Real-world evidence of treatment patterns and survival of metastatic gastric cancer patients in Germany.

BACKGROUND: Patients with metastatic gastric cancer (mGC) have poor prognosis. This real-world study aimed to describe treatment regimens and survival of mGC patients. METHODS: A retrospective analysis was conducted using anonymized German claims data (AOK PLUS) covering a period from 2010 to 2021. The study population included newly diagnosed mGC cases identified from 2011 to 2020. The index date was defined as the first diagnosis of metastasis on or after gastric cancer diagnosis. Therapy regimens were identified based on inpatient and outpatient data, and subsequently stratified by line of treatment. Survival analyses were conducted using the Kaplan-Meier method. RESULTS: The cohort consisted of 5,278 mGC incident cases (mean age: 72.7 years; male: 61.9%). Nearly half of the incident cases received mGC-related treatment (49.8%). Treated patients were more often male, younger, and had fewer comorbidities compared to untreated patients. Of the 2,629 mGC patients who started the first line of treatment (1LOT), 32.8% switched to 2LOT, and 10.2% reached 3LOT. Longer survival time was observed among disease-specific treated cases compared with untreated cases (median real-world overall survival (rwOS): 12.7 months [95%CI 12.1 - 13.3 months] vs. 3.7 months [95%CI 3.4 - 4.0 months]). CONCLUSION: Systemic therapy was not received in almost half of the mGC patients. In those patients, a very short median rwOS was observed. Treatment patterns were generally in line with the guideline recommendations, however, therapy switching rates and poor prognosis indicate high unmet needs also in the treated population.

Spatio-temporal clustering of amyotrophic lateral sclerosis in France: A population-based study.

OBJECTIVE: To assess spatial aggregates of amyotrophic lateral sclerosis (ALS) incident cases, using a solid geo-epidemiological statistical method, in France. METHODS: This population-based study (2003-2011) investigated 47.1 million person-years of follow-up (PYFU). Case ascertainment of incident ALS cases was based on multiple sources (ALS referral centers, hospital centres and health insurance data). Neurologists confirmed all ALS diagnoses. Exhaustiveness was estimated through capture-recapture. Aggregates were investigated in four steps: (a) geographical modelling (standardized incidence ratio (SIR) calculation), (b) analysis of the spatial distribution of incidence (Phothoff-Winttinghill's test, Global Moran's Index, Kulldorf's spatial scan statistic, Local Moran's Index), (c) classification of the level of certainty of spatial aggregates (i.e. definite cluster; probable over-incidence area; possible over-incidence area) and (d) evaluation of the robustness of the results. RESULTS: The standardized incidence of ALS was 2.46/100,000 PYFU (95% CI 2.31-2.63, European population as reference) based on 1199 incident cases. We identified 13 areas of spatial aggregates: one cluster (stable in robustness analysis), five probable over-incidence areas (2 stable in robustness analysis) and seven possible over-incidence areas (including 4 stable areas in robustness analysis). A cluster was identified in the Rhône-Alpes region: 100 observed vs 54.07 expected cases for 2,411,514 PYFU, SIR: 1.85 (95% CI 1.50-2.25). CONCLUSION: We report here one of the largest investigations of incidence and spatial aggregation of ALS ever performed in a western country. Using a solid methodology framework for case ascertainment and cluster analysis, we identified 13 areas that warrant further investigation.

Evaluation of in situ biosurfactant production by inoculum of P. putida and nutrient addition for the removal of polycyclic aromatic hydrocarbons from aged oil-polluted soil.

This work aimed to conduct a laboratory study to evaluate the use of Pseudomonas putida CB-100 and nutrient addition for the removal of PAHs from an aged oil-polluted soil of Veracruz, Mexico. Pseudomonas putida is a biosurfactant-producing bacterium capable of metabolizing polycyclic aromatic hydrocarbons (PAHs), which are toxic compounds with low water solubility, high melting, and boiling points, and low vapor pressure; characteristics that increase as their molecular weight increases and make them more recalcitrant. The methodology consisted in sampling the long-term oil-polluted soil and testing the use of Gamma irradiation (25 kGy) for the sterilization of the soil for abiotic control. We evaluated serological bottles containing 20 g of 35% moist soil (irradiated and non-irradiated) with the following treatments: the addition of nutrients (NH4Cl, NaNO3, KH2PO4, and K2HPO4), an inoculum of P. putida, and both P. putida and nutrients. The parameters assessed were pH, organic matter, humidity, available phosphorus, total nitrogen, cultivable heterotrophic microorganisms, CO2 production, rhamnolipids, surface tension, and the removal of eleven PAHs. The non-irradiated soil added with P. putida was the most efficient in the removal of PAHs; the pattern was: Benzo(a)anthracene > Phenanthrene > Fluoranthene > Benzo(k)fluoranthene > Chrysene > Pyrene > Anthracene > Acenaphthylene > Benzo(b)fluoranthene. In conclusion, P. putida in the non-irradiated soil produced in situ biosurfactants (1.55 mg/kg of rhamnolipids and an 11.9 mN/m decrease in surface tension) and removed PAHs in 10 days.

