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BACKGROUND: Urinary Incontinence (UI) is a global health issue that mainly affects the female population worldwide. Different approaches have been sought for the management of UI including Pelvic floor muscle training (PFMT) using Virtual Reality (VR) gaming. We conducted this study to evaluate the effectiveness of VR gaming for rehabilitation of pelvic floor muscles (PFM) and improving urinary symptoms in patients with UI. METHOD: We've included studies that contain any type of VR in all geographic locations and settings with no restrictions on the date of publication, age, or gender. Our exclusion criteria include reviews, case series, case reports, unextractable data, unavailable full text, abstract only articles, and studies don't show the effects of VR as a treatment for UI. A pre-specified search term was used and modified according to the requirements of each of the following databases: PubMed, Web of Science, Scopus, Cochrane, Google scholar, and ScienceDirect. For risk of bias assessment, two assessment tools have been used: ROB 2.0 for RCTs and NIH for single arm studies. RESULTS: Of 915 papers identified from 6 databases, 341 papers were assigned for screening after removing duplicates, 11 papers were eligible for full text screening, and 4 papers were finally included. The qualitative analysis of the results identifies six outcomes grouped into three primary categories: PFM, urinary symptoms, and quality of life. Only urinary loss outcome was eligible for meta-analysis. The net effect between Game therapy + PFMT and PFMT reached MD = -5.49, 95% CI [-12.36:1.38] (heterogeneity; I2 = 95%, p < 0.01). CONCLUSION: Our research underscores the potential of VR gaming as a valuable adjunctive therapy for pelvic floor muscle rehabilitation in patients with UI. However, further studies are needed to explore its long-term effectiveness, optimal therapy parameters, and cost-effectiveness. REGISTRATION: Our protocol has been registered in PROSPERO (CRD42022384500).
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Incontinência Urinária , Jogos de Vídeo , Humanos , Incontinência Urinária/reabilitação , Feminino , Diafragma da Pelve , Realidade Virtual , Terapia por Exercício/métodosRESUMO
Allostatic load (AL) is a biological measure of cumulative exposure to socioenvironmental stressors (e.g., poverty). This study aims to examine the association between allostatic load (AL) and postoperative complications (POC) among patients with breast cancer. Females ages 18+ with stage I-III breast cancer who received surgical management between 01/01/2012-12/31/2020 were identified in the Ohio State Cancer registry. The composite AL measure included biomarkers from the cardiovascular, metabolic, immune, and renal systems. High AL was defined as composite scores greater than the cohort's median (2.0). POC within 30 days of surgery were examined. Univariable and multivariable regression analysis examined the association between AL and POC. Among 4459 patients, 8.2% had POC. A higher percentage of patients with POC were unpartnered (POC 44.7% vs no POC 35.5%), government-insured (POC 48.2% vs no POC 38.3%) and had multiple comorbidities (POC 32% vs no POC 20%). Patients who developed POC were more likely to have undergone sentinel lymph node biopsy followed by axillary lymph node dissection (POC 51.2% vs no POC 44.6%). High AL was associated with 29% higher odds of POC (aOR 1.29, 95% CI 1.01-1.63). A one-point increase in AL was associated with 8% higher odds of POC (aOR 1.08, 95% CI 1.02-1.16) and a quartile increase in AL was associated with 13% increased odds of POC (aOR 1.13, 95% CI 1.01-1.26). Among patients undergoing breast cancer surgery, increased exposure to adverse socioenvironmental stressors, operationalized as AL, was associated with higher odds of postoperative complications.
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PURPOSE: This study was designed to characterize features of rapid relapse TNBC (rrTNBC), an aggressive, poor prognosis breast cancer subset using the National Cancer Database (NCDB). METHODS: Patients diagnosed with TNBC between 2010 and 2019 within NCDB were included in analyses. rrTNBC was defined as all-cause mortality ≤24 months from diagnosis. Patient demographic, tumor, and treatment association with rrTNBC were evaluated in univariate, bivariate analyses, and multiple logistic regression models. Two-part models are used to compare receipt of treatment (i.e., receipt of both chemotherapy and breast surgery) versus not in its relationship with rrTNBC. RESULTS: Overall, 14.5% of patients were categorized as rrTNBC. Age older than 75 years (-41.3%), Black race (-1.4%), Medicare (-2.6%), and Charlson-Deyo score ≥2 (-4.9%) were associated with a lower probability of receiving both chemotherapy and breast surgery. Not receiving both treatments (vs. receiving both chemotherapy and breast surgery) was associated with a two-to-three-fold higher probability of rrTNBC among patients aged older than 75 years (16.6% vs. 6%), having Medicare (3.6% vs. 1.6%), and Charlson-Deyo score ≥2 (16.6% vs. 5.9%). CONCLUSIONS: Age, insurance, and comorbidity were related to a lower likelihood of treatment; yet receiving treatment reduced the risk of rrTNBC threefold for each. These findings might be valuable to inform clinical care delivery, as well as future research that examines treatment protocols among diverse patients.
