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Agri ; 34(1): 33-37, 2022 Jan.
Article En | MEDLINE | ID: mdl-34988956

OBJECTIVES: In this study, we aimed to compare the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) values of patients with axial spondyloarthritis (ax-SpA) with and without coccydynia. METHODS: We included 42 cases between the ages of 18 to 65 that were admitted to our clinic between August 1, 2019 and April 20, 2020 with the diagnosis of ax-SpA. The first group consisted of 13 patients with coccydynia and the second group consisted of 29 patients without coccydynia. Besides the demographic data Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Functional Index (BASFI), and MASES values of the patients were recorded. RESULTS: We found that 13 (29.5%) of 42 patients with ax-SpA had coccydynia. While the rate of female patients in the coccydynia group was 46.15%, in the group without coccydynia, this rate was 31.03%. The mean of MASES, ASDAS-CRP, and BASFI values of the coccydynia group was statistically significantly higher than the group without coccydynia. We found that the BASFI was the most effective factor affecting the presence of coccydynia. CONCLUSION: Our study supports the increased prevalence of coccydynia in patients with ax-SpA. In this study, we found that the presence of coccydynia may be associated with hypomobility rather than enthesitis.

Spondylitis, Ankylosing , Adolescent , Adult , Aged , Female , Humans , Middle Aged , Prevalence , Severity of Illness Index , Spondylitis, Ankylosing/complications , Young Adult
Trials ; 23(1): 7, 2022 Jan 03.
Article En | MEDLINE | ID: mdl-34980208

BACKGROUND: Excess weight gain in young adulthood is associated with future weight gain and increased risk of chronic disease. Although multimodal, technology-based weight-loss interventions have the potential to promote weight loss among young adults, many interventions have limited personalization, and few have been deployed and evaluated for longer than a year. We aim to assess the effects of a highly personalized, 2-year intervention that uses popular mobile and social technologies to promote weight loss among young adults. METHODS: The Social Mobile Approaches to Reducing Weight (SMART) 2.0 Study is a 24-month parallel-group randomized controlled trial that will include 642 overweight or obese participants, aged 18-35 years, from universities and community colleges in San Diego, CA. All participants receive a wearable activity tracker, connected scale, and corresponding app. Participants randomized to one intervention group receive evidence-based information about weight loss and behavior change techniques via personalized daily text messaging (i.e., SMS/MMS), posts on social media platforms, and online groups. Participants in a second intervention group receive the aforementioned elements in addition to brief, technology-mediated health coaching. Participants in the control group receive a wearable activity tracker, connected scale, and corresponding app alone. The primary outcome is objectively measured weight in kilograms over 24 months. Secondary outcomes include anthropometric measurements; physiological measures; physical activity, diet, sleep, and psychosocial measures; and engagement with intervention modalities. Outcomes are assessed at baseline and 6, 12, 18, and 24 months. Differences between the randomized groups will be analyzed using a mixed model of repeated measures and will be based on the intent-to-treat principle. DISCUSSION: We hypothesize that both SMART 2.0 intervention groups will significantly improve weight loss compared to the control group, and the group receiving health coaching will experience the greatest improvement. We further hypothesize that differences in secondary outcomes will favor the intervention groups. There is a critical need to advance understanding of the effectiveness of multimodal, technology-based weight-loss interventions that have the potential for long-term effects and widespread dissemination among young adults. Our findings should inform the implementation of low-cost and scalable interventions for weight loss and risk-reducing health behaviors. TRIAL REGISTRATION: NCT03907462 . Registered on April 9, 2019.

Mobile Applications , Universities , Adult , Humans , Obesity/diagnosis , Obesity/prevention & control , Overweight , Randomized Controlled Trials as Topic , Weight Gain , Weight Loss , Young Adult
BMC Surg ; 22(1): 4, 2022 Jan 08.
Article En | MEDLINE | ID: mdl-34996420

