Ambispective Study Research Articles

RAD6 Overexpression and Ovarian Cancer Chemo-Resistance: Flow Cytometry and Immunohistochemistry

Objective: Ovarian cancer is one of the deadliest women’s cancers in the world. Nearly all the patients have poor prognosis and recurrence after standard therapy because of chemo-resistance. The standard therapy is cytoreductive debulking surgery followed by platinum-based chemotherapy. RAD6 has an important role in chemo-resistance. RAD6 is an E2 Ubiquitin-Conjugating Enzymes (UBE2) enzyme required for DNA repair, cell proliferation, and cell mutagenesis. Increased expression of RAD6 is believed to be associated with chemoresistance, recurrence, and poor prognosis of the disease. We aimed to study RAD6 relationship with ovarian cancer chemo-resistance and its ability to predict chemo-resistance. Methods: This study is an ambispective cohort study of 32 people in each group at the obstetrics-gynecology and pathology Department of Cipto Mangunkusumo, Tarakan, Dharmais, and Fatmawati Hospital. All patients will undergo standard cytoreductive debulking and histopathological examination followed by six series of chemotherapy followed by six months of observation. After the observation, we determine therapy response with the RECIST Criteria (Response Criteria in Solid Tumors). The chemo-resistance and chemo sensitive groups will be analyzed according to the therapy response. Our study is the first study examining RAD6 in ovarian cancer from flow cytometry blood test and directly from ovarian cancer tissue by double immunohistochemistry.

A cost-effectiveness analysis of using umbilical cord blood pH for the diagnosis and management of neonatal asphyxia in term high-risk pregnancy.

The objective was to evaluate the cost-effectiveness of using umbilical cord blood pH (UC-pH) in combination with APGAR score for neonatal asphyxia, in terms of high-risk pregnancies, compared to using the APGAR score only. Neonatal outcomes and the proportions of patients admitted to the neonatal intensive care unit (NICU) were evaluated. A cost-effectiveness ambispective analysis study was carried out, comparing (i) UC-pH combined with APGAR score and (ii) APGAR score only in 399 term pregnancies with a high risk for neonatal asphyxia. Costs included implementation, medical, and admission costs. Incremental cost-effectiveness ratios (ICER) were calculated. The proportions of patients admitted to the NICU were evaluated. UC-pH combined with APGAR score demonstrated a cost-effective outcome (3990.64 USD vs 5545.11 USD) and an ICER shown as saving 103.66 USD compared to the APGAR score alone. The need for NICU admission was less in the umbilical cord blood collection group (18 vs 33 cases). A combination of UC-pH with APGAR score assessment for neonatal asphyxia in a high-risk term pregnancy can effectively reduce costs and requirement for NICU admission.

An objective way to predict remission and relapse in Cushing disease using Bayes' theorem of probability.

In this study on patients with Cushing disease, post-transsphenoidal surgery (TSS), we attempt to predict the probability of remaining in remission, at least for a year and relapse after that, using Bayes' theorem and the equation of conditional probability. The number of parameters, as well as the weightage of each, is incorporated in this equation. The study design was a single-centre ambispective study. Ten clinical, biochemical, radiological and histopathological parameters capable of predicting Cushing disease remission were identified. The presence or absence of each parameter was entered as binary numbers. Bayes' theorem was applied, and each patient's probability of remission and relapse was calculated. A total of 145 patients were included in the study. ROC plot showed a cut-off value of the probability of 0.68, with a sensitivity of 82% (range 73-89%) and a specificity of 94% (range 83-99%) to predict the probability of remission. Eighty-one patients who were in remission at 1year were followed up for relapse and 23 patients developed relapse of the disease. The Bayes' equation was able to predict relapse in only 3 out of 23 patients. Using various parameters, remission of Cushing disease can be predicted by applying Bayes' theorem of conditional probability with a sensitivity and a specificity of 82% and 94%, respectively. This study provided an objective way of predicting remission after TSS and relapse in patients with Cushing disease giving a weightage advantage to every parameter.