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Bases de Dados Factuais , Recidiva Local de Neoplasia , Neoplasias de Mama Triplo Negativas , Humanos , Feminino , Idoso , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Recidiva Local de Neoplasia/epidemiologia , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Neoplasias de Mama Triplo Negativas/terapia , Neoplasias de Mama Triplo Negativas/patologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Taxa de Sobrevida , Seguimentos , Prognóstico , Mastectomia/estatística & dados numéricos , Fatores de Risco , Medicare/estatística & dados numéricos , Fatores Etários , Idoso de 80 Anos ou mais , AdultoRESUMO
Background: Total hip replacement (THR) is frequently associated with intense post-surgical pain. Effective pain management is of crucial importance to improving patient's condition and increasing his/her satisfaction in the post-operative time. Objectives: This study aimed to compare the analgesic effect and safety of oxycodone and fentanyl after THR. Methods: Seventy-two cases scheduled for elective THR were included in this randomized, triple-blind trial. The patients were equally randomized into 2 groups: Fentanyl group (50 ug of fentanyl) and oxycodone group (oxycodone 4 mg). Drugs were received 20 min prior to the end of the operation. Results: Post-operative visual analog scale (VAS) measurements at rest and movement at the post-anesthesia care unit (PACU) and in the ward, 2 h, 4 h, and 8 h post-operatively exhibited a significantly reduced value in the oxycodone group compared to the fentanyl group (P-value < 0.05). Time to first rescue for analgesia was delayed significantly in the oxycodone compared to the fentanyl group (P-value < 0.001). Fentanyl consumption (ug) in the 1st post-operative 12 h, 24 h, and 48 h decreased significantly in the oxycodone group compared to the fentanyl group (P-value < 0.001). Post-operative nausea, vomiting, headache, and pruritus were matched between the 2 groups (P > 0.05). Conclusions: A bolus dose of 4 mg of oxycodone provided superior analgesic efficacy than 50 ug fentanyl as evidenced by significantly lower pain score, delayed onset to first request for analgesia, and the smaller amount of fentanyl consumption at 12, 24, and 48 h post-total hip arthroplasty compared to fentanyl. The incidence of adverse events was comparable between the 2 groups.
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BACKGROUND AND OBJECTIVES: Given persistent racial disparities in breast cancer outcomes, this study explores racial differences in disease-specific mortality and surgical management among patients with microinvasive ductal carcinoma in situ (DCIS-MI). METHODS: The Surveillance, Epidemiology, and End Results Program was queried for patients aged 18+ years with DCIS-MI between January 1, 2010 and December 31, 2018. The study cohort was divided into non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients. Disease-specific mortality was evaluated using Cox proportional hazards models. RESULTS: A total of 3400 patients were identified, of which 569 (16.7%) were NHB and 2831 (83.3%) were NHW. Compared with NHW patients, NHB patients had more positive lymph nodes (7.6% vs. 3.9% p < 0.001). In addition, NHB women were more likely to undergo axillary lymph node dissection (6.0% vs. 3.8%, p = 0.044) and receive chemotherapy (11.8% vs. 7.2%, p < 0.001). There were no racial differences in breast surgery type (p = 0.168), reconstructive surgery (p = 0.362), or radiation therapy (p = 0.342). Overall, NHB patients had worse disease-specific mortality (adjusted hazard ratio 2.13, 95% confidence interval [CI]: 1.10-4.14) with mortality risks diverging from NHW women after 3 years (6 years rate ratio [RR] 2.12, 95% CI: 1.13-4.34; 9 years RR 2.32, 95% CI: 1.24-4.35). CONCLUSIONS: NHB women with DCIS-MI present with higher nodal disease burden and experience worse disease-specific mortality than NHW women.