BACKGROUND: Primary Ewing sarcoma (ES)/peripheral primitive neuroectodermal tumors (pPNETs) are aggressive bone tumors that rarely occur in the axial skeleton, including the cranial bone and mobile spine. The purpose of this study was to investigate whether there were any differences in patient characteristics, treatment strategies, and outcomes between patients with ES/pPNETs of the cranial bone and those with ES/pPNETs of the mobile spine. METHODS: A retrospective study was performed on 33 patients with ES/pPNETs who had been surgically treated and pathologically confirmed at our institution between 2010 and 2020. Patient characteristics were compared using Fisher exact tests or independent t tests. Survival rates were estimated via Kaplan-Meier survival analysis and compared using log-rank tests. RESULTS: Thirteen patients had ES/pPNETs of the cranial bone (39.4%), while 20 patients had ES/pPNETs of the mobile spine (60.6%). Patients with ES/pPNETs of the cranial bone had a younger mean age (14.8 vs 22.6 years; p = 0.047) and longer mean disease duration (2.5 vs 1.9 months; p = 0.008) compared with those of patients with ES/pPNETs of the mobile spine. Kaplan-Meier analysis showed that gross total resection (GTR) and radiotherapy resulted in a longer median survival time. The overall survival rates and progression-free survival rates of patients with ES/pPNETs of the cranial bone versus those of the mobile spine were not significantly different (p = 0.386 and p = 0.368, respectively). CONCLUSIONS: Patients with ES/pPNETs of the cranial bone were younger compared to patients with ES/pPNETs of the mobile spine. There was no significant difference in the prognosis of patients with ES/pPNETs of the cranial bone versus those of the mobile spine. Taken together, our findings suggest that GTR and radiotherapy offer the best prognosis for improved long-term survival.

Bone Neoplasms , Neuroectodermal Tumors, Primitive, Peripheral , Sarcoma, Ewing , Adult , Bone Neoplasms/therapy , Humans , Retrospective Studies , Sarcoma, Ewing/therapy , Skull , Young Adult
Mymensingh Med J ; 31(1): 24-30, 2022 Jan.
Article En | MEDLINE | ID: mdl-34999675

Lymphadenopathy is a common problem encountered in day to day clinical practices in Bangladesh. It is an abnormal increase in size and/or altered consistency of lymph nodes. The condition generally is not a disease itself but a symptom of one of many possible underlying problems. So it is very much essential to achieve a correct diagnosis of patients presenting with lymphadenopathy. This cross sectional study carried out at the Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh over a period of 6 months from January 2014 to June 2014. This study was carried out to evaluate the clinical presentations and to see the ultimate diagnosis by appropriate investigations of lymphadenopathy patients. It is a male predominance study. Metastatic carcinoma (Met. Ca) belonged to relatively higher age group, tuberculosis (TB) and acute leukaemias belonged to younger age group and lymphoma belonged to middle age group. Among 50 cases metastatic carcinoma comprises total 14(28%), lymphoma 13(26%), tuberculosis (TB) 12(24%), acute leukaemia 7(14%), non-specific (Non Sp.) 4(8%) cases. Among lymphoma non Hodgkin's lymphoma (NHL) was 10 (20%) then Hodgkin's disease (HD) was 3(6%) and among acute leukaemia acute lymphoblastic leukaemia (ALL) was 5(10%) and acute myeloblastic leukaemia (AML) was 2(4%) cases. Most of the patients belong to younger age groups, 32% cases were from 18-30 years. Most of the patients had generalized lymphadenopathy. Biopsy of lymph node was done in 60% cases. Fine needle aspiration cytology (FNAC) was done in 24% cases. Bone marrow study (BMD) was done in 14% cases include all cases of leukemia. Among 50 patients correct clinical diagnosis were found 100% cases of ALL and non-specific infection, 80% cases of metastatic carcinoma, 66.66% cases of AML and NHL, 62.5% cases of TB, 50% cases of HD. AML and ALL were diagnosed by bone marrow study. Over all 70% of clinical diagnosis were found correct in this study. In conclusion malignancy, lymphoma and tuberculosis were the most common cause of lymphadenopathy patients. Most of the cases were diagnosed by taking appropriate history and examination but FNAC, biopsy and bone marrow study were need for final diagnosis.

Lymph Nodes , Lymphadenopathy , Adolescent , Adult , Biopsy, Fine-Needle , Cross-Sectional Studies , Humans , Lymphadenopathy/diagnosis , Male , Middle Aged , Tertiary Care Centers , Young Adult
Invest Ophthalmol Vis Sci ; 63(1): 1, 2022 01 03.
Article En | MEDLINE | ID: mdl-34978560

Purpose: The purpose of this study was to investigate trabecular meshwork (TM) and Schlemm's canal (SC) morphology in Posner-Schlossman syndrome (PSS). Methods: Forty-five patients with PSS were recruited. TM thickness and length as well as SC area and diameter of both affected and fellow eyes were assessed using swept-source optical coherence tomography. Results: TM thickness (108.24 ± 28.29 µm vs. 89.36 ± 25.82 µm, P = 0.014), SC area (6010.90 ± 1287.54 µm2 vs. 5445.69 ± 1368.89 µm2, P = 0.003), and SC diameter (239.38 ± 60.17 µm vs. 217.76 ± 60.79 µm, P = 0.010) were significantly greater in the affected eyes. Furthermore, TM thickness (113.32 ± 30.03 µm vs. 89.00 ± 26.99 µm, P = 0.046), SC area (6216.32 ± 1267.87 µm2 vs. 5476.40 ± 1390.15 µm2, P = 0.001), and SC diameter (246.82 ± 64.12 vs. 212.53 ± 64.29 µm, P = 0.001) were significantly greater in the affected eyes than in the fellow eyes in the ocular hypertension (OHT) subgroup (affected eye with intraocular pressure [IOP] > 21 mm Hg). However, those differences were not noted in the ocular normal tension (ONT) subgroup (affected eye with IOP ≤ 21 mm Hg, all P > 0.05). Conclusions: TM edema might play a role in the IOP elevation in PSS. The edematous TM could make controlling IOP of the affected eyes difficult. When TM edema is relieved, IOP of the affected eyes can reduce to normal spontaneously or with IOP-lowing medications.