Epidemiology of Epilepsy in Low- and Middle-Income Countries: Experience of a Standardized Questionnaire over the Past Two Decades.

INTRODUCTION: Epilepsy affects >50 million people worldwide, with 80% of them living in low- and middle-income countries (LMICs). Studies with a standardized methodology are required to obtain comparable data on epilepsy and implement health policies in order to reduce the treatment gap and improve the diagnosis and management of epilepsy. In 2000, following the guidelines of the International League Against Epilepsy (ILAE), the "questionnaire for investigation of epilepsy in tropical countries" (IENT questionnaire) was developed to promote epidemiological surveys on epilepsy using a standard methodology. This study aims to describe how, when, where, and why the IENT questionnaire has been used through epidemiological studies on epilepsy over the last 2 decades and to acquire users' opinions about the tool. METHODS: Studies that used the IENT questionnaire were searched through international and local bibliographic databases, including the gray literature. An online survey was carried out, including a snowball effect. Original research studies were included. Characteristics of the studies and populations and general information on the instrument and its use were collected. RESULTS: Eighty-two documents were selected referring to 61 studies that were mostly carried out on the African continent (n = 54). Most of them aimed to determine the prevalence (n = 31) and associated factors (n = 28) of epilepsy in LMICs. Among the 61 studies, 35 were population-based, and 30 included both adults and children. A methodological heterogeneity was found between studies, and in cases where the IENT questionnaire alone did not ensure complete data collection, other tools were used concomitantly (n = 40). DISCUSSION/CONCLUSION: Over the last 2 decades, the IENT questionnaire has been continuously used in different LMICs. This result favors its promotion and updating, with the inclusion of new topics related to epilepsy (e.g., comorbidities, quality of life, and stigma), current ILAE guidelines, and digital versions.

Toxoplasma gondii and multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: According to the hygiene hypothesis, infections by agents such as parasites have a protective role against the risk of developing multiple sclerosis (MS). Among parasites, Toxoplasma gondii, an intracellular parasite, showed evidence of a protective effect. This study was undertaken to summarize the available evidence on the association between T. gondii infection and MS. METHODS: A systematic review of all the available articles published up to November 2020 has been conducted independently by two investigators in the following databases: PubMed, Scopus, Lissa, and SciELO. The association between T. gondii infection and MS has been pooled with a random effects model. RESULTS: From 562 articles, seven were included in the systematic review and meta-analysis for a global population of 752 MS cases and 1282 controls. T. gondii infection was associated with MS with a pooled odds ratio of 0.68 (95% confidence interval = 0.50-0.93). CONCLUSIONS: The available evidence supports the hypothesis that T. gondii infection represents a protective factor against the development of MS.

Screening Questionnaires to Detect Neurological Disorders in Developing Countries: A Systematic Review.

INTRODUCTION: Neurological disorders are an important cause of disability and death worldwide. The distribution of these disorders differs significantly in developing countries. Screening questionnaires have been used as an important tool to detect neurological illnesses. This systematic literature review aimed to report the validity of screening questionnaires for neurological disorders in developing countries. METHODS: The PubMed/MEDLINE, Scopus, Science-Direct, and PASCAL databases were searched. All published studies performed in developing countries were eligible. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Summary measures of validity were reported (sensitivity and specificity). RESULTS: Eight hundred and thirty-five records were identified, and 49 articles that met eligibility criteria were selected. The most frequently neurological disorders detected with a screening tool were epilepsy, stroke, and neuropathies (77, 53, and 40%, respectively). Ten screening questionnaires were accessible. Two questionnaires were mainly used to detect neurological disorders: the World Health Organization Protocol for Epidemiologic Studies of Neurologic Disorders and the Ten Questions Questionnaire. The sensitivity of the questionnaires was ranged from 84 to 100% and 56 to 100%, respectively. CONCLUSION: This systematic review presents evidence that screening questionnaires are valid tools to detect neurological disorders in developing countries. Disease detection provides epidemiological data and the opportunity to implement secondary and tertiary prevention strategies that will contribute to reduce the global burden of neurological disorders.

A Standard Framework for Population-Based Neuroepidemiological Studies in Tropical Low- and Middle-Income Countries.

Methodologies of population-based studies on neurological diseases in low- and middle-income countries (LMICs) have not been standardized. The objective of this paper is to provide an overview of the numerous challenges occurring in this context and propose a standard framework for population-based studies in LMICs. We relied on our expertise on few diseases, epilepsy and neurodegenerative disorders. The proposed framework is the result of extensive field experience in tropical LMICs. It ensures that important steps are not forgotten when setting up a study plan. It must remain flexible and be adapted to each situation, to the disease studied, in particular its prevalence, but also to the geography of the study area and the availability of survey technologies.

Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study.