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Neoplasias da Mama , Carcinoma Intraductal não Infiltrante , Disparidades em Assistência à Saúde , Programa de SEER , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias da Mama/etnologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/etnologia , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/cirurgia , Seguimentos , Mastectomia/mortalidade , Invasividade Neoplásica , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Brancos/estatística & dados numéricosRESUMO
PURPOSE: Older adults with hematologic malignancies (HM) have unique challenges due to age and fitness. The primary aim of this pilot study was to benchmark the ability of multiple biomarkers of aging (p16, epigenetic clocks, T cell gene expression profiles, and T cell receptor excision circles (TREC) to identify frailty as measured by a clinical impairment index (I2) in patients with HM. METHODS: 70 patients newly diagnosed with HM had peripheral blood T lymphocytes (PBTL) analyzed for p16INK4a expression using the OSU_Senescence Nanostring CodeSet. PBTL epigenetic age was measured using 7 epigenetic clocks, and TREC were quantified by qRT-PCR. A composite clinical impairment index (I2) was generated by combining values from 11 geriatric metrics (Independent Activities of Daily Living (iADL), physical health score, Short Physical Performance Battery (SPPB), Body Mass Index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, self-reported KPS, Blessed Orientation Memory Concentration (BOMC), polypharmacy, Mental Health Inventory (MHI)-17, Medical Outcomes Study (MOS) subscales). Clinical frailty was defined as a score of 7 or greater on the I2. RESULTS: Age-adjusted p16INK4a was similar in newly diagnosed patients and healthy controls (p > 0.1). PBTL p16INK4a levels correlated positively with the Hannum [r = 0.35, 95% CI (0.09-0.75); p adj. = 0.04] and PhenoAge [r = 0.37, 95% CI (0.11-0.59); p adj. = 0.04] epigenetic clocks. The discrimination ability of the I2 model was calculated using the area under the receiver operating characteristic curve (AUC). After adjusting for chronologic age and disease group, baseline p16INK4a [AUC = 0.76, 95% CI (0.56-0.98); p = 0.01], Hannum [AUC = 0.70, 95% CI (0.54-0.85); p = 0.01], PhenoAge [AUC = 0.71, 95% CI (0.55-0.86); p = 0.01], and DunedinPACE [AUC = 0.73, 95% CI (0.57-0.88); p = < 0.01] measures showed the greatest potential to identify clinical frailty using the I2. CONCLUSIONS: Our pilot data suggest that multiple blood-based aging biomarkers have potential to identify frailty in older adults with HM. IMPLICATIONS FOR CANCER SURVIVORS: We developed the I2 index to quantify impairments across geriatric domains and discovered that PBTL p16, Hannum, PhenoAge, and DunedinPACE are promising indicators of frailty in HM.
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Envelhecimento , Inibidor p16 de Quinase Dependente de Ciclina , Fragilidade , Neoplasias Hematológicas , Humanos , Masculino , Feminino , Inibidor p16 de Quinase Dependente de Ciclina/genética , Idoso , Fragilidade/diagnóstico , Projetos Piloto , Neoplasias Hematológicas/terapia , Neoplasias Hematológicas/complicações , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Biomarcadores Tumorais/sangueRESUMO
BACKGROUND: Glucagon-like peptide 2 (GLP-2) is a highly conserved enteroendocrine hormone that seems to be a regulator promoting intestinal adaptation. This study aimed to summarize the evidence on the efficacy and safety of exogenous GLP-2 in patients with short bowel syndrome (SBS). METHODS: A database search was performed on PubMed, Web of Science Core Collection, Scopus, Ovid, and the Cochrane Central Register of Controlled Trials in November 2022. Clinical trials on the effect of GLP-2 on patients with SBS were included. The Cochrane Risk of Bias 2 and Risk Of Bias In Non-randomized Studies - of Interventions tools for quality assessment of randomized and nonrandomized trials were used. The extracted data were analyzed qualitatively and quantitatively using a network meta-analysis model. RESULTS: This study included 23 clinical trials with 843 patients. The patients' ages ranged from 4.0 to 62.4 years. The treatment doses were 0.1, 0.05, and 0.025 mg/kg/day for teduglutide; 5 and 10 mg/week for apraglutide, and 0.1, 1, and 10 mg/day for glepaglutide. The treatment duration ranged from 1 to 32 weeks. Regarding citrulline level, 0.1 mg/kg/day of teduglutide had the highest mean difference (MD; 14.77; 95% CI, 10.20-19.33), followed by 0.05 mg/kg/day (13.04; 95% CI, 9.79-16.2) and 0.025 mg/kg/day (7.84; 95% CI, 2.42-13.26) of teduglutide. In addition, the effect estimate showed significant differences between all teduglutide dose groups and the control group. Different doses of glepaglutide were analyzed to assess the effect on alkaline phosphatase (ALP) levels, in which 0.1 mg/day of glepaglutide showed a significantly higher MD (20.71; 95% CI, 2.62-38.80) than 1 mg/day (the reference) and 10 mg/day (8.45; 95% CI, -10.72 to 27.62) of glepaglutide. However, 0.1 vs 10 mg of glepaglutide has an MD of -14.57 (95% CI, -437.24 to 148.11) for the indirect estimate, whereas 10 mg of glepaglutide has an MD of 8.45 (95% CI, -10.72 to 27.62) for the network estimate. Regarding safety outcomes, there was no significant difference among all teduglutide and apraglutide dose groups compared with the control group. Catheter-related bloodstream infection was the most common adverse event reported with the use of apraglutide, teduglutide, and glepaglutide. CONCLUSION: Despite the small number of patients in the included studies and variable follow-up duration, GLP-2 seems to be safe and effective in patients with SBS. GLP-2 showed a positive effect on increasing plasma citrulline level and decreasing ALP level.