Limbus Corneae/pathology , Trabecular Meshwork/pathology , Uveitis, Anterior/pathology , Adult , Cross-Sectional Studies , Female , Glaucoma, Open-Angle/pathology , Gonioscopy , Humans , Intraocular Pressure , Male , Middle Aged , Ocular Hypertension/pathology , Organ Size , Slit Lamp Microscopy , Syndrome , Tomography, Optical Coherence , Young Adult
Invest Ophthalmol Vis Sci ; 63(1): 3, 2022 01 03.
Article En | MEDLINE | ID: mdl-34982147

Purpose: Amblyopia is diagnosed as a reduced acuity in an otherwise healthy eye, which indicates that the deficit is not happening in the eye, but in the brain. One suspected mechanism explaining these deficits is an elevated amount of intrinsic blur in the amblyopic visual system compared to healthy observers. This "internally produced blur" can be estimated by the "equivalent intrinsic blur method", which measures blur discrimination thresholds while systematically increasing the external blur in the physical stimulus. Surprisingly, amblyopes do not exhibit elevated intrinsic blur when measured with an edge stimulus. Given the fundamental ways in which they differ, synthetic stimuli, such as edges, are likely to generate contrasting blur perception compared to natural stimuli, such as pictures. Because our visual system is presumably tuned to process natural stimuli, testing artificial stimuli only could result in performances that are not ecologically valid. Methods: We tested this hypothesis by measuring, for the first time, the perception of blur added to natural images in amblyopia and compared discrimination performance for natural images and synthetic edges in healthy and amblyopic groups. Results: Our results demonstrate that patients with amblyopia exhibit higher levels of intrinsic blur than control subjects when tested on natural images. This difference was not observed when using edges. Conclusions: Our results suggest that intrinsic blur is elevated in the visual system representing vision from the amblyopic eye and that distinct statistics of images can generate different blur perception.

Amblyopia/physiopathology , Refractive Errors/physiopathology , Visual Perception/physiology , Adult , Aged , Esotropia/physiopathology , Exotropia/physiopathology , Female , Humans , Male , Middle Aged , Refraction, Ocular/physiology , Sensory Thresholds/physiology , Visual Acuity/physiology , Young Adult
Invest Ophthalmol Vis Sci ; 63(1): 12, 2022 01 03.
Article En | MEDLINE | ID: mdl-34994768

Purpose: The purpose of this study was to investigate the perimetric features and their associations with structural and functional features in patients with RP1L1-associated occult macular dystrophy (OMD; i.e. Miyake disease). Methods: In this international, multicenter, retrospective cohort study, 76 eyes of 38 patients from an East Asian cohort of patients with RP1L1-associated OMD were recruited. Visual field tests were performed using standard automated perimetry, and the patients were classified into three perimetric groups based on the visual field findings: central scotoma, other scotoma (e.g. paracentral scotoma), and no scotoma. The association of the structural and functional findings with the perimetric findings was evaluated. Results: Fifty-four eyes (71.1%) showed central scotoma, 14 (18.4%) had other scotomata, and 8 (10.5%) had no scotoma. Central scotoma was mostly noted in both eyes (96.3%) and within the central 10 degrees (90.7%). Among the three perimetric groups, there were significant differences in visual symptoms, best-corrected visual acuity (BCVA), and structural phenotypes (i.e. severity of photoreceptor changes). The central scotoma group showed worse BCVA often with severe structural abnormalities (96.3%) and a pathogenic variant of p.R45W (72.2%). The multifocal electroretinogram (mfERG) groups largely corresponded with the perimetric groups; however, 8 (10.5%) of 76 eyes showed mfERG abnormalities preceding typical central scotoma. Conclusions: The patterns of scotoma with different clinical severity were first identified in occult macular dystrophy, and central scotoma, a severe pattern, was most frequently observed. These perimetric patterns were associated with the severity of BCVA, structural phenotypes, genotype, and objective functional characteristics which may precede in some cases.

