bluuebunny/crossref_metadata_2025 huggingface dataset:
To determine knowledge, attitude, and practice regarding diabetic retinopathy among diabetic patients in a multispecialty hospital
Authors: Palsule Aratee C. , Kulkarni Aditi A. , Gadre Vaijayanti , Joshi Devika
Published: February 2023

Context:

Diabetic retinopathy (DR) is an important complication of diabetes mellitus (DM). DR accounts for 4.8% of the cases of blindness throughout the world.

Aims:

To assess the patients' awareness about DR and their attitude and practice patterns in a tertiary care system in urban Maharashtra.

Subjects and Methods:

A cross-sectional study was conducted in a tertiary care hospital, Pune, Maharashtra from March 2019 to April 2020 after approval from institutional review board. Patients older than 18 years and who were diagnosed with type II DM were included. Data were entered into Excel and analyzed using the SPSS software version 20.

Results:

Only 28% of diabetic patients had good knowledge of DR, 82.5% were found to have positive attitude toward DR screening, and 27% had scored good in the practice score category. A significant association was found between DR knowledge with level of education (P ≤ 0.001).

Conclusions:

Better knowledge of DR influences a positive practice patterns in patients with diabetes. Onus lies on the healthcare professionals, particularly physicians as they are the first point of contact.
“Blink and you'll miss it”- A case report of Alport syndrome
Authors: Jafar Faiza Syed , Tasneem Alhaj Farhath , Nayak Vittal
Published: February 2023

Alport syndrome is a rare disorder of abnormal type IV collagen affecting basement membranes of the glomerulus, cochlea, and ocular structures. A young male presenting with characteristic ocular signs as well as systemic manifestations of Alport syndrome. The diagnosis of Alport syndrome can be easily overlooked in patients with chronic kidney disease, unless a thorough eye examination is conducted. Genetic counseling and timely examination of patients and their families can help reduce the morbidity of the complications associated with Alport syndrome.
Quality of life in patients with glaucoma using the Glaucoma Quality of Life-15 Questionnaire
Authors: Kumar Mukesh , Parveen Shafia , Chauhan Lokesh
Published: February 2023

Purpose:

The purpose of this study is to measure the quality of life (QoL) in patients with glaucoma using the Glaucoma QoL-15 (GQL-15) questionnaire.

Methods:

A cross-sectional study with a prospective enrollment of glaucoma patients was conducted. A total of 308 patients were participated in the study. Informed consent was obtained before the administration of the GQL-15 questionnaire. The QoL was assessed using an orally administered GQL-15 questionnaire. Patients' QoL was assessed based on their age, gender, visual field (VF) defect, severity of glaucoma, laterality of disease, history of previous glaucoma surgery, and the number of antiglaucoma medications (AGMs) they were taking. Participants were divided into mild, moderate, and severe glaucoma depending on the severity of VF defects using the Hodapp–Anderson–Parrish grading system.

Results:

A total of 308 glaucoma patients were interviewed. The mean age of participants was 57.7 ± 12.9 years; 173 (56.1%) of them were female. The average mean deviation (MD) of the patients was 7.8 ± 4.8 dB. There were 135 (43.8%) patients with mild, 122 (39.6%) with moderate, and 51 (16.6%) with severe glaucoma. In total, 114 (37%) patients had unilateral glaucoma, whereas 138 (44.4%) patients had previous glaucoma surgery. Sixty-two (22.1%) patients did not take any AGM. The correlation coefficient between VF MD and QoL was 0.7, which was significant at 0.01 level (two-tailed).

Conclusion:

The findings of this study demonstrated that the severity of VF defects has a negative impact on patient's QoL.
Post-COVID ischemic maculopathy – A case report
Authors: Parachuri Nikulaa , Prabhushanker M. , Geetha G. , Bagrecha Nipun
Published: February 2023

We report a case of post-COVID ischemic maculopathy, which has not been seen previously in COVID-associated retinal findings. The patient presented with sudden onset loss of vision following COVID infection and was treated at a local hospital. Fundus examination revealed ischemic patches interspersed with blot hemorrhages around the macula. Fundus fluorescein angiography demonstrated delayed filling of macular vessels and nonperfusion of the macula. There were signs of hyperreflectivity of the nerve fiber layer and disorganization of the inner retinal layers with foveal atrophy on optical coherence tomography. The patient responded to steroids with improvement in visual acuity. Coronavirus disease 2019 can cause vascular events such as macular infarction in healthy young people.
Experimental study on the accuracy of non-invasive temperature measurement by magnetic resonance in microwave ablation
Authors: Guo Rui , Wang Xianjian , Liu Jie , Chen Jin , Chen Jian , Lin Qingfeng , Yan Yuan , Liang Ping , Lin Zhengyu
Published: February 2023

Aims:

This study aimed to explore the accuracy of non-invasive temperature measurement based on proton resonance frequency (PRF) phase subtraction in microwave ablation (MWA).

Methods and Material:

The signal change of the agar phantom during the ablation process was monitored by the gradient echo sequence under 1.5 T superconducting magnetic resonance imagining (MRI), and the temperature change was converted by the phase subtraction method of the PRF, which was compared with the temperature measured using an optical fiber.

Statistical Analysis Used:

SPSS software version 22.0 was used for data processing, and the independent sample t-test was used for comparative analysis. P < 0.05 indicated statistical significance.

Results:

The maximum error between the MRI temperature measurement and the standard value was 3.61°C, whereas the minimum and average errors were 0.01°C and 1.19°C ± 0.78°C, respectively.