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Peptídeo 2 Semelhante ao Glucagon , Metanálise em Rede , Síndrome do Intestino Curto , Humanos , Síndrome do Intestino Curto/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Resultado do Tratamento , PeptídeosRESUMO
BACKGROUND/AIMS: We examined the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) initiation on long-term Adverse Liver Outcomes (ALO) in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) cirrhosis and type 2 diabetes using real-world data from the MarketScan database. METHODS: We conducted a retrospective cohort study of patients with MASLD cirrhosis and type 2 diabetes between 2012 and 2020. Cox proportional hazard models examine the association between GLP-1RAs initiation, modelled as time-dependent, and the risk of ALO, a composite endpoint defined by the first occurrence of hepatic decompensation(s), portal hypertension, hepatocellular carcinoma (HCC) or liver transplantation (LT). We used Overlap Propensity Score Weighting (OPSW) to account for confounding. The study included 459 GLP-1RAs and 4837 non-GLP-1RAs patients. RESULTS: The non-GLP-1RAs patients presented with 1411 (29%) ALO over 7431.7 person years, while GLP-1RAs patients had 32 (7%) ALO over 586.6 person years - risk rate difference 13.5 (95% CI: 11.4-15.7) per 100 person-years. The OPSW-adjusted risk of ALO was reduced by 36% (hazard ratio [HR]: 0.64; 95% CI: 0.54-0.76) in patients with vs. without GLP-1RAs initiation. GLP-1RAs initiation was associated with significant reductions in the adjusted risk of hepatic decompensation (HR: 0.74; 95% CI: 0.61-0.88), portal hypertension (HR: 0.73; 95% CI: 0.60-0.88), HCC (HR: 0.37; 95% CI: 0.20-0.63) and LT (HR: 0.24; 95% CI: 0.12-0.43). CONCLUSION: The use of GLP-1RAs was associated with significant risk reductions in long-term adverse liver outcomes, including hepatic decompensation, portal hypertension, HCC and LT, in MASLD cirrhosis patients with type 2 diabetes.
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Carcinoma Hepatocelular , Diabetes Mellitus Tipo 2 , Fígado Gorduroso , Hipertensão Portal , Neoplasias Hepáticas , Doenças Metabólicas , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Agonistas do Receptor do Peptídeo 1 Semelhante ao Glucagon , Carcinoma Hepatocelular/complicações , Estudos Retrospectivos , Neoplasias Hepáticas/complicações , Fígado Gorduroso/complicações , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico , Doenças Metabólicas/complicações , Hipertensão Portal/tratamento farmacológico , Hipertensão Portal/complicaçõesRESUMO
BACKGROUND & AIMS: Previous studies have examined the effects of metabolic syndrome (MetS) rather than its severity on race and ethnic disparities in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). We used the MetS severity score, a validated sex-race-ethnicity-specific severity measure, to examine the effects of race/ethnicity on the association between MetS severity and MASLD. METHODS: This study included 10,605 adult participants from the Third National Health and Nutrition Examination Survey. The MASLD diagnosis was based on ultrasound findings in patients without excessive alcohol intake or other liver diseases. MetS severity Z-scores were calculated and stratified into four categories low (1st-50th), moderate (>50th-75th), high (>75th-90th), and very high (>90th+)]. Multivariable adjusted logistic regression models with complex survey methods were used to test the effect of MetS severity on MASLD. RESULTS: The age-adjusted MASLD prevalence was 17.4%, 25.7%, 42.5, and 54.9% in adults with mild, moderate, high, and very high MetS severities, respectively (P-trend <0.001). MetS severity was significantly higher in patients with MASLD than in those without [mean percentile 60th vs. 44th, P<0.001]. Among patients with MASLD, Mexican-American and Black non-Hispanic females had significantly higher age-adjusted MetS severity (68th and 61st, respectively) than White non-Hispanic females 54th, while Black non-Hispanic males had significantly lower MetS severity (56th) than White non-Hispanic males (70th) (P-Interaction = 0.02). Adults with high and very high MetS severity had 2.27 (95% CI:1.70 to 3.03) and 3.12 (95% CI:2.20 to 4.42), respectively, higher adjusted odds of MASLD than those with mild MetS severity. CONCLUSIONS: Racial/ethnic disparities in MetS severity play a pivotal role in the risk of MASLD. Our findings highlight the potential clinical utility of the MetS severity score in identifying at-risk individuals, which will help guide targeted prevention and tailoring management strategies to mitigate the MASLD burden.
