Is preoperative physical function testing predictive of length of stay in patients with colorectal cancer? A retrospective study.

Surgery is the primary treatment for colorectal cancer. A prolonged Length of Stay (pLOS) can increase risk of complications and physical inactivity, leading to a decline in physical function. While promising results were seen from preoperative exercise training and post-operative functional recovery, the predictive potential of preoperative physical function has not yet been investigated. The objective of this study is to determine if preoperative physical function can predict pLOS in patients with colorectal cancer. A total of 459 patients from 7 cohorts were analyzed. Logistic regression was used to determine risk of pLOS (>3 days), and ROC curve was plotted to establish sensitivity/specificity. Selected variables included age, sex, BMI, comorbidity, ASA status, tumor site, surgical approach, handgrip strength, Timed-Up and Go, 30-s Sit-to-Stand, 30-s Arm Curl Test, 6-Minute-Walking Test (6MWT), CHAMPS Physical Activity Questionnaire for Older Adult and the 36-Item Short Form Survey. The results showed that patients with rectal tumor are 2.7x more at risk to be in the pLOS group compared to those with colon tumor (O.R. 2.7; C.I. 1.3-5.7, p=0.01). For every increment of 20 m in 6MWT, there is a decreased risk of 9% of being in pLOS group (C.I. 1.03-1.17, p=0.00). A cut-off of 431 m can predict 70% of patients in pLOS group (AUC 0.71 C.I 0.63-0.78, p=0.00). Tumor site (rectal) and 6MWT were significant predictors of pLOS. Using the 6MWT as a screening tool for pLOS with cut-off of 431 m should be implemented in the preoperative surgical pathway.

The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries.

BACKGROUND: The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes. OBJECTIVE: We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses. METHODS: We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker. RESULTS: For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: -5.1%, -1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning. CONCLUSIONS: Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.

Implant Therapy in the Rehabilitation of Treated Mandibular Arteriovenous Malformations.

Mandibular arteriovenous malformations are rare congenital malformations that require multidisciplinary care. Implant-supported rehabilitation of significant bone defect after embolization and resection is poorly described in the literature. We present the case of a 24-year-old patient with a right-sided mandibular arteriovenous malformation diagnosed after massive hemorrhage and treated by embolization and resection surgery. Implant rehabilitation was carried out 9 years later with a prior bone graft through iliac extraction and 3 short implants. Implant survival rate and patient satisfaction were evaluated at 3 years postplacement. Arteriovenous malformations treatments frequently result in bone defects that are difficult to reconstruct because of probable unstable vascularization due to embolization. The presence of osteosynthesis material and artifacts at the radiological level complicates implant planning due to the lack of visualization of the inferior alveolar nerve or artery and necessitates the placement of low-height implants. Osteointegration in contact with embolization products should be monitored. The creation of a case series could be of interest in order to better understand implant treatment for patients with a history of arteriovenous malformations.

Childhood immunization during the COVID-19 pandemic: experiences in Haiti, Lesotho, Liberia and Malawi.

OBJECTIVE: To examine changes in vaccination of children younger than 1 year during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-August 2021) in Haiti, Lesotho, Liberia and Malawi. METHODS: We used data from health management information systems on vaccination of children aged 12 months or younger in districts supported by Partners In Health. We used data from January 2016 to February 2020 and a linear model with negative binomial distribution to estimate the expected immunization counts for March 2020-August 2021 with 95% prediction intervals, assuming no pandemic. We compared these expected levels with observed values and estimated the immunization deficits or excesses during the pandemic months. FINDINGS: Baseline vaccination counts varied substantially by country, with Lesotho having the lowest count and Haiti the highest. We observed declines in vaccination administration early in the COVID-19 pandemic in Haiti, Lesotho and Liberia. Continued declines largely corresponded to high rates of COVID-19 infection and discrete stock-outs. By August 2021, vaccination levels had returned to close to or above expected levels in Haiti, Liberia and Lesotho; in Malawi levels remained below expected. CONCLUSION: Patterns of childhood immunization coverage varied by country over the course of the pandemic, with significantly lower than expected vaccination levels seen in one country during subsequent COVID-19 waves. Governments and health-care stakeholders should monitor vaccine coverage closely and consider interventions, such as community outreach, to avoid or combat the disruptions in childhood vaccination.

Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries.