Conclusions:

The temperature measurement technology, which is based on the PRF phase method, has good accuracy in MRI-guided MWA.
MBNL1 and MRTF-A form a positive feedback loop in regulating the migration of esophageal cancer cells
Authors: Liang Chen , Chang Zheng , Luo Ying , Xu Yao , Chen Ao , Zhang Tongcun
Published: February 2023

Background:

Esophageal cancer is a serious human health threat with increasing incidence and poor prognosis. This study explored the effects and mechanisms of MBNL1 and MRTF-A in the migration of esophageal cancer cells.

Materials and Methods:

The analysis of relevant sequencing data showed the impact of MBNL1 expression on esophageal cancer. Western blotting and real-time polymerase chain reaction (PCR) were used to explore the expression levels MBNL1 and MRTF-A. Wound healing and Transwell invasion assays evaluated cancer cell migration. Molecular mechanisms were explored by RNA immunoprecipitation and luciferase and chromatin immunoprecipitation assays.

Results:

MBNL1 is highly expressed in esophageal cancer and associated with poor prognosis. MBNL1 promotes the migration of esophageal KYSE150 cancer cells by stabilizing MRTF-A mRNA. Moreover, MRTF-A activates transcription of the MBNL1 promoter, resulting in the upregulation of MBNL1 expression.

Conclusions:

MBNL1 may be an important regulator of metastasis and a factor associated with poor prognosis in esophageal cancer. Positive feedback regulation between MBNL1 and MRTF-A may be a potential therapeutic target for interrupting esophageal cancer migration. Generally, our results provide a theoretical basis for elucidating the molecular mechanisms of esophageal cancer cell migration.
Microwave ablation combined with I125 seed implantation for treatment of residual lesions of liver cancer after TACE
Authors: Zhang Hao , Wang Jiajia , Li Wei , Liu Shifeng , Li Zixiang , Hu Xiaokun
Published: February 2023

Context:

To compare the efficacy and safety of microwave ablation (MWA) versus MWA combined with I125 seed implantation for the treatment of post-transcatheter arterial chemoembolization (TACE) residual lesions of primary liver cancer.

Methods:

A total of 38 patients with post-TACE residual lesions of liver cancer only received MWA, whereas 33 patients received combined treatment of MWA with I125 seed implantation. Enhanced magnetic resonance imaging (MRI) or positron emission tomography/computed tomography (PET/CT) was performed for review at 1, 3, and 6 months after treatment to observe and compare the short-term efficacy and complications between the two groups.

Results:

The tumor complete response (CR) rate of the MWA group after treatment was 55.3% (21/38) and that of the MWA + I125 group was 81.8% (27/33), indicating a significantly higher value than that of the MWA group (P < 0.05). There was no difference in the minor complications between the two groups, and no serious complications were recorded.

Conclusions:

MWA combined with I125 seed implantation for the treatment of post-TACE residual lesions of primary liver cancer is safe and effective, and its efficacy is better than that of the simple MWA treatment.
Efficacy, safety, and prognostic factors of apatinib plus platinum doublet chemotherapy in advanced non-small cell lung cancer
Authors: Xu Jianping , Liu Xiaoyan , Yang Sheng , Shi Yuankai
Published: February 2023

Background:

Anti-angiogenesis drugs are applicable in treating advanced non-small cell lung cancer (NSCLC); however, the related data regarding apatinib, a Chinese domestic anti-vascular endothelial growth factor receptor-2 (VEGFR-2) production, are limited. Therefore, this study explored the efficacy and safety of apatinib plus platinum doublet chemotherapy in treating patients with advanced NSCLC.

Methods:

Twenty-four patients with advanced NSCLC were retrospectively enrolled. All patients received platinum doublet chemotherapy combined with apatinib 250 mg daily. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events were analyzed.

Results:

Zero (0.0%), seven (29.2%), 11 (45.8%), and six (25.0%) patients had partial response (PR), stable disease (SD), and progressed disease (PD), respectively, resulting in an ORR of 29.2% and a DCR of 75.0%. The median PFS was 12.6 months (95% CI: 3.9–21.3 months) with a 1-year PFS of 56.1%, and the median OS was 18.3 months (95% CI: 13.0–23.5 months) with a 1-year OS of 73.9%. Age ≤60 years (P = 0.034), ECOG performance score 1 (vs. 2; P = 0.005), and first-line treatment (vs. second or higher line treatment; P = 0.043) correlated with longer PFS. The most common treatment-related adverse events included fatigue (83.3%), nausea (79.2%), myelosuppression (70.8), and vomiting (66.7%), while most of them were mild and manageable. Only four (16.6%) patients witnessed grade 3–4 myelosuppression.

Conclusion:

Apatinib plus platinum doublet chemotherapy is effective and well-tolerated in treating patients with advanced NSCLC; moreover, reduced ECOG PS and lower lines of treatment relate to its better efficacy.
Effectivity of involved-field radiotherapy for recurrent brain metastasis in patients with small-cell lung cancer
Authors: Wang Yu , Song JiXiang , Li Wanhu , Zeng Haiyan , Liu Ning , Zhu Shouhui , Yuan Shuanghu , Hu Xudong
Published: February 2023

Objectives:

To investigate the outcome difference of whole brain radiotherapy (WBRT) and involved-field radiotherapy (IFRT) in limited-stage small-cell lung cancer (LS-SCLC) patients with recurrent brain metastases (BMs) after prophylactic cranial irradiation (PCI).

Methods:

A retrospective analysis was carried out in 68 LS-SCLC patients who underwent WBRT or IFRT owing to the occurrence of recurrent BMs after PCI from 2009 to 2020.

