Breast cancer treatment and survival differences in women in remote and socioeconomically disadvantaged areas, as demonstrated by linked data from New South Wales (NSW), Australia.

INTRODUCTION: Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. METHODS: A retrospective cohort study used linked data for invasive breast cancers, diagnosed in May 2002 to December 2015 from the NSW Cancer Registry, with corresponding inpatient, and medical and pharmaceutical insurance data. Associations between treatment modalities, area socioeconomic status and residential remoteness were explored using logistic regression. Predictors of breast cancer survival were investigated using Kaplan-Meier product-limit estimates and multivariate competing risk regression. RESULTS: Results indicated a high 5-year disease-specific survival in NSW of 90%. Crude survival was equivalent by residential remoteness and marginally lower in lower socioeconomic areas. Competing risk regression showed equivalent outcomes by area socioeconomic status, except for the least disadvantaged quintile, which showed a higher survival. Higher sub-hazard ratios for death occurred for women with breast cancer aged 70 + years, and more advanced stage. Adjusted analyses indicated more advanced stage in lower socioeconomic areas, with less breast reconstruction and radiotherapy, and marginally less hormone therapy for women from these areas. Conversely, among these women who had breast conserving surgery, there was higher use of chemotherapy. Remoteness of residence was associated in adjusted analyses with less radiotherapy and less immediate breast reconstruction. In these short term data, remoteness of residence was not associated with lower survival. CONCLUSION: This study provides benchmarks for monitoring future variations in treatment and survival.

P53 IHC Result as a Prognostic Tool in MDS.

Background & Objective: Some of the patients with myelodysplastic syndrome (MDS) are categorized as good prognosis based on the Revised International Prognostic Scoring System (IPSS-R). However, these patients may have poor clinical outcomes. It seems that the current diagnostic tools and IPSS-R cannot consider genetic factors for determining the prognosis of MDS patients. Methods: This cross-sectional study included all adult MDS patients of both genders who were admitted from March 2015 to March 2020 to the Hematology wards of two educational tertiary hospitals in Iran (Namazi and Faghihi, affiliated with Shiraz University of medical sciences). Study data included relevant retrospective data from medical records and the results of immunohistochemical p53 staining on bone marrow biopsies. Results: Of the 84 patients, 65 (77.4%) showed p53 expression in bone marrow. They had shorter median survival than those without p53 expression. Considering both variables of P53 IHC results and IPSS-R score, the patients who died with low-risk IPSS-R score presented high p53 expression. Conclusion: This study shows that the investigation of p53 expression by IHC at the time of diagnosis is a valuable indicator of survival rate in MDS patients. These data suggest that the immunohistochemical analysis of p53 can be a prognostic tool for MDS and should be used as an adjunct test to make decisions on the best therapeutic choice.

Significant Correlation between High-Risk HPV DNA in Semen and Impairment of Sperm Quality in Infertile Men.

BACKGROUND: Human papillomavirus (HPV) is a DNA virus that causes sexually transmitted infections (STI). Recent reports suggest that HPV may affect sperm parameters and lead to male infertility. This study aims to evaluate the correlation between seminal high-risk HPV infection and impairment of sperm quality in infertile Iranian men. MATERIALS AND METHODS: In this case-control study, we collected fresh semen samples from 70 fertile men and 70 confirmed infertile men who referred to Yazd Infertility Centre in 2015. Semen analyses were performed according to the World Health Organization (WHO) guidelines. High-risk HPV DNA was detected by real-time polymerase chain reaction (PCR). RESULTS: A total of 140 subjects participated in the current study. Among 70 confirmed infertile males, only 8 (11.43%) cases tested positive for high-risk HPV and all fertile men were HPV-negative. This data revealed a significant association between high-risk HPV and male infertility (P=0.03). The percentage of normal sperm morphology and sperm motility rate significantly declined in men infected with HPV (P<0.001). CONCLUSION: There was a significantly higher prevalence of high-risk HPV in infertile men than fertile men. HPV infection seemed to be a risk factor for male infertility. Additional, larger studies should be conducted to confirm the impact of HPV on male infertility.