Macular Degeneration/physiopathology , Scotoma/physiopathology , Visual Fields/physiology , Adolescent , Adult , Aged , Aged, 80 and over , Electroretinography , Eye Proteins/genetics , Far East , Female , Genotype , Humans , Macular Degeneration/diagnostic imaging , Macular Degeneration/genetics , Male , Middle Aged , Phenotype , Retrospective Studies , Scotoma/diagnostic imaging , Scotoma/genetics , Tomography, Optical Coherence , Visual Acuity/physiology , Visual Field Tests , Young Adult
Pediatr Ann ; 51(1): e27-e33, 2022 Jan.
Article En | MEDLINE | ID: mdl-35020510

Adolescents and young adults (AYAs) who have cancer face a distinct set of challenges beginning during the initial diagnosis, extending throughout treatment, and continuing into survivorship. Owing to significant strides made in cancer therapy in recent decades, more than 80% of this group will go on to become long-term survivors. Despite these improvements, however, many AYAs continue to have poorer outcomes when compared with older and younger patients. The purpose of this article is to underscore the unique set of multifaceted obstacles that this vulnerable group encounters and to pinpoint critical areas of attention and intervention throughout the health care journey. Moreover, it aims to highlight the importance of the role of the primary care provider as a constant partner in safeguarding the long-term physical and mental health of this diverse population within a complex and, at times, trying health care system. [Pediatr Ann. 2022;51(1):e27-e33.].

Neoplasms , Survivorship , Adolescent , Delivery of Health Care , Humans , Mental Health , Neoplasms/diagnosis , Neoplasms/therapy , Survivors , Young Adult
JAMA Netw Open ; 5(1): e2142210, 2022 01 04.
Article En | MEDLINE | ID: mdl-34994793

Importance: A surge of COVID-19 occurred from March to June 2021, in New Delhi, India, linked to the B.1.617.2 (Delta) variant of SARS-CoV-2. COVID-19 vaccines were rolled out for health care workers (HCWs) starting in January 2021. Objective: To assess the incidence density of reinfection among a cohort of HCWs and estimate the effectiveness of the inactivated whole virion vaccine BBV152 against reinfection. Design, Setting, and Participants: This was a retrospective cohort study among HCWs working at a tertiary care center in New Delhi, India. Exposures: Vaccination with 0, 1, or 2 doses of BBV152. Main Outcomes and Measures: The HCWs were categorized as fully vaccinated (with 2 doses and ≥15 days after the second dose), partially vaccinated (with 1 dose or 2 doses with <15 days after the second dose), or unvaccinated. The incidence density of COVID-19 reinfection per 100 person-years was computed, and events from March 3, 2020, to June 18, 2021, were included for analysis. Unadjusted and adjusted hazard ratios (HRs) were estimated using a Cox proportional hazards model. Estimated vaccine effectiveness (1 - adjusted HR) was reported. Results: Among 15 244 HCWs who participated in the study, 4978 (32.7%) were diagnosed with COVID-19. The mean (SD) age was 36.6 (10.3) years, and 55.0% were male. The reinfection incidence density was 7.26 (95% CI: 6.09-8.66) per 100 person-years (124 HCWs [2.5%], total person follow-up period of 1696 person-years as time at risk). Fully vaccinated HCWs had lower risk of reinfection (HR, 0.14 [95% CI, 0.08-0.23]), symptomatic reinfection (HR, 0.13 [95% CI, 0.07-0.24]), and asymptomatic reinfection (HR, 0.16 [95% CI, 0.05-0.53]) compared with unvaccinated HCWs. Accordingly, among the 3 vaccine categories, reinfection was observed in 60 of 472 (12.7%) of unvaccinated (incidence density, 18.05 per 100 person-years; 95% CI, 14.02-23.25), 39 of 356 (11.0%) of partially vaccinated (incidence density 15.62 per 100 person-years; 95% CI, 11.42-21.38), and 17 of 1089 (1.6%) fully vaccinated (incidence density 2.18 per 100 person-years; 95% CI, 1.35-3.51) HCWs. The estimated effectiveness of BBV152 against reinfection was 86% (95% CI, 77%-92%); symptomatic reinfection, 87% (95% CI, 76%-93%); and asymptomatic reinfection, 84% (95% CI, 47%-95%) among fully vaccinated HCWs. Partial vaccination was not associated with reduced risk of reinfection. Conclusions and Relevance: These findings suggest that BBV152 was associated with protection against both symptomatic and asymptomatic reinfection in HCWs after a complete vaccination schedule, when the predominant circulating variant was B.1.617.2.