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Síndrome Metabólica , Adulto , Feminino , Humanos , Masculino , Negro ou Afro-Americano , Etnicidade , Síndrome Metabólica/epidemiologia , Inquéritos Nutricionais , Brancos , Hispânico ou Latino , Americanos MexicanosRESUMO
Functional Endoscopic Sinus Surgery (FESS) has been performed under controlled hypotension to increase operating field visibility. Intranasal (IN) dexmedetomidine is easy, noninvasive, and possesses lower C max, accompanied by lower pharmacodynamic action, including hypotension, bradycardia, and sedation. This trial aimed to compare IN and intravenous (IV) dexmedetomidine for hypotensive anesthesia during FESS. This randomized, controlled, triple-blinded clinical trial involved sixty cases scheduled for FESS. Patients were divided into two equal groups by random manner. 45-60 min before anesthesia induction, group IN: received 1 µg/kg IN dexmedetomidine diluted in 10 ml of saline 0.9 % intranasally preoperative. Group IV: received 1 µg/kg dexmedetomidine diluted in 10 ml of saline 0.9 % infused over 10 min. The primary outcome was the total amount of administered atropine. The secondary outcomes included hemodynamic, through 1 h before surgery, intraoperatively and postoperatively at different time intervals. The quality of the operative field, sedation, adverse reactions and hemostatic stuffing after FESS were also assessed. The total amount of consumed atropine decreased significantly in group IN compared to group IV. Preoperative Ramsay Sedation scores at T0, T5, T50 and T60 were comparable between the two groups, while at T10, T15, T20, T30, and T40 were lower significantly in the IN group compared with the IV group. Preoperative mean arterial blood pressure at T0, T5 and T60 had comparable differences across both groups while reduced at T10 to T 45 significantly in the IV group than IN group. Both groups had comparable satisfaction, postoperative Ramsey sedation, hemostatic suffering, quality of operative field and complications. In conclusion, IN dexmedetomidine administration is relatively simple and appropriate; moreover, it decreases first-pass metabolism. Onset is prolonged relative to IV dosing; thus, it should be administered nearly 1 h before surgery and recommended in adult patients as they require minor sedation preoperatively.
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PURPOSE: Adverse neighborhood contextual factors may affect breast cancer outcomes through environmental, psychosocial, and biological pathways. The objective of this study is to examine the relationship between allostatic load (AL), neighborhood opportunity, and all-cause mortality among patients with breast cancer. METHODS: Women age 18 years and older with newly diagnosed stage I-III breast cancer who received surgical treatment between January 1, 2012, and December 31, 2020, at a National Cancer Institute Comprehensive Cancer Center were identified. Neighborhood opportunity was operationalized using the 2014-2018 Ohio Opportunity Index (OOI), a composite measure derived from neighborhood level transportation, education, employment, health, housing, crime, and environment. Logistic and Cox regression models tested associations between the OOI, AL, and all-cause mortality. RESULTS: The study cohort included 4,089 patients. Residence in neighborhoods with low OOI was associated with high AL (adjusted odds ratio, 1.21 [95% CI, 1.05 to 1.40]). On adjusted analysis, low OOI was associated with greater risk of all-cause mortality (adjusted hazard ratio [aHR], 1.45 [95% CI, 1.11 to 1.89]). Relative to the highest (99th percentile) level of opportunity, risk of all-cause mortality steeply increased up to the 70th percentile, at which point the rate of increase plateaued. There was no interaction between the composite OOI and AL on all-cause mortality (P = .12). However, there was a higher mortality risk among patients with high AL residing in lower-opportunity environments (aHR, 1.96), but not in higher-opportunity environments (aHR, 1.02; P interaction = .02). CONCLUSION: Lower neighborhood opportunity was associated with higher AL and greater risk of all-cause mortality among patients with breast cancer. Additionally, environmental factors and AL interacted to influence all-cause mortality. Future studies should focus on interventions at the neighborhood and individual level to address socioeconomically based disparities in breast cancer.
