IV therapy for IBD: p < 0.001), SC injections (Private practice: p = 0.006 and current SC injections for IBD: p < 0.001) and PO medication (male gender: p = 0.018, higher studies level: p < 0,001 and current oral medication: p = 0.002). The mean ANS for all IBD treatment regimen were compared in the 1850 patients (Figure 1). No difference was observed between CD and UC. In biologics-naïve patients (n = 315), the treatment regimens were ranked in the following order: PO once daily (8.8 ± 2.2), SC/12 weeks (week) (7.9 ± 3.0), SC/8 week and PO twice daily (7.2 ± 3.2 et 6.9 ± 3.4; ns), SC/4 week (6.2 ± 3.4), SC/2 week et IV/8 week (5.1 ± 3.4 and 5.0 ± 3.5; ns)(p < 0.001 except if ns was mentioned). For the patients, the acceptable loss of efficacy to receive a more convenient medication was 5.2% (non-inferiority trial limit). Conclusion While PO administration was preferred by most of IBD patients, the acceptability of treatment regimen is highly impacted by the interval between two doses and the previous medications. Our data could be helpful to guide therapeutic decision in daily practice in IBD.
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Carbone, T., M. C. Padula, V. Pafundi, C. Schievano, N. Lascaro, A. Padula, P. Leccese, and S. D’angelo. "FRI0569 SERUM AMYLOID A: ASSESSMENT OF REFERENCE VALUE AND COMPARISON OF SERUM CONCENTRATION IN HEALTHY SUBJECTS AND PATIENTS WITH BEHÇET SYNDROME." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 887.3–887. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6357.
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Background:Serum amyloid A (SAA) is a family of acute-phase reactants. The rise of SAA concentration in blood circulation is a clinical marker of active inflammation in several auto-inflammatory diseases, including Behçet syndrome (BS). Despite its practical and analytical advantages, SAA measurement by ELISA has been mainly used as a research tool rather than for the routine laboratory testing due to the lack of a robust reference data in the literature.Objectives:Using the recommended procedures of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), we aimed to develop the SAA reference interval for a well-defined Italian healthy population (HC). Secondly, we compared the SAA serum concentration between HC and patients with BS.Methods:Sera specimens were collected from adult healthy blood donors after rule out the exclusion criteria (inflammatory disorders, ongoing infections, pregnancy and breastfeeding, obesity, using oral contraceptives, use of any medication, or consumed of alcohol), and from unselected BS patients fulfilling the International Study Group (ISG) classification criteria. Serum SAA concentrations were detected and quantified with a commercial solid phase sandwich enzyme-linked immunosorbent assay (Human SAA ELISA kit, IBL International GmbH, Hamburg, Germany) used on automated analyzer (Immunomat, SERION Diagnostic, Alifax, Polverara (PD), Italy) according to the manufacturer’s protocol. Statistical analysis and data normalization of HC SAA values were carried out to determine the reference cut off. In the second step of the study, HC and BS patients were stratified in two groups according to the cut-off value.Results:We recruited 141 HC (84 M and 57 F; mean age, 44.5±13.2 years) and 63 BS patients (39 M and 24 F mean age, 45.3±13.2 years) assayed for SAA. The reference cut-off was calculated as 225 ng/ml. No statistically significant differences were found between males and females when SAA means were compared, suggesting that not gender-partitioned reference range is recommended for this analyte. After the stratification according to the cut-off value (group 1: < 225 ng/ml and group 2: > 225 ng/ml), we found 53/63 (84.1%) BS patients and 133/141 (94.3%) HC with concentration less than cut-off value, respectively. We identified 10/63 (15.9%) BS patients and 8/141 (5.7%) HC within the second group. The difference was statistically significant (p=0.0177; OR: 3.14, 95% CI: 1.17-3.38).Conclusion:This study allowed to define a widely accepted reference cut-off for the SAA detected by ELISA, responding to an unmet need of laboratory medicine. We found a statistically significant higher frequency of BS patients compared with HC when SAA values is higher than cut-off (225 ng/ml). This preliminary data could add significant information for better clarify the role of SAA as biomarker of inflammation and in guidance of clinical practice. Further studies will be required to stratify SAA values in relation to disease activity of BS.Disclosure of Interests:Teresa Carbone: None declared, Maria Carmela Padula: None declared, Vito Pafundi: None declared, Carlo Schievano: None declared, Nancy Lascaro: None declared, Angela Padula: None declared, Pietro Leccese: None declared, Salvatore D’Angelo Consultant of: AbbVie, Biogen, BMS, Celgene, Eli Lilly, MSD, Novartis, and UCB, Speakers bureau: AbbVie, BMS, Celgene, Eli Lilly, Novartis, Pfizer, and Sanofi