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

Childhood immunization during the COVID-19 pandemic: experiences in Haiti, Lesotho, Liberia and Malawi

Objective: To examine changes in vaccination of children younger than 1 year during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-August 2021) in Haiti, Lesotho, Liberia and Malawi. Methods: We used data from health management information systems on vaccination of children aged 12 months or younger in districts supported by Partners In Health. We used data from January 2016 to February 2020 and a linear model with negative binomial distribution to estimate the expected immunization counts for March 2020-August 2021 with 95% prediction intervals, assuming no pandemic. We compared these expected levels with observed values and estimated the immunization deficits or excesses during the pandemic months. Findings: Baseline vaccination counts varied substantially by country, with Lesotho having the lowest count and Haiti the highest. We observed declines in vaccination administration early in the COVID-19 pandemic in Haiti, Lesotho and Liberia. Continued declines largely corresponded to high rates of COVID-19 infection and discrete stock-outs. By August 2021, vaccination levels had returned to close to or above expected levels in Haiti, Liberia and Lesotho; in Malawi levels remained below expected. Conclusion: Patterns of childhood immunization coverage varied by country over the course of the pandemic, with significantly lower than expected vaccination levels seen in one country during subsequent COVID-19 waves. Governments and health-care stakeholders should monitor vaccine coverage closely and consider interventions, such as community outreach, to avoid or combat the disruptions in childhood vaccination.

Early maternal loss leads to short- but not long-term effects on diurnal cortisol slopes in wild chimpanzees.

The biological embedding model (BEM) suggests that fitness costs of maternal loss arise when early-life experience embeds long-term alterations to hypothalamic-pituitary-adrenal (HPA) axis activity. Alternatively, the adaptive calibration model (ACM) regards physiological changes during ontogeny as short-term adaptations. Both models have been tested in humans but rarely in wild, long-lived animals. We assessed whether, as in humans, maternal loss had short- and long-term impacts on orphan wild chimpanzee urinary cortisol levels and diurnal urinary cortisol slopes, both indicative of HPA axis functioning. Immature chimpanzees recently orphaned and/or orphaned early in life had diurnal cortisol slopes reflecting heightened activation of the HPA axis. However, these effects appeared short-term, with no consistent differences between orphan and non-orphan cortisol profiles in mature males, suggesting stronger support for the ACM than the BEM in wild chimpanzees. Compensatory mechanisms, such as adoption, may buffer against certain physiological effects of maternal loss in this species.

Syndromic surveillance using monthly aggregate health systems information data: methods with application to COVID-19 in Liberia.

BACKGROUND: Early detection of SARS-CoV-2 circulation is imperative to inform local public health response. However, it has been hindered by limited access to SARS-CoV-2 diagnostic tests and testing infrastructure. In regions with limited testing capacity, routinely collected health data might be leveraged to identify geographical locales experiencing higher than expected rates of COVID-19-associated symptoms for more specific testing activities. METHODS: We developed syndromic surveillance tools to analyse aggregated health facility data on COVID-19-related indicators in seven low- and middle-income countries (LMICs), including Liberia. We used time series models to estimate the expected monthly counts and 95% prediction intervals based on 4 years of previous data. Here, we detail and provide resources for our data preparation procedures, modelling approach and data visualisation tools with application to Liberia. RESULTS: To demonstrate the utility of these methods, we present syndromic surveillance results for acute respiratory infections (ARI) at health facilities in Liberia during the initial months of the COVID-19 pandemic (January through August 2020). For each month, we estimated the deviation between the expected and observed number of ARI cases for 325 health facilities and 15 counties to identify potential areas of SARS-CoV-2 circulation. CONCLUSIONS: Syndromic surveillance can be used to monitor health facility catchment areas for spikes in specific symptoms which may indicate SARS-CoV-2 circulation. The developed methods coupled with the existing infrastructure for routine health data systems can be leveraged to monitor a variety of indicators and other infectious diseases with epidemic potential.

Postural stability limits in manifest and premanifest Huntington's disease under different sensory conditions.

Increasing evidence indicates that Huntington's disease (HD) produces postural control impairments even before the clinical diagnosis. It has been suggested that postural disorders of HD patients are explained by deficits in the processing and integration of sensory information, but this hypothesis has been under-explored. In the present study, we evaluated the amplitude of the center of pressure (COP) displacement during maximum leaning in four directions (forward, backward, rightward and leftward) and under three sensory conditions (eyes open, eyes closed and eyes closed standing on foam). We assessed the stability limits in 20 individuals with a positive HD genetic test (12 premanifests; eight manifests HD) and 15 healthy controls. The COP displacements were analyzed during the first and second phases of maintenance of the maximum leaning position. Manifest HD patients showed significantly greater COP ranges than healthy controls in both learning phases and all sensory conditions, but the greatest deterioration of their performance was found in the foam condition. In contrast, premanifest HD patients displayed larger COP ranges than controls only during the second phase of maximum learning, especially in the foam condition. Furthermore, both HD groups had significantly smaller limits of stability than healthy subjects during the second phase of maximum learning. However, their ability to maintain the maximum leaning position was degraded during both learning phases. Together, these findings demonstrate that HD reduces the limits of stability even before the clinical disease onset. Furthermore, our results indicate that dynamic postural tasks with high demand for sensorimotor integration and especially the use of proprioception are highly sensitive to early HD disease processes. This dynamic postural task may become a useful biomarker of HD progression.