Results:

The median overall survival (OS) of all patients was 11.43 months [95% confidence interval (CI) 9.39–13.48 months]. In the paired comparison of OS, the IFRT group had a significantly longer survival time than the WBRT group in all patients [17.80 months vs. 8.47 months; hazard ratio (HR), 0.393, 95% CI, 0.213–0.728; P = 0.002] and 46 matched patients (18.23 months vs. 8.73 months; HR, 0.411, 95% CI, 0.195–0.865; P = 0.019). In terms of the intra-cranial progression-free survival (iPFS), there was no significant difference between the WBRT group and IFRT group before matching (5.93 months vs. 7.30 months; HR, 0.644, 95% CI, 0.373–1.112; P = 0.111); similarly, no statistical difference was detected between the WBRT group and IFRT group after matching (5.33 months vs. 8.10 months; HR, 0.623, 95% CI, 0.323–1.199; P = 0.152). Meanwhile, of the 41 patients with symptoms, 27 cases (65.9%) had symptom relief, showing tolerable toxicity without unexpected toxicity during the observation.

Conclusions:

Compared with WBRT, IFRT exhibits better survival benefits for LS-SCLC patients with recurrent BMs after PCI. Re-irradiation for BMs exhibits advantages of symptom relief and tolerable side effects.
Risk factors of secondary infection/recurrence after ablation for liver cancers
Authors: Yin Gang , Zhang Nengwei , BuHe AMin , Yan Wei , Li Tianxiong , Peng Jirun
Published: February 2023

Background:

This study aimed to systemically explore the risk factors of secondary infection/recurrence after ablation in patients with liver cancer.

Methods:

Relevant literature in PubMed, EMbase, and Cochrane Library databases were searched with keywords including “liver cancer or carcinoma,” “ablation,” “infectious or infection or recurrence,” and “risk factor or relevant factor or correlative factor or influencing factor.” Meta-analyses were performed and forest plots were drawn for risk factors, including the tumor size and location, number of tumor nodules, hepatitis B virus (HBV) DNA levels, serum alpha fetal protein (AFP) levels and serum albumin levels, Child-Pugh Class, and lack of antiviral therapy. A funnel plot was drawn to assess the publication bias.

Results:

A total of 23 studies were included from the initial 701 potentially relevant articles. Our meta-analyses showed that a large tumor size (odds ratio [OR] = 1.58; 95% confidence interval [CI]: 1.31–1.92); proximity to the colon, large vessels, and large hepatic vein (OR = 4.10; 95% CI: 2.26–7.43); multinodular tumor (OR = 2.10; 95% CI: 1.46–3.03), the higher HBV DNA levels (OR = 1.34; 95% CI: 1.09–0.64); higher serum AFP levels (OR = 1.56; 95% CI: 1.18–2.05), lower serum albumin levels (OR = 1.67; 95% CI: 1.06–2.65); Child-Pugh Class B and Class C (OR = 1.27; 95% CI: 1.05–1.54); and lack of antiviral therapy (OR = 1.75; 95% CI: 0.93–3.28) were associated with an increased risk of post-ablation infection/recurrence in patients with liver cancers.

Conclusion:

Our results indicated that the tumor size and location, number of tumor nodules, HBV DNA levels, serum AFP levels and serum albumin levels, Child-Pugh Class, and lack of antiviral therapy were the risk factors for post-ablation infection/recurrence in patients with liver cancer. Here, we have provided directions for the clinical prevention of secondary infection/recurrence in patients with liver cancer who underwent ablation therapy.
A novel targeted iron oxide nanocarrier for inhibiting M2-type macrophages in the tumor microenvironment
Authors: Tian Kaixuan , Feng Ruiqing , Wang Xiaoqing , Wu Xiangyu , Li Long , Liu Wei , Wu Rongde
Published: February 2023

Background:

Tumor-associated macrophages (TAMs) are vital to the tumor microenvironment. They are classified as antitumor M1-type or protumor M2-type macrophages. M2-type macrophages accumulate in the tumor stroma and are related to poor prognosis. Iron oxide nanoparticles are used as drug delivery vehicles because of the structure of carboxyl groups on their surface and their ability to be easily phagocytosed by macrophages.

Aim:

The signal transducer and activator of transcription 6 (STAT6) signaling pathway controls M2 macrophage polarization, but the STAT6 signaling pathway inhibitor AS1517499 lacks efficient targeting in vivo. Thus, our study aimed to block the polarization of TAMs to M2-type macrophages.

Methods and Material:

We used ultrasmall superparamagnetic iron oxide nanoparticles (USPIONs) as drug carriers coated with the STAT6 signaling pathway inhibitors AS1517499 and CD163 monoclonal antibodies to synthesize the targeted nanocomplex AS1517499-USPION-CD163 utilizing the carbodiimide method. Then, we determined its physicochemical properties, including hydrodynamic size distribution, ultrastructure, iron concentration, protein content and activity of the CD163 monoclonal antibody, AS1517499 content, and selectivity for M2-type macrophages, and its biological applications.

Results:

The hydrodynamic size distribution was stable (average size = 95.37 nm). Regarding biological applications, the targeted nanocomplex selectively inhibited M2-type macrophages.