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Gandhi, Shreyans, Jie Jiang, Simon Slade, Austin Kulasekararaj, Victoria Potter, Varun Mehra, Petra Muus, et al. "Telomeric Length to Characterize and Prognosticate Bone Marrow Failure, Risk of Clonal Evolution and Multi-System Complications in Aplastic Anemia and Other Hypocellular Cytopenic Disorders, Independent of Telomere Gene Complex Mutations." Blood 134, Supplement_1 (November 13, 2019): 3749. http://dx.doi.org/10.1182/blood-2019-130754.
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Introduction Telomere length is shortened in patients with idiopathic aplastic anemia (AA) and other bone marrow failure disorders (BMFD) and predicts risk of clonal evolution (CE), relapse and overall survival (OS). Telomereopathies predominantly cause bone marrow failure, are multi-systemic disorders with variable penetrance, and may involve inter-play of other factors in disease manifestation and organ affliction. Telomere length (TL) in AA and other hypocellular BMFD, independent of mutations in telomere genes (TGC), has not been studied as a scoring tool, as well predicting the risk of affliction of other organ/systems in these disorders. We systematically review a large cohort of 472 patients in a single centre with AA/BMFD using TL and TGC analysis as a discriminator, to study risk of CE and OS, manifesting with liver/lung and skin complications, cancer predisposition and likelihood of a family member presenting with cytopenias. Methods We screened 1060 consecutive patients at a single centre from the years 2011-18, with AA or unexplained cytopenias for telomere length (TL) analysis using a multiplex qPCR methodology as described by Cawthon et al. 472 (44.5%) patients had TL less than the 25th centile, of whom 243 had <1st centile, 122 had <10th and 107 had TL between the 10-25th centile. These 472 patients underwent TGC mutation analysis on a customised panel of 12 TGC genes (TERT, TERC, DKC1, TINF2, NHP2, NOP10, RTEL1, CTC1, USB1, WRAP53, ACD and PARN) using deeply parallel sequencing and were studied alongside their clinical parameters, disease progression, treatments and OS. Results Table attached. The median age and gender across the 3 cohorts studied (TL 10-25th centile, <10th centile and <1st centile) were comparable, with a median age of 43 for the entire cohort. 127 (26.9%) of patients were detected to have a total of 142 mutation in the TGC. A third of patients with BMFD and TL<1st centile had a TGC mutation, but the prevalence did not statistically differ with the other cohorts of TL <10th centile and between 10-25th centile. Patients with TL<1st centile can have mutations in 2 telomere genes, but this is less frequently seen when TL<10th centile and not seen in the cohort with TL between 10-25th centile. TL does not correlate with the manifestation and presence of liver, respiratory and skin problems of telomere disease. TL in BMFD does not associate with increased predisposition to cancer, as their presence was not statistically significant across the 3 groups. Disease manifestation with bone marrow failure, haematological indices, need for blood transfusions, presence of a PNH clone and karyotypic abnormalities, including complex and monosomal karyotype were not dissimilar across the 3 TL cohorts. Not surprisingly, there were more family members with features of cytopenias and BMFD, on screening of patients with a confirmed TGC mutation. TL did not predict a difference in treatment strategies used across the 3 groups, although more patients with a TGC mutation received anabolic steroids. The risk of clonal evolution to PNH or MDS/AML and overall survival was again similar across the 3 TL cohorts with an OS of 93% at 1078 days follow-up for the entire cohort. Conclusion TL can reliably be used as a screening tool to investigate patients for further TGC mutation analysis in patients with AA or BMFD. Heterozygous state mutations in TERT are the commonest, and can be associated with mutations in other TGC genes, particularly RTEL1 and TERC. This may cause a compounding factor in shortening the TL further. However, TL<1st centile does not associate with more severe cytopenias (BMFD) or predict more multi-system manifestation or increased cancer pre-disposition. Indeed, in our cohort it failed to show an increased risk of clonal evolution or decreased OS. Telomere biology is a dynamic process and assessments at different time points, from diagnosis to the time point of progression and transformation, may yield better understanding in pathogenesis of BMFD. TL and TGC mutation analysis in a single centre study from 2011-18. Table Disclosures Kizilors: Incyte biosciences: Research Funding. Mufti:Celgene: Consultancy, Research Funding.