Sacituzumab govitecan in metastatic triple-negative breast cancer patients treated at Institut Curie Hospitals: efficacy, safety, and impact of brain metastases

BackgroundSacituzumab govitecan (SG) has been approved by FDA in April 2021 for pre-treated metastatic triple-negative breast cancer (mTNBC), following the ASCENT trial results.MethodsWe set up an ambispective bicentric cohort study to assess the real-world effectiveness and safety of SG in patients with mTNBC treated at Institut Curie Hospitals, with a focus on patients with brain metastases.ResultsThis study included 99 patients treated through the French Early Access Program to SG from May 2021 to January 2023. Median age was 55 years [26–89], N = 8 patients (8%) had BRCA1/2 mutation, N = 12 (12%) de novo stage IV disease and N = 31 (31%) brain metastases. Patients had previously received a median of two [1–10] lines of treatment in advanced setting. After a median follow-up of 9.7 months, the median progression-free survival (PFS) and overall survival (OS) were 3.9 months (95%CI[3.4–5.0]) and 8.6 months (95%CI[7.1–11.9]), respectively, while objective response rate was 29% (95%CI[21–39]). Among patients with brain metastases, median PFS and OS were 3.7 months (95%CI[2.6–6.2]) and 6.7 months (95%CI[6.3–NR]), respectively, with intracranial tumor responses. Dose reductions were required in N = 17 patients (17%) within a median of three [2–11] cycles, due to gastrointestinal toxicity (N = 6; 6%), hematological toxicity (N = 9; 9%) including febrile neutropenia (N = 2; 2%), liver enzyme elevation (N = 1; 1%), and physical deterioration (N = 1; 1%). There was no related death to SG.ConclusionsThe observed response rate and safety of SG are consistent with the results of the ASCENT trial, with efficacy observed in patients with brain metastases, but observed PFS and OS are numerically shorter.

Negative magnetic resonance imaging cannot be used to omit an initial prostate biopsy - An ambispective study

IntroductionUp to 40% of patients with suspected prostate cancer (PCa) have a negative prebiopsy magnetic resonance imaging (nMRI), and up to 15% of them may have clinically significant PCa (csPCa). The ability to predict the presence of csPCa despite nMRI may help avoid unnecessary biopsies. We aimed to determine the negative predictive value (NPV) of mpMRI, the influence of MRI reporting patterns in clinical practice, and the factors that might predict csPCa among men with an nMRI. MethodologyIn an IRB-approved, ambispective study, men who underwent prostate biopsy from 2016 to 2023 and had a prebiopsy MRI, were included to determine the presence of csPCa. The reporting patterns of institutional and noninstitutional MRI were evaluated. Age, digital rectal examination (DRE) findings, prostate specific antigen (PSA), PSA density (PSAD), and MRI reports were evaluated for their ability to predict csPCa in men with nMRI. Results1660 patients who underwent prostate biopsy were assessed for eligibility, and 685 patients were enrolled in the study. The median age, PSA and PSAD were 60 years, 11.63 ng/ml and 0.23 ng/ml/cm3, respectively. 62 (9%) men had an nMRI, among which csPCa, non-csPCa, and negative biopsy were found in 34%, 5%, and 61% of men, respectively. 61% had an institutional MRI, while 39% had a noninstitutional MRI. The sensitivity and NPV of any MRI for csPCa were 93% and 66%, respectively, which improved to 96% and 81% for institutional MRI. Univariate and multivariate analyses showed abnormal DRE and PSAD ≥0.25 ng/ml/cc as predictive factors for csPCa in men with an nMRI. Conclusion34% of men with negative MRIs were found to harbor csPCa on prostate biopsy. The NPV of institutional MRI was higher than for noninstitutional MRI. Men with an abnormal DRE or PSAD ≥0.25 ng/ml/cc had a higher incidence of csPCa despite an nMRI.

Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study

The elderly are prone to fragility fractures, especially those suffering from type 2 diabetes mellitus (T2DM) combined with osteoporosis. Although studies have confirmed the association between GNRI and the prevalence of osteoporosis, the relationship between GNRI and fragility fracture risk and the individualized 10-year probability of osteoporotic fragility fractures estimated by FRAX remains unclear. This study aims to delve into the association between the GNRI and a fragility fracture and the 10-year probability of hip fracture (HF) and major osteoporotic fracture (MOF) evaluated by FRAX in elderly with T2DM. A total of 580 patients with T2DM aged ≥60 were recruited in the study from 2014 to 2023. This research is an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 3.8 years through outpatient services, medical records, and home fixed-line telephone interviews. According to the tertiles of GNRI, all subjects were divided into three groups: low-level (59.72-94.56, n=194), moderate-level (94.56-100.22, n=193), and high-level (100.22-116.45, n=193). The relationship between GNRI and a fragility fracture and the 10-year probability of HF and MOF calculated by FRAX was assessed by receiver operating characteristic (ROC) analysis, Spearman correlation analyses, restricted cubic spline (RCS) analyses, multivariable Cox regression analyses, stratified analyses, and Kaplan-Meier survival analysis. Of 580 participants, 102 experienced fragile fracture events (17.59%). ROC analysis demonstrated that the optimal GNRI cut-off value was 98.58 with a sensitivity of 75.49% and a specificity of 47.49%, respectively. Spearman partial correlation analyses revealed that GNRI was positively related to 25-hydroxy vitamin D [25-(OH) D] (r=0.165, P<0.001) and bone mineral density (BMD) [lumbar spine (LS), r=0.088, P=0.034; femoral neck (FN), r=0.167, P<0.001; total hip (TH), r=0.171, P<0.001]; negatively correlated with MOF (r=-0.105, P=0.012) and HF (r=-0.154, P<0.001). RCS analyses showed that GNRI was inversely S-shaped dose-dependent with a fragility fracture event (P<0.001) and was Z-shaped with the 10-year MOF (P=0.03) and HF (P=0.01) risk assessed by FRAX, respectively. Multivariate Cox regression analysis demonstrated that compared with high-level GNRI, moderate-level [hazard ratio (HR)=1.950; 95% confidence interval (CI)=1.076-3.535; P=0.028] and low-level (HR=2.538; 95% CI=1.378-4.672; P=0.003) had an increased risk of fragility fracture. Stratified analysis exhibited that GNRI was negatively correlated with the risk of fragility fracture, which the stratification factors presented in the forest plot were not confounding factors and did not affect the prediction effect of GNRI on the fragility fracture events in this overall cohort population (P for interaction>0.05), despite elderly females aged ≥70, with body mass index (BMI) ≥24, hypertension, and with or without anemia (all P<0.05). Kaplan-Meier survival analysis identified that the lower-level GNRI group had a higher cumulative incidence of fragility fractures (log-rank, all P<0.001). This study confirms for the first time that GNRI is negatively related to a fragility fracture and the 10-year probability of osteoporotic fragility fractures assessed by FRAX in an inverse S-shaped and Z-shaped dose-dependent pattern in elderly with T2DM, respectively. GNRI may serve as a valuable predictor for fragility fracture risk in elderly with T2DM. Therefore, in routine clinical practice, paying attention to the nutritional status of the elderly with T2DM and giving appropriate dietary guidance may help prevent a fragility fracture event.

Surgical treatment and prognosis analysis of hilar cholangiocarcinoma

Objective: To investigate the surgical treatment effect and prognostic factors of hilar cholangiocarcinoma. Methods: This is an ambispective cohort study. From August 2005 to December 2022,data of 510 patients who diagnosed with hilar cholangiocarcinoma and underwent surgical resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively collected. In the cohort,there were 324 males and 186 females,with an age of (M (IQR)) 63(13)years (range:25 to 85 years). The liver function at admission was Child-Pugh A (343 cases,67.3%) and Child-Pugh B (167 cases,32.7%). Three hundred and seventy-two(72.9%) patients had jaundice symptoms and the median total bilirubin was 126.3(197.6) μmol/L(range: 5.4 to 722.8 μmol/L) at admission. Two hundred and fourty-seven cases (48.4%) were treated with percutaneous transhepatic cholangial drainage or endoscopic nasobiliary drainage before operation. The median bilirubin level in the drainage group decreased from 186.4 μmol/L to 85.5 μmol/L before operation. Multivariate Logistic regression was used to identify the influencing factors for R0 resection,and Cox regression was used to construct multivariate prediction models for overall survival(OS) and disease-free survival(DFS). Results: Among 510 patients who underwent surgical resection,Bismuth-Corlett type Ⅲ-Ⅳ patients accounted for 71.8%,among which 86.1% (315/366) underwent hemi-hepatectomy,while 81.9% (118/144) underwent extrahepatic biliary duct resection alone in Bismuch-Corlett type Ⅰ-Ⅱ patients. The median OS time was 22.8 months, and the OS rates at 1-,3-,5-and 10-year were 72.2%,35.6%,24.8% and 11.0%,respectively. The median DFS time was 15.2 months,and the DFS rates was 66.0%,32.4%,20.9% and 11.0%,respectively. The R0 resection rate was 64.5% (329/510), and the OS rates of patients with R0 resection at 1-,3-,5-and 10-year were 82.5%, 48.6%, 34.4%, 15.2%,respectively. The morbidity of Clavien-Dindo grade Ⅲ-Ⅴ complications was 26.1%(133/510) and the 30-day mortality was 4.3% (22/510). Multivariate Logistic regression indicated that Bismuth-Corlett type Ⅰ-Ⅲ (P=0.009), hemi-hepatectomy and extended resection (P=0.001),T1 and T2 patients without vascular invasion (T2 vs. T1:OR=1.43 (0.61-3.35),P=0.413;T3 vs. T1:OR=2.57 (1.03-6.41), P=0.010;T4 vs. T1, OR=3.77 (1.37-10.38), P<0.01) were more likely to obtain R0 resection. Preoperative bilirubin,Child-Pugh grade,tumor size,surgical margin,T stage,N stage,nerve infiltration and Edmondson grade were independent prognostic factors for OS and DFS of hilar cholangiocarcinoma patients without distant metastasis. Conclusions: Radical surgical resection is necessary to prolong the long-term survival of hilar cholangiocarcinoma patients. Hemi-hepatectomy and extended resection,regional lymph node dissection and combined vascular resection if necessary,can improve R0 resection rate.