Conclusions:

The targeted nanocomplex AS1517499-USPION-CD163 showed high selectivity for M2-type macrophages. Therefore, iron oxide nanoparticles targeting TAMs may be an effective approach to TAM therapy.
A rare localization of a common disease
Authors: Göksel Sibel , Karaman Elanur , Karacin Pinar , Ersöz Şafak
Published: February 2023

Genitourinary system lymphomas comprise a small part of extra-nodal lymphomas (ENLs). ENLs of uterine origin are extremely rare and are often confused with gynecological malignancies. We present an 80-year-old female patient diagnosed with diffuse large B-cell lymphoma (DLBCL) with a single focus of the uterus. The patient's only complaint was abnormal uterine bleeding. Magnetic resonance imaging revealed an intramural-subserous-submucous multiple mass lesion with minimal contrast enhancement mimicking leiomyosarcoma. Diffuse pathological 18F-fluorodeoxyglucose uptake was detected in the entire uterus corpus and cervix on positron emission tomography/computed tomography (PET/CT) scanning. The pathology of the endocervical and endometrial curettage material obtained was DLBCL; the patient was diagnosed with ENL, and a single focus was the uterus. ENLs should be considered in the differential diagnosis of gynecological malignancies in patients with abnormal uterine bleeding. PET/CT is crucial in showing metabolically active spread areas in these patients.
Delta and Notch-like epidermal growth factor-related receptor suppresses human glioma growth by inhibiting oncogene TOR4A
Authors: Wang Qun , Li Yaqiong , Li Jiamei , Yao Zhigang , Ma Xiaochun , Ma Ji-wei
Published: February 2023

Delta and Notch-like endothelial growth factor-related receptor (DNER) is a transmembrane protein that mediates signal communication between neurons and glial cells. This study was performed to elucidate the specific mechanism by which DNER inhibits human glioma growth. RNA sequencing was used to detect differentially expressed genes after DNER inhibition in glioma cells. The functions of the Torsin family 4 member A (TOR4A) gene were explored through cell proliferation and clonogenic assays, flow cytometric analysis, in vitro cell migration and invasion assays, in vivo glioma transplantation, and human glioma tissue analysis using the Chinese Glioma Genome Atlas database. Protein expression levels were determined using the western blot assay. We found that TOR4A was highly expressed after the inhibition of DNER in glioma cells. The prognosis of patients with gliomas that expressed high levels of TOR4A was worse than those with low levels of the protein. TOR4A promoted the proliferation of glioma cells and inhibited their apoptosis, likely by enhancing the expression of phosphorylated protein kinase B (p-AKT) and inhibiting that of antiapoptotic proteins. We confirmed that TOR4A is an oncogene and that DNER acts as a tumor suppressor gene by inhibiting TOR4A and its functions of promoting p-AKT and inhibiting antiapoptotic protein expression.
Choroid, a unique site for metastasis in Marjolin's ulcer
Authors: Lokesh Amit Bagur , Kumar Rakesh , Saheer N. , Bhatnagar Amar
Published: February 2023

Marjolin is an aggressive malignancy, which shows initial local aggression, followed by the rapid regional and distant dissemination during the latter part of its growth. Metastasis to the uveal tract, although infrequent, is usually secondary to the malignancies of the breast and lung. Marjolin's ulcer metastasizing to choroid is quite rare and unheard of. We intend to report one such case here. Here, we present a case report of a 55-year-old male, who developed Marjolin's ulcer over a previously injured left lower limb. He developed recurrence and re-recurrences requiring multiple surgeries, radiation, and chemotherapy cycles. He eventually developed disseminated systemic metastases. Over the course of his disease, he reported eye symptoms of pain, blurring of vision, and field defect in the left eye. On further evaluation with imaging and fundoscopy, a metastatic deposit was identified in the choroid of the left eye. Metastasis to the uveal tract is an unusual unreported event in the disease progression of Marjolin's ulcer. The treatment is usually palliative. It heralds the terminal stage of the disease, with inevitable death.
Correlation analysis of body image level and female sexual dysfunction in young patients with postoperative breast cancer
Authors: Du Hua , Chen Chen , Yuan Fangzhen , Hu Anni , Han Jiangying
Published: February 2023

Objective:

To determine the relationship between female body image and female sexual dysfunction (FSD) in young patients (20–40 years) with postoperative breast cancer.

Methods:

Using the convenient sampling method, we identified 276 young patients with postoperative breast cancer from June 2017 to 2019 in the Department of Oncology and Radiotherapy of the First Affiliated Hospital of Anhui Medical University to be included in the study. A general situation questionnaire for body image scale (BIS) and female sexual function index (FSFI) scale was used to evaluate the correlation between body image level and the prevalence of FSD in young patients with postoperative breast cancer.

Results:

The total score for BIS was 10.98 ± 7.19, indicating that patients were moderately dissatisfied with their body image The total prevalence of FSD was 63.41%. Pearson correlation analysis showed a negative correlation between the total score, each dimension score of BIS, total FSD, and the incidence of each dimension disorder (range, r: −0.414 to −0.717, all P values <0.05).