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Jullien, Maxime, Sylvie François, Ana Berceanu, Marie-Anne Couturier, Thierry Guillaume, Pierre Peterlin, Alice Garnier, et al. "Values of Hematopoietic Cell Transplantation-Specific Comorbidity Index, Comorbidity/Age Index and Augmented Comorbidity/Age Index in Recipients of Haploidentical Stem Cell Transplantation Using Ptcy As Gvhd Prophylaxis: A Retrospective Study of 223 Cases." Blood 136, Supplement 1 (November 5, 2020): 37–38. http://dx.doi.org/10.1182/blood-2020-138656.
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Introduction: Pre-transplant comorbidities, which may impact the success of allogeneic stem cell transplantation (AlloSCT) can be appreciated through 3 different scoring systems. The Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) allows to predict non-relapse mortality (NRM) and survival (Sorror, Blood 2005). Its prognostic value was further augmented by the addition of donor age (< vs ≥40 yo) (Comorbidity/Age index, C/AI, Sorror, JCO 2014) then of pre-transplant ferritin (< or >2500 µg/L) and albumin (<3 g/dL vs 3-3.5 g/dL vs >3.5g/dL) serum levels as well as platelet count (< vs >100 109/L) (Augmented Comorbidity/Age index, AC/AI, Elsawy, BBMT 2019). The performance of these 3 scores has not been evaluated in haploASCT using post-transplant cyclophosphamide (PTCY), a procedure in constant expansion worldwide. Material and Methods: We studied retrospectively the impact on non-relapse mortality (NRM), overall (OS) and disease-free (DFS) survival of the 3 comorbidity scores on a cohort of 223 patients (pts) having received a haploSCT with PTCY. All pts had pre-transplant ferritin and albumin levels and platelet counts available. These parameters were evaluated at the time of the pre-transplant check-up or just before conditioning (median from transplant: 20 days, range: 4-49). Results: Pts were recruited in 4 French centers (Nantes n=127; Angers n=45; Besançon n=29, Brest n=22). They had received haploSCT between October 2013 and January 2020. There were 136 males and 87 females with a median age of 55 yo (16-71, >40 years n=172). The majority of pts had a myeloid disease (n=157) and received a reduced intensity regimen (n=161, myeloablative n=30; sequential n=32). Respectively, 132 and 91 pts had low/intermediate and high/very-high Disease-Risk Index (DRI). All pts received PTCY, cyclosporine and mycophenolate mofetyl as graft versus host disease (GVHD) prophylaxis. Donors had a median age of 40.8 years (19.4-71.7). Median HCT-CI, C/AI and AC/AI scores were 2 (0-8), 3 (0-9) and 3 (0-11), respectively. The HCT-CI score was <2 in 139 patients, CA/I was <3, 3-4 and >5 in 110, 83 and 30 pts, respectively, while the AC/AI score was <4 in 112 cases. With a median follow-up for alive patients of 35.6 months (6-77), 3-year