Abemaciclib plus a nonsteroidal aromatase inhibitor as initial therapy for HR+, HER2- advanced breast cancer: Final overall survival results of MONARCH 3.

BACKGROUND: In MONARCH 2, the addition of abemaciclib to fulvestrant significantly improved both progression-free survival (PFS) and overall survival (OS) in patients with HR+, HER2- advanced breast cancer (ABC) with disease progression on prior endocrine therapy (ET). In MONARCH 3, the addition of abemaciclib to a nonsteroidal aromatase inhibitor (NSAI) as initial therapy for HR+, HER2- ABC significantly improved PFS. Here, we present the prespecified final OS results for MONARCH 3. PATIENTS AND METHODS: MONARCH 3 is a randomized, double-blind, phase 3 study of abemaciclib plus NSAI (anastrozole or letrozole) versus placebo plus NSAI in postmenopausal women with HR+, HER2- ABC without prior systemic therapy in the advanced setting. The primary objective was investigator-assessed PFS; OS was a gated secondary endpoint, and chemotherapy-free survival (CFS) was an exploratory endpoint. RESULTS: A total of 493 women were randomized 2:1 to receive abemaciclib plus NSAI (n = 328) or placebo plus NSAI (n = 165). After a median follow-up of 8.1 years, there were 198 OS events (60.4%) in the abemaciclib arm and 116 (70.3%) in the placebo arm (hazard ratio, 0.804; 95% confidence interval [CI], 0.637-1.015; P = 0.0664, non-significant). Median OS was 66.8 versus 53.7 months for abemaciclib versus placebo. In the subgroup with visceral disease (sVD), there were 113 OS events (65.3%) in the abemaciclib arm and 65 (72.2%) in the placebo arm (hazard ratio, 0.758; 95% CI, 0.558-1.030; P = 0.0757, non-significant). Median OS was 63.7 months versus 48.8 months for abemaciclib versus placebo. The previously demonstrated PFS benefit was sustained, and CFS numerically improved with the addition of abemaciclib. No new safety signals were observed. CONCLUSION: Abemaciclib combined with an NSAI resulted in clinically meaningful improvement in median OS (ITT: 13.1 months; sVD: 14.9 months) in patients with HR+ HER2- ABC; however, statistical significance was not reached.

A census of general surgery consultants in England and Wales: implications for the current and future surgical workforce.

INTRODUCTION: This study aimed to describe the composition of the current general surgical consultant body in England and Wales and quantify levels of inequality within it as well as describe future workforce challenges. METHODS: This is an observational study of all general surgical departments in England and Wales. Consultant general surgeons were identified and data regarding their gender, country of undergraduate medical education, subspecialty and private practice were recorded. RESULTS: Of the 2,682 consultant general surgeons in England and Wales identified for this study, just 17% are women, with gender inequality most marked in university teaching hospitals and among certain subspecialties. Almost 40% of consultants did not obtain their primary undergraduate degree in the United Kingdom and there are considerably fewer surgeons who studied abroad in university teaching hospitals. Over 40% of current general surgical consultants have been qualified for more than three decades and there is no equivalent sized group of younger consultants. CONCLUSIONS: There remains considerable gender and racial inequality in the consultant general surgical workforce, with pockets of a lack of diversity within university or teaching hospital surgical departments and some subspecialties. The proportion of surgeons in their fourth decade of clinical practice represents the largest group of current practising consultants, which points towards an impending workforce crisis should senior clinicians seek to reduce activity or consider taking early retirement.

Profile of neonatal candidiasis in tertiary neonatal intensive care unit: A report from a developing country.