Conclusion:

There is a negative correlation between the body image level and the prevalence of FSD in young patients with postoperative breast cancer. This suggests that clinical medical workers should develop an intervention plan to improve the body image level of postoperative young breast cancer patients according to the unique physiological and psychological characteristics of these patients while also reducing the prevalence of FSD.
Fibromatosis mimicking relapse of a neuroendocrine tumor at 68Ga-DOTATOC positron-emission tomography/computed tomography
Authors: Trevisi Elena , Facilissimo Ivan , Taraglio Stefano , Brizzi Maria Pia
Published: February 2023

Mesenteric fibromatosis (desmoid tumor) is a locally aggressive fibroblastic lesion, characterized by a high recurrence rate that makes treatment challenging. Currently, there is no evidence-based treatment approach. We report the case of a female patient with a history of neuroendocrine tumor, who underwent 68Ga-DOTATOC positron-emission tomography/computed tomography (PET/CT), showing increased focal abdominal uptake suggestive of disease relapse. Histological examination revealed typical findings of fibromatosis. These findings indicate the expression of staining for somatostatin receptors (SSTRs) on fibromatosis cell surface and suggest to include fibromatosis among the potential causes of false-positive results at 68Ga PET/CT. Moreover, SSTRs expressed in desmoid tumors could be further investigated as a therapeutic target.
Analysis of antitumor immunity in mouse glioma microenvironment through intercellular communication
Authors: Zhang Yan , Lu Fenghua , Cai Nannan , Tang Lanjing , Zhou Yao , Li Yalin , Liu Kai , Song Wengang , Kang Li , He Hao
Published: February 2023

Objective:

This study aimed to map the antitumor immunity in the glioma microenvironment by analyzing intercellular communication.

Materials and Methods:

The single-cell RNA-sequencing (scRNA-Seq) data were obtained from fresh mouse gliomas. Tumor cells were inferred by estimating genomic copy number profiles. CellMarker database was used to identify cell types. Intercellular communication was inferred using CellChat. Flow cytometry was used to detect the effect of microglia or stroma-educated monocytes on CD4+ T cell proliferation.

Results:

Mouse glioma contained at least eight cell populations, and T cells were the only infiltrating immunocytes. Whether in signal outgoing or signal incoming, intercellular communication could be divided into four patterns by which cell populations in the tumor microenvironment (TME) cooperate with each other. By analyzing the complex communication between brain cell populations and infiltrating T cells in TME, we found that the brain cell populations used 25 signaling pathways to connect to T cells, and T cells used 21 signaling pathways to connect to brain cell populations. We also found that microglia from normal mice and brain stroma-educated monocytes exhibited immunosuppressive activity against CD4+ T cell proliferation.

Conclusions:

We described the previously underestimated complex communication between infiltrating T cells and brain cell populations. Our data suggest that the tolerogenic property of glioma TME is related to the immune privilege of CNS.
Chinese primary adrenal lymphoma complicated with adrenal crisis
Authors: Zhang Yan , Zheng Li , Ai Yi , Luo Min , Shi Lixin , Zhang Qiao
Published: February 2023

Primary adrenal lymphoma (PAL) is an extremely rare malignancy, and it accounts for approximately 1% of non-Hodgkin's lymphoma (NHL). The growth of adrenal lymphoma is characterized by rapid infiltration in the adrenal gland and further involvement and metastasis in other tissues and organs. This report describes the case of a 67-year-old man with fatigue, poor appetite, and weight loss. Positron emission tomography and computed tomography (PET-CT) scan showed irregular mass-like soft tissue density shadows were noted in the bilateral adrenal glands and immunohistochemical (IHC) studies confirmed the diagnosis of PAL with multiple metastases throughout the body. This report characterizes the clinical manifestations in patients with PAL. When the disease progresses to bilateral adrenal involvement, it may be accompanied by adrenal insufficiency or even adrenal crisis occurred.
Clinical practice guidelines on image-guided thermal ablation of primary and metastatic lung tumors (2022 edition)
Authors: Ye Xin , Fan Weijun , Wang Zhongmin , Wang Junjie , Wang Hui , Niu Lizhi , Fang Yong , Gu Shanzhi , Liu Lingxiao , Liu Baodong , Zhuang Yiping , Wei Zhigang , Li Xiao , Li Xiaoguang , Li Yuliang , Li Chunhai , Yang Xia , Yang Wuwei , Yang Po , Lin Zhengyu , Meng Zhiqiang , Hu Kaiwen , Liu Chen , Huang Yong , Huang Guanghui , Huang Kaiwen , Peng Zhongmin , Han Yue , Jin Yong , Lei Guangyan , Zhai Bo , Li Hailiang , Pan Jie , Filippiadis Dimitris , Kelekis Alexis , Pua Uei , Futacsi Balazs , Yumchinserchin N , Iezzi Roberto , Tang Alex , Roy Shuvro H
Published: February 2023

The main contents of the Clinical Practice Guidelines on Image-Guided Thermal Ablation (IGTA) of Primary and Metastatic Lung Tumors (2022 Edition) include the following: epidemiology of primary and metastatic lung tumors; the concepts of the IGTA and common technical features; procedures, indications, contraindications, outcomes evaluation, and related complications of IGTA on primary and metastatic lung tumors; and limitations and future development.
Utility of the Modified Nutritional Risk in the Critically ill Score as an Outcome Predictor in All-Cause Acute Respiratory Distress Syndrome and Acute Febrile Illness-Induced Acute Respiratory Distress Syndrome
Authors: Todur Pratibha , Nileshwar Anitha , Chaudhuri Souvik , Maddani Sagar S , Rao Shwethapriya , Thejesh S.
Published: February 2023

Introduction:

Nutritional risk in the Critically Ill (NUTRIC) score is a predictor of adverse outcomes in the critically ill, and its utility in a specific population of critically ill has been recommended. We aimed to study the utility of modified NUTRIC (mNUTRIC) score as a mortality predictor in acute febrile illness (AFI)-induced acute respiratory distress syndrome (ARDS) and all-cause ARDS patients.

Methods:

We recorded data from two prospective observational ARDS studies conducted at a single-center tertiary care hospital to evaluate the utility of the mNUTRIC score as an independent mortality predictor in all-cause ARDS and AFI-ARDS. A total of 216 all-cause ARDS patients were included, of which 73 were AFI-ARDS and 143 were non-AFI ARDS.