Lobular Capillary Hemangioma of the Ethmoid Sinus: A Report of Two Cases.

Soft-tissue tumors are rare in the paranasal region. Lobular capillary hemangioma (LCH) is a distinctive vascular lesion most commonly seen on the skin and oral mucosa in the fourth and fifth decades of life. Forasmuch as the nasal cavity and paranasal sinuses are rare locations for LCH, it is not well known by many ENT surgeons. Here we present two cases of LCH of the ethmoid sinus. These cases are being reported owing to their scarcity as per the literature published global.

Occupational stress among medical residents in educational hospitals.

BACKGROUND: Occupational stress and its related psychological strain is a concern among resident doctors that may affect patient care adversely. Residents face many stresses because of their high job demands in delivery of hospital care. They are often subject to work load and pressure due to direct involvement with patients, prolonged working hours, poor job opportunities and low support. Their multiple educational and clinical roles can also affect their performance and quality of personal or professional life. The aim of this study was to evaluate the occupational stress among residents of various medical specialties.We aimed to explore the reasons of occupational stress in residents' life and determine how we can enhance the stress-coping strategies and create more suitable conditions. METHODS: This cross-sectional analytical-descriptive study was conducted on all medical residents with various specialties in Shiraz University of Medical Sciences. Data was collected using Osipow occupational stress questionnaire and analyzed by SPSS software version 17. RESULTS: The response rate was 88.8%. The average stress score of all residents was 156.35 out of 250. The highest and lowest average stress scores belonged to gynecology and dermatology specialties, respectively. The highest average score of the stress factors was related to the workload with the score of 35.09 of 50 (moderate to severe stress). The total stress score had a significant relationship with age (P = 0.030) and sex (P = 0.009) as well as lack of time to get the needed healthy meals (P = 0.047), high work hours (P < 0.01), surgical specialties (P < 0.01) and on call shift (P < 0.01). CONCLUSION: Since most of the stressors were related to the workload, interventions such workload reduction, education about occupational stress and its management, promoting interpersonal relations and more supportive measures are recommended.

Using prediction to improve elective surgery scheduling.

BACKGROUND: An ageing population and higher rates of chronic disease increase the demand on health services. The Australian Institute of Health and Welfare reports a 3.6% per year increase in total elective surgery admissions over the past four years.1 The newly introduced National Elective Surgery Target (NEST) stresses the need for efficiency and necessitates the development of improved planning and scheduling systems in hospitals. AIMS: To provide an overview of the challenges of elective surgery scheduling and develop a prediction based methodology to drive optimal management of scheduling processes. METHOD: Our proposed two stage methodology initially employs historic utilisation data and current waiting list information to manage case mix distribution. A novel algorithm uses current and past perioperative information to accurately predict surgery duration. A NEST-compliance guided optimisation algorithm is then used to drive allocation of patients to the theatre schedule. RESULTS: It is expected that the resulting improvement in scheduling processes will lead to more efficient use of surgical suites, higher productivity, and lower labour costs, and ultimately improve patient outcomes. CONCLUSION: Accurate prediction of workload and surgery duration, retrospective and current waitlist as well as perioperative information, and NEST-compliance driven allocation of patients are employed by our proposed methodology in order to deliver further improvement to hospital operating facilities.

Synthesis and antimycobacterial activity of some alkyl [5-(nitroaryl)-1,3,4-thiadiazol-2-ylthio]propionates.

Two series of 2- and 3-[5-(nitroaryl)-1,3,4-thiadiazol-2-ylthio, sulfinyl and sulfonyl] propionic acid alkyl esters were synthesized and screened for antituberculosis activity against Mycobacterium tuberculosis H37Rv using the BACTEC 460 radiometric system. The MIC values for the compounds showing more than 90% inhibition were determined. The result of comparison between two groups of data exhibited that among the synthesized derivatives, the compound propyl 3-[5-(5-nitrothiophen-2-yl)-1,3,4-thiadiazol-2-ylthio]propionate was the most active one (MIC=1.56 microgml(-1)).