BACKGROUND: Systemic candidiasis is an important nosocomial infection in neonatal intensive care units. The objective of this study was to identify the change in the profile of neonatal candidiasis in a tertiary neonatal intensive care unit (NICU) in eastern India in recent times. METHODS: It was a retrospective review of case records from 2014 to 2019 from a tertiary NICU of eastern India. Data of the fungal sepsis, demographic details, risk factors of fungal sepsis and mortality were collected from 103 neonates. RESULTS: One hundred and three neonates had blood culture positive for fungal species of which 91 (88.3%) infants weighed ≥1500 g and 66 (64%) infants were term. There was significant higher incidence of candidiasis among outborn (Relative risk of outborn 18.84, 95% CI 10.74-33.05). Prolonged antibiotic usage (>14 days), meropenem usage (>5 days), central catheterization (>5 days), invasive mechanical ventilation (>5 days), surgical intervention were found in 64 (62.1%), 46 (44.6%), 31(30.0%), 40 (38.8%) and 39 (37.8%) infants. Non albicans candida (NAC) was isolated as the predominant species (82/103, 79.6%). Resistance to both of fluconazole and amphotericin B were found in 19 (18.4%) babies. Presence of NAC infection and resistance to both amphotericin B and fluconazole were independent predictors of candida associated mortality in NICU. CONCLUSION: Neonatal candidiasis is found among outborn infants with higher birth weight and gestational age. NAC species are predominant organisms with resistance to common antifungal drugs.

Forecasting stock indices with the COVID-19 infection rate as an exogenous variable.

Forecasting stock market indices is challenging because stock prices are usually nonlinear and non- stationary. COVID-19 has had a significant impact on stock market volatility, which makes forecasting more challenging. Since the number of confirmed cases significantly impacted the stock price index; hence, it has been considered a covariate in this analysis. The primary focus of this study is to address the challenge of forecasting volatile stock indices during Covid-19 by employing time series analysis. In particular, the goal is to find the best method to predict future stock price indices in relation to the number of COVID-19 infection rates. In this study, the effect of covariates has been analyzed for three stock indices: S & P 500, Morgan Stanley Capital International (MSCI) world stock index, and the Chicago Board Options Exchange (CBOE) Volatility Index (VIX). Results show that parametric approaches can be good forecasting models for the S & P 500 index and the VIX index. On the other hand, a random walk model can be adopted to forecast the MSCI index. Moreover, among the three random walk forecasting methods for the MSCI index, the naïve method provides the best forecasting model.

Conversion of Laparoscopic to Open Cholecystectomy: Experience in A Tertiary Care Hospital.

Now-a-days Laparoscopic cholecystectomy is regarded as the gold standard treatment for benign gallbladder disease but in certain situations conversion to open cholecystectomy is extremely important for the safety of the patient. The objective of this study was to evaluate the reason for conversion of this operation to open surgery. This prospective study was carried out on 392 patients in a single unit of Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh and in a private hospital from July 2013 to December 2018. Maximum (28.3%) patients were 31-40 years age group. Majority (75.3%) was female and 24.7% were male. It was observed that only 2.1% were converted due to dense adhesion (n=3), severe inflammation (n=2), difficult to define anatomy of Calot's triangle (n=2) and Mirizzi syndrome (n=1). Meticulous dissection and proper case selection can reduce the rate of conversion to open surgery.

Evaluation of Fecal Pancreatic Elastase-1 as a Measure of Pancreatic Exocrine Function in Children with Pancreatitis.

Pancreatic exocrine insufficiency occurs as a clinical consequence of chronic pancreatitis leading to fat maldigestion, malabsorption and malnutrition. Fecal elastase-1 is a laboratory-based test used for the diagnosis or exclusion of pancreatic exocrine insufficiency. The aim of the study was to observe the value of fecal elastase-1 in children with pancreatitis as an indicator of pancreatic exocrine insufficiency. This was a cross-sectional descriptive study conducted from January 2017 through June 2018. Thirty children with pain abdomen as control and 36 patients with pancreatitis as cases were included. An ELISA technique which recognizes human pancreatic elastase-1 from spot stool sample was employed for the test. Fecal elastase-1 activity in spot stool samples in acute pancreatitis (AP) ranged from 198.2-500µg/g with a mean of 342.1±136.4µg/g, acute recurrent pancreatitis (ARP) ranged from 15-500µg/g with a mean of 332.8±194.5µg/g and chronic pancreatitis (CP) ranged from 15-492.8µg/g with a mean of 222.2±197.1µg/g was obtained. In controls, fecal elastase-1 ranged from 28.4-500µg/g with a mean of 398.8±114.9µg/g. Disease severity was classified as mild to moderate pancreatic insufficiency (fecal elastase-1 100 to 200µg/g stool) was found in AP (14.3%) and CP (6.7%) cases. The severe pancreatic insufficiency (fecal elastase-1<100µg/g stool) was observed in ARP (28.6%) and CP (46.7%) cases. Malnutrition was observed in severe pancreatic insufficiency cases. This study result showed that fecal elastase-1 can be used as a measure of pancreatic exocrine function in children with pancreatitis.