OS, DFS and NRM were 47.8+3%, 46+3% and 29.4+6%, respectively. In univariate analysis, better 3-year OS and DFS were associated with lymphoid diseases (OS: 60.4+6% vs 42.3+4%, p=0.02; DFS: 56.2+6% vs 41.6+4%, p=0.04), low/intermediate DRI (OS: 59.1+4% vs 30.1+7%, p<0.001; DFS: 56.3+4% vs 31.1+5% p<0.001), donor age <40 years (OS: 58.1+4% vs 36.2+5% p=0.004; DFS: 55.4+4% vs 35.7+4% p=0.01), and albumin level (<3g/dL OS: 33.3+12% vs 3-3.5g/dL 46.1+8% vs >3.5g/dL 50.1+4%, p=0.03; <3g/dL DFS: 30+12% vs 3-3.5g/dL 44.5+8% vs >3.5g/dL 47.4+3%, p=0.05). OS and DFS were not impacted by ferritin levels, platelet count, recipient age, gender, nor any of the 3 comorbidity scores. A lower 3-year NRM was observed in younger pts (<55 yo) (21.8% vs 36.8%, p=0.02) and in those with a younger donor (<40 yo) (20.5% vs 39.2%, p=0.003). NRM was not associated with gender, type of disease, DRI, ferritin, albumin, platelet counts nor any of the 3 comorbidity scores. In multivariate analysis, each comorbidity score was compared to DRI, donor and patient age, type of disease and pre-transplant albumin levels. DRI and donor age remained associated with OS and DFS. This was also the case for recipient age, except when considering a high C/AI index score. Finally, an older age of recipients and donors remained associated with higher NRM. Conclusion: HCT-CI, C/AI and AC/AI do not to predict survivals nor NRM in haploSCT with PTCY, suggesting that pre-transplant comorbidities should not be a contra-indication to this procedure. As donor age is the only factor predicting survivals and NRM in this series, while multiple donors are generally available in the haploSCT setting, the selection of a younger donor should be the rule whenever possible for all patients. Disclosures Hunault: Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Diachi: Membership on an entity's Board of Directors or advisory committees; Jansen: Honoraria; Servier: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees. Deconinck:ImmunoGen: Consultancy, Research Funding; Stemline: Consultancy. Thepot:astellas: Honoraria; novartis: Honoraria; sanofi: Honoraria; celgene: Honoraria. Le Gouill:Loxo Oncology at Lilly: Consultancy; Roche Genentech, Janssen-Cilag and Abbvie, Celgene, Jazz pharmaceutical, Gilead-kite, Loxo, Daiichi-Sankyo and Servier: Honoraria. Chevallier:Incyte Corporation: Honoraria.
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Komninaka, Veroniki, Theodore Marinakis, Dimitrios Christoulas, Konstantina Repa, Dionysia Kolomodi, Maria Mitropoulou, Maria Gkotzamanidou, et al. "Bone Involvement in Patients with Non-Neuronopathic Gaucher Disease Is Characterized by Increased Osteoclast Function Partially Due to High Circulating C-C Motif Ligand 3,." Blood 118, no. 21 (November 18, 2011): 3215. http://dx.doi.org/10.1182/blood.v118.21.3215.3215.