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Alostase , Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/mortalidade , Pessoa de Meia-Idade , Alostase/fisiologia , Idoso , Adulto , Características de Residência , Características da VizinhançaRESUMO
BACKGROUND: Allostatic load (AL) is a biological measure of cumulative exposure to socioenvironmental stressors (e.g., poverty). This study aims to examine the association between allostatic load (AL) and postoperative complications (POC) among patients with breast cancer. METHODS: Assigned females at birth ages 18 + with stage I-III breast cancer who received surgical management between 01/01/2012-12/31/2020 were identified in the Ohio State Cancer registry. The composite AL measure included biomarkers from the cardiovascular, metabolic, immune, and renal systems. High AL was defined as composite scores greater than the cohort's median (2.0). POC within 30 days of surgery were examined. Univariable and multivariable regression analysis examined the association between AL and POC. RESULTS: Among 4,459 patients, 8.2% had POC. A higher percentage of patients with POC were unpartnered (POC 44.7% vs no POC 35.5%), government-insured (POC 48.2% vs no POC 38.3%) and had multiple comorbidities (POC 32% vs no POC 20%). Patients who developed POC were more likely to have undergone sentinel lymph node biopsy followed by axillary lymph node dissection (POC 51.2% vs no POC 44.6%). High AL was associated with 29% higher odds of POC (aOR 1.29, 95% CI 1.01-1.63). A one-point increase in AL was associated with 8% higher odds of POC (aOR 1.08, 95% CI 1.02-1.16) and a quartile increase in AL was associated with 13% increased odds of POC (aOR 1.13, 95% CI 1.01-1.26). CONCLUSION: Among patients undergoing breast cancer surgery, increased exposure to adverse socioenvironmental stressors, operationalized as AL, was associated with higher odds of postoperative complications.
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INTRODUCTION: Mpox is a zoonotic viral disease that emerged in May 2022 and has since shown a high prevalence in non-mpox-endemic areas, resulting in an outbreak that caused more than 84,000 cases in 110 countries around the globe. Several vaccines are available to prevent the disease, and multiple studies have been conducted to assess the attitudes of different populations toward receiving the mpox vaccine. This study systematically reviews all the studies conducted on mpox vaccine acceptance/hesitancy among healthcare workers. METHODS: A systematic literature search was conducted through four electronic databases, including PubMed, Scopus, Web of Science, and Google Scholar, up to March 2023. Studies that described mpox vaccine acceptance/hesitancy among healthcare workers were included, and the data were extracted using a uniform extraction sheet. Following the extraction, the meta-analysis included ten studies with 7322 healthcare workers. Three researchers independently assessed the risk of bias in the included study using the Newcastle-Ottawa Scale (NOS). RESULTS: Ten studies were included in the review. This review indicates that the prevalence of mpox vaccine acceptance was 58.5%, and the prevalence of mpox vaccine hesitancy was 41.5%. There was a higher prevalence of acceptance in countries located in Asian and African areas compared to those in North America and Europe, estimated at 68% and 44.3%, respectively. Among the studies conducted solely among physicians, there was a high prevalence of mpox vaccine acceptance, at 77.1%, compared to 49% in studies that included all healthcare workers. CONCLUSION: There is a significant variation in the prevalence of mpox vaccine acceptance among different populations. Further research is needed to identify the factors that contribute to this variation and to develop interventions to increase vaccine acceptance. In addition, it is important to promote research on mpox vaccine acceptance and hesitancy among healthcare workers in countries where data is limited. This research will help policymakers develop effective policies to increase acceptance and reduce the disease burden.
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Mpox , Médicos , Vacina Antivariólica , Humanos , Pessoal de Saúde , ZoonosesRESUMO
BACKGROUND: The objective of this study was to examine the association between racialized economic segregation, allostatic load (AL), and all-cause mortality in patients with breast cancer. PATIENTS AND METHODS: Women aged 18+ years with stage I-III breast cancer diagnosed between 01/01/2012 and 31/12/2020 were identified in the Ohio State University cancer registry. Racialized economic segregation was measured at the census tract level using the index of concentration at the extremes (ICE). AL was calculated with biomarkers from the cardiac, metabolic, immune, and renal systems. High AL was defined as AL greater than the median. Univariable and multivariable regression analyses using restricted cubic splines examined the association between racialized economic segregation, AL, and all-cause mortality. RESULTS: Among 4296 patients, patients residing in neighborhoods with the highest racialized economic segregation (Q1 versus Q4) were more likely to be Black (25% versus 2.1%, p < 0.001) and have triple-negative breast cancer (18.2% versus 11.6%, p < 0.001). High versus low racialized economic segregation was associated with high AL [adjusted odds ratio (aOR) 1.40, 95% confidence interval (CI) 1.21-1.61] and worse all-cause mortality [adjusted hazard ratio (aHR) 1.41, 95% CI 1.08-1.83]. In dose-response analyses, patients in lower segregated neighborhoods (relative to the 95th percentile) had lower odds of high AL, whereas patients in more segregated neighborhoods had a non-linear increase in the odds of high AL. DISCUSSION: Racialized economic segregation is associated with high AL and a greater risk of all-cause mortality in patients with breast cancer. Additional studies are needed to elucidate the causal pathways and mechanisms linking AL, neighborhood factors, and patient outcomes.