AI-assisted biparametric MRI surveillance of prostate cancer: feasibility study.

OBJECTIVES: To evaluate the feasibility of automatic longitudinal analysis of consecutive biparametric MRI (bpMRI) scans to detect clinically significant (cs) prostate cancer (PCa). METHODS: This retrospective study included a multi-center dataset of 1513 patients who underwent bpMRI (T2 + DWI) between 2014 and 2020, of whom 73 patients underwent at least two consecutive bpMRI scans and repeat biopsies. A deep learning PCa detection model was developed to produce a heatmap of all PIRADS ≥ 2 lesions across prior and current studies. The heatmaps for each patient's prior and current examination were used to extract differential volumetric and likelihood features reflecting explainable changes between examinations. A machine learning classifier was trained to predict from these features csPCa (ISUP > 1) at the current examination according to biopsy. A classifier trained on the current study only was developed for comparison. An extended classifier was developed to incorporate clinical parameters (PSA, PSA density, and age). The cross-validated diagnostic accuracies were compared using ROC analysis. The diagnostic performance of the best model was compared to the radiologist scores. RESULTS: The model including prior and current study (AUC 0.81, CI: 0.69, 0.91) resulted in a higher (p = 0.04) diagnostic accuracy than the current only model (AUC 0.73, CI: 0.61, 0.84). Adding clinical variables further improved diagnostic performance (AUC 0.86, CI: 0.77, 0.93). The diagnostic performance of the surveillance AI model was significantly better (p = 0.02) than of radiologists (AUC 0.69, CI: 0.54, 0.81). CONCLUSIONS: Our proposed AI-assisted surveillance of prostate MRI can pick up explainable, diagnostically relevant changes with promising diagnostic accuracy. KEY POINTS: • Sequential prostate MRI scans can be automatically evaluated using a hybrid deep learning and machine learning approach. • The diagnostic accuracy of our csPCa detection AI model improved by including clinical parameters.

Unravelling the mystery of porta hepatis for surgical benefit.

BACKGROUND: Hepatobilliary surgery is nowadays growing with increasing popularity throughout the world with advent of newer liver imaging modalities. Anticipating a wide range of morphological variations of porta hepatis (PH), a precise understanding is pertinent to preoperative diagnosis, operative procedure and post-operative outcome of hepatobiliary disease. MATERIALS AND METHODS: Considering recent interest, present study was undertaken. One-hundred and ten isolated adult cadaveric livers of unknown age and sex were dissected to explore detail morphology and morphometry of PH. RESULTS: Classical picture of PH was observed in 20% liver. The standard representation of structures was highest in hepatic artery (59.1%) followed by portal vein (55.5%) and hepatic duct (51.8%). On the basis of structural distribution PH was described as 16 types. Maximum variable number was found in hepatic artery followed by portal vein and hepatic duct. In morphometric analysis, transverse diameter of PH was more than antero-posterior diameter, indicated that PH was slightly oval in transverse plane. Position of PH was more towards posterior and slightly right in inferior surface of liver. CONCLUSIONS: Variations of portal anatomy regarding circulatory and biliary dynamics is worth knowing in successful planning of hepatobiliary surgeries with least complications.

Clinical and echocardiographic characteristics associated with evolution of patent ductus arteriosus in preterm neonates: A prospective cohort study.