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Abstract Abstract 3215 Gaucher disease (GD) is a lysosomal storage disease characterized by a genetic disruption in the metabolic breakdown of glucocerebroside caused by a lack of the enzyme beta-glucocerebrosidase. Bone complications are common in the non-neuronopathic form of GD (formerly type I) and lead to considerable pain, limitations in mobility and negative impact on the quality of life. Skeletal manifestations of GD include osteopenia and osteoporosis, bone loss, Erlenmeyer flask deformity and osteonecrosis. Low bone mineral density (BMD) is thought to arise from enhanced bone resorption mediated through macrophage-derived factors, such as the C-C motif ligand 3 (CCL3) chemokine. The aim of this study was to evaluate the clinical and biochemical characteristics of bone involvement in patients with the non-neuronopathic form of GD. We studied 27 adult patients (15M/12F, median age 44.5 years, range: 18–71 years) with non-neuronopathic GD. Three patients were evaluated at diagnosis, while the others after a 6-month discontinuation of replacement therapy with imiglucerase due to temporary shortage of the drug supply in Greece. BMD of the lumbar spine and femoral neck was determined in all patients, using dual energy X-ray absorptiometry (DXA). Furthermore, magnetic resonance imaging (MRI) of the femoral bones was also performed in all patients. The MRI protocol included T1-weighted spin echo and turbo echo sequences, short time inversion recovery (STIR) sequences and T2-weighted spin echo, turbo spin echo (TSE) sequences. Based on the severity of abnormal MRI findings and the decreased fat content in the bone marrow, patients were categorized in 4 grades: I-IV. On the day of MRI, we evaluated also the circulating levels of CCL3 along with two sensitive serum markers of bone resorption: C-telopeptide of collagen type-1 (CTX) and tartrate resistant acid phosphatase isoform type-B (TRACP-5b), which is produced mainly by activated osteoclasts. Bone markers were also evaluated in 25 healthy, gender- and age- matched controls, as well as in all patients, 6 months post re-initiation of replacement therapy (when the drug became available again). Twelve patients (46%) had bone pain, while 3 patients had restrictions in free movement and 2 patients experienced difficulty in walking at the time of study initiation. The majority of the patients (91%) had elevated chitotriosidase levels (median: 1647 nmol/ml/hr, range: 147–18880 nmol/ml/hr; UNL: 150 nmol/ml/hr) indicating active disease, while 25% of the patients had abnormally high levels of acid phosphatase. Six (22%) patients had osteoporosis at least in one of the studied sites, 18 (66%) patients had osteopenia and 3 patients had normal DXA scan. All but one patient had abnormal MRI findings: 3 (11%) had grade I MRI abnormalities, 18 (66%) had grade II, 3 (11%) grade III and 2 (7%) grade IV. Erlenmeyer flask sign was observed in 23 (85%) patients. At study initiation, GD patients had elevated serum levels of TRACP-5b (mean±SD: 7.6±5.3 IU/L) compared to controls (1.3±0.6 IU/L; p<0.001) and high circulating CCL3 (71±31 pg/ml) versus controls (16±11 pg/ml, p<0.001). There was a positive correlation between serum TRACP-5b and chitotriosidase levels (r=0.493, p=0.017) as well as between TRACP-5b and CCL3 levels (r=0.512, p=0.01). Patients with osteopenia or osteoporosis had elevated chitotriosidase levels (4741±4876 nmol/ml/hr) compared to others (478±415 nmol/ml/hr; p=0.035). Patients with advanced MRI disease (grades III & IV) had elevated levels of acid phosphatase (13.1±3.7 U/L) compared to grades I & II (8.6±1.8 U/L; p=0.011). Six months post- re-initiation of replacement therapy TRACP-5b levels (7.1±4.1 IU/L; p=0.011) and CCL3 levels (42±29 pg/ml; p=0.01) were significantly reduced. In conclusion, our findings suggest that patients with active non-neuronopathic GD have abnormal MRI bone findings in the femoral bones and increased incidence of bone loss (osteopenia or osteoporosis). The enhanced osteoclast activity (assessed by the high TRACP-5b serum levels) which is present in GD, is - at least partially - due to elevated CCL3 (a potent osteoclast activator) and it seems to be implicated in the biology of bone involvement in non-neuronopathic GD. Replacement therapy reduces abnormal osteoclast function; longer follow-up will reveal if this reduction is followed by the reversal of bone involvement in this disease. Disclosures: No relevant conflicts of interest to declare.