COVID-19/epidemiology , Health Personnel , Reinfection , SARS-CoV-2 , Adult , COVID-19/etiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Cohort Studies , Female , Humans , Immunogenicity, Vaccine , India/epidemiology , Male , Middle Aged , Surveys and Questionnaires , Tertiary Care Centers , Vaccines, Inactivated/administration & dosage , Virion/immunology , Young Adult
BMJ Open ; 12(1): e055490, 2022 01 07.
Article En | MEDLINE | ID: mdl-34996797

PURPOSE: Obesity prevention is increasingly focused on early childhood, but toddlers have not been well-studied, and children born preterm are frequently excluded. The Play & Grow Cohort was established to investigate child growth in relation to parent-child interactions in mealtime and non-mealtime settings. PARTICIPANTS: Between December 2017 and May 2019, 300 toddlers and primary caregivers were recruited from records of a large paediatric care provider in Columbus, Ohio, USA. This report describes recruitment of the cohort and outlines the data collection protocols for two toddler and two preschool-age visits. The first study visit coincided with enrolment and occurred when children (57% boys) were a mean (SD) calendar age of 18.2 (0.7) months. FINDINGS TO DATE: Children in the cohort are diverse relative to gestational age at birth (16%, 28-31 completed weeks' gestation; 21%, 32-36 weeks' gestation; 63%, ≥37 weeks' gestation) and race/ethnicity (8%, Hispanic; 35%, non-Hispanic black; 46%, non-Hispanic white). Caregivers enrolled in the cohort are primarily the child's biological mother (93%) and are diverse in age (range 18-54 years), education (23%, high school or less; 20% graduate degree) and annual household income (27%,

COVID-19 , Adolescent , Adult , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Obesity , Ohio , SARS-CoV-2 , Young Adult
J Int Med Res ; 50(1): 3000605211069751, 2022 Jan.
Article En | MEDLINE | ID: mdl-35001697

OBJECTIVE: To present the authors' experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations. METHODS: Data from consecutive patients who underwent electrophysiological study (EPS) for MAP ablation in two tertiary centres, between January 1998 and June 2020, were retrospectively analysed. RESULTS: Of the 55 included patients, 27 (49.1%) were male, and the overall mean age was 29.5 ± 11.6 years (range, 12-66 years). MAPs were ablated at the tricuspid annulus in 43 patients (78.2%), mitral annulus in four patients (7.3%), paraseptal region in three patients (5.5%), and right ventricle mid-apical region in five patients (9.1%). Among 49 patients who planned for ablation therapy, the success rate was 91.8% (45 patients). CONCLUSION: MAPs were most often ablated at the lateral aspect of the tricuspid annuli, sometimes at other sides of the tricuspid and mitral annuli, and infrequently in the right ventricle. The M potential mapping technique is likely to be a useful target for ablation of MAPs.

Catheter Ablation , Pre-Excitation, Mahaim-Type , Adolescent , Adult , Electrocardiography , Heart Ventricles , Humans , Male , Mitral Valve , Pre-Excitation, Mahaim-Type/surgery , Retrospective Studies , Young Adult
BMC Public Health ; 22(1): 6, 2022 01 04.
Article En | MEDLINE | ID: mdl-34983466

BACKGROUND: In the City of Vancouver, Canada, non-profit food hubs such as food banks, neighbourhood houses, community centres, and soup kitchens serve communities that face food insecurity. Food that is available yet inaccessible cannot ensure urban food security. This study seeks to highlight food access challenges, especially in terms of mobility and transportation, faced by users of non-profit food hubs in the City of Vancouver before and during the COVID-19 crisis. METHODS: This study involved an online survey (n = 84) and semi-structured follow-up key informant interviews (n = 10) with individuals at least 19 years old who accessed food at a non-profit food hub located in the City of Vancouver more than once before and during the COVID-19 crisis. RESULTS: 88.5% of survey respondents found food obtained from non-profit food hubs to be either very or somewhat important to their household's overall diet. In their journey to access food at non-profit food hubs in the City of Vancouver, many survey respondents face barriers such as transportation distance/time, transportation inconveniences/reliability/accessibility, transportation costs, line-ups at non-profit food hubs, and schedules of non-profit food hubs. Comments from interview participants corroborate these barriers. CONCLUSIONS: Drawing from the findings, this study recommends that non-profit food hubs maintain a food delivery option and that the local transportation authority provides convenient and reliable paratransit service. Furthermore, this study recommends that the provincial government considers subsidizing transit passes for low-income households, that the provincial and/or federal governments consider bolstering existing government assistance programs, and that the federal government considers implementing a universal basic income. This study emphasizes how the current two-tier food system perpetuates stigma and harms the well-being of marginalized populations in the City of Vancouver in their journey to obtain food.