BACKGROUND: In preterm infants, persistence of ductus arteriosus is an important medical condition. Functional echocardiography for patent ductus arteriosus (PDA) may guide clinical decision-making regarding treatment requirement strategies. Objectives of the study were to assess the trends of clinical and functional echocardiographic parameters with evolution of ductus arteriosus in babies≤1250 gm of birth weight and to evaluate whether there is any association of these parameters with persistence of ductus. METHODS: In this prospective observational study, recruited babies were assessed serially for clinical events and functional echocardiography. Babies were classified into three groups: without PDA, with PDA but PDA spontaneously closed (within 7 days) and persistent PDA. RESULT: We included 143 infants (Birth weight 1017±179 g, gestational age 30.8±2.7 weeks). Out of 60 babies with PDA, PDA failed to close spontaneously in first week in 32 (53.4 %) infants. PDA Doppler flow pattern on day 3 was found to be one of the most significant markers for future ductus. The highest frequency of growing pattern (37.5%) and pulsatile pattern (59.4%) was seen in persistence ductus group. PDA diameter and LA/Ao ratio were found strongly correlated with all other variables except E/A ratio. CONCLUSION: We noticed persistence of ductus in preterm infants had significant clinical and echocardiographic association. PDA doppler flow pattern on day 3 was found to be a significant marker for future behaviour of ductus. Significant correlation was found among individual functional echocardiographic parameters in babies with PDA. This would guide judicious treatment of PDA in preterm neonates.

P-FLUX: A phosphorus budget dataset spanning diverse agricultural production systems in the United States and Canada.

Quantifying spatial and temporal fluxes of phosphorus (P) within and among agricultural production systems is critical for sustaining agricultural production while minimizing environmental impacts. To better understand P fluxes in agricultural landscapes, P-FLUX, a detailed and harmonized dataset of P inputs, outputs, and budgets, as well as estimated uncertainties for each P flux and budget, was developed. Data were collected from 24 research sites and 61 production systems through the Long-term Agroecosystem Research (LTAR) network and partner organizations spanning 22 U.S. states and 2 Canadian provinces. The objectives of this paper are to (a) present and provide a description of the P-FLUX dataset, (b) provide summary analyses of the agricultural production systems included in the dataset and the variability in P inputs and outputs across systems, and (c) provide details for accessing the dataset, dataset limitations, and an example of future use. P-FLUX includes information on select site characteristics (area, soil series), crop rotation, P inputs (P application rate, source, timing, placement, P in irrigation water, atmospheric deposition), P outputs (crop removal, hydrologic losses), P budgets (agronomic budget, overall budget), uncertainties associated with each flux and budget, and data sources. Phosphorus fluxes and budgets vary across agricultural production systems and are useful resources to improve P use efficiency and develop management strategies to mitigate environmental impacts of agricultural systems. P-FLUX is available for download through the USDA Ag Data Commons (https://doi.org/10.15482/USDA.ADC/1523365).

Is Thoracic Radiotherapy an Absolute Contraindication for Treatment of Lung Cancer Patients With Interstitial Lung Disease? A Systematic Review.

Thoracic radiotherapy decisions in patients with interstitial lung disease (ILD) are complex due to concerns about severe or even fatal radiation pneumonitis. This systematic review analysed the published evidence regarding the incidence of radiation pneumonitis and mortality after thoracic radiotherapy and investigated clinical and dosimetric predictors of radiation pneumonitis in lung cancer patients with ILD. A systematic search was carried out in PubMed, Medline, Embase and the Cochrane database for articles published between January 2000 and April 2021. Two authors independently screened eligible studies that met our predefined criteria. Studies were assessed for design and quality and a qualitative data synthesis was carried out. The search strategy resulted in 1750 articles. After two rounds of screening, 24 publications were included. The median overall incidence of grade ≥3 radiation pneumonitis was 19.7% (range 8-46%). The incidence was greater in conventional radical radiotherapy-treated patients (median 31.8%) compared with particle beam therapy- or stereotactic ablative radiotherapy-treated patients (median 12.5%). The median rate of grade 5 radiation pneumonitis was 11.9% (range 0-60%). The presence of ILD was an independent predictor of severe radiation pneumonitis. Severe radiation pneumonitis was more common in the presence of usual interstitial pneumonia (UIP) pattern or idiopathic pulmonary fibrosis (IPF) than non-UIP or non-IPF subtype. Several other clinical predictors were reported in the literature. V5, V10, V20 and mean lung dose were the most common dosimetric predictors for severe radiation pneumonitis, often with stricter dose constraints than conventionally used. Patients with lung cancer associated with ILD had a poorer overall survival compared with patients without ILD. In conclusion, patients with lung cancer associated with ILD have a poor prognosis. They are at high risk of severe and even fatal radiation pneumonitis. Careful patient selection is necessary, appropriate high-risk consenting and strict lung dose-volume constraints should be used, if these patients are to be treated with thoracic radiotherapy.