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Alostase , Neoplasias de Mama Triplo Negativas , Humanos , Feminino , Características de Residência , Modelos de Riscos Proporcionais , Sistema de RegistrosRESUMO
INTRODUCTION: This study examines the association between hospital volume and all-cause mortality in Black women with triple negative breast cancer (TNBC) who received surgery and chemotherapy. METHODS: Black women ages 18+ with stage I-III TNBC who received both surgery and chemotherapy were identified in the National Cancer Database (NCDB). Hospital volume was determined using the number of annual breast cancer cases divided by the number of years the hospital participated in the NCDB. Hospital annual volume quartiles ranged from Q1 (lowest) to Q4 (highest). Univariable analysis and multivariable logistic regression modeling with restricted cubic splines examined the effect of hospital volume on all-cause mortality. RESULTS: Sixteen thousand five hundred fifty-six patients met the study criteria. All-cause mortality incidence was lower at higher volume compared to lower volume hospitals Q1 24.1% (95% CI: 22.8 to 25.4), Q2 21.8% (95% CI: 20.5 to 23.1), Q3 20.9% (95% CI: 19.6 to 22.1), Q4 19.0% (95% CI: 17.7 to 20.1), p<0.001. On multivariable analysis, treatment at the highest hospital volume quartile was associated with a 21% reduction in the odds of death compared to the lowest quartile [Q4 Vs. Q1, OR=0.79 (95% CI: 0.67 to 0.92)]. For every 100-patient increase in annual volume, all-cause mortality was reduced by 4% [OR=0.96 (95% CI: 0.94 to 0.98)]. There was a significant linear dose-dependent relationship between increasing hospital volume and all-cause mortality. CONCLUSION: Black women treated at high-volume hospitals have lower all-cause mortality than those at low-volume hospitals. Future studies should examine the characteristics of high-volume hospitals associated with improved outcomes.
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Objective: The present cross-sectional study examined the association between circulating levels of sex hormone-binding globulin (SHBG) and testosterone with bone mineral density (BMD) in middle-aged Arab men. Methods: Clinical data of 103 middle-aged Saudi men (mean age 60.7±7.2) were extracted from the Osteoporosis Registry of the Chair for Biomarkers of Chronic Diseases, King Saud University in Riyadh, Saudi Arabia. Participants were categorized according to the presence of osteopenia (T-score -1.0 to -2.5) (N=47) and controls (N=56). Data collected included demographics and anthropometrics as well as levels of sex hormone-binding globulin (SHBG), testosterone and follicle-stimulating hormone (FSH) which were measured using commercially available assays. Free androgen index (FAI) was calculated. Results: Those with osteopenia had significantly lower levels of FAI (p<0.05), and higher levels of SHBG (p<0.004) and FSH (p<0.005). In the osteopenia group, SHBG was positively correlated with age (r=0.33, p<0.05), while it was inversely correlated with BMD spine (r = -0.39, p<0.05) and T-score femur (r= -0.35, p<0.05) in the same group. Furthermore, testosterone was inversely correlated with BMI in the osteopenia group (r= -0.33, p<0.05) while FAI was positively correlated with T-score femur (r = 0.36, p<0.05) as well as in all participants (r= 0.24, p<0.05). Among controls, FAI had an inverse correlation with FSH (r= -0.28, p<0.05) and over-all (r= -0.22, p<0.05). Conclusion: In summary, the associations elicited suggest that circulating levels of SHBG and FAI may be against age-related bone loss in middle-aged men.