Results:

Mortality of AFI-ARDS was 16/73 (21.9%) compared to 62/143 (43.35%) in non-AFI ARDS (P = 0.002). There were no significant differences in severity of ARDS in AFI-ARDS and non-AFI ARDS groups (P = 0.504). The mNUTRIC score was found to be an independent predictor of mortality in all-cause ARDS patients (n = 216) and AFI-ARDS patients (n = 73) after Cox regression multivariable analysis. In all-cause ARDS, the mNUTRIC score had an area under the curve (AUC) of 0.778, cutoff ≥4, 82.1% sensitivity, and 65.9% specificity as a predictor of mortality. In AFI-ARDS, the mNUTRIC score had an AUC of 0.769, cutoff ≥4, 81.3% sensitivity, 66.67% specificity, and P = 0.001 as a predictor of mortality.

Conclusion:

The mNUTRIC score is an independent mortality predictor for all-cause ARDS and AFI-ARDS patients. AFI-ARDS has significantly lesser mortality than non-AFI ARDS.
Targeting to Brain Tumor
Authors: Kumar Ladi Alik , Pattnaik Gurudutta , Satapathy Bhabani Sankar , Swapna S , Mohanty Dibyalochan
Published: February 2023

Cancer is a class of disorder characterized by anomalous growth of cells escalating in an uncontrolled way. Among all the cancers, treatment of cancerous brain tumors has been a tough challenge for the research scientists. Moreover, the absence of early-stage symptoms delays its diagnosis, consequently worsening its severity. Conventional treatments such as surgery, radiation, and chemotherapy are still linked with several limitations. The therapeutic effect of most of the anticancer drugs is highly restricted by their inability to pass the blood–brain barrier, low solubility, limited therapeutic window, and so on. Alarming incidences of brain cases associated with low survival rate across the globe coupled with the inefficiency of current treatment strategies have forced the formulation scientists to investigate nanotechnology-based advanced therapeutic approaches to tackle the disease. Various nanoplatforms such as polymeric nanoparticles (NPs), nanoliposomes, dendrimers, carbon nanotubes, and magnetic NPs have been reported in the past years to improve the drug administration into brain tumor cells and to minimize their off-target distribution for lesser side effects and better treatment outcomes. The review presents updated information on the nanocarrier-based drug delivery systems reported in the past few years for the treatment of brain tumor along with new advancements in this field. It also throws some light on the recent challenges faced in the practical field for the successful clinical translation of such nanodrug carriers along with a discussion on the future prospects.
Prescription Pattern of Empirical Antibiotic Therapy in the Burn Unit of a Tertiary Care Setting in the Kingdom of Saudi Arabia
Authors: Moinuddin Khaja , Alanazi Deemah Sattam , Alsomali Bushra Abdulrahman , Alotaibi Maram , Parameaswari Parthasarathy Jaganathan , Ali Sheraz
Published: February 2023

Background:

It is crucial to follow rational prescribing practices while prescribing antibiotics for burn patients, thus leading to better patient outcomes. The objective of this study was to assess the initiation of empirical antibiotics in the burn unit.

Methods:

A prospective cross-sectional study was conducted in a large tertiary care setting of the Kingdom of Saudi Arabia between August 2016 and December 2018.

Results:

A total of 102 hospitalized burn patients were included in this study, of whom 84 (82.4%) were males. Burns were classified as first degree, second degree, third degree, or fourth degree depending on their severity and extent of penetration into the skin. The majority (81.3%) of the patients suffered from flame burn, followed by scald (9.85), chemical (6.9%), and electrical (2%) types of burns. Broad-spectrum antibiotic such as piperacillin/tazobactam (40.57%) was the most common empirically prescribed antibiotic. In 35 patients (34.3%), there was a change in antibiotic after culture findings.

Conclusion:

This study demonstrated that 40% of antibiotic therapy decisions followed the recommended clinical guidelines. This study also found that Gram-negative microorganisms such as Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus were ubiquitous in our burn unit. The study results will facilitate to develop antibiogram for our study setting, thus reducing antibiotic resistance. Further studies are needed to explore the extent and consequences of irrational antibiotic prescriptions in critically ill burn patients.
Bidirectional Relationship between COVID-19 and Diabetes
Authors: Khanam Razia
Published: February 2023

Numerous reports have suggested that diabetic patients are at high risk for the development of severe symptoms of coronavirus disease-2019 (COVID-19). However, a few studies have recently proposed that the relationship between diabetes and COVID-19 is bidirectional, as severe acute respiratory syndrome-coronavirus-2 also has the capability to induce diabetes. Various mechanisms have been identified and proposed to be involved in this binary association. In this review, the importance and impact of renin–angiotensin–aldosterone system (RAAS) in this two-way association of COVID-19 and diabetes has been summarized. The role and effect of drugs modulating RAAS directly or indirectly has also been discussed, as they can majorly impact the course of treatment in such patients. Further reports and data can present a clear picture of RAAS and its modulators in restoring the balance of dysregulated RAAS in COVID-19.
Assessment of a Pharmacovigilance Module
Authors: Palaian Subish , Ibrahim Mohamed Izham Mohamed , Mishra Pranaya , Shankar Pathiyil Ravi
Published: February 2023

Background:

The aim of the study was to assess the impact of a pharmacovigilance module on the knowledge, attitude, and practice (KAP) of pharmacy students and elucidate their feedback on the module.