Major improvements in health-related quality of life during the use of etanercept in patients with previously refractory juvenile idiopathic arthritis.

OBJECTIVE: To evaluate changes in health-related quality of life (HRQoL) in patients with refractory juvenile idiopathic arthritis (JIA) who are being treated with etanercept. METHODS: 53 patients with JIA from seven Dutch centres were included. HRQoL was measured by the Childhood Health Assessment Questionnaire (CHAQ), Child Health Questionnaire (CHQ) and Health Utilities Index mark 3 (HUI3) at the start and after 3, 15 and 27 months of treatment. At the same time points the following JIA disease activity variables were collected; physician's global assessment through the visual analogue scale (VAS), number of active and limited joints and erythrocyte sedimentation rate. A statistical method linear mixed models was used to assess outcomes over time. RESULTS: During etanercept treatment both disease-specific and generic HRQoL outcomes improved dramatically. Significant improvements were shown after 3 months and these improvements continued at least up to 27 months of treatment. The disease-specific CHAQ, including VAS pain and wellbeing, showed a significant improvement in all domains. The generic health-profile measure CHQ improved for all the health concepts except for "family cohesion", which was normal. The generic preference-based HUI3 showed impairment and, subsequently, significant improvement in the more specific domains ("pain", "ambulatory", "dexterity"). In accordance disease activity variables also improved significantly over time. CONCLUSION: This study shows that the HRQoL of patients with refractory JIA can be substantially improved by the use of etanercept for all aspects impaired by JIA. Information on HRQoL is crucial to understand the complete impact of etanercept treatment on patients with JIA and their families.

Long-term follow-up on effectiveness and safety of etanercept in juvenile idiopathic arthritis: the Dutch national register.

OBJECTIVE: We undertook an observational study to obtain a complete overview of the long-term effectiveness and safety of etanercept in patients with different juvenile idiopathic arthritis (JIA) subtypes. METHODS: At baseline we collected patient and disease characteristics of all Dutch patients with JIA who started treatment with etanercept. Disease activity was evaluated (at start of the study, after 3 months and then yearly) according to the JIA core set of the American College of Rheumatology paediatric definition for 30, 50 and 70% improvement (ACR Pedi 30, 50 and 70). Use of etanercept and concomitant drugs was monitored. Adverse events were recorded. RESULTS: We included 146 patients with JIA with a median follow-up of 2.5 years per patient (range 0.3-7.3). JIA subtypes represented: 27% systemic, 8% polyarticular rheumatoid factor positive, 38% polyarticular rheumatoid factor negative, 19% oligoarticular extended, 3% enthesitis-related and 5% psoriatica. Most patients (77%) met the criteria of the ACR Pedi 30 in the first 3 months of treatment. For the majority of patients this improvement was sustained; 53 (36%) of all patients met the remission criteria. No other second-line agents were needed in 43 patients. Although patients with systemic JIA responded initially less to etanercept therapy than patients from other subtypes, those who did respond showed equal effectiveness in the long term. Serious adverse events rate was low (0.029 per patient year). CONCLUSIONS: Etanercept is effective and safe in JIA, even for a large proportion of the patients with systemic JIA. The greatest improvement occurred in the first 3 months of treatment, and was sustained for a long time in most patients (up to 75 months).

Development of a web-based register for the Dutch national study on biologicals in JIA: www.ABC-register.nl.

OBJECTIVES: Most clinical studies use paper case record forms (CRFs) to collect data. In the Dutch multi-centre observational study on biologicals we encountered several disadvantages of using the paper CRFs. These are delay in data collection, lack of overview in collected data and difficulties in obtaining up-to-date interim reports. Therefore, we wanted to create a more effective method of data collection compared with CRFs on paper in a multi-centre study. METHODS: We designed a web-based register with the intention to make it easy to use for participating physicians and at the same time accurate and up-to-date. Security demands were taken into account to secure the safety of the patient data. RESULTS: The web-based register was tested with data from 161 juvenile idiopathic arthritis patients from nine different centres. Internal validity was obtained and user-friendliness guaranteed. To secure the completeness of the data automatically generated e-mail alerts were implemented into the web-based register. More transparency of data was achieved by including the option to automatically generate interim reports of data in the web-based register. The safety was tested and approved. CONCLUSIONS: By digitalizing the CRF we achieved our aim to provide easy, rapid and safe access to the database and contributed to a new way of data collection. Although the web-based register was designed for the current multi-centre observational study, this type of instrument can also be applied to other types of studies. We expect that especially collaborative study groups will find it an efficient tool to collect data.

Synthesis and in vitro antibacterial activity of new steroidal thiosemicarbazone derivatives.