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Densidade Óssea , Osteoporose , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Estradiol , Hormônio Foliculoestimulante , Osteoporose/complicações , Arábia Saudita/epidemiologia , Globulina de Ligação a Hormônio Sexual , TestosteronaRESUMO
BACKGROUND: Although SARS-CoV-2 vaccines are generally safe, there are growing concerns about their link to a potentially life-threatening multi-system inflammatory syndrome following vaccination (MIS-V). We conducted this systematic review to elucidate the prevalence of MIS, severity, treatment, and outcomes following SARS-CoV-2 vaccination. METHODS: We searched PubMed, Scopus, ScienceDirect, Google Scholar, Virtual Health Library (VHL), Cochrane Library, and Web of Science databases for articles and case reports about MIS-V. We performed a qualitative analysis of individual cases from the included studies. RESULTS: Of the 1366 studies identified by database search, we retrieved twenty-six case reports and two cohort studies. We analyzed the data of 37 individual cases extracted from 27 articles. The average age of the cases included in this review was 18 (1-67) years, with the most being male (M: F 3.1:1). Of the 37 included cases, the cardiovascular system was the most affected system by MIS (36, 97.3%), followed by the gastrointestinal tract (32, 86.5%). CONCLUSION: MIS after SARS-CoV-2 vaccinations can be fatal, but the incidence is low. Prompt recognition of MIS and ruling out the mimickers are critical in the patient's early recovery.
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BACKGROUND: The American Society of Haematology defines immune thrombocytopenic purpura (ITP) as a common hematologic disorder characterized by a transient or long-term decrease in platelet counts (< 100 × 109/L.), purpura, and haemorrhagic episodes caused by antiplatelet autoantibodies, with the exclusion of other clinical conditions. We aimed to systematically determine the incidence of ITP in adults and children following influenza vaccination, the duration between vaccination and the occurrence of ITP, and to identify predictors of ITP after the vaccine. METHODS: We searched PubMed, Cochrane Library, Google Scholar, Web of Science, Scopus, and Science Direct. We included primary studies that assessed the occurrence of immune thrombocytopenia in individuals who had received any influenza vaccine (primary or booster dose), regardless of the dosage, preparation, time of administration, or age of the participants. We excluded studies that were (a) Narrative, scoping, and umbrella reviews ;(b) studies with no accessible full text, abstract-only studies, or (c) Overlapping or unreliable data. The risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) tool. We categorized studies for qualitative analysis based on study design. Descriptive statistics were used to summarize quantitative data, including the incidence of ITP after influenza vaccination. RESULTS: Out of 729 articles retrieved from the database search, we included 24 studies. All patients identified and included in this systematic review presented with immune thrombocytopenia, determined by their platelet count. The period between vaccination and the occurrence of ITP ranged from (2:35 days). The mean duration was 13.5 days. The analysis revealed a statistically significant incidence rate ratio (IRR) = 1.85,95% CI [1.03-3.32] of ITP occurrence after 42 days. CONCLUSIONS: Influenza-associated ITP is uncommon, self-limiting, non-life-threatening, and curable. None of the patients reported having severe adverse events or death. Further studies are required to confirm the exact incidence of the ITP to better understand the pathophysiology of ITP development post-influenza vaccination.
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Pediatric obesity has become a global pandemic in the last century, contributing to short and long-term medical conditions that heighten the risk of morbidity and mortality in children. The 12-month school-based obesity management educational program aims to assess the effect of adherence to the lifestyle educational program and target outcomes, obesity, and hypertension. A total of 363 (nonadherent, N = 179; adherent, N = 184) Saudi school adolescents aged 12-18 were recruited from 60 schools in Riyadh City, Saudi Arabia. Anthropometrics, lipid profile, and blood glucose were measured at baseline and post-intervention. The level of adherence was based on the number of attended educational sessions, and participants were grouped accordingly into two groups: adherent group (attended ≥ 3 sessions) and nonadherent group (attended 1-2 sessions) out of a total of five sessions. Results demonstrated that significantly more participants in the adherent group achieved the primary program goal of reducing obesity indices [body weight, body mass index (BMI), and BMI z-score] than the nonadherent group. Additionally, among adherent obese participants, BMI z-score significantly decreased after the 12-month intervention (post-intervention: 1.5 ± 0.7 vs. baseline: 1.7 ± 0.6, p < 0.05), while the trend in BMI z-score modestly increased in the nonadherent obese participants post-intervention (post-intervention: 1.8 ± 0.7 vs. baseline: 1.7 ± 0.6, p > 0.05). Moreover, there was a substantial reduction in hypertension prevalence only in the adherent group (p = 0.003) and among adherent obese participants in particular (p = 0.03). Furthermore, adherence to session attendance was higher in girls than boys, which led to better outcomes among girls than boys. For the secondary outcomes, lipid profile indices increased in both groups, while no changes were observed in the glycemic profile. In conclusion, greater adherence to educational sessions achieved modest but favorable weight changes and improved blood pressure among obese adolescents. Future intervention studies should take into consideration the need to improve attendance to enhance adherence to the program among adolescents at risk.