COVID-19 , Adult , Food Supply , Humans , Reproducibility of Results , SARS-CoV-2 , Surveys and Questionnaires , Transportation , Young Adult
BMC Neurol ; 22(1): 11, 2022 Jan 05.
Article En | MEDLINE | ID: mdl-34986800

BACKGROUND: Myoclonus-dystonia is a rare movement disorder with an autosomal dominant inheritance pattern characterized by a combination of myoclonic jerks and dystonia that may have psychiatric manifestations. Our aim is to present neurologic and psychiatric phenotypic characteristics in the first Filipino bi-ethnic myoclonus-dystonia patient and her father. CASE PRESENTATION: We investigated a Filipino myoclonus-dystonia patient with a positive family history. This 21-year-old woman of mixed Filipino-Greek ethnicity presented with involuntary jerking movements of her upper extremities, head, and trunk. Her symptoms affected her activities of daily living which led her to develop moderate depression, mild to moderate anxiety, and mild obsessive-compulsive disorder (OCD). Her 49-year-old Greek father suffered from adolescence-onset myoclonus-dystonia. CONCLUSION: Genetic testing revealed a novel epsilon-sarcoglycan (SGCE) gene nonsense mutation c.821C > A; p.Ser274* that confirmed our clinical diagnosis. For co-morbid anxiety, depression, and OCD, this patient was given duloxetine, in addition to clonazepam for the myoclonus and dystonia.

Dystonic Disorders , Myoclonus , Activities of Daily Living , Codon, Nonsense , Dystonic Disorders/drug therapy , Dystonic Disorders/genetics , Female , Humans , Male , Middle Aged , Mutation , Myoclonus/complications , Myoclonus/drug therapy , Myoclonus/genetics , Sarcoglycans/genetics , Young Adult
Agri ; 34(1): 23-32, 2022 Jan.
Article En | MEDLINE | ID: mdl-34988957

OBJECTIVES: We aimed to compare the intraoperative and post-operative analgesic activities of the preventive applied serratus anterior plane (SAP) block and infiltration block in patients undergoing video-assisted thoracoscopic surgery (VATS). METHODS: The study was carried out in 60 patients aged between 18 and 80 who were eligible for elective VATS, with the American Society of Anesthesiologists classification I-II, following ethical committee approval and written informed consent form. Patients were divided into two groups as SAP (group serratus anterior plane block [SAPB]) and group infiltration block after routine monitoring and general anesthesia induction by recording demographic data after randomization. Hemodynamic data of all patients were recorded before, after induction and within intraoperative 30 min period. Patient controlled analgesia (PCA) prepared with morphine was applied to all patients postoperatively. Intraoperative hemodynamic data and opioid consumption of patients, resting time, and coughing visual analog scale, time to first PCA dose, post-operative opioid consumption, rescue analgesic requirement, mobilization times, opioid side effects, and patient and surgical team's satisfaction were evaluated. RESULTS: Intraoperative hemodynamic data and opioid consumption were similar between the two groups. Post-operative pain scores (0 and 30 min, 1, 2, 4, 8, and 12 h) were lower in the SAPB group (p<0.005) and time to use the first PCA (p=0.002) was longer in the SAPB group. Post-operative PCA and rescue analgesic requirement were lower in the SAPB group (p=0.002, p=0.00). It was found that the first mobilization time was shorter in the SAPB group (p=0.003), and opioid-related side effects were similar in both groups (p=0.067). Patient and surgical team satisfaction was high in the SAPB group (p=0.004, p=0.000). CONCLUSION: As a result, more effective post-operative analgesia was provided with preventively SAPB, compared to infiltration block in patients undergoing VATS.

Nerve Block , Thoracic Surgery, Video-Assisted , Adolescent , Adult , Aged , Aged, 80 and over , Analgesia, Patient-Controlled , Humans , Middle Aged , Pain, Postoperative/prevention & control , Ultrasonography , Young Adult
BMC Gastroenterol ; 22(1): 13, 2022 Jan 08.
Article En | MEDLINE | ID: mdl-34998372

BACKGROUND: Neuroendocrine tumors (NETs) arise from neuroendocrine cells and are extremely rare in the biliary tract. Currently, there are no guidelines for the diagnosis and treatment of biliary NETs. We presented a case with NETs G1 of the hilar bile duct and the challenges for her treatment. CASE PRESENTATION: A 24-year-old woman was presented to our department with painless jaundice and pruritus, and the preoperative diagnosis was Bismuth type II hilar cholangiocarcinoma. She underwent Roux-en-Y hepaticojejunostomy with excision of the extrahepatic biliary tree and radical lymphadenectomy. Unexpectedly, postoperative pathological and immunohistochemical examination indicated a perihilar bile duct NETs G1 with the microscopic invasion of the resected right hepatic duct. Then the patient received 3 cycles of adjuvant chemotherapy (Gemcitabine and tegafur-gimeracil-oteracil potassium capsule). At present, this patient has been following up for 24 months without recurrence or disease progression. CONCLUSION: We know little of biliary NETs because of its rarity. There are currently no guidelines for the diagnosis and treatment of biliary NETs. We reported a case of perihilar bile duct NETs G1 with R1 resection, as far as we know this is the first report. More information about biliary NETs should be registered.