Clinicopathological study of masses of nasal cavity and paranasal sinuses and its correlation with radiology

Abstract Background: Nasal and paranasal abnormalities frequently represent the primary observations in the otorhinolaryngology domain. Thorough clinical evaluation and radiological methodologies aid in establishing a preliminary diagnosis; however, histopathological examination (HPE) remains indispensable for confirming a definitive diagnosis. The objective is to determine the demographic breakdown of patients exhibiting sinonasal lesions and to evaluate and correlate clinical and radiological observations with histopathological diagnoses. Materials and Methods: This ambispective observational study involved 128 sinonasal lesions diagnosed via histopathology spanning 3 years (2020–2023). All pertinent clinical radiological observations were recorded, and tissue samples underwent staining with hematoxylin and eosin (H&amp;E), special stains, and immunohistochemistry (IHC) when necessary. The collected data were organized into tables, and statistical analyses were conducted. Results: Among the 128 cases examined, 98 (76.56%) were identified as non-neoplastic lesions, 14 (10.93%) as benign neoplasms, and 16 (12.50%) as malignant lesions through HPE. The male-to-female ratio stood at 1.2:1. The highest number of cases was observed within the age bracket of 21–40 years. Nasal obstruction emerged as the predominant symptom, accounting for 46 (35.93%) cases. Conclusion: A broad range of lesions can impact the sinonasal tract. While clinical and radiological characteristics may exhibit similarities, histopathology is the ultimate standard for confirming a definitive diagnosis.

The triglyceride glucose index as a sensitive predictor for the risk of MACCEs in patients with diabetic foot ulcers: An ambispective longitudinal cohort study.

The triglyceride glucose (TyG) index has been confirmed a predictive value for type 2 diabetes mellitus (T2DM). However, no research has yet confirmed whether there is a linear correlation between the TyG index and MACCEs in DFUs. The present study aimed to delve into the association between the TyG index and the risk of MACCEs in patients with DFUs. A total of 960 inpatients with DFUs were recruited. All participants were followed up every 6 months for 11 years with a median of 83 months. According to the cut-off value of the TyG index acquired from receiver operating characteristic (ROC) analysis, the subjects were divided into two groups: low-level (<9.12, n = 480) and high-level (≥9.12, n = 480). The relationship between the TyG index and MACCEs was evaluated by the multivariable Cox regression model, restricted cubic spline (RCS) model, stratified analysis and the Kaplan-Meier survival analysis. Out of 960 participants, 271 experienced MACCEs (28.22%), of whom 79 (29.15%) died. ROC analysis got the optimal TyG index cut-off value of 9.12. Multivariable Cox regression analysis combined with the RCS model showed that the TyG index was positively associated with MACCEs in an S-shaped non-linear dose-dependent manner within the range of TyG index 7.5-9.5 (p < 0.001). The Kaplan-Meier survival analysis indicated the higher the TyG index, the greater the cumulative incidence of MACCEs (log-rank, p < 0.001). The study first confirmed an S-shaped non-linear dose-dependent positive relationship between the TyG index and the risk of MACCEs in DFUs. Consequently, lowering the TyG index level aids in improving the prognosis of patients with DFUs.