Methodology:

Bachelor of pharmacy students at Pokhara University, Nepal, were assessed for their baseline KAP on drug safety and related issues using a KAP questionnaire (Cronbach alpha 0.70) consisting of 25 questions. Students’ baseline KAP was assessed and after that, they were grouped into either control (2nd and 4th year) or test (1st and 3rd year) groups. The later received the pharmacovigilance training in three 1-h sessions spread over 6 months at 0, 90, and 180 days; the sessions covered introduction to pharmacovigilance, theoretical aspects of pharmacovigilance, and adverse drug reaction reporting procedures. KAP scores and student feedback were analyzed at 5% significance level.

Results:

A total of 124 students (control = 56 and test = 68) were studied. The median (interquartile ranges [IQRs]) of the baseline scores prior to grouping the students into control and test groups was 20 (18.25–21.00) for knowledge, 19.5 (18.00–21.00) for attitude/practice, and 39 (37.00–41.00) for the total score. Males (n = 81) had a slightly higher median score of 40 (37–42) than females (n = 43), who had a median score of 38 (36–41). The KAP score for the control group was 40 (38–42) at baseline, 42 (20–44) during first follow-up, 41.5 (40–44) during second follow-up, and 41 (39–44.5) during third follow-up. For the test group, upon intervention, the KAP scores improved from 39 (36.25–40.75) at baseline to 42 (39.50–44.00) at the 1st follow-up, 43 (41–45) at the 2nd follow-up, and 44 (42–45) at the 3rd follow-up (P < 0.001). The median feedback score (IQR) was 86 (81.5–90.0).

Conclusions:

Pharmacy students had good attitude/practice scores and relatively poor knowledge scores at baseline, which improved postintervention. Student feedback about the module was positive.
Metformin Use in Gestational Diabetes
Authors: Daud Nur Aizati Athirah , Mohiuddin Syed Ghouse , Ong Yi Ping , Yusof Faridah , Yusoff Fadhleena , Harun Sabariah N. , Ghadzi Siti Maisharah S.
Published: February 2023

Background:

Metformin has been added in the Malaysian clinical practice guideline (CPG) as one of the first-line options in the management of gestational diabetes mellitus (GDM); however, the uptake on this practice among healthcare professionals is unknown.

Objective:

The objective of the study is to determine the awareness, attitude, and practice and their predictors on the use of metformin for GDM among healthcare professionals in Malaysia.

Materials and Methods:

This was a multicenter, cross-sectional study in three tertiary hospitals in Malaysia. Medical doctors and pharmacists working in several departments were invited to participate in a survey using self-administered questionnaires.

Results:

From 350 questionnaires distributed, 225 were completed by medical doctors (43.1%), pharmacists (40.4%), and specialists (7.5%). Less than 30% of them were aware on the option of using metformin as one of the first-line agents in GDM. Education level, department, and profession were found to be associated with the awareness level (P = 0.016, P = 0.004, and P = 0.001, respectively). 70.2% of the respondents showed a positive attitude toward metformin use in GDM. Only 64 (28.4%) of the respondents have prescribed/dispensed metformin for GDM before, although more than half will consider doing so in the future. Having postgraduate qualifications increased the likelihood of having a good awareness (odds ratio [OR]: 2.44, 95% confidence interval [CI] 1.23–4.85) and to consider prescribing/dispensing metformin for GDM patients (OR: 2.27, 95% CI 1.08–4.78).

Conclusion:

Despite a positive attitude toward metformin use in GDM among healthcare professionals in Malaysia, their awareness level on this practice was low as they currently prefer the use of insulin over metformin.
Role of Hematological and Immunological Parameters in COVID-19 Patients
Authors: Kumar Avanindra , Sepolia Shipra , Shilpa R. H. , Rezayani Gilda , Kumari Soni , Aastha  , Gupta Shivangi
Published: February 2023

Background:

The ongoing pandemic of coronavirus disease 2019 (COVID-19) which was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to efforts from the medical and scientific community in understanding the biological basis of COVID-19 pathophysiological mechanisms. Thus, analysis of various hematological and immunological parameters may be helpful for COVID-19 infection evaluation for risks involved and effectiveness in management.

Aim:

The aim of this study was to analyze the role of various hematological and immunological parameters in patients infected with SARS-CoV-2.

Materials and Methods:

This retrospective analysis was performed on 300 patients who tested positive for SARS-CoV-2 by quantitative reverse transcription–polymerase chain reaction analysis. All participants of the study were divided into – (a) Group I: patients with mild symptoms and normal chest radiographic findings; (b) patients with moderate disease presenting with fever and cough along with other respiratory symptoms, and (c) patients suffering from severe disease. Data collection was done from all patients at the time of hospital admission for hematological and immunological parameters – (a) total leukocyte count, (b) lymphocyte count, (c) lymphocytic subset count, (d) lactate dehydrogenase (LDH) levels, (e) D-dimer, (f) C-reactive protein (CRP), and (g) ferritin levels. SPSS 22.0 software was used for determining P values by independent t-test and Chi-square test.

Results:

The median age was 65 years (interquartile range –57–71 years). While comparing white blood cell and lymphocyte counts, extremely significant P values were obtained. D-dimers and ferritin levels demonstrated extremely significant P values while both LDH and CRPs showed statistical significance. Correlation of lymphocytic subsets showed extreme significance in total lymphocyte counts in mild-to-moderate as compared to severely infected patients while both CD4+ and CD8+ counts demonstrated statistical significance in mild-moderate infected cases. Statistical significance was noted in D-dimer, CRP, and LDH levels also.