We investigated the antibacterial activity of some new steroidal thiosemicarbazone derivatives, prepared from the reaction of cholest-5-en-7-one with thiosemicarbazides, in ethanol in the presence of a few drops of HCl at 80 degrees C in high yield. All the compounds have been characterized by means of elemental analyses, IR, 1H NMR and mass spectroscopic data, to find an effective antibacterial agent. The antibacterial activity was first tested in vitro by the disk diffusion assay against two Gram-positive and two Gram-negative bacteria, and then the minimum inhibitory concentration (MIC) of compounds was determined. The results showed that the steroidal thiosemicarbazones derivatives inhibit growth of both types of the bacteria (Gram-positive and Gram-negative). The acetoxy and chloro derivatives of cyclopentyl and cyclohexyl amine thiosemicarbazones were found to have more antibacterial activity than the other derivatives.

Differences in the coordination of agonist and antagonist muscle groups in below-knee amputee and able-bodied children during dynamic exercise.

A lack of co-contraction may predispose to knee instability or laxity, resulting in additional shear stress on the internal structures of the knee, especially in below-knee amputee (BKA) subjects. The purposes of this study were: (1) to provide information on how BKA children regulate agonist and antagonist muscle coordination, and (2) to quantify the level of knee co-contraction in able-bodied (AB) and BKA children during the stepping-in-place (SIP) task. Fourteen children (7 BKA vs. 7 AB), paired for age, weight and height, participated in this study. One-way ANOVA with Newman-Keuls post hoc tests (p<0.05) were used to compare peak power, the co-contraction index, and the resultant agonist and antagonist moments during different phases of SIP. Statistical analysis revealed that BKA children perform the task with similar kinematics than AB children while they generated less co-contraction in both their non-amputated limb and amputated limb, notably because the two groups of children used different agonist and antagonist muscles during the same periods of the SIP. This lack of co-contraction may reduce knee stability and may stress the internal structures of the knee in both the NAL and AL, and may lead to the development of premature knee osteoarthritis.

Muscle adaptation patterns of children with a trans-tibial amputation during walking.

BACKGROUND: Many studies have shown that trans-tibial amputation involves modifications of resultant muscle patterns during gait. However, these experiments did not estimate the contribution of simultaneous agonist and antagonist muscle action (co-contraction) during gait tasks. Diminution of co-contraction could create joint instability and, thus, change joint integrity, which is particularly important in the etiology of degenerative diseases, such as osteoarthritis, present at the knees of amputated limbs, and particularly in non-amputated limbs. The purpose of this study was to determine if there is any difference in the production of co-contraction about the knee between able-bodied children and children with a trans-tibial amputation during gait. METHODS: Six children with a trans-tibial amputation vs. six able-bodied children paired for gender, age, weight and height participated in this study. Four one-way ANOVAs (P<0.05) were used to observe differences in resultant, agonist and antagonist moments, power, and co-contraction index during different phases of gait between able-bodied children limbs, the amputated and the non-amputated limbs of children with trans-tibial amputation. FINDINGS: Children with a trans-tibial amputation modified muscle patterns at their amputated limb and produced smaller co-contraction (P<0.05) during single limb support, for both the non-amputated and amputated limbs when compared to able-bodied children. INTERPRETATION: These results suggest that children with a trans-tibial amputation altered their muscle patterns to perform locomotion. These changes produced a diminution of co-contraction during single limb support for both the amputated and non-amputated limbs and, thus, could create joint instability.

Postural control following a self-initiated reaching task in type 2 diabetic patients and age-matched controls.

Although the postural stability of diabetic patients is affected in the presence of polyneuropathy, it has been suggested that diabetes per se has no effect on balance control during quiet standing. However, recent studies have reported muscular mechanical deficits in patients with type 2 diabetes (T2D) that may be highlighted during a more destabilizing task than quiet standing. Therefore, the objective of this study was to compare non-diabetic and T2D subjects during a modified version of the functional reach (FR) test in order to discriminate differences in postural control associated with diabetes per se. Thirty subjects (15 non-diabetic and 15 T2D) were requested to stand on a force platform and to perform the FR test. Center of pressure velocity (V(COP)), root-mean-square (RMS) amplitude and range of the COP were calculated in the anterior-posterior direction during three specific periods of the FR performance: namely "before", "on-going" and "after". No significant difference between the non-diabetic subjects and the T2D subjects was found for the FR performance. However, T2D subjects had significantly higher V(COP), RMS and range of COP displacements for the "after" period compared to the non-diabetic group (p<0.05). These results suggest that T2D subjects without peripheral neuropathy may have difficulties regaining their stability after a self-initiated reaching task. Therefore, diabetes mellitus per se, could have a direct effect on postural control during standing after a self-induced forward reaching movement.