OBJECTIVE: We describe and compare the sociodemographic and clinical features, treatments, and prognoses and survival times of patients with amyotrophic lateral sclerosis (ALS) in Africa. METHODOLOGY: We conducted a multicentre, hospital-based cohort study in Africa. Patients with ALS diagnosed in the neurology departments of participating hospitals from 2005 to 2017 were included. Subgroup analysis was performed by subcontinent. Survival analyses were conducted using the Cox proportional hazards model. RESULTS: Nine centres from eight African countries participated. A total of 185 patients with ALS were included: 114 from Northern Africa, 41 from Western Africa and 30 from Southern Africa. A male predominance (male to female ratio 2.9) was evident. The median age at onset was 53.0 years (IQR 44.5-64.0 years). The onset was bulbar in 22.7%. Only 47 patients (26.3%) received riluzole, mainly in Northern and Western Africa. The median survival from the time of diagnosis was 14.0 months (95% CI 10.7 to 17.2 months). The median survival was longer in Northern Africa (19.0 months, 95% CI 10.8 to 27.2 months) than in Western (4.0 months, 95% CI 0.8 to 7.1 months) and Southern (11.0 months, 95% CI 5.6 to 16.4 months) Africa (Breslow test, p<0.0001). Both subcontinental location and riluzole treatment independently affected survival. CONCLUSION: More African patients with ALS were male and younger and exhibited a lower proportion of bulbar onset compared with patients with ALS from Western nations. Survival was consistent with that in Western registers but far shorter than what would be expected for young patients with ALS. The research improves our understanding of the disease in Africa.

Residential exposure to ultra high frequency electromagnetic fields emitted by Global System for Mobile (GSM) antennas and amyotrophic lateral sclerosis incidence: A geo-epidemiological population-based study.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease of unknown etiology. Mobile communication antennas have increased over the last few decades. Consequently, there has been a steady increase in environmental exposure to ultra high frequency electromagnetic fields (UHF-EMFs) emitted by Global System for Mobile (GSM) communication antennas, which raises concerns about possible health risks in the general population. We aimed to evaluate the relationship between residential exposure to UHF-EMFs generated by GSM antennas and the risk of ALS in general population. A geo-epidemiological population-based study was performed in Limousin (France). ALS incident cases were identified through a register (FRALim, 2000-2012 period). A model to estimate UHF-EMF exposure was developed based on the distance and the power of GSM antennas. Exposure to multiple emissions from multiple directions was considered. A non-cumulative and a cumulative model were established. A geographic information system integrated the raster model of exposure, and the residential distribution of observed and expected cases. A generalized linear model was performed to test the association. Overall, 312 ALS cases were included. We estimated exposures below 1.72 V/m in urban areas and below 1.23 V/m in rural areas for 90% of the population. A gradient effect between UHF-EMF exposure and ALS incidence was apparent with a statistically significant trend. A significant increased risk of ALS was observed between the non-exposure category and the highest exposure category, with a relative risk of 1.78 (95% CI: 1.28-2.48) in the non-cumulative model and 1.83 (95% CI: 1.32-2.54) in the cumulative model. Our results suggest a possible association between residential UHF-EMF exposure and ALS. Ecological studies are a means of generating hypotheses. Further studies are needed to clarify the potential role of EMFs on neurodegeneration.

Epilepsy-associated levels of perceived stigma, their associations with treatment, and related factors: A cross-sectional study in urban and rural areas in Ecuador.

BACKGROUND: Epilepsy is felt to be a stigmatizing condition. Stigma has been considered one of the major factors contributing to the burden of epilepsy and to the treatment gap. Stigma has a negative effect on the management of people with epilepsy (PWE). Furthermore, lack of information and inappropriate beliefs are still the factors that most contribute to stigma and discrimination. In this study, we assessed the level of perceived stigma in urban and rural areas and we report their association with in antiepileptic drug (AED) use, effects on seeking medical care, and stigma-associated factors. METHODS: A cross-sectional study in urban and rural areas in Ecuador from January 2015 until May 2016. People with a confirmed diagnosis of epilepsy were included using three sources of information. The survey was implemented through a questionnaire to determine perceived stigma and evaluate the factors associated. The perceived stigma was measured using the revised Jacoby's stigma scale to detect differences in levels of stigmatization. Access to treatment was evaluated through self-report of AED use, and attainment of medical care and stigma-associated factors were assessed. Furthermore, a multivariate analysis adjusted for possible confounders was performed using stigma as the outcome variable. RESULTS: A total of 243 PWE were interviewed, 65.8% reported feeling stigmatized and 39.1% reported a high stigmatized level. We found a significant difference in high stigma perception in the urban area compared to the rural area. However, the lack of use of AEDs was significantly higher in the rural areas. No significant correlation was found between use of AEDs and the levels of perceived stigma. PWE who did not talk about their condition and those who did not feel well informed about their epilepsy had significantly higher perceived stigma levels. Additionally, the multivariate analysis demonstrated that area, educational level, type of seizure, talk about epilepsy, and information were associated with perceived stigma. CONCLUSION: The stigma perception was relevant in all PWE. We found a higher stigma level perception in the urban compared to rural area. Moreover, the lack of treatment was a serious problem mainly in rural areas. Even though we did not find that perceived stigma was associated with AED use, our study pointed out the influence of educational level and information related to stigmatization. Consequently, a coordinated effort to reduce stigma should include strategies focused on PWE education and information about their condition.