An ambispective observational study on antibiotics in pulmonology department in a tertiary care hospital

Background: Respiratory tract infections (RTIs) caused by various viruses and bacteria are a major cause of morbidity and mortality worldwide. Although they are usually more severe in children, the elderly and people with weakened immune systems, people of all ages and backgrounds are susceptible to these infections. Antibiotics are commonly prescribed for RTIs in primary care in adults and children. The main purpose of this study is to monitor the use of different antibiotics for respiratory infections. Methods: It is an ambispective observational study, during which data are collected on specially designed data collection forms. The study lasted 6 months (from December 2022 to May 2023). Results: The source of data is a total of 100 patients who were prescribed at least one dose of antibiotics. Out of 100 people, 53% were men and 47% were women. LRTI and URTI are the most common conditions for which antibiotics are prescribed, and we found that the most commonly prescribed antibiotics are a higher percentage of patients using cephalosporins. Of the various cephalosporins, the most commonly prescribed is ceftriaxone, a third-generation cephalosporin. Conclusions: From this particular observational study, we concluded that the most frequently prescribed antibiotics for respiratory infections were cephalosporins, ceftriaxone, third-generation cephalosporins were most frequently prescribed, followed by macrolides, penicillin, tetracyclines, lincomycin, fluoroquinolones, oxazolidinones. The use of antibiotics helps to improve patient care by reducing side effects such as antibiotic resistance, hypersensitivity reactions, respiratory difficulties and risks associated with respiratory infections.

'Suspension Palatoplasty' - A method of surgical correction of VPI post Cleft Palate repair.

To design the technique of 'Suspension Palatoplasty' for Velopharyngeal Insufficiency (VPI) post Cleft Palate (CP) based on optimal spatial positioning of palate at the time of VPI correction, by using a non-obstructive, high, midline pharyngeal flap for predictable velopharyngeal closure and normal speech. To evaluate the results of CP patients with VPI operated using the technique of 'Suspension palatoplasty'. An ambi-spective longitudinal clinical study. Comprehensive cleft care clinic in a private trust hospital. Patients operated using the 'Suspension Palatoplasty' technique for VPI post CP repair between 2014 and 2018 with a minimum follow-up period of 5 years. 'Suspension Palatoplasty' - Double Opposing Z (DOZ) plasty with palatal myoplasty is used to revise soft palate and a narrow superiorly based pharyngeal flap is used to suspend it for a dynamic velopharyngeal closure. Speech outcome and surgical complications. 70 out of 119 studied were found to have normal speech (59%), and another 25 patients (21%) had acceptable speech. Thus 95 out of 119 patients (80%) had normal or near-normal speech and did not require any further speech therapy or surgeries. 12 patients had snoring without difficulty in breathing. One patient had symptoms suggestive of obstructive sleep apnea. Younger patients had a higher percentage of normal speech outcomes. Many of our adult patients also attained normal speech. 'Suspension Palatoplasty' aims to achieve normal speech with little effort. It has minimal side effects. The author has performed 403 cases to date.

Spanish registry of hemoglobinopathies and rare anemias (REHem-AR): demographics, complications, and management of patients with β-thalassemia

IntroductionThe increase in the number of patients with hemoglobinopathies in Europe in recent decades highlights the need for more detailed epidemiological information in Spain. To fulfil this need, the Spanish Society of Pediatric Hematology and Oncology (SEHOP) sponsored the creation of a national registry of hemoglobinopathies known as REHem-AR (Spanish Registry of Hemoglobinopathies and Rare Anemias). Data from the transfusion-dependent (TDT) and non–transfusion-dependent (NTDT) β-thalassemia cohorts are described and analyzed.MethodsWe performed an observational, multicenter, and ambispective study, which included patients of any age with TDT and NTDT, registered up to December 31, 2021.ResultsAmong the 1741 patients included, 168 cases of thalassemia were identified (103 TDT and 65 NTDT-patients). Survival at 18 years was 93% for TDT and 100% for NTDT. Regarding management, 80 patients with TDT (77.7%) and 23 patients with NTDT (35.4%) started chelation treatment during follow-up, with deferasirox being the most widely used. A total of 76 patients within the TDT cohort presented at least 1 complication (73.8%), the most frequent being hemosiderosis and osteopenia-osteoporosis. Comparison of both cohorts revealed significant differences in the diagnosis of hepatic hemosiderosis (p = 0.00024), although these were not observed in the case of cardiac iron overload (p = 0.27).DiscussionOur registry enabled us to describe the management of β thalassemia in Spain and to analyze the morbidity and mortality of the cohorts of patients with TDT and NTDT. Complications related to iron overload in TDT and NTDT account for most of the morbidity and mortality of the disease, which is associated with a considerable social, psychological, and economic impact, although cardiac, osteopathy and endocrinological complications requiring more attention. The convenience and simplicity of online registries make it possible to homogenize variables and periodically update data, thus providing valuable information on these diseases.