Placental characteristics and risks of maternal mortality 50 years after delivery.

INTRODUCTION: Adverse pregnancy outcomes such as preterm delivery and preeclampsia are associated with a higher maternal risk for subsequent cardiovascular disease (CVD) and all-cause mortality. While such pregnancy conditions are related to abnormal placentation, little research has investigated whether pathologic placental measures could serve as a risk factor for future CVD mortality in mothers. METHODS: Longitudinal study of 33,336 women from the Collaborative Perinatal Project (CPP; 1959-1966) linked to mortality information through December 2016. Pathologists took extensive morphological and histopathological measures. Apart from assessing associations with morphological features, we derived an overall composite score and specific inflammation-related, hemorrhage-related, and hypoxia-related pathologic placenta index scores. Cox regression estimated hazard ratios (HR) and 95% confidence intervals (CI) for mortality adjusting for covariates. RESULTS: Thirty-nine percent of women died with mean (standard deviation, SD) time to death of 39 (12) years. Mean (SD) placental weight and birthweight were 436 g (98) and 3156 g (566), respectively. Placenta-to-birthweight ratio was associated with all-cause mortality (adjusted HR 1.03: 1.01, 1.05 per SD in ratio). In cause-specific analyses, it was significantly associated with respiratory (HR 1.06), dementia (HR: 1.10) and liver (HR 1.04) related deaths. CVD, cancer, diabetes and kidney related deaths also tended to increase, whereas infection related deaths did not (HR 0.94; 0.83, 1.06). Placental measures of thickness, diameters, and histopathological measures grouped by inflammatory, hemorrhagic, or hypoxic etiology were not associated with mortality. DISCUSSION: Placental weight in relation to birthweight was associated with long-term maternal mortality but other histopathologic or morphologic features were not.

Vapor Pressure versus Temperature Relations of Common Elements.

The vapor pressure values of common elements are available in the literature over a limited temperature range and the accuracy and reliability of the reported data are not generally available. We evaluate the reliability and uncertainty of the available vapor pressure versus temperature data of fifty common pure elements and recommend vapor pressure versus temperature relations. By synthesizing the vapor pressure values from measurements reported in the literature with the values computed using the Clausius Clapeyron relation beyond the boiling point, we extend the vapor pressure range from 10-8 atm to 10 atm. We use a genetic algorithm to optimize the fitting of the vapor pressure data as a function of temperature over the extended vapor pressure range for each element. The recommended vapor pressure values are compared with the corresponding literature values to examine the reliability of the recommended values.

Determinants of Pre-Hospital Delay after Myocardial Infarction in Bangladesh: A Rural Center Experience.

Determinants of pre-hospital delay after myocardial infarction, strictly among South-Asian rural community, till now is largely unknown. And Bangladesh is not an exception. It is a fact that though around two third of its population still live in villages, we do not know what factors are having influence on such delay. To find out these primers of time consumption before seeking medical help, this is a picture of a medical college hospital situated in a rural precinct. This cross-sectional analytical study was conducted among 98 patients came with Myocardial Infarction (MI) who had met inclusion and exclusion criteria from July 2019 and December 2019. Both STEMI & NSTEMI patients were selected as they have similar attributes. Data was collected in the coronary care unit using a preformed questionnaire. Among 98 MI patients, where 16 female and 82 male patients had average age 53±12 years. Average income rural community was around 100 USD. Almost 50% of sample were illiterate or below 5th grade. On average 6.6 hours (95% CI: 3.5-12.3) were required to reach CCU after symptom onset, whereas distance to first medical contact (FMC) was about 10.2 Km (95% CI: 6.4-16.2). Median distance to nearest PCI-capable hospital was 140 Km (IQR- 20 Km). Only 28% of patients could reach hospital within 2 hours, where 85% had onset of symptom while they were at home. Tertiary level medical college (74.5%) followed by Upazilla (Sub-urban) government health complex (22.4%) were frequent site of FMC. Principle mode of transport to hospital was CNG-three-wheeler (75% of cases). Logistic regression analysis showed only low literacy was as significant predictor about more than 2 hours pre-hospital delay (OR=2.58; p=0.043). Other factors such as low income (OR=2.51; p=0.126), diabetes mellitus (OR=2.99; p=0.059), female sex (OR=1.56; p=0.753), house wife (OR=1.88; p=0.547), previous MI (OR=1.52; p=1.000), symptom ignorance (OR=2.14; p=0.455) increases pre-hospital delay and distance to FMC <10 Km (OR=0.44; p=0.079) no significant prediction of pre-hospital delay after myocardial infarction. As rural community has less access to education low literacy has a significant impact on pre-hospital delay after myocardial infarction. So measures should be taken in rural areas through patient education and social awareness program regarding MI symptom and danger of delayed medical attention.