Conclusion:

Assessment of hematological and immunological parameters can be used to plan the management of COVID-19 patients.
Utility and Impact of Early Diagnostic Assessment of Sepsis on Mortality in an Emergency Department of a Tertiary Hospital in Lagos, Nigeria
Authors: Akase Iorhen Ephraim , Akujobi Henry Chukuma , Oghide Oziegbe , Olusegun-Joseph Akinsanya Daniel , Agbarakwe Chukwuemeka Abraham , Opawoye Adefolarin
Published: February 2023

Context:

Currently, little is known about the timely application of clinical screening tools and blood sampling for decision-making in the management of patients with suspected sepsis in the accident and emergency units of hospitals in Nigeria.

Aim:

The aim of the study was to ascertain the association between the time taken for the conduct of serum lactate and blood culture investigations following a clinical suspicion of sepsis, and the mortality of patients admitted to a Nigerian tertiary hospital.

Methods:

Over a 6-month period (November 2021 to April 2022), 119 patients hospitalised for sepsis or septic shock at the Lagos University Teaching Hospital were followed until discharge or death. The proportion of patients whose serum lactate, serum procalcitonin and blood culture samples was taken was also determined. Predictors of mortality were determined using bivariate analysis and logistic regression. Kaplan–Meier plots were used to predict survival using sepsis diagnostic criteria.

Results:

Eighty (67%) of 119 sepsis patients met systemic inflammatory response syndrome or quick sequential (sepsis-related) organ failure assessment criteria. Only 3 (2.5%) patients had blood cultures and serum procalcitonin and 0 (0%) had serum lactate tests. Forty-one (34.5%) patients died, but clinical and laboratory procedures for sepsis management were not linked to death. A shorter hospital stay increased the death risk (χ2 = 14.83, P = 0.002).

Conclusion:

This study revealed low compliance with sepsis care guidelines and no impact of timely clinical and laboratory procedures on sepsis mortalities. Further study is needed to explore patient care models that can improve the objective assessment and treatment of sepsis patients in emergency departments of busy tertiary hospitals.
A Systematic Review of the Current Status of Carbapenem Resistance in Nigeria
Authors: Tula Musa Yakubu , Enabulele Onaiwu Idahosa , Ophori Endurance Anthony , Aziegbemhin Abumhere Samuel , Iyoha Osaretin , Filgona Joel
Published: February 2023

Carbapenem antibiotics are considered one of the most effective and the last-resort antibiotics for the treatment of infections caused by multidrug-resistant Gram-negative bacteria. However, with the advent of carbapenem resistance, it becomes obvious that quality health-care delivery will be hampered if adequate measure is not put in place. This review assessed the prevalence of carbapenem-resistant Gram-negative bacteria (CR-GNB) and also provided an up-to-date position on carbapenem resistance (CR) in Nigeria. Three electronic databases (Google Scholar, PubMed and African Journal online) were searched for relevant literatures, and 38 articles published between January 2013 and June 2022 that met the criteria for inclusion were recruited into the study. The mean prevalence of CR in Nigeria stands at 21.3%, with the southern and northern regions documenting a mean prevalence of 22.0% and 20.9%, respectively. Most of the reviewed articles were from clinical settings (81.6%), with urine samples (38.7%) constituting the most prevalent clinical sample in which CR-GNB were detected. The preponderance of phenotypic methods (55.3%) over molecular method (44.7%), particularly the use of disk diffusion test breakpoint and Modified Hodge test was documented. The most prevalent carbapenem-resistant bacteria were Escherichia coli (50.0%) and Klebsiella pneumoniae (26.3%). The bla

NDM
and bla

VIM
were the major reported carbapenemase-encoded genes, particularly among E. coli, K. pneumoniae and Pseudomonas species. This systematic review revealed a mean prevalence of CR-GNB in Nigeria that required urgent attention. Furthermore, the detection of clinically and epidemiologically important carbapenemase coding genes is of public health importance.
Legalisation of Abortion in a Poor-Resource Setting
Authors: Fehintola Funmito Omolola , Ajibola Idowu , Olowookere Samuel Anu , Akande Yemisi Roseline , Komolafe Tolulope , Eledah Emmanuel , Faneye Eniola , Oyewale Seun
Published: February 2023

Background:

Abortion is one of the leading causes of morbidity and mortality amongst Nigerian women in a country with restrictive abortion laws. Despite being illegal, abortions are still performed, and about 50% of abortions are performed by untrained persons in unhygienic conditions. This study assessed the determinants of attitude of undergraduates to legalisation of safe abortion in Nigeria.

Methods:

It is a descriptive cross-sectional study. We used a three-stage sampling technique to select 423 undergraduates using a pre-tested questionnaire. The predictors of attitude towards abortion and its legalisation were identified during multivariate analysis.

Results:

Good knowledge of abortion and its sequelae was found in about two-thirds (62.2%) of the participants, while over half (56.3%) had a negative perspective to abortion legalisation in Nigeria. Older participants were more likely to have positive perspectives to legalisation of abortion compared to their younger counterparts (odds ratio [OR] = 4.72, confidence interval [CI]: 2.61–8.55). Furthermore, respondents from upper social class and those with good knowledge were more likely to have positive perspectives to legalisation of abortion compared to their counterparts (OR = 5.63, CI: 3.12–10.16 and OR = 4.50, CI: 2.89–7.01).

Conclusion:

The study showed that respondents' knowledge of abortion was relatively low amongst the study population, and more than half of the respondents did not want abortion to be legalised. Increasing awareness on the importance of abortion and its complications in Nigeria will curb the menace of death due to abortion now and in the future.