The Effect of Polymorphisms and Other Biomarkers on Infliximab Exposure in Paediatric Inflammatory Bowel Disease: Development of a Population Pharmacokinetic Model.

Therapeutic drug monitoring (TDM) of infliximab has been shown to be a effective strategy for inflammatory bowel disease (IBD). Population pharmacokinetic (PopPK) modeling can predict trough concentrations for individualized dosing. The aim of this study was to develop a PopPK model of infliximab in a paediatric population with IBD, assessing the effect of single nucleotide polymorphisms (SNPs) and other biomarkers on infliximab clearance. This observational and ambispective single-centre study was conducted in paediatric patients with IBD treated with infliximab between July 2016 and July 2022 in the Paediatric Gastroenterology Service of the Hospital Universitari Vall d'Hebron (HUVH) (Spain). Demographic, clinical, and analytical variables were collected. Twenty SNPs potentially associated with variations in the response to infliximab plasma concentrations were analysed. infliximab serum concentrations and antibodies to infliximab (ATI) were determined by ELISA. PopPK modelling was performed using nonlinear mixed-effects analysis (NONMEM). Thirty patients (21 males) were included. The median age (range) at the start of infliximab treatment was 13 years (16 months to 16 years). A total of 190 samples were obtained for model development (49 [25.8%] during the induction phase). The pharmacokinetics (PK) of infliximab were described using a two-compartment model. Weight, erythrocyte sedimentation rate (ESR), faecal calprotectin (FC), and the SNP rs1048610 (ADAM17) showed statistical significance for clearance (CL), and albumin for inter-compartmental clearance (Q). Estimates of CL1 (genotype 1-AA), CL2 (genotype 2-AG), CL3 (genotype 3-GG), Q, Vc, and Vp (central and peripheral distribution volumes) were 0.0066L/h/46.4kg, 0.0055L/h/46.4kg, 0.0081L/h/46.4kg, 0.0029L/h/46.4kg, 0.6750L/46.4kg, and 1.19L/46.4kg, respectively. The interindividual variability (IIV) estimates for clearance, Vc, and Vp were 19.33, 16.42, and 36.02%, respectively. A popPK model utilising weight, albumin, FC, ESR, and the SNP rs1048610 accurately predicted infliximab trough concentrations in children with IBD.

Cohort profile: China undergraduate cohort for environmental health study

The China Undergraduate Cohort (CUC) is an ambispective cohort study with its major purpose to better understand the effects of lifetime environmental exposures on health outcomes. We recruited 5322 college students with an average age of 18.3 ± 0.7 years in China from August 23, 2019 to October 28, 2019. Follow-up surveys were conducted annually. The dataset comprises individual demographic data (e.g. age, sex, height, weight, birth date, race, home address, annual family income, contact information), health-related behavior data (smoking status, smoking cessation, passive smoking exposure, drinking habit, physical activity, dietary status), lifestyle data (physical exercise, dietary habit, length of time spent outdoors), disease history (respiratory disease history, cardiovascular disease history, urinary system disease history, etc.), mental health status data (sleep quality, self-reported stress, anxiety and depression symptoms), lung function and blood samples data. Preliminary results from our cohort have found the association between air pollution, summer heat and mercury exposure and lung function among young adults in China.

Oncological outcomes of post neo adjuvant chemotherapy breast conservation surgery in patients with locally advanced breast cancer