Bile Duct Neoplasms , Bile Ducts, Extrahepatic , Klatskin Tumor , Neuroendocrine Tumors , Adult , Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic , Female , Humans , Neuroendocrine Tumors/surgery , Young Adult
BMC Med Educ ; 22(1): 23, 2022 Jan 08.
Article En | MEDLINE | ID: mdl-34998393

BACKGROUND AND AIM: Nurses perception and attitude towards an older patient can positively or negatively influence the quality rendered. As students under training, the views of this population needs to be sought and shaped to improve the quality of care the older patients receive. This is because life expectancy is on the rise. The study aimed to explore students' perception of ageing and their attitude towards care of the older adults. METHODS AND MATERIALS: An exploratory descriptive design was used. Data form containing the sociodemographic attributes of the students and a semi-structured interview form developed by the researchers in line with the literature. The participants interviewed were student nurses who had been in clinical practice for at least one semester. Four focus group discussions (FGD) were held. RESULTS: Average age of the participants was 22.30 years. An equal number of males and females (15 each) were recruited to have a balance in gender. Students expressed that they saw the older adults as their grandparents so they try to accord them respect and care. However, older adults are perceived not receptive to nurses in training. The students stated that registered nurses neglected the basic care of older adults such as diaper changes, bathing, and feeding, and would rather beckon student nurses to attend to the older adults. CONCLUSION: Gerontology as a stand-alone course is necessary for early years of training to give an in-depth education to nursing students and instil a positive attitude towards older adult patients.

Education, Nursing, Baccalaureate , Geriatrics , Students, Nursing , Adult , Aged , Attitude of Health Personnel , Female , Focus Groups , Humans , Male , Perception , Young Adult
BMC Health Serv Res ; 22(1): 42, 2022 Jan 08.
Article En | MEDLINE | ID: mdl-34998394

BACKGROUND: The costs associated with the treatment of sickle cell disease (SCD) are understudied in low and middle-income countries (LMIC). We evaluated the cost of treating SCD-related acute complications and the potential cost-savings of hydroxyurea in a specialized hematology center in Brazil. METHODS: The costs (US dollars) of emergency department (ED) and hospitalizations from SCD-related complications between 01.01.2018 and 06.30.2018 were ascertained using absorption and micro-costing approaches. The reasons for acute hospital visits were grouped as: 1) vaso-occlusive (VOC) pain, 2) infection, 3) anemia exacerbation, and 4) chronic organ damage complications. Hydroxyurea adherence was estimated by medication possession ratio (MPR) during the study period. RESULTS: In total, 1144 patients, median age 17 years (range 0-70), 903 (78.9%) with HbSS/HbSß0-thalassemia, 441 (38.5%) prescribed hydroxyurea, visited the ED, of whom 381 (33%) were admitted. VOC accounted for 64% of all ED visits and 60% of all admissions. Anemia exacerbation was the most expensive reason for ED visit ($321.87/visit), while chronic organ damage carried the highest admission cost ($2176.40/visit). Compared with other genotypes, individuals with HbSS/HbSß0-thalassemia were admitted more often (79% versus 21%, p < 0.0001), and their admission costs were higher ($1677.18 versus $1224.47/visit, p = 0.0001). Antibiotics and analgesics accounted for 43% and 42% of the total ED costs, respectively, while housing accounted for 46% of the total admission costs. Costs of ED visits not resulting in admissions were lower among HbSS/HbSß0-thalassemia individuals with hydroxyurea MPR ≥65% compared with visits by patients with MPR <65% ($98.16/visit versus $182.46/visit, p = 0.0007). No difference in admission costs were observed relative to hydroxyurea use. DISCUSSION: In a LMIC hematology-specialized center, VOCs accounted for most acute visits from patients with SCD, but costs were highest due to anemia exacerbation. Analgesics, antibiotics, and housing drove most expenses. Hydroxyurea may reduce ED costs among individuals with HbSS/HbSß0-thalassemia but is dependent on adherence level.