A 21-year analysis of the publication patterns and level of scientific evidence in three major oral and maxillofacial surgery journals.

High-quality research in surgical sciences is constrained by a number of barriers including funding, blinding, adjusting for surgical experience, and inability to recruit sufficient numbers. As a result, surgeons have been reported to accept lower levels of scientific evidence to validate procedures. Our study analysed the quantity and quality of publications in three journals in Oral and Maxillofacial Surgery over a 21-year period. A retrospective analysis of all issues published between 1998 and 2018 in the International Journal of Oral and Maxillofacial Surgery, the British Journal of Oral and Maxillofacial Surgery and the Journal of Oral and Maxillofacial Surgery was conducted. A total of 14,324 articles were analysed and grouped according to their National Health and Medical Research Council of evidence. The analysis revealed that there has been a promising increase in both the quantity and quality of publications with statistically significant increases in each of the variables analysed. We found a statistically significant increase in the number of articles published in the most recent decade compared with the previous decade across the three journals. The level of evidence also increased during the study period, with greater numbers of level I and II studies being published in more recent years. These findings were found to be statistically significant (P˂0.001).

Chronic odontogenic nasal discharge: report of two cases.

Supernumerary teeth are those that form in excess to the normal dental formula and while there is no clear pathogenesis for their formation, they are known to vary in size, morphology, location and presentation. We present two cases of otherwise healthy patients who presented with pain, discomfort and discharge from the nasal passages. CT imaging identified a tooth-like density present in the bone of the nasal floor in both patients. In both cases, the tooth was extracted surgically under anaesthetic. A symptomatic supernumerary in the nasal floor might cause a plethora of symptoms and complications, decreasing the overall quality of life for a patient. Patients who present with a supernumerary tooth in the nasal floor should be further investigated with a simple nasal speculum examination and a CT scan. Their surgical management is simple and brings near immediate relief of symptoms.

Coexistence and Interaction of Spinons and Magnons in an Antiferromagnet with Alternating Antiferromagnetic and Ferromagnetic Quantum Spin Chains.

In conventional quasi-one-dimensional antiferromagnets with quantum spins, magnetic excitations are carried by either magnons or spinons in different energy regimes: they do not coexist independently, nor could they interact with each other. In this Letter, by combining inelastic neutron scattering, quantum Monte Carlo simulations, and random phase approximation calculations, we report the discovery and discuss the physics of the coexistence of magnons and spinons and their interactions in Botallackite-Cu_{2}(OH)_{3}Br. This is a unique quantum antiferromagnet consisting of alternating ferromagnetic and antiferromagnetic spin-1/2 chains with weak interchain couplings. Our study presents a new paradigm where one can study the interaction between two different types of magnetic quasiparticles: magnons and spinons.

Variation in descriptors of patient characteristics in randomized clinical trials of peptic ulcer repair: a systematic review.