Abstract Introduction: Breast cancer in India is phenotypically different with locally advanced breast cancers (LABCs) forming 30–50% of all cases. Use of neoadjuvant chemotherapy (NACT), among other things has contributed to surgeons using breast conservation surgery (BCS) in very selected patients with good results. Herein, we describe the oncological outcomes of BCS in LABC patients undergoing surgery post NACT. Patients and Methods: This is an ambispective observational cohort study conducted between January 1996 and December 2019 after approval by Institute Ethics Committee, to study the ipsilateral breast tumor recurrence (IBTR) in patients with LABC undergoing BCS post NACT. The secondary objectives were to ascertain the disease-free survival (DFS) and overall survival (OS) and factors associated with IBTR in these patients. Patients were staged according to the anatomic American Joint Committee on Cancer (AJCC) VIII Tumor Node Metastasis (TNM) classification and clinic-demographic, pathologic, treatment, and follow-up details were noted. Results: Out of 822 patients with LABC, 71 patients undergoing BCS post NACT were included. Average tumor size at presentation was 6.43 cm. The most common T stage was T3 (57.7%) and N stage was N1 (53.5%). The most common stage group was IIIB in 40.8%. Around 75% received anthracycline-based NACT with 28.2% having a complete clinical response. A pathological complete response was seen in 16 patients (22.5%). The mean follow-up duration was 6.14 years. A total of 25 patients had recurrences: five patients had IBTR (7%) and four had a local with regional recurrence. Two, 5, and 10 years OS were 94.0, 83.8, and 61.9%, respectively, and DFS were 87.8, 67.1, and 50.6%, respectively. A higher clinical T stage was associated with poor DFS (p = 0.01). The risk of IBTR was not found to significantly correlate with any of the standard prognostic factors. Conclusion: BCS post NACT in suitably selected patients of LABC is a safe and viable option without adversely affecting oncological outcomes.

Microsurgical treatment of ruptured intracranial aneurysms: An Ethiopian experience

IntroductionIn this ambispective cohort study, the authors share their experience with surgical outcomes of intracranial aneurysms in a resource-limited setting. MethodsThe study spans a 10-year period (January 2010 to December 2022) at Myungsung Christian Medical Center (MCM) in Addis Ababa, Ethiopia. Patient data, aneurysm characteristics, preoperative, intraoperative, and postoperative factors, along with patient outcomes, were collected using a structured questionnaire. Data analysis employed SPSS version 25, utilizing descriptive statistics and Multivariable logistic regression to identify independent predictors of outcomes. The primary outcome measure was the Glasgow Outcome Scale (GOS) at discharge. ResultsThe study included 71 patients with ruptured intracranial aneurysms, with 63 aneurysms clipped in 62 patients. No sex predilection was observed. Aneurysms were predominantly in the anterior cerebral circulation (98.6%), with 60.6% in the anterior communicating artery. Aneurysm size was less than 10 mm in 75.76% of cases. Favorable outcomes were achieved in 83.9% of patients, while 16.10% had unfavorable outcomes. Unfavorable outcomes correlated with a worsening neurological grade assessed by the Glasgow Coma Scale (GCS). The occurrence of delayed vasospasm and hemiparesis showed strong predictive value. ConclusionThe study demonstrated acceptable mortality and favorable outcomes. Patient outcomes in ruptured cerebral aneurysms were primarily influenced by non-modifiable factors, such as GCS on admission and neurological deficit. GCS exhibited a superior predictive value for outcomes compared to commonly used WFNS and Hunt–Hess scales in patients with intracranial aneurysms.

Influence of zoledronic acid and pamidronate on tooth eruption in children with osteogenesis imperfecta

IntroductionOsteogenesis imperfecta (OI) is a congenital disease comprising a heterogeneous group of inherited connective tissue disorders. The main treatment in children is bisphosphonate therapy. Previous animal studies have shown that bisphosphonates delay tooth eruption. The aim of this study is to determine whether patients with OI treated with pamidronate and/or zoledronic acid have a delayed eruption age compared to a control group of healthy children. MethodsAn ambispective longitudinal cohort study evaluating the age of eruption of the first stage mixed dentition in a group of children with OI (n = 37) all treated with intravenous bisphosphonates compared with a group of healthy children (n = 89). Within the study group, the correlation (Pearson correlation test) between the type of medication administered (pamidronate and/or zoledronic acid) and the chronology of tooth eruption is established, as well as the relationship between the amount of cumulative dose received and tooth eruption. ResultsThe age of eruption of the study group was significantly delayed compared to the age of eruption of the control group for molars and lateral incisors (p < 0.05). Patients who received higher cumulative doses had a delayed eruption age compared to those with lower cumulative doses (p < 0.05). There is a high positive correlation between age of delayed tooth eruption and Zoledronic acid administration. ConclusionPatients with OI have a delayed eruption of the 1st stage mixed dentition compared to a control group of healthy children. This delayed eruption is directly related to the cumulative dose of bisphosphonates and the administration of zoledronic ac.