Anemia, Sickle Cell , Adolescent , Adult , Aged , Anemia, Sickle Cell/drug therapy , Anemia, Sickle Cell/epidemiology , Child , Child, Preschool , Costs and Cost Analysis , Emergency Service, Hospital , Hospitalization , Humans , Hydroxyurea/therapeutic use , Infant , Infant, Newborn , Middle Aged , Young Adult
J Int Med Res ; 50(1): 3000605211063027, 2022 Jan.
Article En | MEDLINE | ID: mdl-35001690

OBJECTIVE: Primary mediastinal B-cell lymphoma (PMBCL) lacks standard treatment regimens. This study aimed to identify the disease's clinical features and prognostic factors. METHODS: This retrospective study included 56 patients with PMBCL. Patient demographic details and clinicopathological characteristics were summarized, and their effects on progression-free survival (PFS) and overall survival (OS) were analyzed. RESULTS: The median patient age was 29 years (range, 14-56). Twenty-two patients received DA-EPOCH-R (dose-adjusted etoposide, vincristine, and doxorubicin for 96 hours with bolus doses of cyclophosphamide and oral prednisone, as well as rituximab), and 34 patients received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). Clinical/laboratory parameters, overall response rates, and 5-year PFS and OS rates did not differ between the treatment groups. Kaplan-Meier analysis indicated that late-stage disease and a higher International Prognostic Index (IPI) were associated with shorter PFS and OS. Furthermore, patients with B symptoms and first-line treatment non-responders exhibited worse OS. 18Fluorodeoxyglucose-positron emission tomography/computed tomography quantitative parameters, such as higher metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were corrected with shorter PFS. CONCLUSIONS: This study revealed that stage IV disease, higher IPI, and B symptoms were poor prognostic factors in patients with PMBCL. Significantly, higher MTV and TLG portended worse PFS.

Lymphoma, Large B-Cell, Diffuse , Adolescent , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Fluorodeoxyglucose F18 , Humans , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/drug therapy , Middle Aged , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , Prednisone/therapeutic use , Prognosis , Retrospective Studies , Vincristine/therapeutic use , Young Adult
Evol Psychol ; 20(1): 14747049211067172, 2022.
Article En | MEDLINE | ID: mdl-35014559

This is a brief history of my intellectual life from age 13 to 29 years-and beyond. It encompasses mathematics, US history, and evolutionary biology, especially social theory based on natural selection.

Biological Evolution , Selection, Genetic , Adolescent , Adult , Biology , Humans , Mathematics , Young Adult
Mymensingh Med J ; 31(1): 80-87, 2022 Jan.
Article En | MEDLINE | ID: mdl-34999684

Glomerular disease is one of the most important causes of chronic kidney disease in developing countries like Bangladesh as well as the whole world. The pattern of glomerular disease varies in different countries and can have different clinical presentations. The aim of the study was to analyze the clinical profile and to determine the histological pattern of glomerular diseases in a large tertiary care hospital in Bangladesh. All kidney biopsies performed in Mymensingh Medical College Hospital, Bangladesh from October 2018 to March 2020 were prospectively analyzed in the study. A total of 101 patients with kidney biopsy were examined by clinical and laboratory findings and by light and immuno-fluorescence microscopy. The mean age was 30.0±14.6 years and 50(49.5%) were male and 51(50.5%) were female with a male to female ratio of 1:1. The clinical syndromes namely nephrotic syndrome, nephritic syndrome, nephrito-nephrotic presentation, RPGN like presentation, macroscopic haematuria and asymptomatic urine abnormality were present in 31.7%, 34.5%, 22.8%, 11.9%, 19.8% and 10.9% patients respectively. The most common histological varieties found in the study were mesangial proliferative glomerulonephritis (MesPGN) (18.8%) and focal segmental glomerulosclerosis (FSGS) (18.8%). Other histopathological pattern among the studied subjects revealed minimal change disease (MCD) in 5.9%, membranous nephropathy (MN) in 7.9%, membranoproliferative glomerulonephritis (MPGN) in 16.8%, IgA nephropathy in 5%, IgM nephropathy in 2%, IgG nephropathy in 2%, diffuse proliferative glomerulonephritis (DPGN) in 1%, focal proliferative glomerulo-nephritis (FPGN) in 3%, crescentic GN in 3%, lupus nephritis (LN) in 13.9%, amyloidosis in 1% and fibrillary glomerulopathy in 1% patient. The pattern of glomerular disease found in this study was similar to other studies performed in Bangladesh with a little variation. It may guide the future researchers to establish a national kidney biopsy registry in Bangladesh.

Renal Insufficiency, Chronic , Adolescent , Adult , Bangladesh/epidemiology , Biopsy , Female , Humans , Kidney , Male , Retrospective Studies , Tertiary Care Centers , Young Adult