BACKGROUND: The ability to compare findings across surgical research is important. Inadequate description of participants, interventions or outcomes could lead to bias and inaccurate assessment of findings. The aim of this study was to assess consistency of description of participants using studies comparing laparoscopic and open repair of peptic ulcer as an example. METHODS: This systematic review is reported in line with the PRISMA checklist. Searches of MEDLINE and Embase databases were performed to identify studies comparing laparoscopic and open repair of perforated peptic ulcer in adults, published in the English language. Manuscripts were dual-screened for eligibility. Full texts were retrieved and dual-screened for inclusion. Data extracted from studies included descriptors of participants in studies from tables and text. Descriptors were categorized into conceptual domains by the research team, and coverage of each domain by study was tabulated. RESULTS: Searches identified 2018 studies. After screening, 37 full texts were retrieved and 23 studies were included in the final synthesis. A total of 76 unique descriptors were identified. These were classified into demographics (11 descriptors), vital signs (9 descriptors), disease-specific characteristics (10 descriptors), presentation and pathway factors (4 descriptors), risk factors (8 descriptors), laboratory tests (14 descriptors) and baseline health (28 descriptors). The number of descriptors in a single study ranged from three to 31. All studies reported at least one demographic descriptor. Laboratory tests was the least frequently described domain. CONCLUSION: Study participants are described inconsistently in studies of a single example surgical condition.

ANTECEDENTES: La capacidad de comparar los hallazgos en la investigación quirúrgica es importante. Una descripción inadecuada de los participantes, las intervenciones o los resultados podría conllevar sesgos y una evaluación incorrecta de los hallazgos. El objetivo de este estudio fue evaluar la consistencia en la descripción de los participantes utilizando los estudios comparativos de la cirugía laparoscópica con la cirugía abierta en el tratamiento de la úlcera péptica, como modelo. MÉTODOS: Esta revisión sistemática se presenta de acuerdo con la lista de verificación PRISMA. Se realizaron búsquedas en las bases de datos MEDLINE y EMBASE para identificar estudios, publicados en inglés, que compararan el tratamiento quirúrgico laparoscópico y abierto de la úlcera péptica perforada en adultos. Los artículos elegibles fueron sometidos a un doble cribaje para su selección. Se recuperaron los textos completos de los artículos y se evaluaron por partida doble para su inclusión. Los datos extraídos correspondían a los términos que describían las poblaciones de estudio en el texto y en las tablas de los artículos. Dichos términos descriptores fueron clasificados por el equipo de investigación en dominios conceptuales, registrándose la cobertura de cada dominio en cada estudio. RESULTADOS: Las búsquedas bibliográficas identificaron 2.018 estudios. Después de la selección, se recuperaron 37 artículos de texto completo y se incluyeron 23 estudios en la síntesis final. Se identificaron un total de 76 descriptores únicos. Dichos descriptores se clasificaron en demográficos (11 variables), signos vitales (9 variables), características específicas de la enfermedad (10 variables), factores de presentación y del proceso (4 variables), factores de riesgo (8 variables), pruebas de laboratorio (14 variables) y estado de salud basal (28 variables). El número de descriptores en un solo estudio varió de 3 a 31. Todos los estudios presentaron al menos un descriptor demográfico. Las pruebas de laboratorio fueron el dominio descrito con menor frecuencia. CONCLUSIÓN: Esta revisión demuestra que los participantes en los estudios se describen de manera inconsistente, tras haber tomado como modelo los estudios de una sola patología quirúrgica.

Salt Intake Behaviors among Type 2 Diabetic Patients of a Tertiary Level Hospital in Dhaka City.

Hypertension and diabetes co-exist frequently. Therefore, salt intake behavior, a risk factor of hypertension, in diabetic patients plays an important role in determining their cardiovascular outcome. The purpose of this study was to assess the knowledge and behaviors of health risks associated with a salt intake in adults with type 2 diabetes. This cross-sectional study was conducted among the type 2 diabetic in-patients of Bangladesh Institute of Health Sciences General Hospital, Dhaka, Bangladesh from October to December 2016. Data were collected from 131 respondents through interview using WHO STEPS module of salt with adaptation to local context like on amount of added salt while taking meal. Information on blood pressure, body mass index and relevant co-morbidities were also collected. About half of the respondents were women (56.5%). Mean age of the respondents was 54.3±14.4 years. More than six in 10 of them (62.6%) took added salt while taking meal; and 40.5% took processed foods with high salt. The mean amount of added salt intake among the users was 4.4±1.6gm per day having no significant difference between men and women. Though 47.3% of the respondents believed that lowering salt in meal is very important and 77.9% of them believed that excess salt or salty sauce can cause health problems. Salt intake behavior is poor in patients with type 2 diabetes even having regular contacts with doctors and other health professionals. Appropriate measures can be taken to increase awareness, change their attitude and behavior regarding salt consumption.