Superiority of the Septal Extension Graft Technique in Rhinoplasty Patient Satisfaction Versus the Intercrural Strut

Background: Considering that rhinoplasty is one of the most demanded surgeries nowadays, it is necessary to analyse the relationship between the final result and the satisfaction of the patients who have undergone surgery. The objective of this study was to measure patient satisfaction by comparing the results achieved 6 months after their surgery following the use of two surgical techniques: the intercrural strut type technique, in contrast to the septal extension graft technique. Methods: Ambispective analytical cohort study in two parallel groups with patients scheduled for rhinoplasty. Sample size was calculated with a confidence level of 95% and a power of 80%, resulting in a minimum of 20 subjects to be included. Fifty-three patients participated: 22 operated with the i ntercrural strut technique and 31 with septal extension grafting. Results: An increase in the nasolabial angle was identified, with similar results between techniques. At 6-month evaluation, a decrease in the nasolabial angle was observed in all patients. Conclusion: The nasolabial angle remained higher at 6 months in the septal extension group compared to the intercrural post group; however, these differences were not statistically significant. Notably, the patient satisfaction survey revealed that only 59.1% of individuals who underwent surgery with the intercrural strut technique expressed satisfaction with the results. Conversely, 100% of the subjects who underwent surgery using the septal extension graft technique reported being satisfied with the final outcome.

Association of Attention Deficit Hyperactivity Disorder with the Use of Oral Propranolol in Infantile Haemangiomas: An Ambispective Comparative Study.

Previous studies have raised concerns about the effects of oral propranolol on the central nervous system in infants, the exact measure and mechanism and the long-term follow-up of which is less well studied. This was an ambispective comparative study of children with infantile haemangioma (IH) followed by a repeat visit 4-10 years after completion of propranolol therapy. Parents were asked about psychologic functioning along with an initial screening examination. All patients were evaluated by a paediatric psychiatrist. After evaluation by the Strength and Difficulties Questionnaire, and subsequently by the paediatric psychiatrist, 2 of 12 patients (16.67%) showed features of attention deficit hyperactivity disorder in comparison to 0 of 40 subjects in the control group (0.0498; α = 0.05). These results indicate an increased risk of neuropsychiatric illnesses such as attention deficit hyperactivity disorder (ADHD) in patients given propranolol for IH, as supporting evidence to previous claims.

Maternal and neonatal outcomes during COVID-19 pandemic and pre-pandemic in an urban slum in North India - A community-based ambispective cohort study.

Coronavirus disease 2019 (COVID-19) has affected millions of people globally since its first case reported on December 2019 in Wuhan, China. The maternal and neonatal outcomes during COVID-19 pandemic were not much reported in low- and middle-income countries. Therefore, we aimed to assess the maternal and neonatal outcomes during COVID-19 and compared them with those of the pre-pandemic period (i.e., 2019). We obtained data from the cohort of pregnant women who delivered during COVID-19 pandemic and women who delivered in the pre-pandemic period. All registered antenatal mothers resident of the selected dispensary who delivered in health care facilities from January 2019 to June 2019 and from January 2021 to June 2021 were included in the study for assessing the socio-demographic, antenatal, natal, post-natal, and new-born characteristics. A semi-structed questionnaire was used for obtaining details regarding pregnancy and COVID-19 status. The neuro-development assessment of the newborn was done in the community using Trivandrum Developmental Screening Chart (TDSC). Chi-square test and Fischer exact test were used to draw association between the maternal and neonatal outcomes during COVID-19 pandemic and the pre-COVID-19 period. A P value of <0.05 was considered statistically significant. A total of 158 and 220 women delivered in pre-COVID and during COVID, respectively. Out of them, 83 mothers (47.4%) who delivered in 2019 (pre-COVID) and 158 mothers (76.4%) who delivered in 2021 (during pandemic) were contacted. The mean age was 25 ± 3.9 years. The prevalence of anemia was significantly higher during COVID pandemic. The proportion of Rh-negative mothers and other antenatal investigation reports was similar in both the groups. The proportion of high-risk pregnancy is high among mothers who delivered during COVID than the pre-COVID period. On applying multivariate analysis, developmental delay at 3 months was found to be significant among children who were born during pandemic. A simple tool was used for assessing development milestones, and we have found that newborns delivered during COVID-19 pandemic were reported to have inappropriate developmental milestone at 3 months post-delivery. However, further research needed to assess the neuro-developmental status and follow-up of children born during COVID-19 pandemic for comprehensive neuro-developmental assessment. It is important to identify children with developmental delays associated with the pandemic and provide them with support for learning, socialization, physical and mental health, and family support.